Daniel Sher educates us on how to deal with the psychological burden of financial stress when living with diabetes.
Case study of patient with financial stress
Doug (not his real name) is a 33-year-old Capetonian who visited me looking for a bit of extra support in meeting his diabetes-related goals.
What was Doug struggling with exactly? Well, it wasn’t entirely clear. It never is. When it comes to thriving with diabetes, there are always complex interacting factors that need to be considered. In Doug’s case, however, financial stress was one of the biggest factors leading him to neglect his health.
Doug most certainly isn’t alone in this regard. As a person living with diabetes, how frequently have financial concerns negatively affected your ability to cope? Research has backed up what so many of us know all too well: diabetes is expensive! This, in turn, can create a whole lot of stress and anxiety that makes it even harder for us to thrive.
A tale of two cities
In South Africa, historically-based economic inequality means that a large proportion of people rely on public health to manage their diabetes. Research has consistently shown that public clinics and hospitals are overburdened – and people with diabetes struggle as a result.
However, even for those who are lucky enough to have access to private medical aid, there are hidden costs that hold many back.
The hidden costs of diabetes
- Your endocrinologist is really good at what she/he does. She/he is now charging above medical aid rates, meaning that you must front a co-payment.
- Lantus insulin isn’t covered by medical aid, even though your doctor has motivated for it.
- Having diabetes means that you’re more susceptible to colds and bugs. You find that you’re spending a fortune on vitamins, cold remedies and doctor visits.
- You have maxed-out your sick leave at work and need to take unpaid leave.
- When your blood glucose levels are out, you struggle with fatigue and low motivation. This means that at work, you’re not meeting your targets.
- It’s not cheap to eat healthily.
- You would love to be able to test more frequently, but extra strips are very pricey. What about that shiny new Dexcom? That would cost the equivalent of three months of rent.
- You have developed an additional chronic condition, such as hypertension, kidney disease, psoriasis or coeliac disease. People with diabetes are at a higher risk of developing these sorts of conditions. This means more specialist visits and expensive medications.
- You’re depressed or anxious. As people with diabetes, you’re two to three times more likely to have a psychological disorder. This means extra fees for therapy or psychiatry visits, as well as reduced productivity at work.
What can you do about financial stress?
So, what can you do to cope with these sorts of feelings and barriers to healthcare?
If you want to manage the costs and financial stress of diabetes, your best bet is to become as healthy as possible.
You’ve heard all of this before. It’s important to think about diet, exercise, testing, medication adherence, mental health, self-care and so on. This is more than just behavioural change. This is a shift in mindset that is going to save you money and allow you to be the happiest and healthiest version of yourself.
Let’s address the elephant in the room: it’s not easy to simply ‘get healthy’. This is a process; and a challenging one at that. It can also be expensive to maintain healthy habits.
But it’s important to see this as investing in yourself. By adopting a healthy lifestyle now, you’re going to avoid developing complications that could cost you more in the future. You’re also going to increase your emotional and financial well-being in the present moment.
Shift your mindset
When Doug came to see me, he benefited from analysing and altering some of his thinking patterns. As mentioned, one of Doug’s biggest challenges was that he was not all that well-off, financially speaking. Of course, compared to many in our country, Doug was in a very privileged position. Nonetheless, he often made unhealthy choices based on his financial worries. These included:
- Buying cheaper meals rather than opting for low-carb options.
- Seeing his doctor once per year, rather than every six months.
- Choosing not to test in the morning because he wanted to deny the fact that his glucose level was high, so that he could avoid having to up his Lantus dose.
In therapy, we worked on a skill, called cognitive restructuring. This forms a part of cognitive behavioural therapy (CBT), which is a powerful psychological approach that has been shown to help people with diabetes cope better.
In Doug’s case, cognitive restructuring helped him to catch subtle thoughts that lurked just below the level of conscious awareness. These thoughts reminded him of his financial stressors, triggering anxiety and leading him to make unhealthy choices.
Once Doug could identify these problematic thoughts, he was able to replace them with healthier thinking patterns. Often, this involved him reminding himself that it was worth spending that extra bit on his diabetes care so that he could reduce costs in the long run.
If you want to learn more about the basics of CBT and changing unhelpful thinking patterns, you can visit this page.
Talk to your doctor or therapist
If you’re struggling financially, this is nothing to be ashamed of. It is vital to speak to your treating team so that they can help you find creative solutions. At times, doctors and therapists may be willing to negotiate a reduced rate. Alternatively, they may be able to provide pointers for reducing expenses by, for example, taking full advantage of chronic cover possibilities.
What about counselling and psychotherapy?
Once I had met with Doug, it became clear that he was suffering from clinical depression. Just like many other people with diabetes. Together, we filled out an application form and his medical aid agreed to help cover treatment of depression as a chronic (Prescribed Minimum Benefit) condition.
If you know that you can improve your diabetes control by seeing a therapist, don’t let the costs involved hold you back. Chat to a therapist about applying for chronic cover. This applies to anyone who is on a medical aid, including hospital plans.
Invest in yourself
Diabetes is a complicated and challenging condition to manage. A big part of this challenge involves the hidden costs that we have discussed. Just another one of the many factors that we need to consider and address as a part of our everyday management plans.
Remember, though, that by addressing these concerns, we can learn to take our coping skills to the next level. At times, this may simply be a matter of shifting your mindset, adopting healthier lifestyle habits, or speaking to your treating professional to find creative solutions.
- Endocrine Society. (2014, June 23). High blood sugar causes brain changes that raise depression risk. ScienceDaily. Retrieved June 19, 2019 from sciencedaily.com/releases/2014/06/140623092011.htm
- Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.
- Pinchevsky, Y., Raal, F., Butkow, N., Chirwa, T., Distiller, L., & Rothberg, A. (2018). Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa. International journal of general medicine, 11, 383.
- Cognitive Behavioral Therapy: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/cognitive-behavioral-therapy-cbt/
- Comorbid chronic conditions: https://www.verywellhealth.com/comorbidity-disease-diabetes-1087365
* Not his real name
MEET OUR EXPERT
Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital, in Cape Town, where he works with Type 1 and Type 2 diabetes patients to help them thrive. Visit danielshertherapy.com