While sharing lunch with her kids, Joanne Graham, a 36-year-old mother of three, has to stop to think before she snacks from her children’s plates – when was the last time I checked my blood glucose level?

The former athlete was diagnosed with late onset type-1 diabetes seven years ago. A chronic illness that affects 18 to 20 per cent of Nova Scotians and more than nine million Canadians, diabetes can be a life-altering condition as it requires self-regulation of blood sugar levels throughout the day, every day.

After almost 30 years of living without diabetes, Joanne found the condition not only affected her lifestyle but also caused stress on her mental health.

Today, to safely manage her diabetes, Joanne’s new routine involves testing her blood sugar first thing in the morning to see if she took enough insulin the night before. Then, after breakfast she has to test it again, count her carbohydrates, and test again. It is a tedious procedure she repeats every time she wants to eat something.

“Living with diabetes is a struggle for me,” says Joanne. “I lived the first 30 years of my life not having to think about it – and now I do have okay days, but I also have days where I revert back to hold habits and it’s hard to stay positive.”

Feeling isolated and some days defeated, Joanne needed to find new ways to help manage her new lifestyle.

It was two years ago when Joanne found Dr. Michael Vallis, a psychologist who practices at the QEII Health Sciences Centre. An Associate Professor in Family Medicine and Psychiatry, as well as an Adjunct Professor in Psychology at Dalhousie University, Dr. Vallis has expertise in Adult Health Psychology, with a clinical emphasis on diabetes, gastroenterology, cardiovascular risk and obesity.

Dr. Vallis studies the connection between diabetes and depression. He says his research has shown that, for patients suffering from chronic illnesses such as diabetes, more than half are affected by disease-related distress. He is currently working to educate patients and physicians on the difference between distress-caused-by-disease and what often feels like depression.

“It’s about knowledge translation. It’s centered on educating healthcare providers and patients about how managing chronic diseases can really impact a patient’s life, “says Dr. Vallis. “It’s about helping patients identify what they truly are struggling with as a result of their condition, and educating doctors on the options available to support their patient so they can confidently manage and live with their condition.”

Dr. Vallis points out that Joanne is “a grazer,” meaning that she naturally prefers to eat small meals and snacks throughout the day rather than larger meals. He says this type of eating makes it more difficult for her to follow the dieting and food recording procedures she needs in order to manage her blood sugar levels effectively. 

Joanne’s disease-related distress centres on the anxiety and negative emotions she feels as a result of managing her diabetes. When Joanne gets discouraged, it not only negatively impacts her health but often leaves her feeling like she can’t do it.

Dr. Vallis says one of the ways patients can identify and work through their distress is by working with their physician and a psychologist.

Since working together, Joanne is more confident in her ability to manage her diabetes. Even just talking to Dr. Vallis and having him identify her points of stress was helpful because she is now focused on how to overcome them.

“It’s important to know that not all patients are the same,” she says. “We need to empower patients to identify and find ways to manage their conditions that work for their lifestyle and doesn’t hurt their health - and believe me there are ways.”

Together Dr. Vallis and Joanne have identified that an insulin pump would be a better option for Joanne’s lifestyle. They are working with her physician now to start planning for an insulin pump.

“For some people, it’s not as simple as ‘take your insulin,’ ” says Dr. Vallis. “As healthcare providers, sometimes we have to personalize the relationship with the patient and empower them to take control of their own health. We can’t do clinical care without the connection to the patient and considering their lifestyle.”