How a Mindset Shift Can Improve Diabetes Self-Care


Today, we know that medical treatment, nutritional intervention and diabetes education must be personalized and seek to satisfy the specific needs of each patient.

Since the Association of Diabetes Care and Education Specialists (ADCES) introduced the 7 Self-care Behaviors proposed by the American Association of Diabetes Educators in 1997 as the starting point for diabetes education, the diabetes community and healthcare professionals have long emphasized the importance of emotional health as one of the key pillars in managing this condition. In fact, we speak of emotional health as part of two of these self-care behaviors (healthy coping and problem-solving) that diabetes educators often use as a starting point and reference for our interventions.

Dr. Mark Heyman, diabetes psychologist, certified diabetes educator and founder and director of the Center for Diabetes and Mental Health (CDMH) delighted us with a conference on how to help our patients with diabetes to change their relationship with their condition.

Seeing Diabetes as a Relationship

“When one part of a system changes, the whole system changes.” Many times, people think that there is nothing they can do to change the way they think and act about their diabetes. However, if we think of diabetes as a relationship, according to Dr. Heyman, this is not entirely true.

If we see diabetes as a relationship and recognize that we cannot change diabetes, but we can change the relationship we have with it, we may be able to see positive changes. A clear example is that when one part of a system changes, the whole system changes.

A relationship is how two or more entities behave. How these two entities interact with each other. How we respond to the actions of the other. These are dynamic relationships, and since they are dynamic, they can change.

The relationship that a person has with their diabetes can have power over them, it can have an impact on their behavior. If we can change that relationship, Dr. Heyman says, we can empower people to make changes that will improve their quality of life.

The Difference with Other Types of Relationships

The main difference is that this is not the relationship that we have chosen. We can explain to our patients how to work to accept and shape it.

This is not a relationship that we can escape or end, we do not have the option to ignore it. In fact, ignoring it would also be a relationship

Patterns of a Relationship with Diabetes

According to Dr. Mark Heyman, these are the types of relationships with diabetes that he has identified and that will help us to work on our interventions.

Rigid vs. Flexible Relationship

In a rigid relationship, diabetes is viewed as a set of rules. This type of relationship makes it difficult for us to behave and live the way we want. Some people even report feeling trapped.

In a flexible relationship with diabetes, we see a person who can navigate the challenges of diabetes. This type of relationship allows flexibility to cope with difficulties. They are people who accept the challenge and are willing to learn how to manage diabetes better.

Avoidance Relationship vs. Participative Relationship (Engaged)

In an avoidance relationship, people will do anything they can to avoid managing or dealing with diabetes. Many times, they act as if diabetes does not exist. Diabetes management is much more complex in this type of relationship and the results can be negative.

Instead, a participative relationship is when we adapt to deal with these challenges as they arise. In this type of relationship, it is recognized that if diabetes is managed well, it is less stressful and you end up working less in the end, allowing a good quality of life and allowing us to enjoy life more.

Resentment Relationship vs. Acceptance Relationship

In a resentment relationship, the person feels that the world is against them, that diabetes is their enemy. They feel like they have a weight on their shoulders. There is resentment and this makes it difficult for them to move forward with their lives. In this type of relationship, too much meaning is put into life with diabetes: it’s wrong, it’s too much. People with resentment handle their diabetes with anger.

On the other hand, in the acceptance relationship, it is recognized that there is a challenge and a problem, we recognize and are aware of what we are, but we do not assign an additional meaning. Diabetes is recognized for what it is, but no added value is attached to it, to mention it in some way.

Shy Relationship vs. Confident Relationship

Mark Heyman explained that the shy relationship is one where diabetes seems scary to us, and we approach it with too much caution. We do not do anything to not disturb it, as if we were walking on tiptoe, Mark Heyman tells us. In this type of relationship, people avoid eating foods that they like a lot if they are not sure of the glycemic result. They are people who are afraid.

A confident relationship is someone who knows they will be able to handle their living condition. They are people who trust their skills and knowledge. They know that if they follow the plan that they have created together with their team, there will be a better chance of having good results. They are people who accept that they are capable of managing their condition.

Recommendations for Health Providers and Diabetes Care and Education Specialists (DCES)

As a person with diabetes, your health provider or DCES are encouraged to follow the below recommendation. It’s important for you to know these recommendations in order to better advocate for yourself and receive the care you deserve.

  • Help patients to raise awareness: explain this relationship to your patients. Help them recognize that they have a relationship with diabetes and that they can work to change it.
  • Help patients to be open to change: ask and investigate if your patients are willing to allow the changes. Help them discover that they are capable of changing this relationship. Help them find motivation and hope to accept the possibility of a change in this relationship.
  • Direct patients towards Diabetes Education: help your patients discover tools that help them develop skills and abilities to manage their life conditions. Help them discover tools to view diabetes differently and change behaviors that positively impact their condition.

In the end, this relationship will be healthier if we are confident in our abilities. We will be better prepared to change the relationship we have with our diabetes if we have the right tools.

WRITTEN BY Mariana Gomez, Diabetes Educator, B.A. Psychologist, POSTED 08/17/21, UPDATED 12/13/22

Mariana is a psychologist and diabetes educator. She is the creator of Dulcesitosparami, one of the first online spaces for people with type 1 diabetes in Mexico. She is the co-author of the children’s book Había una vez una Diabetes (Once Upon a Time There was Diabetes) with Eugenia Araiza and co-founder of Diabetes and Co, a diabetes education online platform for Spanish-speaking audiences with type 1 and type 2 diabetes. Mariana is currently the director of emerging markets at Beyond Type 1. She was diagnosed with type 1 diabetes more than 30 years ago and is the mother of a teenager.