It’s January and the time for New Year’s resolutions. For those of us with a chronic disease it may be the time to set goals for the new year concerning how we take care of ourselves. The problem with making these goals with little forethought as to what they are and how to carry them out successfully is that by mid-January we may well be back into overeating, not taking blood glucose levels regularly or as often as needed, bingeing, watching TV instead of exercising, and even worse, back into that old frame of mind that says we just will never be able to get a handle on this so we might as well forget it.
With some help, honesty, and rethinking, we can enjoy success, so let’s look at some ways of going about this daunting task. It’s not too late to modify your resolutions to better insure your attaining them.
First, we need to decide what we want to modify in our behavior. You notice that we did not say ‘change’ because we don’t want to fall into that old thought process that says we have to make a 100% turn around to become ‘perfect.’ Perfect is impossible. Remember, statistically, if you are 100% you are better than 100% of everyone, including yourself, and that’s an impossibility, so let’s begin by stamping out that kind of thinking. Rather, let’s work backwards from what we decide our goal is and figure out the steps to get there. Not only do we need to decide on those steps, but we have to make sure that they are doable.
For all of us some goals are harder than others and we need to acknowledge that fact, so if your friend has begun an exercise program and stuck to it at 7 am and you have failed miserably, you may want to keep the same goal, but look at the steps you need to take to make sure you succeed. Maybe you aren’t a morning person and a 12 o’clock exercise class will work better, or maybe it’s the type of exercise or the place, or maybe there is another goal you need to work on before you get to this one. For example, if your diabetes is out of control you will have little energy to exercise. In fact, if your blood glucose levels are high, you should not be exercising. Are you beginning to get the picture?
The whole idea is to change the odds in your favor by knowing yourself and then working toward your goal. To do this we need to use our strengths to modify those parts of us that need to worked on. No strengths? Nonsense. You’re reading this, aren’t you, so you do want to better yourself. That’s a real strength.
Second, we need to prioritize our goals. What comes first? Do you want to gain weight, lose weight, or maintain weight? Are you at the point after living with diabetes for a while that you want to learn all you can about this chronic disease which effects you and your family? Have you been told to exercise but don’t know how or what’s safe? Are you afraid of hypoglycemia and unable to control it? Are you ready to rein in your blood glucose levels with tight control and need help to start this? Do you want to feel less isolated at meal times when you fear eating what the rest of the family eats, or learn how to cook healthfully for all of you? Are you concerned about other medical conditions that diabetes may cause or exacerbate and yet you have not had yourself checked out? Are you ready to have a partnership with a healthcare team? All of these are laudable goals for a diabetic, but no one can handle them all at one time. Each of us could probably argue the merits of putting some of these first on our lists.
At our diabetes clinic, patients came with the expressed desire to gain back their health, but often because their blood glucose levels had been high for some time, their thinking was not as clear as one should be when asked to make these major decisions. Having someone to help as a sounding board of reason who has knowledge of your condition, the disease, and the ability to listen is very important. For one person starting to walk with his wife each morning was the first step to taking control of his diabetes, while for another it was losing 10 pounds before she would exercise. One burly truck driver needed special sessions with his family to see the necessity of taking insulin injections. His cloudy thinking had convinced him that if he did inject himself twice a day he would become less of a man and become addicted to a dangerous drug. Hard psychiatric work, family confrontation and support, and his own strengths allowed this man who was half a day away from hospitalization to take control of his diabetes. For some of our patients getting over the fear of the numbers on the blood glucose monitor was the first step, for another it was keeping a true record of everything they ate and the stresses of their days. They examined what they did to feel better including eating, not taking blood glucose levels, sabotaging relationships or becoming depressed. Only after they looked at their ways of dealing with diabetes did they know which steps they needed to take to regain control. At that point, the priorities became self evident and they could make realistic goals and take steps to get to attain them. Success was at hand.
Now that you have an idea of what you want to work on and what order will work for you , you need to get all the information you can about how to go about modifying your behavior. Here, we at www.diabetic-lifestyle.com, the ADA, the JDF, and other groups with information about diabetes can be of helpful in answering questions and giving you the very best in up to date information available. Don’t forget, you have people all around you who know you and care. Few people want to or need to cope with the daily ups and downs of a disease like diabetes alone. You have a health team, family and friends, and support groups. If you bring your goals and steps to them they can help clarify what you are doing. For example, if you wish to lower your HbA1c test to the desired below 7% that is suggested, you may have thought of three plans; one, lower the number of calories you eat; two, add medications or raise the amount or change your insulin; or three, try to watch your carbohydrates and calorie intake and change your medication or insulin in the short run until you get the blood test results you have set for your goal. Your health care team should have as much information for you as you need to make healthy decisions and also be able to answer the questions you have never asked before either out of denial or just plain fear of the unknown. They can refer you to other professionals as you need them so that you do not feel overwhelmed. Your family can give you support as you try to change. No one, perhaps except yourself, has more to gain from your good health. Watch and see the changes in other’s responses to you and the respect you garner as you make goals, find the steps to attain them, and in the process begin to see just how capable you are. The strong parts of your personality will be strengthened as they help you maintain health, and taking care of yourself will become second nature. Now that’s a goal!
Taking care of your diabetes every day includes eating healthy food, getting regular exercise, taking medications properly, and monitoring your blood sugar. Anyone who has read anything about diabetes in the last years since the D.C.C.T report came out knows that keeping blood glucose levels as close to normal as possible is the way to go. We can forestall long term complications, feel better, and maintain our busy lives with a healthy mind and body. People with diabetes do not need to eat special foods. We all know now that a carbohydrate is a carbohydrate so we do not have feel isolated at family meals. The foods that are good for everyone else are good for us. We do need to eat foods low in fat, salt, and sugar, and high in fiber such as beans, fruits, vegetables, and grains. Eating well will help you reach and stay at a weight that is good for your body type. It will help keep your blood sugar in a good range and will also prevent heart and blood vessel disease. Your daily meal plan should include foods from the milk and milk product group, protein group, fruits and vegetabl groups, and starches like bread, cereal, rice, pasta and potatoes. Most diabetics are on a diet of less than 30% fat with only !0% saturated fat, 10 to 20 % protein and the remaining calories from carbohydrates. This diet may be modified because other medical conditions, but it is very livable. Just look at the recipes we share with you here in the web site or in our books.
Make sure you have your own individualized meal plan that takes into account the foods you and your family like. Ask your doctor to refer you to a dietitian to get this important part of diabetes control accomplished. If you take insulin, take your injection at the proper time before you eat. Different insulins take affect at different times. Eat the same amount of carbos and calories each day at about the same time. Learn how to modify times and food intake if you go out, travel etc. Don’t skip meals if you have taken your insulin. Hypoglycemia is dangerous. If you take oral agents, follow your meal plan. It was made to be covered by your medication. Don’t skip meals as you will tend to over eat at the next one. Several small meals are better than one large one.
Exercise regularly. Even house work is exercise, but we can all think of things to do that are more fun. The benefits of exercise are many; it helps to keep your weight down, it makes insulin work more effectively to lower blood glucose levels, it’s good for your heart and lungs, and it gives you more energy and a sense of well being. Before you begin exercising it’s important to check with your doctor. For example if you have high blood pressure or eye problems something like weight lifting may not be safe for you. Once you decide to exercise, do it regularly, at least three times a week for 45 minutes. Start slowly and for less time if you are a novice. Be prepared to take your blood glucose level before, during, and after exercising to guard against low blood sugars. Keep carbos handy if needed and wear a medical ID.
If you take insulin, exercise after eating, not before. Don’t exercise if your blood glucose level is over 240. Don’t exercise just before you go to sleep as this might cause hypoglycemia during the night. If you take oral agents, do talk over your exercise program with your doctor and be prepared to take your blood glucose levels to see if you need extra carbohydrates.
Take your medication and insulin as prescribed each day. If you take insulin, rotate the injection sites. The best places to give yourself shots are in the outside part of your upper arms, around your waist and hips, and the outside part of your upper legs. Avoid areas with scars and stretch marks. Keep extra insulin in the refrigerator for future use in case you break a vial or other emergency. Keep your current insulin in the refrigerator if possible. Do not allow it to freeze, or heat to over 85 degrees. Have an insulated carrier for when you travel as the glove compartment and insulin do not go together well on a hot summer’s day. If you take oral agents make sure to take them as prescribed and tell your doctor of any adverse reactions.
There are five types of oral agents. Each work at different sites in the body, but all are designed to lower blood glucose levels. Some stimulate the pancreas to release insulin, one stops the release of glucose from the liver, one slows the rate of metabolism of carbohydrates after you eat, and one helps to resensitize muscle cell walls to the insulin you have in your blood stream.
Understand the importance of ketones in your urine. If these are present either on sick days or not, contact your physician. Ketoacidosis is serious and if left untreated can cause death. The symptoms include fruity breath, vomiting, weakness, and fast breathing.
Finally, keep a good record of your blood glucose levels and any eventuality or circumstance that may effect them. To gain tight control you may want to take your blood glucose levels after you eat, not just before, as some people have low glucose readings before meals only to spike one or two hours after. A change in insulin or medications can deal with this so don’t be afraid to suggest this if your HbA1c is higher than you think it should be and your premeal levels are normal.
The new year is here and we all can use some tuning up. Let’s look at our long term goals, prioritize our needs and make up our individualized steps to attain them. With the help of those in the know and our own input we can do it. It’s done every day, and with your new knowledge you can do it too. And by the way, tackling problems in one part of our lives successfully makes doing the same in other parts easier. You’ll see.
