Psycho-sexual Dysfunction in Men and Women with Diabetes

Question 1

What is this showing? (Diabetes and…

Answer 1

Diabetes and the Control Agenda

Controlling diabetes is such a central part of the work we do with our patients. The idea of “good” and “bad” control is never far from our thinking and our patients’ thinking. Therefore the Control Agenda is the implicit number 1 business item during many consultations

The blood glucose test has for a long time – although this may be changing – been a major front in the battle for control and for many of the patients with Type 1 diabetes I meet this test becomes emblematic of their own struggle for control and tied up with many aspects of their lives that are not simply levels of sugars in their bloodstream.

And this is the meeting ground of the Control Agenda in diabetes consultations and the Control Agenda as a core component of Clinical Psychology in therapy. In therapy the Control Agenda is a description of the experience we can all have of our relationship to struggle, distress and discomfort.

Question 2

What can ‘controlling’ the threat lead to? (control agenda - diabetes)

Answer 2

1. Obessional
2. Perfectionism
3. Over test
4. Demand

• all of which can lead to anxiety and despair

Question 3

What can ‘avoiding’ the threat lead to? (control agenda - diabetes)

Answer 3

1. Ignore - DNA
2. Deny
3. Project
4. Procrastinate

• All of which can lead to depression and burnout

Question 4

Diabulimia refers to what?

Answer 4

Diabulimia (a portmanteau of diabetes and bulimia), also known as T1ED, is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss.

Question 5

…% of Type 1 adolescents have experimented with diabulimic behaviour (insulin omission)

Answer 5

40%

Question 6

T1 diabetes - prevalence of eating disorder is … x general population

Answer 6

2x

Question 7

Poorer outcomes for diabulimia, why?

Answer 7

due to secondaries and acute risk of DKA (Diabetic ketoacidosis)

Question 8

Is Diabulimia fatal?

Answer 8

Yes - •Can be hours away from fatality even if not appearing obviously unwell

Question 9

Signs of Diabulimia:

• Symptoms of … diabetes
• Severe fluctuations in …
• Fear of …
• Co-occurence of … or other disturbances such as …
• Anxiety/distress over …
• Frequent requests to switch …
• Encyclopaedic knowledge of …
• Is it serious?

Answer 9

• Symptoms of untreated diabetes
• Severe fluctuations in weight
• Fear of injfecting or extreme distress at injecting
• Co-occurence of depression/anxiety or other disturbances such as borderline personality disorder
• Anxiety/distress over being weighed at appointments
• Frequent requests to switch meal plans
• Encyclopaedic knowledge of carbs
• Is it serious - yes - MDT + MH services

Question 10

Diabetes and Sex

• … damage:
  
  • ​Loss of …
  • Vaginal … and erectile … (sexual dysfunction in …-…% of men, approx …% of women)
• … damage
  
  • ​fear of hypos
  • body … and devices
  • feeling of …

Answer 10

• Microvascular damage:
  
  • ​Loss of sensation
  • Vaginal dryness and erectile dysfunction (sexual dysfunction in 35-70% of men, approx 33% of women)
• Psychological damage
  
  • ​fear of hypos (Fear of hypos is a specific and intense feeling brought on by the risk or experiences of having low blood sugar.)
  • body image and devices
  • shame

Question 11

Diabetes know-it-alls

• … are often experts - ensure you treat them with … and interest - check their knowledge before lecturing them
• Many patients do not know others with diabetes and can feel … and alone with their condition, which makes them more … to advice or judgement from others
• … can unintentionally create distress and … the patient through ill-informed comments

Answer 11

• Patients are often experts in their condition - ensure you treat them with respect and interest - check their knowledge before lecturing them
• Many patients do not know others with diabetes and can feel isolated and alone with their condition, which makes them more sensitive to advice or judgement from others
• Family / work / friends can unintentionally create distress and stigmatise the patient through ill-informed comments

Question 12

Diabetes and behaviour change

• On the board…
• … for struggle
• Connect … to meaning
• Expect & … for failure
• … without fear-mongering

Answer 12

On the board…

• Compassion for struggle
• Connect behaviour to meaning
• Expect & Plan for failure
• Facts without fear-mongering