By Michael Weiss and Martha Funnell, MS, RN, CDE | December 20, 2007 12:00 am
Whether you have had diabetes for years or are newly diagnosed, you know that dealing with this condition can be a challenge. For one thing, diabetes never goes away. Although there are numerous medicines and other therapies available for treating diabetes, none of them are cures. Diabetes is always present, and almost everything you do, including ordinary activities like eating or taking a walk, affects your blood glucose level.
Another key characteristic of diabetes is that the primary responsibility for managing it rests with you and not with your health-care providers. Managing diabetes requires making decisions and performing various tasks several times a day. Your doctor or diabetes educator can’t possibly be there with you each time you have to make a choice about what and how much to eat, what physical activity to perform, and how much insulin or medicine to take. You will have your health-care providers’ input and guidance for managing your diabetes, but only you can perform the daily tasks necessary for keeping yourself healthy. No one can make you use a meal plan or get the regular physical activity that could make you feel better today and possibly prevent serious complications down the line. Similarly, no one can force you to take medicines or monitor your blood glucose. When it comes down to it, you must take care of your diabetes for yourself, by yourself.
Another defining feature of diabetes is the number of decisions you have to make each day. It is easier to make these decisions if you develop an overall plan. While medicines, meal planning, physical activity, and blood glucose monitoring form the basis of most diabetes plans, each person’s plan is different. Your plan needs to combine what you know about yourself with what you and your health-care team know about diabetes. So along with caring for the physical side of diabetes, your plan needs to take into account the amount of stress you face, your emotional response to diabetes, and the other demands and priorities in your life.
The chronic nature of diabetes, along with the need to make so many daily decisions, can make living with diabetes feel overwhelming at times, but it may feel less so once you have an overall plan to guide you in your daily choices. This article provides an outline for making and using a plan for managing your diabetes. The basic steps are to learn more about diabetes and how it affects you physically, emotionally, and practically; establish your goals for blood glucose, blood pressure, and cholesterol and determine what you are willing to do to meet these goals; develop a self-management strategy with the help of your health-care team; give your plan a trial run and see what’s working and what’s not; and seek out support to help you stay the course.
Most people know little about diabetes before they’re diagnosed and even less about the impact it will have on their lives. A good way to start learning is to take a diabetes education class in your community. Inquire at your local hospital or visit www.diabetes.org, the Web site of the American Diabetes Association, to find classes in your area. Books and organizations that focus on diabetes, such as those listed in Diabetes Resources, are good starting points, as well. Your health-care providers should also be a source of information, not just about diabetes in general but about your diabetes in particular and how it can best be managed. But managing diabetes is about more than just learning about an illness. To create a workable plan, you also need to know about yourself and how your priorities, cultural and religious beliefs, personality, genetics, likes, and dislikes affect how you care for yourself and your diabetes.
The effect that diabetes will have on your life will become clearer — and will also probably change — over time. Most people react to a diagnosis of diabetes with shock or fear, often followed by anger or sadness. Feelings like these can make it difficult to take steps to learn about your condition and how to manage it. Because your feelings can affect what steps you take to care for yourself, your plan needs to take your feelings into account and include strategies for dealing with them. Your health-care professionals can help you identify such strategies.
If you’re having a rough time or your feelings are keeping you from caring for yourself or doing the things you enjoy, consider seeking out support from others who have diabetes and have gone through what you’re going through. Many hospitals and clinics that provide diabetes education also have diabetes support groups that meet regularly. Some communities also have diabetes support groups that operate independently of any hospital or organization. The people in your group can provide both emotional support and practical information about living with diabetes that may be helpful to you. Another option is to seek the counsel of your clergy or to make an appointment with a mental health-care provider who has experience working with people with diabetes (or at least with other chronic illnesses).
Diabetes doesn’t just affect you physically and psychologically; it can have a noticeable financial impact as well. Even when you have insurance coverage, the co-payments for frequent health-care appointments and multiple drugs can add up quickly. Your financial situation may also influence decisions about what foods you eat and where and how you exercise. Ask your health-care providers for any money-saving tips they may have, and tell them if you cannot afford the drugs or other products they recommend.
When you are first diagnosed with diabetes, your doctor will probably offer you a plan of action. However, as you learn more about diabetes and as you experience its effects on your life, you will probably want to take on a greater role in designing your own plan. On the other hand, your attitude may be “tell me what to do and I’ll do it.” Either way, let your health-care providers know how involved you want to be in the decision-making process.
One of the first decisions you need to make is what your target blood glucose goals will be. Although the American Diabetes Association and the American Association of Clinical Endocrinologists have established target levels for the general population with diabetes, your goals may be different. Even if you choose to work toward maintaining near-normal blood glucose levels, there are many reasons it may make sense to set interim goals as you work toward your ultimate targets. For one, you may be just learning how to care for yourself. For another, if your blood glucose levels have been very high, it will take time and effort to bring your blood glucose down into your target range.
Other areas of decision-making include your meal plan, exercise plan, whether weight loss is part of your plan, blood cholesterol and blood pressure control, and strategies for coping with stress and the emotional side of diabetes. Your health-care providers can offer advice about the various options, and you need to tell them what actions you are willing and able to take at this time. Remember, no one knows what will fit into your life better than you do.
Keep in mind that the more flexibility you want in your daily routine, the more work you will probably need to do. If you wish to have more flexibility in your food choices or the timing of your meals, you will probably have to make more daily decisions, monitor your blood glucose more often, or take more injections. That is the trade-off, and only you can decide if greater flexibility is worth the extra work to you.
Once you have learned about diabetes and established your treatment goals, you are ready to work on creating a self-management plan or fine-tuning the one you are currently using.
As you carry out your plan, note what works and what doesn’t. You will probably need to make changes as you go along. One common barrier to carrying out a diabetes plan is trying to make too many lifestyle changes at once. If that seems to be the case for you, you may need to prioritize the items in your plan or scale back in some areas. For example, if your original plan was to exercise every day and you haven’t exercised once since then, try revising your goal to exercising twice a week or to whatever you feel confident you’ll actually do. In fact, every time you set a goal, ask yourself how confident you feel about achieving it. If your answer is “not very confident,” revise your plan until you’ve come up with an action you’re sure you will do. Breaking large goals into smaller steps often makes them more manageable.
It’s also common to try to make a particular lifestyle change because your health-care provider or family is encouraging you to do so. If your heart isn’t in it, however, you are unlikely to do it. But that doesn’t mean that all is lost. Rather than trying to ignore the parts of your plan that aren’t working, examine them more carefully to see if you can figure out why they aren’t working. Maybe you need to focus on another area of your diabetes right now or talk with your health-care team about an alternative approach.
Make sure your concerns get addressed at your doctor appointments by making a list of questions or topics you’d like to discuss before each appointment. This includes dealing with the emotional side of diabetes as well as the physical side. If something has happened in your life that has affected how you care for your diabetes, let your health-care provider know. Be sure to tell your doctor at the start of the visit that you have some things to discuss. Remember that your health-care providers are there to help you create a plan that will work for you, not to judge you on your ability to carry out a particular plan.
Once you have diabetes, you have it for life, which means that you need to care for it every single day. There may be times when you feel burned out by the demands diabetes puts on you. When this happens, it’s good to have people to turn to for support. For many people, family members and close friends are the people they turn to first. The people close to you may be able to offer emotional support, if that’s what you need most, or practical help with carrying out diabetes tasks. It makes it easier for both you and them if you are able to tell them exactly what you would like in the way of help. Maybe you need someone to listen without judging or offering advice, or maybe you want a friend or family member to perform a specific activity, such as accompanying you to a doctor appointment. The clearer you can be about your needs, the more likely you are to have them met.
Your health-care providers can also be a source of support. They, too, may be available to just listen, or they may be able to refer you to resources you weren’t aware of. It can also be helpful to talk to other people who are living with diabetes, either in a support group or online, through a message board or chat room devoted to diabetes.
While you never want to forget your ultimate goals, whatever they may be, it often feels less overwhelming to focus on the choices and steps you will make today. Some days will be better than others, and you will probably feel disappointed and discouraged from time to time. Celebrate your successes and learn from the things that do not work as well. Don’t forget to give yourself a pat on the back, too, every now and then. You’ve taken on a responsibility that you never wanted and that most people don’t have to deal with. Give yourself credit for learning as much as you have about diabetes and for all of the efforts you make every day to stay in good health.
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