The Underlying Truths of Diabetes
Written by Chris Mosunic, VP of Behavioral Health
The cost of diagnosed diabetes cases totaled $245 billion in the United States in 2012, including $176 billion for direct medical costs and $69 billion in reduced productivity. In the case of type 2 diabetes, it is estimated that the sickest 20% of people with diabetes account for more than 80% of all diabetes-related spending.
The whole picture: The underlying truth, often untold, is that a diabetes diagnosis is seldom just diabetes.
Diabetes often coexists with other mental and/or physical conditions as well. It is a combination of medical, behavioral, and nutritional factors that must all be addressed in order to successfully manage the condition.
The most common condition that also affects individuals with type 2 diabetes is obesity. People often mistakenly think that diabetes is the price you pay for being overweight and while they are linked, genetics and environment play an even bigger role.
Most of us have genes that make us prone to becoming overweight if our environment has a surplus of food in it. Humans simply eat more when there’s more food around. We are living in a world of abundance. And while our genes haven’t changed over the past 30 years, our food environment most certainly has. Food is now cheaper, more calorically dense, and more readily available compared to thirty years ago. Individuals who live in food deserts or live with food insecurity are often at the mercy of the food that is physically around them, which is usually highly processed and has low nutritional value.
Consider that nearly 30% of the world is now overweight or obese, and the rates are highest in developed countries. It’s not a “worldwide lack of willpower” epidemic. It’s the toxic food environment we live in combined with our core biology. When calorie-rich, nutritionally-lacking food is cheap and ubiquitous, people will eat it. And they’re even more likely to do so in times of stress and anxiety.
In addition to obesity, diabetes can also significantly impact mood and behavior, both short-term and long-term.
Short term, mood correlates strongly with blood sugar levels. High blood sugar levels often mimic sadness and feeling lethargic. Low blood sugars mimic alcohol intoxication.
For example, if a person with diabetes has a typical American carbohydrate-laden lunch, their blood sugar will sky rocket. Energy levels will start to drop as a result – as does mood. Soon, a nap feels almost impossible to resist. On the other hand, a person with diabetes who forgets to, or cannot, take a break for lunch might have their blood sugar start to fall. Low blood sugar levels often lead to a person being punchy, goofy, nasty, or otherwise less inhibited than usual. This often makes a person appear drunk when in fact, they are hypoglycemic.
The differing levels of blood sugar can feel like a roller coaster ride each day in terms of mood.
The genesis debate is far beyond this blog but the point is simple: if you suffer from diabetes, your odds of suffering from depression are very high.
Here’s where it all comes full-circle. The catch-22 is that if a person starts feeling depressed, they often approach life just “trying to get through the day.” They can only focus on the short-term, and it becomes a challenge to make decisions like eating well and exercising that will lead to better health down the road,
What you can do: conquering the “diabetes management stool”
In order to conquer diabetes, individuals and their providers must address all three legs of the diabetes management stool: medical, behavioral, and nutritional. If one of these legs is not in place, diabetes management fails. That’s where a solution like Vida comes in, connecting each piece of the puzzle to help address the complexity of chronic disease.
Medical: Specifically, when a person is living with diabetes, we want them to be on the right medications to help them achieve their goals. Our medical team assists with this and our coaches work with individuals to make sure the medication is working. Our first priority is to make sure they are on the right meds and adherent. From there, we substitute and/or change meds where appropriate. This is especially true as people lose weight and improve their health, and may be able to come off of insulin.
Behavioral : Most of helping a person living with diabetes is on the behavioral level, meaning that Vida helps a person to change their behaviors over time through both coaching and therapy.
Many people say that they know exactly what they should be doing (ie, eating a balanced diet, exercising and taking their medications) but “how” they should do it usually eludes them.
Vida’s coaching and therapy helps a person with the “how.” In cognitive behavioral therapy and motivational interview based coaching the therapist or coach works with the member to become their own therapist/coach. Each member has access to a therapist through text, audio, and video, along with weekly video sessions with the therapist. It’s essential that the member take ownership of their own health/mood and outcomes over time.
Nutritional: In diabetes, food logging is one of the main habits most Vida members choose to start with. Logging one’s food is one of the best, if not the best, long term predictor of weight loss and helping with diabetes management. Vida provides a robust food tracker that makes it simple to jot down food choices. We find that members use the food log as a discussion point on their weekly calls with their coaches.
In addition to the log, Vida provides unique nutrition pathways that match each member’s needs. For example, a Mediterranean diet may be the best choice both for adherence and for the disease state. Once a pathway has been chosen, members can measure macros and calories along that path, and receive constant support and advice to help adhere and leverage it to help reverse the chronic disease.
Vida works with experts in the industry to ensure each leg of the stool is rock solid. Dr. Gabbay from Joslin Diabetes Center says he "applauds Vida's approach to treating Diabetes and other co-occurring chronic conditions by taking into account the whole person and specifically targeting and improving the root behavioral health drivers underlying the chronic conditions."
How Vida Works for People with diabetes
Vida’s diabetes program starts by setting up each person with their health team – including coaches and Registered Dietitian (RD)/Certified Diabetes Educators (CDE) clinicians who will guide them on their journey. Members meet with their RD/CDE weekly and have ongoing chats via the app when needed as they work towards achieving the outcomes owned by the member.
The Vida RD/CDE is the coach in the diabetes program and in addition to the above, they are also the “quarterback” – they coordinate care when needed with the rest of the Vida team.
For example, if the member were suffering from depression, the coach would arrange for a warm connection with one of our therapists, quickly getting the member into therapy. Another example would be if a member wanted to up their exercise program, the RD/CDE could bring in one of our exercise physiologist coaches as a guest coach.
Vida also provides customized content to each member based on their goals and what habits they are looking to form. Vida also offers food logging, integrates with 40+ blood glucometers for remote monitoring, and a wearable fitness devices. It’s a one-stop shop for everything a person needs to make long lasting behavior change.
Start tackling your diabetes with Vida today. Sign-up for a free week!