Busy healthcare providers may not always be able to listen to their patients' needs. Here's what to look for in a healthcare team and how to advocate for your mental health.
Picture it: You’ve been working tirelessly to reduce your A1C to the elusive less than 7 percent touted by your diabetes team. You’ve rarely missed a bolus. You’ve answered every alarm in a meaningful way, especially those 2 a.m. wake-ups for hyperglycemia.
You’ve dutifully checked for ketones when your blood sugar spiked over 300 mg/dL. At your next endocrinology appointment, you learn that your A1C has decreased from 7.8 to 7.4 percent.
Provider A says: “Wow, you’ve clearly been making some great changes. I’m so proud of you. Can I show you where we can make some tweaks so you can get to that A1C goal on your next visit?”
Provider B says: “Well, you missed a bolus here. And here. And what the heck happened when your blood sugar was over 300 mg/dL for six hours?”
While both providers likely mean well and have your best interests at heart, you’d likely rather work with provider A because their positive attitude makes you feel better about the changes you’ve made – even when your A1C didn’t go down as much as you would have liked. So, where might the provider B healthcare team have gone astray?
The link between diabetes and mental health
Regardless of blood sugar levels, diabetes and mental health are inextricably related. people with diabetes are 2-3 times more likely to have depression than their counterparts without diabetes, according to the Centers for Disease Control and Prevention (CDC).
Unfortunately, only 25-50% of those with diabetes who have depression get diagnosed and treated for it. In addition, 33-50% of people experience diabetes distress, which is defined as overwhelming feelings of frustration, worry, and exhaustion in daily care.
And it doesn’t end there. People with diabetes – especially women – are at heightened risk of developing eating disorders. Women and girls with type 1 diabetes have two times the risk of developing an eating disorder compared with the general population; less is known about eating disorders in men and boys with diabetes.
How diabetes care teams can address mental health
“All healthcare providers are trying to help patients stay healthy physically and mentally,” said Dr. Daniel Shumer, a professor of pediatric endocrinology at the University of Michigan.
Emily Miller, a social worker at UP Health System – Marquette in Michigan, said that some providers focus on the negatives. They may set their own goals for the patient (instead of involving them in the goal-setting process), which may be difficult to achieve, and can’t or don’t always listen to patients’ needs.
Shumer agreed. “The same plan may not work for each patient based on their strengths and challenges. When providers are not considering the unique situation of each patient, this can lead to challenges that may worsen a patient’s health, including mental health.”
It’s fairly common for patients to come to a new provider or diabetes team with poor mental health. Though the reasons for this are varied, a contributing factor could be a negative experience the patient experienced with their last healthcare team.
“When mental health has been poor, I take an extra moment to get to know that client and what their needs are,” said Chris Alderton, a nurse and certified diabetes care and education specialist who lives with diabetes.
“Managing diabetes is both mental and physical. By taking those extra moments to validate how my client is feeling mentally, we can proceed with a goal that helps them feel empowered and confident in their diabetes management,” Alderton said. “Deep breaths, validation, and teamwork while offering support is a key to mentally managing diabetes.”
When caring for people with type 1 diabetes, Alderton said healthcare teams should embrace a multidisciplinary approach. This typically involves a nurse, social worker, dietitian, diabetes educator, and endocrinologist. The aim is to meet the patient and family where they are so that providers can build on their strengths.
“By having a team approach, we aim to focus not only on blood sugar, but also the whole person,” said Shumer.
“The educator has to provide support, hear, and validate [the client’s] feelings. They need to work together as a team to set goals the client can feel confident they can obtain,” added Alderon. “It's about empowerment and providing confidence.”
Clinical visits are an excellent opportunity for healthcare teams to build on strengths, provide care that supports mental health, and aid in setting goals. On subsequent visits, a patient might seek to build on what’s been accomplished in previous visits.
If you’re living with diabetes, experts recommend coming to visits prepared since multidisciplinary appointments can be lengthy. At their core, however, they are about you. Your healthcare team is there to make sure that you have the best outcomes. They want you to set goals and not just achieve them, but thrive while doing it.
Prepare topics to bring to your team. Questions for the dietitian? Bring labels that are confusing. Unsure about calculating your insulin doses? Do you think your dosing is incorrect? Voice any concerns to your endocrinologist.
Feel like your mental health is suffering? A social worker can help in this realm, or if one isn’t available, adding a therapist or psychologist to your healthcare team can help address mental health issues.
What traits should a person with diabetes look for in their healthcare team?
Looking back at our sample clinic visit, both provider A and provider B are very skilled in diabetes care and management. They can both offer feedback on insulin and medication dosing and provide care for comorbid conditions, such as hypertension (high blood pressure), high cholesterol, kidney problems, and more.
Chances are you’ve chosen provider A, but what makes them different? Provider A focused on the positive, asked open-ended questions, and provided empathy, whereas provider B nitpicked rather than using the visit as a teaching experience. Provider B used closed communication and asked questions in a condescending way.
Ultimately, you must select the provider that is best suited to your needs. Provider A may be a great fit compared to provider B, but only you can make that decision. One way of knowing that is by understanding which personality traits meld best with your own individual needs.
Experts like Shumer and Miller agree that empathy goes a long way in caring for patients with diabetes.
“Having empathy by being aware of the root causes of why the patient feels a certain way allows time to vent and explain what is going on in their life, which may be contributing to poor diabetes management,” said Miller.
Alderton said it’s helpful to step into a patient’s shoes. Though this can be difficult, it can go a long way in connecting with the patient.
“If you can step in their shoes for a moment and show them you have a glimpse of understanding, the patient will trust you,” Alderton said. “Without their trust, it’s impossible to support them. As an educator, it’s my job to support, educate, and show understanding to their efforts – even if it’s not what was initially planned.”
The bottom line
Advocating for yourself in regard to your healthcare team may mean the difference between helping or hurting your mental health.
Your diabetes care team can help or worsen your mental health, so it’s vital to seek care with professionals who practice empathy, respect, provide the right kind of education, and help you reach or realign your goals.