DIABETES DISTRESS AND EMOTIONAL WELLBEING. Presented by: Eliot LeBow LCSW, CDE

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1 DIABETES DISTRESS AND EMOTIONAL WELLBEING Presented by: Eliot LeBow LCSW, CDE November 10, 2016

2 Disclosure: Eliot LeBow LCSW, CDE With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for-profit company in the past 24 months which could be considered a conflict of interest. DIABETES SYMPOSIUM AND VENDOR EXPOs 1

3 Eliot LeBow LCSW, CDE MR. LEBOW IS A DIABETES-FOCUSED PSYCHOTHERAPIST WITH A PRIVATE PRACTICE IN NEW YORK CITY. HE PROVIDES TALK THERAPY, COUNSELING, DIABETES EDUCATION AND CONSULTATIONS IN HIS OFFICE AND ONLINE TO PEOPLE LIVING WITH DIABETES WORLDWIDE. MR. LEBOW WAS DIAGNOSED WITH DIABETES IN SEPTEMBER OF 1977 AND HE HAS MANAGED IT FOR MORE THAN 38 YEARS. DIABETES SYMPOSIUM AND VENDOR EXPOs 2

4 Diabetes Distress Diabetes Distress is a combination of emotional burdens and worries that are related to the experience of living with and managing diabetes. Diabetes Distress is sometimes misdiagnosed as depression and has links to problematic glycemic control and difficulties with self-care behaviors. It causes frustration with diabetes management, and patients experience fears around potential complications, erratic blood glucose levels, an increase in hyper and hypoglycemic episodes. DIABETES SYMPOSIUM AND VENDOR EXPOs 3

5 Internal Sources Underlying causes of Diabetes Distress for Type 1 Diabetes Feeling powerless around controlling diabetes Excessive worries about long-term complications Frustration with management tasks Fear that food constraints are controlling their life Poor confidence with regards to quickly identifying hypoglycemia Fear of embarrassment and potential risk of life DIABETES SYMPOSIUM AND VENDOR EXPOs 4

6 Social Sources Underlying causes for Type 1 Diabetes Negative Social Perceptions Fear about being treated differently Less attractive to employers Family and Friends Over or under-involved Treat as overly fragile DIABETES SYMPOSIUM AND VENDOR EXPOs 5

7 Physical Sources Underlying causes for Type 1 Diabetes Insufficient help, support or understanding from health-care team DIABETES SYMPOSIUM AND VENDOR EXPOs 6

8 Type 2 Sources Four areas of distress Emotional/Internal Related Fear, Anger, or Powerless Physician/Health-Care Related Regimen Related Medication & Diabetes Management Interpersonal Related Family & Friends DIABETES SYMPOSIUM AND VENDOR EXPOs 7

9 Mini-Traumas Micro-traumas in your patients lives can be anything that is related to managing diabetes that prevents or interrupts what they are doing at that moment. Essentially, anything deviating your patient from their plan. DIABETES SYMPOSIUM AND VENDOR EXPOs 8

10 Diabetes Fact It s never as simple as = 2 DIABETES SYMPOSIUM AND VENDOR EXPO 9

11 Symptoms Behavior and emotional changes to look for: Victim Role Poor Me. Struggling with everyday tasks and diabetes management Poor Blood Glucose Management Feelings of frustration and exhaustion DIABETES SYMPOSIUM AND VENDOR EXPOs 10

12 Symptoms Behavior and emotional changes to look for: Blood glucose testing has reduced or stopped altogether Isolation with feelings of depression Missing Medical Appointments Problems with Healthcare system DIABETES SYMPOSIUM AND VENDOR EXPOs 11

13 Prevention Things your patients can do to avoid or reduce distress: 1. Be Patient Swim with the current 2. Avoid Impulsivity 3. Flexibility Stop and change direction DIABETES SYMPOSIUM AND VENDOR EXPOs 12

14 Prevention 4. Planning Ahead 5. Acceptance Situation Medical System Health Insurance Personal DIABETES SYMPOSIUM AND VENDOR EXPOs 13

15 Prevention 6. Talking To Others Non-bias people Avoid Isolation 7. Here & Now. 8. Relaxation Activities 9. Cognitive Behavioral Therapy DIABETES SYMPOSIUM AND VENDOR EXPOs 14

16 Diabetes Self-Management It s Personal DIABETES SYMPOSIUM AND VENDOR EXPOs 15

17 Helpful Tips Judgment Resistance Labeling Hemoglobin A1c Encourage Motivate DIABETES SYMPOSIUM AND VENDOR EXPOs 16

18 Forgiveness Allow Your Patients To Be Human DIABETES SYMPOSIUM AND VENDOR EXPOs 17

19 In-general Enjoying life is critical to reducing diabetes distress. However, if you believe your patient is suffering from diabetes distress, please refer them to Psychotherapist whose specialty is diabetes or chronic illness. DIABETES SYMPOSIUM AND VENDOR EXPOs 18

20 CONTACT Here s Where You Can Find Us ELIOT LEBOW LCSW, CDE Diabetes-Focused Psychotherapist Sessions available in the Manhattan office or via Skype e: eliot.lebow@gmail.com o: West 96 th Street, New York City Website: Facebook: DIABETES SYMPOSIUM AND VENDOR EXPOs 19

21 References: Fisher L, Polonsky WH, Hessler DM, Mullan J. When Is Diabetes Distress Clinically Meaningful?. Diabetes Care 2012 Feb; 35(2): Gonzalez JS, Polonsky WH, Fisher L. Depression in Diabetes: Have We Been Missing Something Important? Diabetes Care 2011 Jan; 34(1): Pallayova M, Taheri S. Targeting Diabetes Distress: The Missing Piece of the Successful Type 1 Diabetes Management Puzzle. Diabetes Spectrum 2014 May; 27(2): Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan JT, Jackson RA. Assessing psychosocial stress in diabetes. Diabetes Care. 2005;28: Polonsky WH, Fisher L, Hessler DM, Masharani M, Blumer I, Peters AL, Strycker AL, Bowyer V. Understanding The Sources Of Diabetes Distress In Adults With Type 1 Diabetes. J Diabetes Complications May-Jun; 29(4): DIABETES SYMPOSIUM AND VENDOR EXPOs 20