So often we see a line drawn between “physical health” and “mental health.” In reality, the two are inextricably intertwined! Broadly speaking, physical health conditions can have a significant impact on one’s mental health and increase risk factors for mental health conditions--and the inverse is equally true.
To consider this relationship between mental and physical health more closely, let’s take a look at diabetes. Diabetes is a chronic illness that afflicts millions of people in Canada, and across the globe. Understandably, much of the discussion around diabetes focuses on it’s physical symptoms and effects--monitoring diet, taking insulin, adjusting lifestyle and exercise etc. Diabetes however, along with other chronic illnesses, can also have a very impact on one’s mental health.
About one in three people living with diabetes experience symptoms of depression.
Similarly, fourteen percent have generalized anxiety disorder, or G.A.D., and three times that number experience symptoms of anxiety. In fact, the relationship between diabetes and mental health goes both ways: people living with diabetes have a higher risk of developing mental illness, and individuals living with mental illnesses have a higher risk of developing type 2 diabetes.
Living with diabetes or other chronic health challenges impacts a person’s daily life in a big way. During pre-diagnosis, those struggling with their health may experience frustration, fear, despair or isolation as they seek to find out what is happening to them. After diagnosis, the individual is armed with more information and resources, but is often tasked with making serious changes to their life and living with the daily demands and reminders of their illness.
In fact, every day the average person living with type 1 diabetes makes 300 diabetes related decisions and performs 600-1500 extra tasks related to their illness.
The daily battle of managing their illness with the demands of their life, work, relationships and activities can often lead to feelings of guilt--“It’s my fault,” “I’m not doing enough,” or “I did this to myself.” In reality, there are many reasons for fluctuating blood sugar, and to blame one's self or attribute these fluctuations to a lack of attention to the illness is unfair and can lead to further harm through emotional stress.
The state of stress, guilt, or denial that can arise from living with diabetes and the burden of self management has been named a condition in itself, which is different from typical depression--called Diabetes Distress.
Another layer of challenge that many persons living with diabetes and other chronic health conditions face is the need to advocate for themselves in healthcare spaces. In our fast-paced and sometimes fragmented healthcare system, a person may feel alone in advocating for themselves and their care. Repeatedly explaining their symptoms and concerns, doing research into treatment options, and/or visiting a multitude of specialists or clinics can be exhausting and isolating.
The DAWN2 study (second Diabetes Attitudes, Wishes and Needs Study) asked individuals with diabetes if they felt they were listened to and helped by their healthcare provider in setting diabetes related goals. They found that only 51% of those with Type 1 and 36% with Type 2 felt this was the case. Interestingly, the results of the healthcare practitioners surveyed are a stark contrast. 73% of family doctors and specialists and 98% of nurses and dieticians reported that they are “listening always/most of the time” to patients with diabetes.
What are some actionable tips for how the relationship between people with diabetes and healthcare professionals can be improved to better support the mental health of patients?
Gabrielle Schmid, Diabetes Educator, Registered Dietitian and Certified Pump Trainer with LMC Diabetes & Endocrinology, sat down with us to share some tips and insights. Schmid volunteers with Diabetes Canada, JDRF, and CHEO, working to support those living with type 1 diabetes, and their families. What’s clear from her impressive resume and incredible is Gabrielle’s immense passion to empower diabetes patients and to drive change in the way that healthcare is provided to Canadian’s living with diabetes.
In general, what advice would you give healthcare providers on supporting the mental health of patients living with diabetes?
Psychological and physical pillars are one and the same, but often times the psychological support is missing. There is the idea that if a healthcare provider starts to ask a person about how they are feeling about their diabetes or what it’s like to live with diabetes, this might open up a ‘can of worms, which may not line up with a health care provider’s agenda for the appointment. We need to let this happen. We as healthcare providers need to let go of fixing the person in front of us and instead help them heal or grieve their loss of their life without diabetes – ultimately, our job is to provide a safe space, listen and provide empathy.
As a diabetes educator, what do you do to support patients' mental health?
I do my best to remember that I’m simply one person helping another person. I create a safe space for people with diabetes to just show up and talk. I think this approach helps instill a message that life is always changing, that diabetes is also always changing, and that’s okay. I do my best to help my patients focus on their many daily successes that are often overlooked – they often focus on the hard days. We need to provide affirmations that they are capable and have been capable of positive outcomes, or that they are in fact ‘doing diabetes’--they’re doing the daily, nitty-gritty behaviours to help their diabetes. That in itself is commendable!
The Diabetes Distress Scale is a tool that I may use to dig a little deeper to see if there are any signs of diabetes distress. I consider the language that I use. I explore my patient’s capacity versus their capability when it comes to behaviour change. Ultimately, I help them fit diabetes into their life.
What are some tips you have for people with diabetes and healthcare providers alike on how to have these conversations?
My advice for people with diabetes, when consulting a healthcare provider--be open:
- Examine your body language. Do you feel like you’re closing yourself off from the healthcare provider?
- Have your agenda ready.
- Enter the room expecting that you will receive help today.
- Try and identify a feeling that you have towards your diabetes and lead the appointment with it.
- Outside of your appointment, engage in positive self-talk when you’re managing your diabetes. Instead of saying “my blood sugar numbers are bad, rephrase it and think “I checked my readings – my numbers are data.”
My advice for healthcare providers assisting people with diabetes--be open:
- Examine your body language. Offer a safe space
- Consider a flourishing-treatment approach, i.e. help people build on their successes with diabetes.
- Be vulnerable – it’s okay if you don’t know what to say or how to say it – by asking you are helping the person in front of you. Listening is often enough.
- Acknowledging the work being done by the patient.
2018 Clinical Practice Guidelines Committees. (2018). Canadian Journal Of Diabetes, 42, A6-A16. doi: 10.1016/s1499-2671(17)31026-2
Nicolucci, A., Kovacs Burns, K., Holt, R., Comaschi, M., Hermanns, N., & Ishii, H. et al. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767-777. doi: 10.1111/dme.12245
Gabrielle Schmid RD, CDE, CPT
Gabrielle is a Diabetes Educator, Registered Dietitian and CertifiedPump trainer with LMC Diabetes & Endocrinology in Ottawa. She also volunteers with Diabetes Canada to organize and facilitate monthly type 1 support groups. She connects with families and children living with type 1 diabetes through the JDRF and volunteers with CHEO to help bridge the gap between diabetes care and youth living with type 1 diabetes. Ultimately, Gabrielle is passionate about driving change in the health care provider approach to help empower all people living with diabetes.