Type 2- This One’s For You
Unlike the clinicians you are all used to working with my job is a bit different. I teach group outpatient diabetes self-management education (DSME) classes at a local, suburban hospital. The majority of people coming to class have type 2 diabetes, but I also teach a separate class for those that are insulin dependent (type 1 or type 2). I have been teaching diabetes self-management education for 11 years now. I have always loved teaching in the group setting. I don’t know what it is, I just love the challenge. So many of the participants walk into class skeptical and unsure of what they signed up for and potentially unsure of me and if I can make this disease less annoying. They are confused about diabetes and frustrated. My job is to make sure they leave feeling more confident about their diabetes management and empowered to conquer the beast that is diabetes. So month after month, class after class I say… Challenge accepted.
The DSME course that I teach is a total of 10 hours split into four sessions. Within our 10-hour comprehensive DSME course that is accredited by the American Association of Diabetes Educators (AADE), there are 7 core areas that we focus our curriculum around. These topics are called the “AADE 7 Self-Care Behaviors”. They are: Healthy Eating, Being Active, Monitoring, Problem Solving, Reducing Risks, and Healthy Coping.
One of my favorite topics to discuss in class is, believe it or not, Healthy Coping. It may be viewed as the underdog of topics out of the 7, so maybe that is why I like it. Sure, everyone wants to talk food and exercise, which are obviously important, but I like to dive into the less discussed topic. I cover this topic in class four. I joke with everyone that if I asked them to open up and talk about their feelings in class 1 I would be faced with eye rolls and potential walk-outs. Waiting until class four allows me time to build rapport and trust between myself and the participants. In my experience, discussing the psychosocial component of diabetes is major.
I have found that one of the most liberating sentences for people with type 2 diabetes comes in the form of just four simple words:
It’s not your fault. Type 2 diabetes is not your fault. Let me repeat that for the people in the back… IT’S NOT YOUR FAULT!
So many people with type 2 diabetes blame themselves. They think it’s something they ate, didn’t eat, and activity they didn’t do. Yes, our eating and activity choices play a role, but they are not the whole story. Again, our lifestyle is NOT THE WHOLE STORY. We know the known risk factors for type 2 diabetes, such as: family history/racial background, age, stress, inactivity, and being overweight. But we don’t know the exact reason why some people are diagnosed and others with similar lifestyles are not.
Within the topic of healthy coping we discuss all the feelings that are associated with not only the diagnosis, but also the day-to-day of diabetes self-management. The class becomes a safe space to be able to let out the feelings that have been bottled in. Having a chronic condition, like diabetes, isn’t easy. It requires lots of demands on you physically, but also emotionally. The emotional component is what is far less discussed, not only in your doctors’ offices but also in general. Diabetes is hard, messy, confusing, frustrating and frankly just a pain sometimes (or a lot of times). Feel free to insert your own adjective (G, PG, PG-13, or R rated) here: _______________. So being able to discuss those thoughts and feelings help us to know and understand what they are, name them, express them, and then find a way to accept them.
When you carry the weight of blaming yourself, how is that helping anything? So, drop the emotional weight you’re carrying! Now! It isn’t helping. The guilt, blame, and shame, are likely hindering your overall management. Take it off your back and you will literally feel the relief. I have personally witnessed liberation in the form of tears, smiles, and exhales. It is a beautiful thing to watch when you see someone let go of all the negatives thoughts they were carrying around in their head about themselves. So, if you haven’t said it to yourself yet, please repeat, “It’s not my fault!”
As an educator, I take my role in this very seriously. The participants that come to class trust me to provide them tools that they need to thrive with diabetes and in return I am a new resource for them to utilize as an ear or shoulder, if needed.
As part of the completion of the course, everyone gets a chance to fill out an evaluation. This allows them to rate their experience of various topics that are covered, the overall program, and me. They also get to include free text of any additional comments they would like to leave for us to review. I have received overwhelming response from the participants that they greatly benefited from the healthy coping conversation.
Not many people realize that they needed to talk about their feelings about having diabetes. Many have said that they needed to hear that it wasn’t their fault and that they appreciated having the space to talk about the things that aren’t so easy to bring up to family members or friends. A huge benefit of class is that I have time on my side. I talk a lot, but I also listen a lot too.
One of the biggest takeaways I have experienced in my role as a diabetes educator in the classroom and also personally living my own life is that people want to be heard. People with diabetes want to be heard. Well, I hear you and I’m here for you. It’s not your fault and you got this!