Diabetes and mental health

Transcription

Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County, now Rady Children’s Health. I’m Melanie Cole, and today we’re talking about diabetes and mental health. Joining me is Dr. Mercedes Palacios. She’s a Licensed Clinical Psychologist, Licensed Marriage and Family Therapist, and she works as a Pediatric Psychologist at CHOC.

Dr. Palacios, thank you so much for joining us today. As we get into this topic, what are some of the common emotional responses that are associated with living with diabetes? And to set this for the listeners, Type 1 diabetes, typically found in juveniles and in children as young as seven or eight, and Type 2, which is more of a lifestyle diabetes that we’re now seeing in teenagers, correct?

Mercedes Palacios, Ph.D., LMFT: Yes, Melanie, that’s correct. I currently work as a Pediatric Psychologist at CHOC. I’m also part of our endocrinology team as their Attending Psychologist in clinic. I tend to work with a lot of kiddos who either have Type 1 or Type 2 diagnosis.

And some of the common emotional responses that I often see in clinic are just feelings of sadness. I see increased anxiety or worry that’s really hard for them to control, or feelings of anger and frustration. Another big piece to note is that diabetes is a complex chronic health condition and most people do live long, healthy, happy lives, right?

But at the same time, we know that oftentimes it is common for mental health conditions to come up, particularly in different points where there’s increased stressors or periods of adjustment. So, when kiddos or families are newly diagnosed, when maybe they’ve experienced a hospitalization stay that was longer length than they thought it would, or during stressful life events that just makes managing diabetes a lot harder. So that is when we might see some of the emotional responses come up a little bit more.

Host: I imagine that there are so many for the whole family, really, because when you’re living with diabetes, there’s much to manage, especially with Type 1. Whether it’s exercise, foods that they eat, their insulin, glucose monitoring, there’s so many things to manage that it can be overwhelming, I imagine, for the patient and for the parents of these children.

Speak about when you talk about emotional responses, Dr. Palacios. For example, school, peers, feeling left out, not able to eat the same things or do some of the same things. Do you see that as well, that these kids are feeling different than other kids? Maybe they even wear a glucose monitor or an insulin pump.

Mercedes Palacios, Ph.D., LMFT: Absolutely. Yes. So that is very common reaction that we might see, feeling, you know, nervous to wear their devices, even though it’s helpful for their health, they don’t want to be able to share that diagnosis with their peers. Oftentimes they’re worried about what if their sensor beeps while they’re in class and what are people going to say, not wanting to answer certain questions or certain responses from their peers.

And that leads to increased anxiety. Oftentimes, like you described, there is so many steps to diabetes cares. It’s not just a one time thing. It’s multiple times a day. Every time they eat, they have to make sure that they are being mindful of their blood sugars. So it’s also something that separates them from peers at times, having to go to the nurse often, or, needing extra accommodations, which they don’t like. As teens, as young youth, they don’t want to feel different than their peers. So that causes additional stress and, frustrations for them, which makes it hard. And contributes to sometimes what we see in terms of the diabetes distress or the burnout of I don’t want to do this anymore.

Or not wanting to take care of their needs, because they want to avoid those interactions or feelings.

Host: Well then let’s talk about the burnout or depression because there are so many things that they have to manage. And I’ve known a few college kids over the years that are living with diabetes and for them being in a college campus and dorms and such, it’s very hard not to fall into the trap of over drinking and binging and, just wanting to be a part of everything. What are some of the signs and symptoms that parents can look out for that says, your child is really going through something?

Mercedes Palacios, Ph.D., LMFT: I do want to highlight that diabetes distress, can be a common reaction. When we think about it, just the everyday stressors of managing something so complex and difficult, and that is, we can normalize that. We can definitely say, Hey, it makes sense that you’re stressed and that this is hard.

When it becomes diabetes burnout, that’s when we see extreme feelings of frustration or feeling discouraged by their cares. Many youths I’ve worked with have described it as feeling mentally and physically exhausted by their cares. When we notice signs and symptoms like youth feeling more sad or a lot more worried while managing their cares, it’s important to pay attention. It’s also key to recognize when it’s more than just sadness they can easily shake off.

It’s lasting for longer periods of time, it’s also maybe happening more days than not. So longer periods, they’re not able to kind of move past in some ways. We might also notice increased irritability or crankiness and just frustration about wanting to engage in their cares. And those are some signs and symptoms that we want to make sure that we’re mindful of so that we know when they might need additional help and support. Especially if it starts to impact any of their activities or things that they need to do. The example that you gave of, you know, students in college, if they’re maybe having lower energy levels, not wanting to go to class or not feeling as motivated to go to class.

We often see trouble with sleep, like sleeping more than usual. When symptoms start affecting daily functioning, that’s a concern. It’s important to watch the duration, severity, and frequency of symptoms. Diabetes can cause low or high blood sugars, which impact mood and motivation. Sometimes mood changes are linked to blood sugar levels at that moment. So, we need to differentiate between mood issues and blood sugar effects.

Host: If a child is struggling with these symptoms, what can parents and caregivers do to help? What signs show it’s time to bring in a professional, like a psychologist? Managing diabetes is a lifelong journey, so knowing when to seek that help can make a big difference.

Mercedes Palacios, Ph.D., LMFT: I would say that one of the main things that I often recommend is making sure that we’re increasing communication between parents and kiddos, and encouraging that be able to talk about their feelings. And that can look like, you know, so many different ways.

So number one, of course, talking to their parents or encouraging them to talk to other trusted adults. It could also be more creative like drawing their feelings, journaling, encouraging them to talk and share with their friends, to find that social support as well and validating more than anything that it’s okay to have these different emotional reactions.

Oftentimes, I find that parents want kiddos to not feel sad or not feel anxious or might, encourage them, Hey, it’s okay, you got this. And that’s great. And at the same time, if they do feel sad, it’s okay to say, Hey, your feelings are valid. Let’s talk through that, right?

Let’s work together as a team to address that. Another important recommendation is encouraging kids to keep doing activities they already enjoy. These are the things they know make them feel happy. Sometimes, after a diabetes diagnosis, kids feel confused or overwhelmed. They might think, “Do I have to stop doing everything I used to love?” Or they may feel, “This makes me so different from everyone else.”

We want to encourage kids to keep doing the things they love. Diabetes may change some aspects of life, but not everything. They can still enjoy activities like sports, dancing, or bike riding. Going on walks, listening to music, or other hobbies is still possible. Doing these activities together can be really supportive and helpful.

Parents can encourage relaxation or mindfulness strategies to help manage mood. Another big piece is working together as a team. Parents can step in to offer help and support when needed. If burnout, anxiety, or depression appear, it’s important to take action. Parents might say, “I’ll take over care for a while,” or “I’ll help supervise.” They can also offer reminders and encouragement during tough moments. The goal is to make sure kids don’t feel like they have to handle everything alone.

And at the same time, providing maybe positive reinforcement or praising them along the way. One thing that I often recommend is talking about blood sugar numbers as if, in a neutral and non judgmental way, maybe avoiding using the term good numbers or bad numbers. Because, oftentimes that contributes to maybe that pressure that youth might feel.

So instead, we can focus on this: the numbers are giving us information. They tell us what to do next to help manage care. For example, how to get blood sugar back in range. But it’s important not to get mad at the child for a certain number. That kind of reaction makes diabetes much harder to manage.

And just creating that space to talk about it, talk about their feelings and, talk about what are the difficult pieces about diabetes management.

Host: So, when you are working with these kiddos, what do you do with them to help them? Because, I mean, obviously, depression, and as we talked about, burnout, and feelings of insecurity, self esteem, there’s a lot that goes into it. What do you do to help them?

Mercedes Palacios, Ph.D., LMFT: One of my main strategies is definitely helping to validate their feelings. Encouraging that they’re able to have this safe space to talk about what they’re feeling. Another big part of treatment we use is cognitive behavioral therapy (CBT). This helps address unhelpful thoughts about managing diabetes. We work with kids to reframe those thoughts in a more positive way. The goal is to help them change their mood and mindset. This can improve how they feel about their diagnosis and daily care tasks.

Another big component of my work is working with the family. So some of the strategies that I mentioned earlier, that is what I often do in my treatment and help parents and youth figure out what is a good plan that will work for them to work collaboratively. How can we help them feel like they’re working as a team as opposed to, having a negative interaction or a lot of difficulties with communication related to diabetes.

A lot of positive communication with families and youth, and then helping them also advocate for what their needs are, and being able to communicate with the medical team. It’s helping them come up with questions that they might have and working collaboratively in that way as well.

Host: What about siblings? Because I guess, when there’s somebody in the family living with a chronic disease, sometimes the siblings will feel like that child gets all the attention and that they’ve got the issues and that the parents care more about them. Do you work with the siblings when you say you work with the family? Do you ever see that kind of thing?

Mercedes Palacios, Ph.D., LMFT: Absolutely. Yes. So I definitely see that often. And a lot of, just, dynamics that shift the family and the way that they interact with each other. So I do see that often. I actually don’t personally, have siblings join often because here at CHOC, we do have a short term model. We have what’s called our medical coping clinic and we really make it a targeted approach with kiddos.

I often involve parents, but we don’t typically do full family therapy. If family issues are a main concern, I refer them to community clinics. These clinics focus more on family support and therapy. I also give parents strategies to build quality time with all their children. This helps address concerns about attention and family dynamics. I encourage siblings and youth to work as a team to support each other.

Host: Wrap it up for us with your best advice for the parents listening when they’re thinking about their child that’s living with diabetes and the mental and emotional health and resilience that really we look to our children to help them build that. What’s your best advice here?

Mercedes Palacios, Ph.D., LMFT: My best advice is to work as a team to overcome diabetes together. Having diabetes won’t stop kids from living the life they want. Parents should learn the signs that mean extra support is needed. At CHOC, we have a strong endocrinology team for help and guidance. Building a support team is important wherever kids receive diabetes care. Signs to watch for include increased A1c levels and missed clinic appointments. Also pay attention if kids aren’t following through with their diabetes care. Then that might be the time to, Hey, I need additional support.

I need additional guidance, and in that case, asking their team for referrals for mental health support. It could be the endocrinology team, it could be pediatricians, but really, building that team. So I would say that that’s a huge part, where they don’t have to feel like they’re alone or they have to navigate the stressors alone.

Host: Thank you for joining us again. And for more mental health and wellness tips and information, please visit choc.org/ mentalhealth. Thank you so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County.

Together, we can keep kids happy and healthy. We’d like to invite our audience to download, subscribe, rate, and review Long Live Childhood on Apple podcast, iHeart, Spotify, and Pandora. I’m Melanie Cole. Thanks so much for joining us today.

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