Counseling people living with diabetes

In the United States, 14.6 million people have been diagnosed with diabetes and an estimated 6.2 million more people have the disease but are undiagnosed. In addition, 54 million adults are estimated to have pre-diabetes, which places them at risk for developing diabetes (Centers for Disease Control and Prevention [CDC], 2005). The number of people diagnosed with diabetes has doubled in the past 15 years, resulting in a health care crisis, and diabetes is the sixth leading cause of death in the United States. It is estimated that 20-50% of people with diabetes experience impairments and functional limitations related to their diabetes (Songer, 1995), including coronary artery disease, stroke, blindness, end-stage renal disease, and lower-limb amputations (National Institute of Diabetes and Digestive and Kidney Diseases, 2004). Central to preventing these complications is not only good glucose control, which depends on day-to-day and even hour-to-our self-care, but also behaviors such as frequent glucose self-monitoring, regular exercise, and eating healthfully. This self-care regimen does not come easily to most people. Living with diabetes and the challenges of self-care can be stressful, and depression and anxiety are highly associated with diabetes (Barnard, Skinner, & Peveler, 2006; Grigsby, Anderson, Freedland, Clouse, & Lustman, 2002). In addition, diabetes and its complications can have adverse psychosocial and vocational implications. For all these reasons many people with diabetes could benefit from rehabilitation counseling services. The purpose of this paper is threefold: (a) to provide a general overview of diabetes (b) to provide information about the medical, psychosocial, and vocational implications of diabetes, including adjustment and self-care issues, and (c) to educate rehabilitation counselors about services and strategies that could benefit people living with diabetes. Because some people with diabetes are not getting the care they need, it is important that rehabilitation counselors increase their competence to work with this population and strive to help medical professionals recognize the benefits of including therapeutic counseling in diabetes care. Introduction to Diabetes Diabetes mellitus is a chronic metabolic disease in which the body either cannot make insulin or cannot use the insulin it makes, impairing the storage and utilization of glucose, which is the main fuel generated from digestible carbohydrates. Diabetes is characterized by hyperglycemia (elevated blood sugar [glucose] levels) and is categorized into two main types. Type 1 diabetes mellitus (T1DM) is considered to be an auto-immune disease because the insulin-producing beta cells in the pancreas are attacked and "erroneously" destroyed by the immune system early on in the disease process, resulting in little to no insulin production in the pancreas. Type 2 diabetes mellitus (T2DM) is characterized by the cells in the body being resistant to insulin due to genetic, intrauterine, and behavioral factors. The pancreas then overproduces insulin to compensate for this resistance. For some individuals the pancreas "wears out" over time and may stop producing insulin (Kahn & Porte, 1997). There is a strong genetic predisposition for both types of diabetes but behavioral factors are strongly linked to T2DM, including obesity, poor diet, and inactivity (Stumvoll, Goldstein, & van Haeften, 2005). TIDM is usually diagnosed in childhood or early adulthood, and typically requires insulin therapy at diagnosis or soon thereafter. T2DM is usually diagnosed in mid-adulthood but there has been a rapid increase in diagnoses in children and adolescents due to increases in obesity, inactivity, and poor eating habits (Sullivan & Gerken, 2003). T2DM does not always require insulin therapy. Instead, behaviors and medications that mitigate insulin resistance can be used, particularly in the early stages of the disease. …