When working with your diabetes care & education specialist is a mistake
My boss is probably reading the title of this article thinking ‘ALICIA! WE are diabetes care & education specialists! We want people calling to work with us! What are you doing here?!’
It’s ok Gary, go with me here, I’m helping people, and that’s what we do here at IDS.
There are times when people come to us with a goal related to blood sugar management. It may be more time in range, a better A1C, or heading off complications. These are awesome goals are we are the specialists at helping people reach those kinds of goals.
Typically, we can help people reach their goals, and even surpass those goals and reach goals they never even considered in a pretty short amount of time. (When one considers Diabetes is a lifelong disease the length of time to achieve goals can be relative) However, there are also times when someone comes to us seeking to reach a blood sugar related goal, but after assessing their needs, their abilities, their strengths and barriers and often doing all we can to help them, the reality is that diabetes education is not what this person needs to help them reach their goals.
At this point we refer this person to another specialist.
This may be for mental health services or psychiatric prescribing – I always say that Diabetes is a medical diagnosis with a Behavioral health treatment.
This disease is not treated by prescribing medication, it is treated by how we think about it and how we live with it day to day.
IT may be to a medical specialist to address a medical need that is a priority issue. Whatever the referral made, the bottom line is that we have reached a point where blood sugar management simply can not continue to proceed toward the goal until the barrier issue is addressed.
- This may mean addressing a mental health need so that one has the consistency and clarity of thought and behavior to build new coping skills and maintain them over time.
- This may be working with a gastroenterologist to address an underlying gut issue to stabilize carbohydrate absorption so that blood sugars and insulin needs are not so widely variable.
- It could even be seeing one’s PCP to address a serious medical condition that poses a serious risk of harm or lasting injury that can impact the individual immediately, here elevated A1C may take years to post a significant risk.
In all these cases we here at IDS are never trying to “fire” a patient or “offload” them. We are diabetes care & education specialists. Not only are we passionate about what we do, empowering and improving the lives of our diabetes community; but we are also here to do a job, and chasing away our customers is just plain bad business!
When you get a referral from a knowledgeable and compassionate clinician, follow that advice. That referral was given in the greatest care for you as a person with diabetes, as a member of a community, and because it truly is the best next step you can take in your Diabetes Management.
Rarely it does become necessary to help someone make the choice to seek help outside of their diabetes care & education specialist.
Sometimes we can become so blood sugar-focused that we lose sight of the fact that the next best step for our Diabetes Management is to address a “non-diabetes” issue. This patient will insist that their educator just work harder to address the blood sugar issue that they wish to overcome. Perhaps the educator has been so knowledgeable and helpful in overcoming barriers in the past that the individual feels that the educator is the person to help them overcome this barrier as well and wants them to do so.
Unfortunately, as diabetes care & education specialists, we must keep our practice within the boundaries of diabetes management and the “Scope of practice” dictated by our individual licensures. This means that a nurse cannot act as a therapist, no matter how knowledgeable or empathetic they may be. And a dietitian cannot give medical advice, no matter how astute and informed they may be.
Occasionally if an individual can not make the decision to disconnect from their educator to seek assistance, they need to overcome a barrier preventing them from making progress in their diabetes management, the responsibility then falls to their educator to set a boundary in the clinical relationship to motivate the individual to seek that assistance. This may include reducing access to the educator, requiring following through with the referral before continuing with education, or even termination of the education clinical relationship. This is never punitive, but supportive. It would actually be entirely unethical for that educator to continue to work with the individual knowing that they are not making progress and that the individual continues to be at higher and higher risk of harm or injury with the passing of time as resources are being spent on education that is not appropriately effective rather than on pursuing the referral needed to overcome barriers to reaching goals and holistic wellness.
Here at Integrated Diabetes Services, we work with a very diverse and well-rounded team of diabetes educators specializing in nutrition, exercise, nursing, mental health, pediatrics, geriatrics, pregnancy, young adults, women’s health, metabolics, “alternate forms of diabetes” and a wide range of other needs.
This is so we can meet the needs of the wide array of life that diabetes touches and the range of persons touched by diabetes. So, when we find an area beyond our specialty, we have the humility and compassion for those we work with to identify our limitations and make referrals with care and support. We are very proud to be able to always put the needs and best interests of our clients first, even if that means someone is not working with us, they are getting the best care for them to be well.
If you are looking for a group of diabetes care & education specialists to help you reach your diabetes groups and you’re not sure if your situation is too complex, I encourage you to give us a call. We have worked with incredibly complex cases and helped people reach their goals through collaborative patient-centered care.
We cooperate as a team and with outside providers to support our client’s entire wellness journey, not just good blood sugars. We also consider it our responsibility to maintain a network of many of the best diabetes-savvy specialty providers and services across the country to assist clients where our reach finds its limit.
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