Welcome to this course. Thank you for being curious about how diabetes stigma might look in a session. You wonder how diabetes stigma is different than diabetes distress. Keep reading to help untangle these familiar terms, learn how these other conditions can present, and what you could say to help your patient.
What is Diabetes Stigma?
Diabetes Stigma refers to the experience of negative feelings such as exclusion, blame, rejection, or judgment due to having a chronic disease. The experience of sigma is not only related to diabetes because your clients aren't simply a condition but complex humans who may have racial, gender, or size identities that magnify the experience of diabetes distress.
Diabetes Stigma may present in a session in the following ways:
Tears
Anger, shifting blame
Frustration
Self-blame, shame, and fear that diabetes was self-inflicted
Silence
What to do when diabetes or any stigma is present during a session?
Acknowledge the stigma. “There is a lot of stigma surrounding diabetes.”
Remind your patient that stigma and judgment are wrong. "It isn't okay to be judged because you have diabetes."
Normalize feelings. “It is normal to be [frustrated, angry, or confused]about this diagnosis/change in lab values.”
Anticipate self-blame. "It is tempting to blame ourselves for diabetes because many people think diabetes is caused by eating certain foods or your diet."
Provide "space and grace" to your clients. Many clients feel they are expected to change everything all at once. When you challenge this thought, you can give space (time) and grace (permission to try many options until your patient finds what works for them.)
Why is Diabetes Distress a problem?
“Adults who expressed self-stigma for their diabetes reported less diabetes self-management and lower self-efficacy, and those who reported being judged about their weight by a doctor exhibited greater diabetes-specific distress.”
Diabetes Distress may present in a session in the following ways:
Expressing the feelings that changes in diabetes are due to personal failure. This can be seen as self-blame and shame.
Patients may be unable to tolerate these feelings and offload them as anger or blame.
The frustration your patient feels may be redirected towards self-blame.
Shame or the inaccurate belief that they are the problem may be expressed.
Denial may be present because honest emotions weren't expressed during the session.
Silence in which the patient doesn’t talk or express themselves.
What to do when diabetes distress is present during a session?
Inform the patient that diabetes distress is a real condition different from depression. We have created the following handout.
If you think it might be helpful, offer the diabetes distress scale, a validated way to measure the amount of distress your client might be experiencing.
When these feelings of exclusion, blame, and rejection are internalized, they can be felt as shame, a universally painful experience. Many people with diabetes feel that because of diabetes, they deserve to be excluded, blamed, and left out. Brené Brown explains, "Shame is a focus on self, guilt is a focus on behavior.”
Shame says, "I am bad."
Shame: “I’m sorry. I am a mistake.”
Guilt says, “I did something bad.”
Guilt: “I’m sorry. I made a mistake.”
Diabetes Burnout may present in a session in the following ways:
“I don't know what you want me to say."
Refusal to take responsibility
Refusal to take action
Blaming diabetes on something else: Job, Family, Medication
What to do when diabetes burnout is present during a session?
It is hard to meet a new provider. Your experience hasn't always been positive, and you want me to understand what you are facing with your diabetes.
Reflect on their feelings. “You are burned out from having diabetes.”
Normalize their feelings. “This is a challenging condition. It is normal to feel burnt out from dealing with it.”
As you listen, allow your client to express their painful feelings while occasionally pulling for their deeper desire to feel better, find a solution, make diabetes easier to manage, feel heard, or be supported.
"This is hard, and you want to feel better."
"This is exhausting, and you want not to be so tired."
“You want diabetes to be easier to manage.”
“Your experience is real.”
“You are looking for support to make changes to your overall diabetes plan.”
How are Diabetes Stigma, Distress, and Burnout different?
Diabetes Stigma: The CDC defines Diabetes Stigma as "negative attitudes, judgment, discrimination, or prejudice against someone because of their diabetes.”
Diabetes Distress: The American Diabetes Association defines Diabetes Distress as "The emotional distress that results from living with diabetes and the burden of relentless daily self-management."
Diabetes Burnout: Beyond Type 1 defines Diabetes Burnout as "a state in which someone with diabetes grows tired of managing their condition, and then simply ignores it for a period of time, or worse, forever.”
These three conditions are interrelated conditions and can contribute to depression.
Helpful Resource
Diabetes Behavioral Institute offers a Diabetes Etiquette handout to help people without diabetes better understand what is helpful.
Diabetes Distress
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