Language Matters

The American Diabetes Association has released multiple statements on language and it’s important to remember that language matters I would encourage you to erase some words and phrases from your practice.

Erase These   Diabetic Diabetes causes Fail/Can't as a clinical marker 'You' Empower These   Person with diabetes (PWD) Diabetes-RELATED complications Physiology focus 'WE'

One such word is diabetic. This word does not speak about the patient--it speaks about the disease. Instead we should refer to a diabetic as a 'person with diabetes'. Another acceptable moniker is 'the diabetes community'. Diabetic retinopathy and other diabetic complications can be referred to as 'diabetes-related complications'. After all, people who do not have diabetes still get neuropathy, nephropathy, retinopathy, and other opathies. Too often I hear clinicians tell patients, "If you can’t lose the weight by yourself then we’ll start this medication", or "if we fail to lower your blood sugar to our goal then you’re going to need to do this". That’s really unacceptable because it implies to the patient their entire picture is somehow under their control. And this is many times not true! This is going to lead to the patient getting discouraged and feeling judged. And they could start wanting to avoid clinical encounters and their medications because they feel that they are being medicated as punishment for not reaching their goals. Instead, maintain a physiology focus, "if modifications to both your diet and exercise don't improve your insulin sensitivity to the point where your body is able to self-regulate, then we'll need to use pharmacologic support. The medication will help your body to do what it needs to do to make sure you’re healthy. If your body is not able to produce sufficient insulin on its own then we'll need to supplement that with injected or inhaled insulin".

And, finally, let's talk about 'you-based' phrasing. When we talk about what you need to do or what you’ve done in the past, it can come off as very judging and blaming. A better way to communicate is to use 'we' statements such as, we are going to work to reach this goal, or we’re going to see if this medication works well for you and, of course, we’re going on this journey together. That gives the ongoing message that this is a team approach that whether or not we get the desired clinical outcomes.

Isolation - The Silent Symptom of Distress

One particularly important area to screen for is isolation. Isolation can portrayed in several ways: avoiding parties, not going out to eat, expressing anger at others for their food choices, feeling distress at being connected or disconnected from their care team or supports, or even not being able to use food as a coping mechanism.

Ask your patients what they avoid due to their diabetes and let them know that it’s OKAY to have moments of unstable blood sugars (for instance, during holiday meals with families). Let them know that it’s okay as long as it’s not an everyday occurrence. Encourage them to keep a long-term view of their progress and remind them that it’s all about building healthy sustainable lifestyles.

A major factor in the burden diabetes on our mental health is the added number of decisions that must be made.

A 2014 Stanford University study found that the average person with type 1 diabetes makes more than 180 diabetes specific decisions per day! That’s on top of what they’re having to do as a part of their normal routine. Other statistics measure the amount of mental energy put into diabetes management. The findings being similar to that of a part time job--and many of our patients already have full-time commitments like jobs or school. These decisions include things like medication dosing, blood glucose monitoring, dietary choices, physical activity adjustments, safety concerns, side effects from medications, hyperglycemia or hypoglycemia prevention, and financial concerns.

Anything we as caregivers can do to reduce the number of decisions a patient has to make is going to reduce their burden. Helping the patient to figure out how to reduce the number of times they have to check their blood sugar throughout the day, or reducing the number of medication dosages, or maybe combining correction and meal time boluses, or lumping together medication schedules so that they take medications only in the morning and at night. Also, helping patients find healthy strategies and working out a viable implementation schedule—writing them in a calendar or (better yet) a scheduling app so that they can just get alerts when they need something.