Diabetes Educators Make A Difference

I am a 40-year-old Hispanic woman living in Sacramento, California, and I have diabetes. When I was diagnosed five years ago, I thought I was well-prepared to deal with the disease. Both my late mother and my brothers already had diabetes, and since I work in health care, I figured I knew everything there was to know.

But two years later, I saw no improvement. I started feeling frustrated, so I decided to talk to my doctor about it. That’s how I got referred to a diabetes educator.And that’s when things started to change for the better.

Despite my love and appreciation for the medical profession as a whole, I, like many people with diabetes, do not like diabetes educators. In fact, I don’t just not like them; I feel openly hostile toward them. Nearly every interaction I’ve had with a certified diabetes educator (CDE) has left me feeling judged and condescended to, no matter how well my actual diabetes care was going at the time.

I feel bad about these sentiments, because most CDEs are very nice people. They’re so nice, in fact, that they have devoted their careers to trying to help other people, deliberately entering a field that nearly guarantees that they will be overworked and underpaid. In reward for their efforts, they are often faced with patients who don’t listen, don’t act on their suggestions, take out their anger on them, or – this definitely applies to me – express skepticism at everything they say. It’s amazing anyone signs up!

Given this mutual frustration and mistrust, I was very excited by a talk I attended at this month’s American Association of Diabetes Educators (AADE) conference in Philadelphia. Titled “Making Shifts Happen: From Drama to Empowered Conversation,” it suggested a powerful new approach that might change this dynamic for patients and diabetes educators alike.

The two speakers were Paige Reddan, MS, RD, CDE, who’s been living with Type 1 since 1993, and David Emerald Wolmeldorff, who has Type 2 diabetes and is the author of the book The Power of TED (The Empowerment Dynamic), on which the talk was based.

In a nutshell, the point of the talk – and the TED approach to diabetes – is to redefine the role each person plays in relationship to diabetes. In most situations, explained Wolmeldorff, a patient and CDE are two players in what he calls “the dreaded drama triangle” (a play on the Karpman drama triangle). This triangle consists of three interconnected roles: the victim (in this case the person with diabetes), the persecutor (diabetes itself) and the rescuer (the diabetes educator).

Intuitively, this makes sense: diabetes is the persecutor victimizing the person with diabetes, and the educator (or any diabetes-related professional) is there to “rescue” the victim by providing expert help and support that only they are qualified to provide. But the problem is that this desire to help the victim – well intentioned though it might be – can actually perpetrate the person’s sense of victimhood.

While diabetes can certainly feel like an unwanted persecutor, viewing yourself as a victim of diabetes is very disempowering and stressful. Part of the definition of being a victim, after all, is not being in control; not being in control means that you don’t have the power to proactively change the situation. And being powerless provokes anxiety.

In this situation, diabetes becomes something to be feared, a problem that you just want to go away. And while the diabetes educator may truly want to “rescue” you from this, in reality, by perpetrating this anxiety and sense of victimhood, they’re often just enabling the cycle. As Wolmeldorff explained, when you feel anxious about something, you often will take action to get rid of that anxiety.

But when the anxiety goes away, you may revert to your previous behaviors. In the case of diabetes, where your previous behaviors may have been causing the anxiety, reverting to those behaviors will make your anxiety spike again – perhaps with a touch of guilt thrown in at your perceived lack of willpower or self control (perceptions that the CDE may inadvertently – or advertently – reinforce as well)...... Read More.....