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Managing diabetes involves far more than medications and the food we eat. For adults in Nova Scotia’s Central Zone, Dr. Tiffany Shepherd, psychologist, and Heather Smith, master’s-trained clinical social worker, play vital roles in addressing the emotional and practical challenges of living with this chronic condition.
Dr. Shepherd and Smith specialize in providing psychosocial support to adults living with diabetes at Diabetes Centres in Halifax and surrounding areas. Patients are referred to them by diabetes educators or endocrinologists when they need help managing the emotional and mental health challenges associated with diabetes. Depending on the patient’s needs, their work may involve a single session, ongoing appointments, or periodic follow-ups over time to address evolving challenges. Together, they help patients navigate the complexities of diabetes care, improve self-management, and enhance overall well-being.
“Diabetes management is not just about physical health—it’s about mental and emotional well-being, too,” said Smith, who has worked in this field for over two decades.
For many, the demands of diabetes feel relentless. Patients often experience "diabetes distress," a term Dr. Shepherd uses to describe the unique stress tied to the disease’s emotional and behavioral burdens. “It’s not a diagnosable mental health condition, like depression or anxiety disorders. It can have a profound impact on self-management and overall well-being,” she explained. With an estimated 180 health-related decisions to make each day, managing diabetes can feel like a full-time job. This constant cognitive load, compounded by stigma and misinformation, often leads to burnout.
Stigma remains a significant barrier for many people. Dr. Shepherd and Smith frequently encounter patients who internalize blame for their condition. “People often see needing insulin or additional medication as a sign they’ve done something wrong,” Dr. Shepherd said. “But sometimes, our bodies just need extra help, and that’s okay.”
What makes diabetes especially challenging is the sheer number of factors that influence blood sugar levels—many of which are outside a person’s control. “There are over 40 factors that affect blood glucose, including things like stress, illness, medications, and sleep quality,” Dr. Shepherd explained. “Some surprising ones include dehydration, allergies, hormonal changes, and even something as simple as a sunburn.” The unpredictability of these factors means that what works one day might not work the next, leaving patients feeling frustrated and overwhelmed.
Smith helps patients navigate these challenges by focusing on manageable steps. “Sustainable, long-term change comes from small steps,” she said. “It’s not about being perfect—it’s about doing the best you can on any given day.” She emphasizes that success in diabetes management isn’t about rigid rules or unattainable goals but about progress that fits into each patient’s life. “You don’t have to cram yourself into diabetes,” Smith said. “Figure out how it fits into your life, not the other way around.”
Dr. Shepherd agrees. “Diabetes is something you live with, not something you are,” she said. “Our job is to help people live full, meaningful lives—even with the challenges diabetes brings.” She works to help patients normalize their struggles, building trust and understanding along the way. “When someone tells me, ‘This is hard for me,’ I can say, ‘It’s hard for a lot of people,’” she said. “That validation helps people feel less isolated.”
For those looking to support someone with diabetes, Smith offers practical advice: “No one wants to feel like they’re under surveillance,” she cautioned. “Ask your loved one what kind of help they want and check in regularly to make sure it’s still working for them.”
Living with diabetes can be challenging, but with the right support, it is possible to build a life that feels manageable and fulfilling. The work of Dr. Shepherd and Smith underscores the importance of addressing both the physical and emotional aspects of diabetes care, helping patients take meaningful steps toward better health.
For more information on diabetes care and management, view Diabetes Centres across Nova Scotia to find services near you or explore diabetes patient education resources for tools and tips to support your journey toward living well with diabetes.