Signs to look out for: Preoccupation with food, Glycemic outcomes, weight and body image that negatively impacts quality of life A feeling of loss of control around food, including compulsive eating habits Using exercise, food restriction, fasting or purging to "make up for bad foods" consumed Limiting diet as primary means of glycemic control “I eat the same thing every day because I don’t like to see the blood sugar move” *Diabulemia- insulin omission for weight loss – if insulin amounts reported don’t match glycemic outcomes

Special Considerations: LGBTQIA+

Members of the LGBTQIA+ community face hardships and inequities throughout the healthcare experience. From more bias and judgement from clinicians that leaves them less likely to seek care, to less access to knowledgeable care providers, these patients are often underserved.

Members of this community also have rates of depression and suicide that are 2-4x higher than the national average. With transgender individuals having the highest risk for suicide of all societal demographics.

Gay men report 3x the rates of disordered eating as their heterosexual peers.

When diabetes is an added stressor in the lives of these individuals, the risk for reduced self-management or mental health impacts multiplies.

Higher rates of depression and suicide (2-4x) Experience more clinical judgment and bias – less likely to seek care Have less access to knowledgeable clinicians Gay men report 3x the disordered eating rate Support systems in “renovation” Housing, Financial security and sexual security compromised

It is also important to be mindful that the support systems of LGBTQIA+ individuals may be in a state of “renovation”. As one shares one’s self with one’s supports some will choose to leave or shun the individual, and the time of discovering one’s “found” or “made” family takes time. This is a very vulnerable time for their mental health. These individuals may also experience times of transition in which their housing, financial security and even their physical safety and sexual safety are all compromised. When their basic needs are compromised they oftentimes lack the resources and mental bandwidth to properly manage the often complex needs of diabetes self management. Additional supports from social, and clinical services are vital to keeping these individuals safe and moving forward.

Clinicians may wish to seek out LGBTQIA+ competent training in order to empower them to utilize the full diversity of the diabetes community for their patients.

 

Special Considerations: Age 65+

Another group? seniors.

Seniors are always at an increased risk for mental health decompensation. Aging is a phase of life where their self actualization and esteem are directly impacted. When younger, they identified with their role in society, professionally, or within their family or culture. But with retirement, or children leaving the home, those identities are compromised and seniors can feel they are losing their ability to contribute to their community. This is referred to as stagnation.

Higher rates of depression Higher rates of isolation Higher risks associated with hypoglycemia May have Longer duration of diabetes diagnosis Factors associated with aging make diabetes management more difficult – vision/hearing impairment, reduced mobility, financial instability, loss of social supports

Seniors also have higher risks of hypoglycemia as their body’s hormonal compensatory systems are not as reactive, so they are less likely to feel low blood sugars before losing consciousness. And should they have a hypoglycemic event-related injury, the ramifications on their health are far greater with age.

Seniors are also likely to have had a longer life with diabetes, making their risk of complications and other health decline higher than younger individuals with diabetes. So though they’ve done everything “right” for decades they may now perceive their body as “betraying them”.

And at the same time factors associated with aging are making it ever more difficult to continue to manage their diabetes effectively and independently.

Seniors are more likely to have impaired sensory abilities, mobility, and are at a far higher risk of financial instability due to the unforeseen costs of health maintenance that come with age, and the loss of social supports as friends are also aging.

Generational differences also increase the stigma associated with seeking and needing mental health care. This may cause seniors to be resistant to discussing their struggles, feelings or deficits. Ongoing assessment and careful listening over time can be the key to gently uncovering areas of need. And educating, even when need is not immediately apparent, is beneficial.