Behavioral Health and Diabetes
OHSU Harold Schnitzer Diabetes Health Center is at the forefront of diabetes care in the United States, providing both medical and behavioral health care resources for people living with diabetes. Our center understands that diabetes care requires a comprehensive approach. Behavioral healthcare is available at our center (see below for provider options). To learn more information on aspects of living with diabetes and behavioral health that may impact you or a loved one living with diabetes continue reading below.
A healthy and realistic approach to living with diabetes
• Establish your team: this includes parents, partners, friends, other individuals with diabetes, doctors, educators, dietitians, nurses, social workers, psychologists, teachers, bosses, etc.
• Establish SMART goals: S (specific), M (measurable), A (attainable), R (realistic), and T (timely). Set yourself up for success by establishing both short and long-term goals.
• Eating: work with your dietician to eat food you like that also promotes your health. Consider taking refresher classes when needed.
• Activity: work up to 30 minutes of activity each day. Start where you are and slowly build increased activity, consider finding an accountability partner. Talk to your doctor about how activity impacts diabetes management.
• Medications and blood glucose: if you forget or get tired of taking medications and checking blood glucose, talk to your doctor and ask for support. Try to set routines.
• Choice: find the tools and medications that work best for you to reduce barriers to self-care. Diabetes is not a one-size-fits-all condition. Talk with your diabetes educator about the options that can help you reach your goals.
• . Connect: participate in diabetes-related events, support groups and find others who live with diabetes to create connections.
• Have fun! Don't forget to engage in stress reducing activities.
Diabetes support groups
OHSU currently offers support groups for both families and for adults (18+) with type 1 diabetes that is of no cost: learn more about our diabetes support groups. The OHSU support group meetings include a variety of member-led and guest speaker topics within the community.
Getting support from friends, family, and community
We all know that managing diabetes is complex. Your support team should include people beyond your healthcare team like friends, family, and your community. Tell people you trust about your diabetes, explain how they can help, and be sure to inform work and school, when needed.
How can a psychologist or social worker support you in your diabetes care?
At the Harold Schnitzer Diabetes Health Center, we have several psychologist who provide individualized care for children, teens, adults and families living with and/or supporting people with diabetes. Psychologists are experts in behavioral health and can help individuals and families adjust to a new or changing diagnosis, continuing care, and support goals shared by individuals and physicians.
Diabetes is rarely the only important issue in one's life. A psychologist can help support an individual or family in the various aspects of life that may impact diabetes care. Such challenges may include diabetes burnout, diabetes denial, stress, anxiety, or other chronic health issues that can complicate or interfere with diabetes care.
The Harold Schnitzer Diabetes Health Center social worker is available to provide access to resources for children, teens, adults and families impacted by diabetes. Our center’s social worker coordinates resources within the clinic and externally in the greater community. The social worker can meet with individuals and families to help solve problems and review options to improve care, as well as seek to increase access to community resources. Access to resources may include areas such as transportation, food, clothing, housing, utilities, language translation, as well as resources to underinsured or uninsured individuals and families (dependent on income and availability some resources may or may not be available).
Diabetes and depression
When a person has symptoms of depression, accomplishing normal self-care can be quite challenging. The additive effect of a chronic health condition like diabetes can make it much more challenging to manage day-to-day activities including the various tasks of diabetes management. Managing depression is critical since treatment of depression can improve both mood and blood glucose control.
• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms
Denial is most common during the early stages of diabetes and its onset, especially in the case of type 2 diabetes. However, denial can also occur much later in one's life and as a component of burnout (see below). Denial can be present as a means of coping and may show up when people need a "vacation" from diabetes. However, as we all know, there is no vacation from diabetes, which is what makes caring for diabetes so challenging. You can recognize denial when you start making excuses or ignore diabetes care. If you recognize denial, the best strategy is to make a plan, ask for help, and tell others how they can be helpful.
• Feeling overwhelmed
• Disengaging from your health care team
• Not practicing recommended diabetes care on a regular basis
Diabetes burnout commonly occurs when individuals become tired of managing diabetes. It is something that occurs when a person no longer wishes to provide the endless attention diabetes care requires. Managing diabetes is complex and negative feedback from multiple sources is common. For example, meters, doctors, partners, and parents, may routinely provide negative feedback about diabetes management. It is easy to feel overwhelmed when receiving this type of feedback. This experience may indicate diabetes burn out. Remember to stay realistic; maintaining motivation is better than attempting to achieve perfection. If something does not go well, be kind to yourself and try again. If this sounds like you or someone you know, consider seeking support from a behavioral health professional that specializes in chronic conditions and reaching out to family and friends for support.
- Ignoring diabetes management such as infrequent blood testing or not testing at all
- Feeling unmotivated or unwilling to change habits
- Negative feelings about diabetes
- Isolation - feeling alone in living with diabetes
- Avoiding or frequently missing healthcare appointments
Individuals with diabetes are at a higher risk for an eating disorder. Eating disorders are complex, can be dangerous, and require professional help. The short-term consequences of having both diabetes and an eating disorder can include muscle atrophy, diabetic ketoacidosis, and staph infections. If you or someone you know has an eating disorder associated with their diabetes care, seek help from a professional medical provider.
- Unexplained weight loss
- Obsession with food and body image
- Avoiding eating with family or in public
- Extreme anxiety about body image
- Excessive exercise
- Persistent thirst and frequent urination
- Low energy
- A high hemoglobin A1c
- Recurrent DKA (diabetic ketoacidosis) without any explainable cause
- Irregular or lack of menstruation