6 Things Doctors Should Say to Patients with Diabetes
Editor’s note: If you can’t simply print this out and hand it to your doctor, you may have to either find a better provider or help them learn how to better support you! Advocating for your needs with your healthcare team isn’t easy. Here are additional tips on communicating with your doctor and asking for the support you need.
Living with any type of diabetes can come with a lot of guilt, frustration, shame and isolating stress. In order to work closely with your doctor, you need to feel like they understand just how demanding diabetes can be. You also need to be able to show them imperfect blood sugars and talk about imperfect decisions without being scolded and lectured.
Feeling like your doctor (or other members of your healthcare team) is actually part of your team takes effort. It starts with feeling understood and safe.
Here are a few things doctors could and should say to people with diabetes to create a safe environment at every appointment.
“I know managing diabetes isn’t easy—you’re working really hard.”
Yes, people with diabetes need to hear this acknowledged loud and clear at least once. Even if your A1c is high and your blood sugars are all over the place, managing diabetes is still really stressful and hard.
Too often, diabetes is simplified by the media, friends, strangers, family, and even healthcare professionals as a problem that has a simple solution: “Eat healthy food. Take your insulin. Go get some exercise.”
In reality, managing diabetes is a non-stop juggling act that demands your concern and attention every minute of the day. Trying to ignore it for even an hour can lead to dangerously low blood sugars and frustrating high blood sugars.
To have this acknowledged fully by your healthcare provider gives you the sense that they understand how hard you’re working to just get through another day alive. Children and adults with diabetes need to hear this throughout their lives. It sets them apart from the media and dismissive comments, jokes and advertising that has no clue how much work managing diabetes truly is.
The more you feel they understand this, the more open you’ll be about what you’re struggling with.
“High blood sugars do not mean you’ve failed.”
One high blood sugar can leave you feeling like you’re failing for the rest of the day. As a person with diabetes, you are constantly trying to score a perfect “100” on a test that isn’t fair from the start. But diabetes shouldn’t be perceived as a “test” by people with diabetes or their doctors! It puts unnecessary pressure on the situation when there already is so much. People with diabetes need compassion.
If achieving perfect blood sugars was easy we wouldn’t need doctors at all!
If your healthcare team uses every high blood sugar or high A1c result as an excuse to lecture and blame you, they’re doing far more damage to your diabetes health than helping.
Your healthcare team needs to remember that diabetes is a 24/7 responsibility. Some might even compare diabetes management to caring for a newborn child—but the child takes naps! Diabetes never sleeps.
Whether your body produces zero insulin or too little insulin, your body doesn’t have the tools it needs to manage perfect blood sugars all day long. Expecting any person to do this perfectly is unrealistic.
- High blood sugars should be expected.
- High blood sugars should be a conversation trigger for making adjustments.
- High blood sugars should let your healthcare team know you need support—not judgment.
In fact, even if your high blood sugars are the result of intentionally skipping your insulin, this should still be treated as a sign that you need some type of support that you’re not already getting.
“A healthy diet doesn’t have to be perfect—and it should include some of your favorite foods.”
Simply being diagnosed with diabetes doesn’t mean your cravings, involvement in the holidays and appreciation for a slice of pizza just disappear. Should a diabetes diagnosis help you find ways to improve the balance and quality of what you’re eating? Sure, but that doesn’t mean it needs to be perfect.
People with diabetes need to know that their doctor doesn’t expect a 100% “perfect” diet. If this is the vibe during an appointment, you won’t be honest with your doctor about your nutrition which means they can’t properly help you with insulin doses and medication adjustments.
A balanced diet means there’s room for those more indulgent favorite foods that keep you from feeling deprived. Often referred to as an 80/20 diet, it means you’re striving to make mostly healthy choices throughout the day that support your diabetes health while leaving room for a fun choice or two. A realistic, flexible approach to nutrition prevents restrictive dieting that leads to binge-eating and a non-stop yo-yo relationship with food.
Your healthcare team should understand and acknowledge out loud that they don’t expect you to become a perfect dieting robot just because you have diabetes. (Chances are…their diet isn’t perfect either.)
“What kind of support would you like from me?”
When you ask someone what kind of support or help they want, you may give them the opportunity to ask for something you didn’t know they needed.
For instance, a doctor may look at your blood sugars and think you’re being lazy, forgetting to take your insulin, and ignoring the doctor’s orders. In reality, you may be struggling with fear of hypoglycemia after experiencing a severe low blood sugar! Your doctor may not even know this severe low happened if you were treated at home with emergency glucagon.
Asking open-ended questions is an approach that can be used in just about any relationship (try it with your teenager, your spouse, your employee, etc.) because more often the person who is struggling knows what they need.
With the huge list of variables a person might struggle within diabetes management, it’s dangerous to make assumptions. When your doctor asks this question, you can skip all the assumptions and get right to the heart of what you need.
“What one part of diabetes management would you like to work on?”
It’s hard to feel motivated when the to-do list is everything. Too often, you might feel extremely overwhelmed by the endless list of things a person with diabetes ought to be doing to reach your blood sugar goals.
By choosing just one part of diabetes management to focus on, you’re taking the “oh my gosh, I can’t handle this!” stress out of it.
And yes, it’s very important that this goal came from your mind, not theirs. When you create the goal you will feel far more ownership of that goal.
By choosing one very specific task or goal—like checking your blood sugar every morning if you haven’t been checking much at all—you’re also starting with something doable. The feeling that comes with succeeding in that very specific task can gradually grow to feel ready to tackle another.
Start small. Be specific. Be realistic. (Yes, that SMART goals thing…but that acronym is annoying.)
If your healthcare team expects you to return in six months having successfully improved on every aspect of diabetes management, they’ve forgotten that you’re human. They need to step back and let you be in charge of what you’re ready to tackle.
“Diabetes is really stressful—how are you feeling?”
This question needs to be asked regularly during patient care for people with diabetes.
In a disease that requires hour-by-hour attention, diabetes burnout is not only common, it’s also normal. Who wouldn’t get burnt out? The stress of diabetes can evolve beyond burnout, too.
Anxiety and depression are really common in people living with any type of diabetes. Unfortunately, it’s also rarely acknowledged or treated. According to research, only 36% of people with diabetes struggling with anxiety ever receive any support and treatment.
- One in six people with T1D is affected by moderate-to-severe anxiety symptoms.
- One in five people with T2D who use insulin are affected by moderate-to-severe anxiety symptoms.
- One in six people with T2D who do not use insulin is affected by moderate-to-severe anxiety symptoms.
It shouldn’t take research to identify how stressful living with diabetes can be. And that stress, anxiety and depression can have a huge impact on how you manage your blood sugars and medications. Instead of judging and scolding high blood sugars, your healthcare team should start seeing this as a sign that you need a type of support you’re not already getting.
Research from T1D Exchange has actually led to a diabetes-focused depression screening program to improve a clinic’s ability to identify patients who need mental health support.
The bottom line
In a disease that comes with so many constant goals (ie: tests), people with diabetes need to feel like they have a healthcare team that is actually on their team. That means compassion, support and understanding.
These basic conversational sentences can completely change the doctor-patient relationship which then helps a person with diabetes handle the intense demands of type 1 or type 2 diabetes.