Denial is a powerful thing. With diabetes, it has the power to convince someone to ignore the warning signs for future severe health problems, including heart and kidney disease, vision loss, nerve damage, and circulatory problems, and sit in front of the TV with a box of cookies and a soda or beer. So here’s how to talk to them so they reconsider. Nearly every patient faced with the news that they have diabetes insists they eat right (or close enough), don’t eat too much sugar (but usually do), and feel fine (but don’t).

Denial is especially common in diabetes, a disease that comes with the stigma of poor lifestyle habits and a sense the world thinks they brought it on themselves. The early signs — blurry vision, weight loss, frequent urination, fatigue — may come on slowly, and people can ignore them. They don’t notice they feel worse after skipping meals or sitting down to a plate loaded with carbohydrates. People who drink alcohol are especially likely to ignore the signs, convincing themselves they get hungover easier than they used to.

As a healthcare provider, it’s not just your job to identify the signs of diabetes but also to educate your patients to understand and accept what it means to their future health and to give them a sense of power to change that future.

Here are a few steps to approaching that first discussion:

• Ask them questions to identify how they feel now, compared to how they used to feel, to help them notice the difference.

• Ask them what causes these signs and whether they want to change them.

• Explain simple ways to feel better and have more energy every day.

• Rather than using terms like “overweight,” “obesity,” or “diet,” try to advocate making some adjustments to thinking and daily habits that can make a big difference.

• Use positive-sounding phrases like “nutrition and activity plan to manage your blood sugar levels.”

• Give them tools, but first, find out what works best for them. Do they use their phone?

• If so, apps are great. For the computer, there are websites. However, some people will feel better going to traditional resources like books and pamphlets.

• Set up positive goals and interactions that will reinforce them. Everybody wants to be congratulated when they do something they didn’t think they could do.