PLEASE MASTER : Dialectical Behavioral Therapy (DBT)

PLEASE MASTER is a Dialectical Behavioral Therapy (DBT) skill to help reduce vulnerability to negative emotions. This is a great skill to help with emotional regulation while also having a framework for steps to take that create healthy habits within daily routines. 

Adjusting to LIfe as a Youth with T1D

Adjusting to life after being diagnosed with T1D can be overwhelming as you are navigating through a new “normal”. Continue reading for some helpful tips to help you adjust to your life.

Trauma in Youth with T1D

Outpatient therapy is a great option to consider for yourself of your child if either of you have found that you have been experiencing trauma after learning about a T1D diagnosis.

Depression in Youth with T1D

Depression is very common in youth who have T1D, if you are a parent who is concerned that your child may be having a difficult time, there is treatment and resources available.

Anxiety in Youth with T1D

Parenting a youth with Type 1 Diabetes can be tough, when a mental health diagnosis has also been ruled in it can make it difficult to manage both aspects. Anxiety is a common among those with T1D, if you think that your child may be experiencing symptoms of anxiety there is lots of helpful resources!

Being a Mother with a Demanding Job

Being an attorney and a mother can be extremely difficult. Finding work-life balance may seem impossible and mother’s may begin to feel guilty for working as much as they do. Continue to read on some tips that can help next time the working mom guilt sets in.

4 Motivational Interviewing Skills for Parents

4 Ways to Help your Child Deal with T1D Management

What Is Motivational Interviewing? It is one of the most effective ways to decrease ambivalence in clients suffering from long-term illness and the incredible burden associated with it. Many of these skills focus on simple bite-size steps that will begin building self-esteem and feelings of hope. Actively practicing these skills can greatly increase the level of success your child feels over time.

1. Create achievable, realistic goals.

Why? When you place too much on someone’s plate and pair it with severe negative downside, you have a solid recipe to create indecision and apathy.

How? If your child is struggling with daily tasks, don’t talk about things like the A1C blood test constantly. Instead, focus on the next meal, day, or week to help create the right habits.

2. Empower your child rather than manage your child.

Why? Success does not mean blood sugar within the desirable range; it means helping your child take active steps required to create the right habits. Exclusively trying to manage your child’s outcome based on good blood sugar or other fact-based outcomes can put a lot of uncontrollable elements onto your child’s plate and ultimately create hopelessness or low self-esteem.

How? As you talk to your child, work to identify areas of pride or success and incorporate asking about these items while you check in on insulin levels or carb intake. Additionally, try to elicit ideas from your child on how to manage a certain situation (e.g. how much to eat or how much insulin to take). This will support their confidence in their ideas instead of always looking to you for the answers.

3. Listen to your child.

Why? Your child has a 24/7 job that they did not apply for and they cannot quit. Creating an atmosphere that allows your child to safely explore conflicts and face difficult realities is critical to successfully managing T1D.

How? Show empathy, and then communicate your empathy. As a parent raising a child with T1D, it can be easy to hyper-focus on the next blood sugar reading or meal. Simply saying, “That makes sense. I can see how frustrating that would be.” can go such a long way.

4. Roll with Resistance.

Why? Managing T1D can be extremely discouraging. Your child might do everything right and still have a high blood sugar reading at the next meal. Helping your child understand that managing T1D is a roller coaster and not every blood sugar reading will be in the desirable range will help tremendously.

How? Normalize your child’s experience: “You ate the right amount, took the correct dose of insulin, and you still have high blood sugar. That happens all of the time.” Also, spend your mental energy on controlling what you can control and let everything else run its course.

 

These tips are helpful and supported by research but can be incredibly hard to implement consistently. If you ever need help or want someone to talk to, give us a call at (612) 223-8898 or schedule an appointment here.

Improving Treatment Adherence for Type 1 Diabetes

Despite all the advances in medical science and technology, there is still no cure for diabetes. A person with diabetes has to live with it and manage it all their life. The challenge, of course, is being diligent and consistent with diabetes management. Type 1 diabetes is challenging to manage because it is so comprehensive. Research shows that the adherence rate for chronic conditions is about 50%. Despite extensive studies and research, that number has not changed significantly over the past 3 decades.

What is adherence? How does it apply to people with type 1 diabetes? How can a person with type 1 diabetes improve their adherence? And how can mental health professionals help? These questions were answered by Dr. Katherine Fan, a psychiatrist and pediatrician, at the 2016 Asian Outreach Day. Dr. Fan spoke with attendees about the factors that affect a person’s short and long-term dedication and commitment to managing their diabetes. Here’s a recap of her talk:

Asian Outreach Day, Dr. Katherine Fan discusses factors that affect treatment adherence

What is Treatment Adherence?

Adherence is the active, responsible, and flexible process of self care and self management with a goal of overall health and wellness. An adherent patient strives to achieve good health by working in close collaboration with health care staff, instead of simply following rigidly prescribed rules.

In the context of type 1 diabetes, adherence can also be known as “collaborative diabetes management”, “patient empowerment”, or “self care behavior management”.  It can be useful to break down diabetes adherence into a number of areas:

  • Glucose monitoring
  • Administration of medication / insulin
  • Dietary intake / carb counting
  • Physical activity
  • Follow up visits

This may help the patient, medical care providers, and support system prioritize and focus on which parts to work on.

Also, it is important to distinguish between Adherence and Compliance. Compliance implies a paternalistic relationship between and patient and his/her doctor. The patient takes a passive role in diabetes management, simply following doctor’s orders and doing what they say. On the other hand, adherence is more of a partnership between a patient and his/her doctor, as well as his/her support network. In fact, the patient is an active participant in planning and management.

 

Factors Impacting Adherence

What makes a person with diabetes more or less likely to adhere to their diabetes management plan?  There are 4 main types of factors that diabetes adherence:

Treatment and Disease Characteristics

Complexity of treatment: The more complex the regimen, the lower the adherence rate. For example, if a patient has to take 10 different kinds of medication, 4 times per day, it is difficult to integrate this routine into daily life.

Duration of disease: The more chronic the illness, the lower the adherence rate. This may seem counterintuitive, but patients who have been diagnosed longer actually tend to have lower adherence rates than those recently diagnosed. Managing a condition over long periods of time may lead to a more casual attitude, or it may lead to burnout.

Delivery of care: Diabetes care can be delivered a number of ways: via a multidisciplinary team, a single general-care provider, or community treatment, to name a few. Research has shown that patients with diabetes seen specifically for their diabetes received more counselling on diet and adherence than patients with diabetes seen for an acute illness.

Intra-personal factors

Age: The teenage years tend to be hardest time to stick to a diabetes management plan. In contrast, parents of young children with diabetes are more likely to be adherent.

Self-esteem: Research has shown that high levels of self-esteem are related to high levels of adherence to physical activity regimens, adjustment of insulin doses and dental self-care

Self efficacy: Self-efficacy is defined as an individual’s belief in their ability to succeed specific or accomplish a task. A healthy sense of self-efficacy can play a major role in approaching goals, tasks, and challenges. The more a patient is able to advocate for him and herself, the better the outcome.

Stress: Stress and emotional state is also correlated with treatment adherence. The less stresses a person experiences, the more likely he or she will adhere to diabetes management.

Comorbid conditions: A comorbid condition is one that occurs at the same time as another illness or condition. Comorbid conditions such as depression, alcohol abuse, eating disorders, and others can adversely affect diabetes adherence. This effect is not limited to mental conditions: physical comorbidities also tend to lower the adherence rate of diabetes.

Inter-personal factors

Patient-provider relationship: The better the relationship between a patient and his or her provider, the higher the patient’s adherence rate will be. Patients and providers who communicate with each other tend to have improved relationships.

Social support: The benefits to have a social network for a person with type 1 diabetes are well known. Greater social support means better levels of adherence. For children and teens with type 1 diabetes, great parental involvement also means better levels of adherence.

Environmental factors

Stressors:The more stress a person has in their life, the harder it is to prioritize and manage diabetes

Conflicts: People with diabetes are as multifaceted as everyone else. Frequently, they are called upon to choose between giving attention to diabetes self-management or to some other life priority. They can face time pressures and social pressures during school events, work events, family events, holidays, and more.

Lifestyle factors: A person’s lifestyle can directly affect their diabetes adherence levels. Are they sedentary or active at work? Do they work long hours? Do they travel a lot? How much time do they spend in front of the television? Do they have a hobby?  Different circumstances require individuals to adjust and maintain their diabetes management.

Socio-economic status: The economically disadvantaged and ethnic minorities may find it particularly challenging to visit healthcare providers or to live a healthy lifestyle. They may have limited access to fresh fruits and vegetables, small living spaces. Their schools may not provide opportunities for physical activity. What’s more, financial constraints may prevent them from going to a gym. Those factors, combined with their local climate, may make regular exercise challenging.

 

The Diabetes Adherence Team: What can we do?

There are four kinds of players on any diabetes management team: the Patient, the Parents (or family/friends), the Physician, and the Environment. All players have a role to play in diabetes adherence. When each “player” contributes in a positive way, it leads to better adherence and better outcomes. Here are tips on how each team player can work to enhance adherence and wellness:

The Patient

It takes a team to manage diabetes, but adherence starts with the patient. As the person with diabetes, you’re going to be living with your body for a long time, so take care of it! Here are some things the patient can do to make diabetes adherence easier:

  • Be informed and understand your condition. Understand what it does to your body, and understand the complications that can occur if one does not manage the condition and stick to the plan.
  • Identify your strengths and future goals. Don’t see diabetes as something that defines you, but something that is a part of you. You cannot change it but you can manage it.
  • Stress proof your life. Work on areas such as sleep, nutrition, exercise, hobbies, mind-body exercise, healthy coping strategies, and more. Also, develop a support network of family, peers, school, religion, and/or support groups.

The Parents

Parents (and family) play a huge role in enhancing adherence. Here are some things parents can do to help their child with T1D:

  • Understand the developmental needs of your child and recognize where they are. Remember, each child is different! At any given age, a child may be a different levels with respect to cognitive, motor, social-emotional, and physical skills.
  • Be informed and stay involved. Invest in your relationship with your child! Additionally, help your child be informed and involved. Help educate your child’s school, as well as caretakers, friends, and family.
  • Balance “take control” and “letting go”. We all want to be there for our kids, but we want our kids to take responsibility and be independent so that when they leave home, they can take care of themselves.
  • Create a supportive home environment. Avoid judgement words such as “good” or “bad” sugar/A1C. Instead, use phrases like “in or out of range”.
  • Foster a positive attitude about the condition.
  • Model self care. Kids learn by watching!
  • Focus on incentives, not threats or fear tactics. Consequences are for behaviors that you want to stop, while incentives are for behaviors that you want to foster.
  • Don’t be shy about asking for professional help!

The Physician

Physicians play an important role. A physician who can help enhance adherence is one who:

  • Keeps it simple and simplifies treatment regiments as much as possible
  • Makes sure patients understand the consequences of non-adherence
  • Connects with the patient in a way they understant
  • Enhances patient communication via phone, text, etc..
  • Leaves bias out of the relationship and avoids judgement. Patients already feel shame and guilt, and when they feel judged, it negatively affects the doctor-patient relationship.

The Environment

Some environmental factors are difficult, if not impossible, to control, so focus on things that you can control. For example, you may not be able to enhance access to health care, but you can provide diabetes awareness and education. You can educate not only yourself and your family, but also the broader community. Parents can help educate their children’s school teachers and friends. Adult patients can start support groups online and in real life. Technology can also improve diabetes awareness and education.

 

The role of Mental Health Clinicians

How can mental health clinicians help patients achieve overall wellness?

  • They can support the patient and the patient’s family, not just during diagnosis, but throughout their journey.
  • Acceptance is the first step towards adherence. Mental health clinicians can help patients work on accepting their condition and coping with it.
  • Mental Health Clinicians can help the patient process some of the emotional factors that come with diabetes: anger, fear, guilt, shame, stress, sadness
  • They can facilitate communication and conflict resolution, between you and parents and friends, between doctor and patient
  • They can help identify other emotional disorders that can complicate diabetes management, such as depression, anxiety, eating disorders, or substance abuse.

Mental health clinicians can provide treatments such as cognitive behavioral therapy, motivational interviewing, behavior modification plans, or family therapy.  Diabetes affects the mind as well as the body. Mental health is an important step towards the journey to your best self. Never be afraid to ask for help from a mental health professional!

 

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The Most Important Things to Know About Diabetes and Alcohol

Party time!

You can probably imagine it. Some snacks to nibble on, a live DJ spinning the (digital) wheels of steel, and some tasty adult beverages. In a situation like that, It’s all too easy to get caught up in the atmosphere and not think about your blood sugar. That’s totally natural – who wants to think about diabetes when you’re having a good time? I certainly don’t. But does drinking alcohol affect your diabetes and blood sugar? Is it something to be concerned about?

Pay Respect!

Here’s the deal. If you don’t pay some attention to alcohol and learn how it interacts with your diabetes, it will stop your party in one way or another, either during the dance-off or perhaps more commonly, hours later when you’re sound asleep and dreaming about your fancy moves. Cruelly, that’s when you’re least expecting it and when you’re at your most vulnerable.

Having diabetes is no reason to avoid drinking if it’s something you’d like to do. But you should understand how it works so you can do so safely. I’m not personally a big drinker, but I’ve done some digging and hope to share a few bits of useful information to help keep you safe.

We’re all different, but basics are basic…

One of the most important things I can share is that we’re all different, especially when it comes to our diabetes. Many people also differ in how they respond to alcohol. So like everything – your mileage may vary.

In any case, there’s no harm in talking about some of the basic ways alcohol affects metabolism, and what it does to blood sugar. Ready?

Alcohol inhibits glucose release from the liver. So what?

The presence of alcohol in your system can cause low blood sugar. Why? Because it plays games with your liver. How? Your liver is a big reserve of sugar, and throughout the day and night, it normally releases glucose (sometimes even when we don’t want it to).

But when alcohol is present it switches focus to clearing alcohol from your bloodstream and forgets all about releasing glucose. That liver is no good at multitasking.

If there’s less sugar in the blood, you’ll need less insulin (or you’ll need to eat more). Aha! Makes sense, right?

And the time delay…

Each alcoholic beverage takes between 1 to 1.5 hours to process through the liver. During that entire time, your risk for lows is increased. So if you have two drinks, you’re looking at three hours. Three drinks and it could be more than four hours. Can you see how quickly the hours add up? If you’re not planning way ahead, this can easily sneak up and catch you off guard during the middle of the night.

Many alcoholic beverages (beer, wine, mixed drinks, etc.) contain carbohydrates, which will quickly increase your blood sugar and usually require a bolus. But the bolus should be calculated very carefully, because although your blood sugar may go up quickly, the alcohol is also setting the stage for a fall later on.

A tip from Gary Scheiner.

Gary Scheiner, award-winning Certified Diabetes Educator and author of “Think like a pancreas” offers a guideline for insulin pump users. He suggests that the basal rate should be reduced by 30-50% for 2 hours for each alcoholic drink. Meaning if you had three drinks, you’d set this temp basal rate for six hours.

Ok, at first glance this might sound a bit complicated. Actually, you’re right, dealing with diabetes and alcohol is a bit complicated. And as mentioned at the beginning, everyone reacts differently, which means it can be really hard to find clear and simple instructions on what to do. So like almost everything else with diabetes, you have to start with some basic knowledge (which I hope I’ve given you here) and experiment (safely).

Things to Remember:

  • Be very conservative and cautious if you use insulin to lower your blood sugar when drinking, and test often.
  • Have a meal or snack with carbohydrates when you consume alcohol.
  • Remember to keep glucose tabs or other fast-acting glucose with you at all times.
  • Dancing? Oh yeah! But remember, it counts as exercise, which also lowers blood sugar.
  • Consider going to bed with a blood sugar higher than normal if you’ve been drinking. Keep in mind that the drop in BG is often dramatically delayed and you’ll want to play it extra safe when sleeping.
  • Alcohol can make it hard to notice symptoms of a low. Check your blood sugar often. Check more often than you think you need to. Have I mentioned that you should check often?
  • Drunkenness and lows have similar symptoms. It makes sense for a few of your closest party buddies to know about your diabetes and how to help in case of trouble.
  • Wear your medical ID at all times (you do have a medical ID, right?).

A few more things that are good to know:

  • When you’ve been drinking, a glucagon rescue shot may not work!
  • I am going to repeat that – a glucagon shot may not work when your liver is busy clearing alcohol from your system!
  • You might need to hear that a third time… glucagon may not save you if you pass out from a low while drunk.
  • If you’re a woman, you typically process alcohol a bit slower than your male counterparts.

There is much more to know about diabetes and alcohol, but I hope that this has been a helpful start. There seems to be precious few community-based resources out there that cover drinking with diabetes. One I know of is drinkingwithdiabetes.com, and they even have a couple of nice infographics you can download.

Diabetes and Alcohol Infographic

I’d love to hear if you know of any other helpful resources. If so, please leave a comment.

Have fun out there, and stay safe!

And here is where I am also obliged to officially advise you to discuss your specific situation with your doctor.

Sources:
Diabetes & Alcohol – UCSF
A Diabetic’s Guide to Drinking – University of Southern California
Understanding Alcohol’s Effects – University of Rochester Medical Center

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