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Diabetes as a Cultural Competency

When I was in grad school, we talked a lot about how important it is to be a culturally competent psychologist. According to the Georgetown Health Policy Institute, cultural competency is the ability of health care providers to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. Culture matters in health care, and it matters even more in behavioral health care. People from different cultures respond to stressors in different ways and a good therapist recognizes this and adjusts their treatment accordingly. What it comes down to is that people want to feel understood by their health care team, and understanding the person’s culture and speaking their language – both literally and figuratively – goes a long way.

I get a lot of calls from people looking for a therapist who ‘gets’ diabetes. They tell me stories about how with other therapists they’ve had to spend a lot of their time in therapy educating their therapist about diabetes and they walked away wondering why they wasted their time. These folks don’t want to have to explain what a low blood sugar feels like, or why their phone is alarming during session. Many people with diabetes want a therapist who understands them and who can treat them within the context of their life with diabetes.

Simply put, understanding diabetes and the specific challenges of living with diabetes is a type of ‘cultural’ competency. While having diabetes is not a culture in the traditional sense, it has a lot of the same attributes that cultures have. Diabetes has its own lingo and it impacts family and social relationships in some very specific ways. Also, diabetes is associated with some specific behaviors and emotions that need to be looked at in the right context in order to provide effective treatment. People with diabetes deserve mental health providers who are ‘diabetes competent’ and mental health providers who work with people with diabetes have a responsibility to become competent or refer their patient to someone who is. If this doesn’t happen, people with diabetes may not get the high quality mental health treatment they deserve.

Are you a mental health professional looking for training to become ‘diabetes competent’? Here are some resources that might help:

Mental Health Provider Diabetes Education Program

Addressing Mental Health Concerns in Patients with Diabetes

Are you a person with diabetes looking for a mental health provider who is ‘diabetes competent’? Check out this directory:

American Diabetes Association Mental Health Provider Directory

 

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Telemental Health

A couple years ago, I had a patient who lives about an hour from my office ask if we could do our sessions over video. With traffic, coming to see me in my office would take almost half a day and even though he really needed help, he just couldn’t make it into my office on a regular basis. Since he has diabetes, and my practice focuses exclusively on the mental health needs of people with diabetes, he didn’t feel like he had anywhere else to turn. I’ll be honest, I was pretty skeptical about seeing a patient online. I had never done anything like that before and I had no idea what to expect. But my goal has always been to expand mental health treatment for people with diabetes and this was one tangible way to do it.

Now I see patients online every week and I am a big believer that tele-mental health treatment can help meet many of the mental health needs of people with diabetes. When I first started, I was worried that doing therapy online would be awkward. I’ll be honest, with each new patient it usually is awkward…. for about 2 minutes – and the people I see online tell me they have the same experience. After a couple minutes of getting used to it, talking over video becomes normal, and it feels no different than an in-person session. I’ve actually seen a lot of people over video that I’ve never met in person, and I’m confident that their outcomes have been just as good, and sometimes better, than the people I see in person.

My goal is to make diabetes related mental health services available to as many people as possible no matter where they live and I’ve found that telemental health is an ideal way to expand my reach to areas where these specialized services aren’t available. I do my best to limit my online practice only to people who have specific mental health challenges related to living with diabetes for a couple reasons. First, I’ve found that telemental health is most effective for people who come to treatment for a specific reason and with measurable goals and this is often the case for people with diabetes-specific issues. For example, I’ve had a lot of success with online treatment for fear of hypoglycemia and diabetes burnout – issues that have targeted treatments and measurable goals. The second reason is simply time. There are only so many patients I can see in a week, and if someone can get high quality treatment (in-person or online) from someone without expertise in diabetes, that is usually a better option for them, and lets me  focus my time working with patients who need very specialized treatment they can’t get from someone else.

Tele-mental health is not without challenges. One of the most common symptoms for anyone dealing with mental health challenges, diabetes-related or not, is avoidance. And avoidance rears its head in a lot of different ways like not showing up to appointments, avoiding certain topics or not talking at all. Avoidance is difficult to work with when someone is in the room with you and it’s even more challenging when working with someone over video. In fact, seeing a therapist over video can be an avoidance strategy – you can tell yourself you’re checking the box of getting treatment while using video as a way to avoid the hard work that therapy requires. These challenges tend to be amplified when the patient and therapist aren’t sitting in the same room.

There are some interventions that I’m hesitant to do over video. For example, when I treat people with a fear of hypoglycemia, sometimes I do a type of exposure therapy where I have them take insulin to make their blood sugar go low to show them that they have the ability handle and treat low blood sugar. It’s really difficult to do this type of exposure over video.

I am a licensed psychologist in California, so I can only see patients who are physically located in California. Most insurance policies cover telemental health, but each plan is different so if you are interested in getting tele-mental health treatment, you’ll want to check your policy to be sure that these services are covered.

Telemental health has been a great way for me to increase access to specialized services to people who really need them and I’m always looking for ways to keep expanding. In the near future, I plan on offering group therapy online. If you are interested in talking more about diabetes-specific telemental health for yourself or someone you know, please give me a call at 858-461-9295 or send me an email (mark@cdmh.org). If I am not the best therapist for you, or if you don’t live in California, I would be happy to help you find a provider who can help you.

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Social Capital

You’ve planned every last detail of your weekend trip to Chicago. You have your dinner reservations, your tickets to see the Cubs play and you can’t wait to ride the Ferris wheel at Navy Pier. As the plane is taking off, you grab a granola bar out of your bag to snack on. As you reach for your insulin pen so you can cover the granola bar you freeze as you realize that you forgot to pack your insulin. You meant to grab it out of the fridge as you ran out of your house and into the Uber, but somehow it slipped your mind. And now you are on your way to Chicago to hang out with your friends and you don’t have the one thing you need to stay alive. What to do?

Recently, people have been talking a lot about how important peer support is for people with diabetes – and I couldn’t agree more. But when I suggest to folks that they get involved in peer support communities, their reaction is not always so positive. I think they probably imagine sitting around a table with a bowl of sugar-free candy in the middle with a bunch of people they can’t relate to, talking about which brand of glucose tabs is best, or how to bake a carb-free cake. The perception is that peer support communities are going to be at best awkward and at worst, creepy with a bit of boring and depressing thrown in. And if that were the case, that’s certainly not something that I’d want to be a part of.

If you ask people with diabetes who know others with diabetes what they get out of these relationships, their first answer is almost always that they feel less alone. Knowing that there are other people out there who totally understand your experiences, without having to explain or justify anything is worth its weight in gold. However, the benefits of having a support network of other people with diabetes goes way beyond having someone you can vent to.

The dictionary defines social capital as the interpersonal relationships, institutions, and other social assets of a society or group that can be used to gain advantage. Put in simple terms, social capital is a person’s ability to call in a favor. Of course you’re going to be most successful in calling in favors to people you know and have relationships with. They know you, they trust you and they’re willing to go out on a limb for you in your time of need. Almost everybody has some social capital. Think about what kind of social capital you have. Who would you call if you need a ride to the airport? If you need a reference for a job? If you need to borrow money to tide you over until you get your next paycheck?

Peer support networks give you access to diabetes-related social capital. Who would you call if you were visiting Chicago for the weekend and you forgot your insulin? If you’re looking for a new endocrinologist? If you want some advice on what brand of insulin pump you should get? I believe that everyone with diabetes has some amount of diabetes social capital just because they have diabetes and most people that I know with diabetes will go to great lengths to help someone else with diabetes in a time of need. Insulin, test strips, information – you name it and someone will be there for you. But unless you have a network of other people with diabetes, you have no way to access this social capital. Knowing other people with diabetes gives you the key to access what you need and lets you pay it forward and help other people when they need it.

There are many faces of the diabetes peer support community and all of them can give you access to social capital. Whether it’s a group of friends you met at diabetes camp many years ago, a support group run by your doctor, a group on Facebook or a hashtag on Instagram, there’s no wrong way to be part of a diabetes community. Maybe you don’t need the ‘shoulder to cry on’ type of support and maybe you don’t want to spend time talking about diabetes – that’s ok. The value of the diabetes community is multi-dimensional, including having your back in your time of need.

You land in Chicago. You didn’t eat anything on the plane because you didn’t want your blood sugar to go high so you’re hungry. Your mind is racing and you’re hoping you can get ahold of your doctor. While you’re waiting at baggage claim, you’re scrolling through Facebook and you see a post from someone in the diabetes group you joined a couple months ago. You figure, why not – and you ask if anyone in the group lives in Chicago and has an insulin pen you can use this weekend. Within five minutes, three people who you’ve never met message you with offers to help – and one of them lives down the street from your hotel. You meet up with them a couple hours later and when they give you a pen, you ask what you can do for them and they say ‘pay it forward with social capital.’

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The Problem with Compliance

How would you react if you found out there was a law that said you have to manage your diabetes in a certain way, and if you don’t follow the letter of the law, then you’ll be punished? Sounds a little absurd doesn’t it? But from the words some people use to talk about managing diabetes, you would think there’s some authority watching over you all times, shaking their finger at you every time you don’t do things the ‘right’ way.

The dictionary defines compliance as conformity in fulfilling official requirements. And this is a word that so many health care professionals and many patients use when they talk about diabetes management. Last time I checked, there is no law or rule about how anyone has to manage their health issues, including diabetes, yet the language some people use implies that there is. I’ve talked to a lot of doctors who say they just don’t understand what’s wrong with talking about ‘compliance’ and they get really defensive when someone asks them to change the words they use. Let’s dig a little deeper into the message that ‘compliance’ sends.

I don’t know about you, but I don’t like it when someone tells me what I must do, even (or especially) my doctor. Your relationship with your health care team should be collaborative, with you as the patient at the center of everything. When a healthcare provider uses the word compliance, what I hear is the provider believes that they’re an authority figure that I have to listen to. They make the rules and I have to follow the rules. The reality is health care providers are not authority figures. They are experts who can provide education, information and guidance to help you meet your health goals. As the patient, you are always the decision-maker, and you get to choose what to do with the advice you get from your doctor.

Your doctor is not a police officer, sitting there watching to make sure that you’re always following the speed limit and that you come to a complete stop at every stop sign. But it sure does feel that way sometimes. Going to the doctor can feel like you are going before a judge and praying that he or she will go easy on you – and don’t you dare test their authority. If you feel helpless and powerless in your relationship with you doctor – because of the language that they use or how they treat you (or both) – then it’s time to find a new doctor. Words matter. Doctors may use the word compliance out of habit or ignorance, but when they do, this attitude bleeds into how they treat their patients. Work to find doctors who are self-aware and who use language that empowers their patients, rather than empowering themselves.

People generally don’t thrive when they feel powerless. And while words don’t change the reality of the hard work needed to manage diabetes, words empower – and disempower – more than people realize. Managing diabetes requires perseverance, and if you feel like you’re failing, no matter what you do, it’s going to be hard to stay motivated to keep going. Seeing tangible benefits to your behavior will motivate you to keep going much more than ‘complying’ with your doctor’s orders will. We need to empower people in their own health, and telling people they must ‘comply’ with a diabetes treatment plan does just the opposite. Words like compliance send the wrong message.

I believe that diabetes providers, myself included, are serious about helping our patients feel good, stay healthy and live fulfilling lives with diabetes. Our primary role is to empower, but not by playing power games with the words we use. We do this by educating, guiding and supporting our patients in managing diabetes, not by requiring compliance. We have to let go of any illusion that we can force our patients to do anything. What we can do is empower them to make healthy choices, and this empowerment starts with the language we use.

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What Golf Can Teach Us About Diabetes

I was playing golf yesterday and it dawned on me that if people approached managing diabetes in the same way I approach playing golf, they would probably have an easier time with diabetes. I’m not a good golfer by any stretch of the imagination. Actually, I’m a pretty mediocre golfer. I like to get out on the course and have fun. Sometimes I hit a great shot, but most of the time I don’t. But no matter what, I always get the ball in the hole. Eventually. There are definitely some lessons here that apply to diabetes.

Play strategically: When I first started playing golf, I played as aggressively as possible. I took risks that had a really low chance of success. Over the water? Through the trees? On the green off the tee from 300 yards? Trust me, I tried – and most of the time I failed miserably. I never even thought about playing smart and taking shots that I knew would actually get me to where I needed to go. Once I started playing smarter – which usually means being more conservative and patient, given the conditions and my skill level, I usually got the ball on the green and in the whole a lot faster and I felt better about my game. I felt a lot more confident about my golf game, my score improved and I was a lot less frustrated. This approach is also true for diabetes. Impatience and over-bolusing usually leads to trouble. Being intentional and strategic with your management decisions, will almost always get you to a better place, faster.

Perfection is not possible: If I think I’m going to get a hole in one when I golf, I’m most likely going to be really disappointed. I’ll probably play too aggressively and land in a sand trap, or I’ll overshoot the green and end up out of bounds. Diabetes is no different. If you are too aggressive with diabetes, it’s really easy to end up in trouble. You may take too much insulin and then have a rebound high when you correct. You may spend more time than you want to exercising or you may skip a party because of the type of food being served. If nothing else, you’ll probably end up really frustrated with yourself. Just like with golf, we can’t expect perfection with diabetes. Do the best you can and continually work to improve your game/management, but thinking you can be perfect at golf/diabetes is setting yourself up to fail.

Flexibility is key: Golf is a game of problem solving and the conditions that you face are constantly changing. Before you tee off, you assess where you want your drive to go. Even when you hit a great shot, the wind might pick up and change the way you approach the rest of the hole. When I play golf, I am mentally prepared for things not to go exactly as planned. It’s helpful to take the same approach with diabetes. There are so many things that can affect blood sugar (Diabtribe put together a great list) and sometimes it’s hard know when you’ll hit a rough spot. Just like with golf, if you’re mentally prepared for diabetes not always to go as planned, it’ll be a lot easier to deal with whatever challenge comes your way.

A fresh start: In golf, every hole is a new hole. Just because I didn’t do so well on one hole doesn’t mean that I can’t (in theory) make a birdie on the next hole. Even when I’m feeling like a  miserable golfer, each hole is a fresh start and a chance to redeem myself. If you’ve had some bumps in the road with managing diabetes, that doesn’t mean you can’t start anew. Just like each hole is an opportunity to play well in golf, each day is a new opportunity to do better with diabetes. That doesn’t mean that all holes/days moving forward will be good, but there’s usually an opportunity to do better on the horizon.

As hard as I try and as much as I practice I can’t always control where my golf shots go. But that doesn’t stop me from getting out there and playing. As frustrating as it can be, playing golf is important to me. In the end, my score matters less than me getting out there and hitting every shot. Diabetes is no different.

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Bike Beyond

Last week, I went to Nashville to spend some time with the Bike Beyond team. This team of 20 people, all living with type 1 diabetes, are spending their summer biking from New York to San Francisco. The leadership team at Beyond Type 1, the organization who planned this amazing event, asked me to come hang out with the members of team on one of their off days – about 25 days into their 70 day ride – to give them some support. While I’m not going to talk about any of the private conversations I had with the riders, I wanted to share some of the things I took away from my day with these amazing riders.

For a team made up of people with type 1 diabetes, it was striking how diabetes faded into the background. Everyone lives with it, so it’s just a normal part of life. When the people you are surrounded by all have diabetes, the daily tasks just become what you do, and they start to seem a lot less annoying. We went to a yoga class and CGM alarms went off multiple times. If this were a normal yoga class, these alarms would probably be met with confusion, dirty looks or nasty comments. At this class, they were as normal as the teacher’s dialogue. One of the hardest parts of diabetes is that it makes people feel different. When the people who are around you every minute of every day have to do the same things you do, diabetes just becomes part of normal life. Isn’t that the goal for all of us?

You may be thinking that you could never ride a bike across the country (or even across town). You may think you don’t have the motivation, or you’re not in good enough shape, or your A1c isn’t low enough. The reality is these riders are just like every person with type 1 diabetes. The only difference between the Bike Beyond riders and everybody else is that these riders said yes to this adventure. They all deal with high and low blood sugars like the rest of us. Some of them had no experience riding a bike before the ride. Their motivation to keep on riding sometimes changes by the minute. Isn’t that a common story? If we wait until things are ‘perfect’ with diabetes, our motivation or anything else before we’re willing to take a risk and make a change, we may be waiting a really long time. Hopefully these riders can inspire us to say yes, even when we have all kinds of excuses about why we can’t.

New York to San Francisco is a long way on plane, not to mention a bike. These riders are showing the world that people with diabetes can do anything they put their mind to. Diabetes isn’t holding these riders back. They’re actually using diabetes to showcase their strengths to the rest of the world. This diverse team has come together with a very clear purpose – to educate people about diabetes and to demonstrate in a very real way, that diabetes can’t stop anyone from living their dreams. They are making a difference and their message is being heard.

I left Nashville last week inspired by this amazing group of riders. They all decided to take something that makes them different in the real world to find community. They are educating the world and building communities in the process, across this country and around the world, not because they are different from anybody else with diabetes, but simply because they believed in themselves and said yes. This team shows us all, in a tangible way, that diabetes can’t stop you from doing anything you want to do. I know that this team and their message will continue to empower people for a long time!

 

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Mental Health Provider Diabetes Education Program

Every month I get at least a couple calls/emails from people around the country asking if I know of any mental health providers with knowledge of diabetes in their area. Sometimes I have a name to give them, but more often than not I have to tell them that I don’t know of anyone – which makes me feel horrible. These are folks who really need help, and there’s no one in their area with the expertise to give them the treatment that they need.

The demand for diabetes-specific mental health services is increasing because, over the past several years, we’ve started talking a lot more about the relationship between diabetes and mental health. This is great news! Physicians, diabetes educators, and people with diabetes are becoming much more aware the impact of diabetes on quality of life and how mental health challenges can affect the self-care behaviors that are so important for good diabetes management. In December 2016, the American Diabetes Association put out their first position statement on the Psycho-social Care for People with Diabetes (http://care.diabetesjournals.org/content/39/12/2126).

This increased awareness has raised demand for mental health services for people with diabetes. The challenge is that it’s really hard to provide high-quality mental health treatment for people with diabetes without an understanding of diabetes, how it’s managed, and the common psychological and emotional challenges that living with diabetes involves. There simply aren’t enough mental health providers who have this specialized knowledge. We have a capacity problem, and this needs to change!

Recognizing that there aren’t enough specialized mental health providers to meet this increasing demand, the American Diabetes Association (ADA) has partnered with the American Psychological Association (APA) to tackle this problem head on. Together, these two organizations have developed a 2-part continuing education program for licensed mental health professionals to help them become familiar with the psycho-social and emotional challenges of living with diabetes and gain a basic understanding of how to address these issue with their patients. The first part of this continuing education program will be a 7-hour in-person course that will be held at both the ADA convention in San Diego (June 9-13) and at the APA convention in Washington DC (August 3-6). After attending one of these seminars, there is an additional 5-hour online course. Once a licensed mental health provider has successfully completed this program, they’ll be eligible to be listed in the ADA Mental Health Provider Referral Directory on the ADA website.

I, along with some of the greatest minds in diabetes and mental health, was part of the working group that developed this program, so I know first-hand how impactful this program is going to be. If you are, or know of, a licensed mental health professional who wants to become more competent in meeting the mental health needs of people with diabetes, please consider taking part in this program. There’s more information in the link below:

http://professional.diabetes.org/meeting/other/mental-health-provider-diabetes-education-program

I am really looking forward to the day when I can respond to the calls and emails I get by referring them to the ADA Mental Health Provider Referral Directory. Thanks to the ADA and APA, I am excited to say that day is coming soon!

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Diabetes Education and Mental Health Treatment

About a year ago, I became a Certified Diabetes Educator (CDE). Since then, one that’s that’s become really clear to me is how much impact a little bit of basic diabetes education can have on a person’s psychological well-being. Even though my primary role is psychologist, and not diabetes educator, it’s my job to work with my patients to develop a treatment plan that addresses their needs, which includes helping them cope with the stress of living with diabetes. More often that not, this treatment plan includes some form of diabetes education.

The more I think about it, educating patients is very much in-line with my training as a psychologist – even if the diabetes aspect is a bit unique. Psychologists educate the their patients on a regular basis. At the beginning of treatment, we give our patients information about their condition (e.g., if someone has depression, we would explain the symptoms, what we know about the causes, and what we can do to help them). It sounds simple, but this information can really help give people’s experience some context and take the mystery (and anxiety) out of these uncomfortable emotions.

This same thing is true for people who are struggling emotionally with diabetes. Most of the people that I see in my practice come because they having trouble adjusting to diabetes or because diabetes is overwhelming them or causing them anxiety. The common theme is that my patients, in some way, are not steady on their ‘diabetes feet’. I’ve found that integrating simple diabetes education into my broader treatment plans goes a long way in improving my patients’ emotional and psychological functioning. Here are some thoughts on why…

Diabetes education reduces anxiety: The unknown is scary and overwhelming, and for many folks, diabetes is full of mystery. The more information I can give my patients, in a way that’s simple and easy to understand, the more comfortable, and less anxious they’ll be. Reducing anxiety makes them feel more confident in their ability to manage diabetes and breaks down barriers to working on deeper issues.

Diabetes education empowers: The more people with diabetes understand their condition, the more empowered they’ll feel to take steps to manage it well. So many of the people I see feel like diabetes controls them, rather than the other way around. My goal is to help folks change their relationship with diabetes, and one of the best tools I have to do that is education. The more people know about diabetes, the more empowered they’ll be to take the reins.

Diabetes education instills hope: As a psychologist, one of the most important things I can do for my patients is give them hope that things can get better. Diabetes education is a key to hope because it shows the person that there are steps they can take to manage their diabetes and gives them confidence that they can take these steps. Helping patients understand how their diabetes treatment works, and why it will help, and teaching them simple ways to integrate the different aspects of their treatment into their lives can give them hope that they can be successful, and make it all feel less overwhelming.

I really hope that framing diabetes education as a psychosocial intervention also inspires confidence in other diabetes educators. So many of the CDEs that I’ve met believe they don’t have the knowledge and tools they need to really address their patients’ emotional concerns, when in fact good diabetes education, combined with a dose of empathy is worth it’s weight in gold. There are some people who have issues these CDEs don’t have the complete skill set to tackle, but most CDEs probably have more tools than they think they do!

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Why See a Diabetes Psychologist?

This article was originally published in 2014 by Insulin Nation: http://insulinnation.com/living/should-you-go-to-a-diabetes-psychologist/

When I tell people I am a psychologist who specializes in diabetes (and who also happens to have Type 1 diabetes), they often are startled that there is such a specialty. I can’t tell you how many times I’ve been asked “Is there really a need for that?” or “How hard can having diabetes really be?”

It’s no secret to anyone who has diabetes that living with the condition can be really tough – and that the biggest challenges are often mental. Think about it for a minute. There are 8,760 hours in a year, and if you see your doctor every 3 months for a 15-minute appointment, that means that there are about 8,759 hours a year that you are on your own to manage your diabetes. You have to make important (sometimes life-or-death) decisions about your health multiple times a day, every day.

For some people that responsibility can get so overwhelming, frustrating, and embarrassing that some people stop checking their blood sugar and taking insulin. Also, people with diabetes must deal with things like the fear of low blood sugar, how to handle complications, and combating a diabetes-related eating disorder – the list just goes on. When I tell mental health professionals about all this, they often tell me they had no idea how hard living with diabetes can be.

If you have diabetes and you’re struggling, how do you know if you should get help? When someone asks me this, there a couple of things I encourage them to ask themselves:

1) Are your struggles affecting your ability to manage your diabetes? One of the most common reasons that people come to see me is that they are feeling frustrated and defeated by diabetes, and that these feelings make it really hard for them to get motivated to check their blood sugar and take insulin.

2) Is your diabetes having a negative impact on your relationships? For example, do other people tell you that they are worried about you or that they don’t want to be around you because you are moody, irritable, or just not yourself?

3) Is the stress of living with diabetes making it harder for you to do the things that are important to you?

If someone answers yes to any of these questions, it might be helpful for them to seek help.

Not all therapy is equal for a person with diabetes. If what you are struggling with is diabetes-related, then its important that your therapist really understands the condition. For example, I’ve had people see me because they aren’t taking insulin regularly for fear of going low; a therapist who doesn’t know much about diabetes may have a hard time understanding this issue, and many not know how to help. If you see someone who understands diabetes, then they will at least understand what you are talking about and (hopefully) will have some idea about how to help.

A lot of people wonder what happens in therapy. Therapy isn’t a magic bullet – it’s hard work – but it can be a safe, supportive place where you can work on whatever challenges you are facing. A therapist will try to help you develop the emotional skills to better tolerate the challenges of living with diabetes, problem-solve around difficult issues, and see how your thoughts are affecting your emotions and your behavior. I also always encourage those who come to me to meet others with diabetes, either online or in person, because it’s such a great way to get support and feel less alone.

If you’re looking for a therapist who specializes in diabetes, the best place to start is with your endocrinologist. A lot of times, they can refer you to a therapist who specializes in this. You can also do a Google search or ask other people with diabetes for a recommendation. Unfortunately, there aren’t enough of us out there, so if you find someone who has helped you, let your doctor and others know of this therapist.

As a psychologist with diabetes, I struggle sometimes as well, and my diabetes doesn’t go away when I am seeing patients – I’m reminded of this all the time! I can’t tell you how many times I have had to pull out my pump during a session to correct a high or stop to adjust because my CMG alarm is telling me I’m low. Because my patients all have diabetes, I try to use these moments to let them know that I understand what they are going through – and I try to be good example.

Diabetes can be really tough, and if you are having a hard time handling it on your own, please know that there are people out there who can help you!