Five minutes with… Dr Rose Stewart

Living with diabetes can lead to a multitude of psychological challenges – Dr Rose Stewart, Principal Clinical Psychologist for Wrexham Young Adult Diabetes Service, told Ella Rhodes her expertise in this under-represented area was of particular importance in times of Covid-19.

Could you tell me about your day-job and some of the psychological problems people with diabetes might struggle with?

I have two jobs: I work clinically as an integrated Clinical Psychologist within a young adult diabetes service. My post was commissioned on the back of a successful pilot project and last year we won a national award for the model of psychological support we provide. The other half of my time is spent in an All-Wales role developing guided self-help materials for people with diabetes: the Talking Type 1 range. The prevalence of anxiety and depression are double in people with type 1 diabetes, and eating disorders are about three times more prevalent than in people without diabetes. Providing support for young adults is particularly important because this is when distress traditionally peaks, and they have been through transition from paediatric to adult diabetes services, which is often difficult. Some people might start omitting their insulin in order to lose weight, abuse it as a form of self-harm, and then lots of young adults just try and pretend their diabetes isn’t there at all.

Could you tell me more about the Talking Type 1 range of self-help materials you’ve created?
Many people with diabetes never get the support they need unless they’re in a real crisis, and there just aren’t enough diabetes psychology posts to meet demand. We’re using the books across Wales as a first step in psychological care; they’ve been particularly useful in areas where psychology is difficult to access. The first book we published was on diabetes burnout – people who are in burnout will often stop checking their blood glucose, or might not be taking their insulin regularly, it’s about trying to reinvigorate people and help them feel motivated again. The second one was about needle phobia, if you have type 1 you may have to do 12 needle pricks a day; if you’ve got needle phobia that’s a really big problem. The third one was a book called How to Manage a Mammoth which was an illustrated children’s version of the diabetes burnout book, and we’re about to publish Burnout for Parents.

What has the impact of Covid-19 been on people with diabetes and how have you been helping to support them through lockdown?
We knew that the outbreak would be particularly difficult for people with diabetes, because they have a higher baseline distress level and the risks to them from Covid were a lot higher. Many health psychology colleagues had been redeployed to staff support services, so we needed to look for strategies to support as many people as possible.

I was already using social media a lot because there’s a really active diabetes community on Twitter and at the beginning of lockdown, when things were unclear, I noticed that diabetes nurses were being contacted with the same questions over and over again. This was one of the reasons we set up the @_Diabetes101 account on Twitter. We felt if we had a place online where we could give that information, coming from credible NHS professionals, it could be a way to take some of the burden off teams. We provided reassurance, information and had a daily support routine, and we’d mix in educational sessions. A trainee clinical psychologist on placement with me needed to do a teaching session so we got her to deliver a ‘tweetorial’. Her session about compassion-focused therapy had an absolutely incredible response – one of her slides has had more than 12,000 views!

I also started creating infographics to share basic self-care information. One we did in March (How to Manage Worry About Covid and Type 1 Diabetes) was a really simple list of things you can and can’t control and that got picked up by the Australian version of Diabetes UK who sent it out to all of their members – well over a million people, and it got translated into 26 different languages. I’ve made infographics covering everything from sleep to understanding hazard ratios which meant that people with diabetes could go and look at Covid risk papers and work out their own individual risk. The Covid work is far from over, but it’s been a real privilege to demonstrate how useful psychologists can be in diabetes services.

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