By Megrette Fletcher M.Ed., RDN, CDCES
Diabetes professionals are quickly learning how COVID-19 is changing their counseling focus.
Moving to Telehealth
We are connecting with our clients in new and different ways, including navigating the world of telehealth. This shift requires up to date knowledge on the changing modifiers and billing requirements for these services. Jennifer McGurk, RDN, CDN, CDE, CEDRD-S, owner of Pursuing Private Practice, acknowledges that there is a lot to consider but for professionals shifting to telehealth it’s forcing us to be creative with how we can support our clients. The nuts and bolts of offering virtual appointments are listed on the ADCES website and include both an overview of telehealth, technical specifics, tip sheets about how to prepare for your visit, and most importantly, billing answers.
"Clients are reporting more bingeing and then so much shame and anxiety about weight gain."
Coping with COVID-19
Cherie Miller, MS, LPC states, "Clients are reporting more bingeing and then so much shame and anxiety about weight gain." Miller explains this is causing clients to struggle with wanting to address the emotional eating, but fear and uncertainty about COVID-19 is increasing their emotional response to the pandemic. "Some clients do food journaling, which helps spot the pattern," Miller says.
If you are looking for resources to help with emotional eating, outside of engaging in therapeutic work, Miller suggests episodes of the Food Psych podcast, the books, Intuitive Eating: A Revolutionary Program that Works by Evelyn Tribole, Eat What You Love, Love What You Eat with Diabetes: A Mindful Eating Program for Thriving with Prediabetes or Diabetes by Michelle May, MD, and yours truly, and a website for diabetes care professionals, Weight Neutral 4 Diabetes Care (WN4DC).
While not all clients are ready to give up on the idea that the COVID-19 pandemic is the ideal time to restrict eating, other clients are more open to intuitive eating (IE), mindful eating (ME), and health at every size (HAES) approaches to eating. The reason for this is that, more than ever, the pandemic is a daily reminder of the value of self-care, self-kindness, compassion and patience. Miller acknowledges that teaching these compassionate approaches to food and eating can help clients begin a compelling and essential journey. She explains, "They've expressed feeling a new sense of hope and optimism with the idea of giving up restricting."
Reducing Risk and Problem-Solving
While some clients now have time to focus on self-care and self-kindness, other clients are struggling. Janice Baker MBA, RDN, CDCES, CNSC, BC-ADM explains that many clients are distracted by COVID-19 and aren't thinking about the 'what if' problems associated with diabetes. Baker explains, "I'm giving them info on resources as they typically don't want to admit this is a need." These resources include how to access food pantries, welfare offices and community services. Individuals who are self-isolating are likely feeling alone and may forget that, to some extent, everyone is experiencing the hardships associated with COVID-19. Baker worries that clients might forget what to do if they get ill or experience a change in their blood glucose. She has made it a habit to review sick day guidelines with each client and encourages obtaining medication refills before they run out.
Many companies are stepping up to help clients with diabetes continue to get their needed medication if they are experiencing unemployment or loss of insurance. DiaTribe.org, a nonprofit organization founded by Kelly L. Close, is dedicated to improving the lives of people living with diabetes and prediabetes. They are providing an up-to-date resource list for clients and professionals, as well.
The ADA states, "People with diabetes are not more likely to get COVID-19 than the general population," which is vital information to communicate to our clients.
Misinformation and Disease Prevention
The American Diabetes Association is helping by addressing the confusion and misinformation about risks associated with COVID-19 and diabetes. The ADA states, "People with diabetes are not more likely to get COVID-19 than the general population," which is vital information to communicate to our clients. COVID-19 prevention is the focus of the ADA's message. "The problem people with diabetes face is primarily a problem of worse outcomes when the virus is contracted, not a greater chance of contracting the virus." Therefore, important additions to client education are reviewing the steps needed to reduce the transmission of the virus, which include hand-washing, using masks correctly, having ways to decrease the presence of the virus, and affirming efforts to engage in social distancing.
Helping clients with uncertainty and improve coping, problem-solving and overcoming misinformation are just a few of the emerging educational needs diabetes professionals are addressing with their clients. The Association of Diabetes Care and Education Specialist, ADCES offers excellent resources on the AADE7 Self-Care Behaviors, with handouts for professionals to share with clients.
For additional COVID-19 resources and guidance for your practice, visit DiabetesEducator.org/COVID-19.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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