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427 -Psychosocial Aspects of Diabetes

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Psychosocial Aspects of Diabetes
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director,
Host: Counselor Toolbox Podcast
~ Define diabetes type 1 & 2 and Gestational Diabetes
~ Learn about complications of diabetes 1 & 2
~ Learn about the causes of diabetes 1 & 2
~ Learn how blood sugar alterations can impact mood, cognition and energy
~ Identify chronic conditions associated with uncontrolled diabetes
~ Describe emotional issues associated with having a diagnosis of diabetes
~ Describe social issues associated with having diabetes
~ Explore common treatment goals for persons with diabetes 1 or 2
Diabetes and Mental Health
~ Nearly 10% of the US population has diabetes
~ 84 million adults ages 18 years or older (34 percent of U.S. adults) have prediabetes
~ People with mood and psychotic disorders are at increased risk of developing diabetes, emphasizing the bi-directional relationship of diabetes and mental disorders
~ Inflammatory changes associated with diabetes itself can be linked to the development of depression
Types of Diabetes
~ Type 1 AKA Juvenile Onset or Auto-Immune
~ Chronic condition where little or no insulin production is observed due to autoimmune reaction against the pancreas
~ Can be caused by pancreatic diseases, genetics or auto-immune destruction of pancreatic cells.
~ Type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old.
~ Some children inappropriately may be referred for mental health care due to irritability and/or depression
Types of Diabetes
~ Symptoms of Type 1 can appear relatively suddenly and may include:
~ Increased thirst
~ Frequent urination
~ Extreme hunger
~ Unintended weight loss
~ Bed-wetting in children who previously didn't wet the bed during the night
~ Irritability and other mood changes
~ Fatigue and weakness
~ Blurred vision
~ There's no known way to prevent type 1 diabetes
Type 2 Diabetes
~ Type 2 diabetes develops due to a combination of insulin deficiency and ineffective use of insulin
~ Diets that lack certain nutrients, such as magnesium, calcium, fiber, and potassium.
~ Smoking: This can impair insulin sensitivity and production
~ Sleep issues: Losing 1-3 hours of sleep per night for as few as 3 nights can increase insulin resistance.
~ Age: Being over 45 years of age might increase the risk of insulin resistance.
~ Use of steroids due to arthritis, blood disorders, breathing problems, severe allergies, skin diseases, cancer, eye problems, and auto immune disorders
Type 2 Diabetes
~ Causes cont…
~ Underlying health conditions: High blood pressure, previous episodes of stroke or heart disease, and polycystic ovarian syndrome (PCOS) can all increase a person's risk of developing insulin resistance.
~ Hormonal disorders:
~ Cushing's syndrome (too much cortisol)
~ Menopause: Estrogen and progesterone affect how your cells respond to insulin
~ Lack of exercise
~ Obesity
~ Adults may present for mental health care when diabetes is the underlying cause of their mood and energy changes.
Gestational Diabetes
~ Pregnancy complications. High blood sugar levels can be dangerous for both the mother and the baby.
~ Miscarriage, stillbirth and birth defects
~ Diabetic ketoacidosis
~ Diabetic eye problems (retinopathy)
~ Pregnancy-induced high blood pressure and preeclampsia.
~ Women with diabetes often have more difficulty getting and staying pregnant
~ Gestational diabetes is not the cause of an increased risk of Type 2 diabetes. The increased risk of Type 2 diabetes was there all along and is the cause of the gestational diabetes
~ Mothers who gain a lot of weight when pregnant and do not lose it increase their risk of Type 2 Diabetes
Symptoms of Hypoglycemia
~ Causes
~ Mismatch of medicine, food, and/or exercise
~ Having pre-diabetes or being at risk for diabetes
~ Stomach surgery, which can make food pass too quickly into your small intestine

Symptoms of Hypoglycemia
~ Symptoms
~ Shakiness
~ Nervousness or anxiety
~ Sweating, chills, or clamminess
~ Irritability or impatience
~ Dizziness and difficulty concentrating
~ Hunger or nausea
~ Blurred vision
~ Weakness or fatigue
~ Anger, stubbornness, or sadness

Psychosocial Aspects
~ Routinely monitor patients and their families for diabetes related distress at diagnosis, when treatment targets are not met and/or at the onset of diabetes complications
~ Psychological problems such as temporary adjustment disorder with somatic complaints, social withdrawal, anxiety or depression
~ Quality of life declines as the number and severity of complications increases
Psychosocial Aspects
~ Cognitive Dysfunction
~ Mild impairment of cognition due to hypoglycemia (also related to
~ Psychosocial and educational disruption associated with management and complications
~ impairment may be largely due to inability to concentrate effectively and use optimal learning strategies to organize and encode information
~ 24% of children with an early onset of diabetes showed neuropsychological deficits
~ The child who develops diabetes before age 5 is particularly vulnerable to the effects of repeated hypoglycemia.
~ Age related forgetfulness and mobility impacting self-management and coping
Psychosocial Aspects
~ Consider the burden of treatment and patient and family levels of efficacy when making treatment recommendations
~ Issues of autonomy and independence related to self-management
~ Hypoglycemia unawareness results from fear of hypoglycemia.
~ Family cohesiveness and conflicts influence the psychological and self-care behavior of the child.
~ Treat the person rather than just the blood glucose values and give the child a sense of complete well being.
Treatment Goals
~ Physical Management Goals
~ Develop and stick to a healthy eating and activity plan
~ Address social and environmental factors impacting ability to comply with treatment
~ Learn to test blood sugar and keep a record of the results
~ Recognize the signs of high or low blood sugar and what to do about it
~ Self-Administer insulin by syringe, pen, or pump
~ Monitor feet, skin, and eyes to catch problems early

Treatment Goals
~ Physical Management Goals
~ Prevent Diabetic Ketoacidosis (lack of insulin makes body unable to use glucose and turn to using fats for fuel and ketones build up) (Life threatening)
~ Prevent hypoglycemia associated with irritability and long term cognitive impairment
~ Prevent vascular complications associated with depression and anxiety related to oxygenation and circulation
~ Prevent nervous system complications (neuropathy) associated with depression related to altered ADLs
~ Address financial barriers to treatment compliance

Treatment Goals
~ Engaging in Physical Activity can help:
~ Maintain weight
~ Improve mood
~ Improve sleep
~ Improve memory
~ Control your blood pressure
~ Improve cholesterol levels
~ Improve insulin sensitivity
~ Controlling blood pressure and cholesterol
~ Diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which increases the risk for heart disease and stroke

Treatment Goals
~ Psychological Wellbeing
~ Manage stress (Cortisol)
~ General life stress which can increase cortisol
~ Diagnosis adjustment and management (Health literacy and empowerment)
~ Related to reactions from co-habitants and friends
~ Depression, Grief
~ Related to activity and eating changes
Resource 1

Barriers to Treatment
~ Key barriers
~ Dysfunctional health beliefs/ lack of appropriate diabetes education
~ Low feelings of self-efficacy
~ Emotional distress and mood disorders
~ Problematic eating
~ Lack of social support
~ Functional limitations (e.g., Blindness, problems with dexterity, low health literacy)
~ Disruption in routines
~ Deficits in problem-solving or coping skills
~ Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes
~ Assess patient and family symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance.
~ Monitor patient performance of self-management behaviors as well as psychosocial factors impacting the person’s self-management.
~ Assess life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. (Stress, psychiatric disorders, food and medicine availability, concurrent health issues including pregnancy, menopause shift work…)