We quizzed test takers on diabetes and sexual health. 73% of respondents, chose the best answer. Since we are addressing diabetes distress in our December newsletter, we thought this would be the right time to explore this topic in more depth. As we all know, sexual health and well being are interrelated. We want to share this important info on discussing sexual well being, so you can pass it on to people living with diabetes and your colleagues.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is a 33-year-old who is non-binary and was recently diagnosed with type 2 diabetes. During your assessment, JR asks if diabetes can affect their sexual health.

What is the best response?

Answer Choices:

• That is a complicated question that is best discussed with your provider
• Here is a pamphlet on LGBTQ+ issues and sexuality that explains the most frequently asked questions.
• According to the data, there is a higher rate of erectile dysfunction in people living with diabetes.
• There is a relationship between elevated blood sugars and sexual health.

---

As shown above, the most common choice was option 4, the second most common answer was option 3, then option 1, and finally option 2.

Getting to the Best Answer and Providing Inclusive Care

If you are thinking about taking the certification exam, providing person-centered care is at the heart of the exam. Being familiar with diabetes care across the lifespan and for diverse populations is also really important. This practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer based on the person’s characteristics.

Inclusive Care and Gender Identity

In this Question of the week, we are working with JR who identifies as non-binary. Let’s take a moment and address how this might impact our approach to care.

First, since JR let’s us know that they are non-binary, what does that mean?

Nonbinary describes someone whose gender doesn’t fit within the gender binary of a man or a woman. “Nonbinary” is an umbrella term that expresses a wide range of gender identities; other terms someone may use to describe themselves is genderqueer or gender non-conforming, among others. It is important to check in with each person and ask them how they identify. One way of doing this is to introduce yourself, along with your pronouns, and then ask what pronouns the other person uses, as in the example below.

“Hello, my name is Beverly and I go by ‘she, her’ pronouns. What pronouns do you use?” 
or
“How would you like me to refer to you?”  

By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details, such as inclusive gender questions on intake forms or gender-neutral signage on the bathrooms, are great first steps to show your care and respect for those you work with.

Next, what do we know about providing care to members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community with diabetes?

Studies have shown that those who are LGBTQ+ are subject to unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. Diabetes care and education specialists are in a pivotal position to advocate for this medically underserved and vulnerable population, to make sure they get the best possible care.

Lastly, JR wants to know how diabetes will affect their sexual health.

At this juncture, we may provide a general overview of how elevated blood sugars can affect blood vessel health and cause nerve damage, that may impact their sexual function over time (such as difficulty feeling pleasure or achieving an orgasm). Then we might ask if they have any particular questions. Our willingness to explore this sensitive topic free of judgment will be very meaningful. And, it’s okay if this feels new and uncomfortable.

“We all have our own personal experiences and internalized biases which impact the care we deliver. Our job is to practice cultural humility by checking in with our biases so they do not interfere with helping someone find a path to thriving with diabetes. It can feel uncomfortable at first, but as we take the time to expand our knowledge about others, it will feel more comfortable” 

And just know, it takes time to get up to speed. I’d encourage readers to check out the ADCES handout below and watch this funny video clip that a colleague sent me, “What “The Sex Talk” Looks Like Now, by Alternatino. This video made me crack up and appreciate the nuance of all the terms. Thanks so much, for your willingness to consider this topic. I truly hope you find it helpful in improving in delivery of care.

Getting to the Best Answer

Answer 1 is incorrect. 4.82% chose this answer, “That is a complicated question that is best discussed with your provider.” Even though sexual health may not be our area of expertise, we can certainly provide a general answer and explore their particular questions. Of course, if a question is beyond our knowledge, referring back to the provider would be best.

Answer 2 is incorrect. 3.01% of you chose this answer, “Here is a pamphlet on LGBTQ+ issues and sexuality that explains the most frequently asked questions.” This is not the best answer, because it doesn’t address the question the person is asking. JR wants to know how diabetes can affect their sexual health, not the relationship between LGBTQ+ and sexuality.

Answer 3 is incorrect. 18.52% of respondents chose this answer, “According to the data, there is a higher rate of erectile dysfunction in people living with diabetes.” It is true that up to 50% of men with diabetes experience erectile dysfunction. However, we are not sure of JR’s sex assigned at birth, so this answer may not apply to JR. Instead, we could provide a general overview of how elevated blood sugars can affect blood vessel health and cause nerve damage, that may impact their sexual function over time (such as difficulty feeling pleasure or achieving an orgasm).

Finally, Answer 4 is correct. 73.64% chose this answer, “There is a relationship between elevated blood sugars and sexual health.” YES. This is the BEST answer. And, we might then ask if they have any particular questions.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!

---

Resources for Inclusive Care

ADCES Inclusive Care for LGBTQ+ People with Diabetes Handout – this handout provides definitions, terms to avoid, and a cultural competency checklist to help you move towards improving inclusivity within your practice.

All Gender Restroom Sign PDF

A Guide To Gender Identity Terms by NPR – A glossary for gender identity terms to use more inclusive language.

Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ+ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.

Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ+ community.

Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.”

---

Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs

Annual Update Airs Live on December 21st at 11:30 am PST

This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

Objectives:

1. State strategies to assess and address social determinants of health
2. Discuss health care delivery systems using a person-centered approach
3. List screening tools that can help detect distress, depression, trauma, and cognitive decline
4. Describe psycho-social and emotional barriers to diabetes self-management
5. Provide strategies for healthcare professionals to identify and overcome barriers to self-care

Intended Audience:  A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

[yikes-mailchimp form=”1″]

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.