From Shame to Self-Efficacy: A Patient-Centered Success Story
Oct 25, 2026, 09:00 AM
By Nichole Lewis, RN, CDCES
Around the middle of 2025, I began working with a 26-year-old woman living with Type 1 Diabetes (T1D). She was diagnosed at age 22 after an initial diagnosis of gestational diabetes that never resolved in the postpartum period. Although we live in a rural area, our Federally Qualified Health Center (FQHC) has provided additional diabetes support for over a decade. Despite having access to care during and after her pregnancy, she came to me carrying a profound sense of shame about her condition and her blood glucose levels.
At her initial visits, her body language spoke volumes before she said a word. She would sit down, avoid eye contact, and look down or away as she answered my questions. Her words reflected deep self-blame. She would say things like, “I know I shouldn’t have done that,” or “It’s my fault my blood sugars have been so high, I know I need to do better.” It quickly became clear that she was not just managing a complex chronic illness but also internalizing it as a personal and moral failing.
This mindset is not uncommon. Many individuals with diabetes, regardless of type, internalize messages from the media, family, community, and even healthcare environments that frame blood glucose numbers as indicators of discipline, success, or failure. Over time, this can erode a person’s self-efficacy and create a cycle of shame and blame that interferes with effective diabetes self-management.
Recognizing this, I made a deliberate decision to shift the focus of our work. While we continued to address the practical aspects of diabetes care, such as insulin dosing, glucose monitoring, and carbohydrate counting, I also prioritized creating a space where she felt safe, supported, and free from judgment. Each time I noticed her slipping into shame or self-blame, I paused to acknowledge how difficult this disease is to manage and reminded her that none of this was her fault, that glucose numbers are not a measure of her worth or a reflection of her effort, they are simply data we can use to learn and make adjustments. I also emphasized that perfection in diabetes management is not required, and in reality, not even attainable.
I watched her take in those words. Slowly, I could see her sit a little straighter, as if some of the weight she had been carrying was beginning to lift. One day, she wept, not out of frustration, but from relief. Relief that she was going to be okay and that she did not have to do this perfectly to manage her DM well. Over time, her language began to shift from self-criticism to curiosity and problem-solving. The consistent reminders and handling things one step at a time, as they came up, without rushing things, developed personal trust and self-efficacy.
Through open-ended questions, reflective listening, and affirmations, I worked with her to separate her identity from her disease. Together, we focused on small, achievable goals to build her confidence, always emphasizing progress over perfection. We repeated this process visit after visit, and gradually, her perceptions changed… she started to believe in herself. She started out with calculating her insulin dose with her blood sugar and carbohydrate count one meal a day, then two, then asking questions about complex and simple carbohydrates, then she started splitting boluses for better coverage with higher fat meals, and today… she is on an insulin pump, happy, and thriving in her diabetes management.
Witnessing this transformation was deeply impactful. It reinforced for me that effective diabetes education extends far beyond teaching skills or reviewing numbers. It requires addressing the emotional and psychological burden that so often accompanies chronic illness. When patients are supported in rebuilding their sense of self-worth, they are better able to engage in their care and make meaningful, sustainable changes.
Moments like these are the most fulfilling part of being a diabetes care and education specialist. Supporting patients as they rediscover their confidence, develop self-efficacy, and take pride in navigating such a complex condition is both a privilege and a responsibility. It is in these moments of connection and growth that the true impact of this work becomes clear.