Looking Around the Corner: Reducing Risk for People with Diabetes

An helpful handout to help your clients to avoid complications.

Your clients want to understand how diabetes increases other health risks. Explaining how this happens is challenging because discussing risk can evoke unnecessary fear, such as, "Will I go into a coma if I have a low blood sugar?" "Does everyone go blind with diabetes?" "High blood sugars are bad, right?" 

You want your clients to learn about diabetes and take this knowledge to assess their risks. This article explains ways to discuss this emotionally charged subject without triggering diabetes stigma.

Diabetes Stigma

The CDC defines diabetes stigma as negative attitudes, judgment, discrimination, or prejudice against someone because of their diabetes. It comes from the false idea that people with diabetes made unhealthy food and lifestyle choices, which resulted in their diagnosis. Many clients have internalized diabetes stigma, believing that diabetes is something to be ashamed of, triggering self-blame and frustration driving diabetes distress.

Adding to this burden is that diabetes risk can also touch on other stigma, including the stigma of ignorance. When a healthcare provider asks too many questions in a row, it lands as blame that sounds like, "Why don't you know? Why didn't you learn? Why can't you learn?" 

Why Monitoring Matters

Many people with diabetes are asked to monitor their blood glucose. What is missing is the purpose and value of monitoring. Clients have shared that they are monitoring because "I was told to test my blood sugar." Being told vs asked is triggering for adults. Additionally, there are many different numbers used in diabetes care. When a client searches the internet for blood glucose, results from A1C, Blood glucose targets, hypoglycemia targets, and diagnosis targets are presented. It is easy to see how confusing and scary these numbers are to them.

As a provider, reviewing your expectations about blood glucose monitoring with the client is helpful. Your conversation may include the gap between what is recommended and what is possible for your clients. Also, be mindful of word choices, for example, 'testing' blood sugars. The word' Test' has a weight that indicates a 'correct' or 'right' number. It creates a hierarchy where you, the healthcare professional, are in charge vs the client.

Additionally, taking a test multiple times a day is a challenging experience. Shift language from test to check and pair your request with your larger intention, "You are checking your blood glucose to learn. When you check at X time, it helps you recognize patterns. It will allow you and me to understand what is working in your diabetes plan." 

Taking time to slow down your counseling session is helpful. For example, I use a transitional statement such as, "I want to pause and let you catch your breath. What questions, if any, still need to be answered? 

Now that the client feels seen and heard, the concept of risk can be broached. Risk isn't a discussion about what will happen but a conversation about what could happen. It is why your emotionally vulnerable or overwhelmed clients are susceptible to misunderstanding and catastrophizing. They benefit from being told the same information 2, 5, or 10 times before they can fully understand. The need for repetition is a normal part of learning. Unfortunately, it can feel stigmatizing because past experiences are being relived. For example, saying, "You don't know what to eat, so I will send you to the dietitian." VS: "Managing your diet is confusing; many clients like talking with a dietitian. Is this something you could imagine doing?" [Client responds] "What would be the benefit of meeting with a dietitian to answer your questions?"

What the client hears

When a person feels overwhelmed, the limbic system, which is the brain's emotional processing, is activated. Like a game of telephone, what you say and what they hear are not the same thing. Knowing that this happens every time the conversation of diabetes risk is mentioned prompted the creation of My Diabetes Action Plan. 

This tool explains diabetes risk like a stop light, dividing risk into three sections. The behaviors being assessed are on the left side of the handout. On the right, list the helpful behaviors to take or continue to do to reduce risk. 

As a Diabetes Care and Education Specialist at Mass-General-Brighams, having this tool made my job easier. If you would like to learn more and obtain CPE from CDR the Inclusive Diabetes Care, IDC has a course titled, Essential Tools to Understand Diabetes: Seeing the big picture. This program will provide 1 CPE from the Commission of Dietetic Registration, perfect for Dietitians, Diet Technicians, Health and Fitness professionals, Community Health Workers, Social Workers, Case Managers, and Health Coaches.