If a problem has no solution, it may not be a problem, but a fact — not to be solved, but to be coped with over time. —Shimon Peres
When you are diagnosed with a chronic illness such as diabetes, you must face the fact that there is no cure. Despite the millions of dollars spent in research to better understand diabetes and the ongoing advances in treatment options for it, a person with diabetes has to realize that it will accompany him for the rest of his life.
Among chronic diseases, diabetes is unique in the amount of time and attention it requires of the person who has it to remain healthy. It is therefore no surprise that taking care of yourself may feel difficult or challenging at times. That’s why dealing with diabetes over the long term requires developing a range of coping skills and techniques, from learning to carry out the daily tasks of diabetes control, to finding ways to deal with the emotions that having diabetes and having to care for it are bound to bring up at times.
Much of what you do to keep your blood glucose, blood pressure, and blood cholesterol levels in the near-normal range is aimed at preventing long-term complications. But it’s also about feeling good today. Keeping your blood glucose level in your target range, in particular, can help you feel more energetic and alert, enabling you to participate in and enjoy the other parts of your life.
So how do you carry out the tasks of eating right, getting physical activity, monitoring your blood glucose level, and taking any prescribed medicines every day for the rest of your life without getting overwhelmed? Here are some tips:
Knowledge is power. All aspects of diabetes care require a certain amount of knowledge: Meal planning requires some knowledge of nutrition; being physically active requires knowledge about what’s safe for you to do, how to do it, and what gear or equipment you need; monitoring your blood glucose level requires learning not only how to use your meter, but also how to respond to the readings you get; and taking medicine requires knowing how to take it, what doses (amounts) to take, and when to take them. Making the effort to acquire this knowledge will make your daily life easier, because you won’t have to stop and think about every step in your daily diabetes care routine as you do it.
The health-care professionals who help you manage your diabetes can provide a lot of the information you need. Meeting with a dietitian, for example, can help you learn how your food choices affect your health and how to plan healthy meals. A certified diabetes educator can help you learn about blood glucose monitoring, taking medicines, and much more. See “Your Diabetes Care Team” for more information about the types of knowledge the various members of your diabetes care team can help you gain.
In addition to talking with health-care professionals, reading up-to-date books, magazines, and Web pages can help to keep you informed in many areas of diabetes care.
Experience is also a wonderful teacher. The more you carry out the various parts of your diabetes care regimen, the better you will get to know your body and how to take care of it. You will also learn from experience how best to fit your diabetes care tasks into your life and when to seek help from others.
Planning is key. Having a daily routine — with fairly regular mealtimes, activities, and bedtime — can make diabetes management easier; you can pretty much do the same thing every day. When you break from your usual routine, however, keeping your diabetes in control will require more planning. Activities such as vigorous exercise, eating out, staying out later than usual, drinking alcohol, etc., are likely to disrupt your blood glucose control unless you make some changes in your diabetes care regimen.
Your health-care providers and your experiences will help you determine what adjustments in your diabetes plan may be necessary for different activities. Keeping written notes on how you altered your routine — and how well those alterations worked — can make planning for the next time easier. Over time, you may develop specific plans for activities you enjoy occasionally or frequently, such as taking a weekly dance class or spending a day hiking.
Certain events or circumstances require special planning. Sick days and traveling are two that affect just about everyone at some time. Life transitions such as going away to college or planning a pregnancy are also common. Once again, acquiring knowledge and having a plan are key for coping successfully with such stressors.
Sick days. Getting sick with a cold, the flu, or some other common ailment is inevitable. And because even a common cold can affect blood glucose levels, everyone with diabetes should have a written sick-day plan that spells out how to care for their diabetes while sick. If you do not have such a plan, let your doctor or diabetes educator know you’d like one, and arrange an appointment to develop one.
Travel. Travel tends to involve all kinds of changes that can affect diabetes control: changes in time zone, activity level, daily routine, food choices, stress level, and more. While it may be impossible to predict exactly how a trip will affect your diabetes, knowing that it can makes it that much more important to plan ahead and make sure you have extra diabetes supplies with you when you travel. Monitoring your blood glucose frequently will allow you to see how your trip — and any adjustments you’ve made to your diabetes regimen — are affecting you. If you’re not sure how to adjust your diabetes regimen for travel across one or more time zones, ask one of your diabetes care team members for help.
Life transitions. Big changes of any kind — positive or negative — can be mentally and physically stressful, but if you know they’re coming, you can plan ahead for how to cope. Your diabetes care team can help — with specific instructions or information, or with referrals to other health-care providers, if necessary. Even if you don’t anticipate that a transition or change in your life will affect your diabetes care, it’s worth mentioning it to your diabetes care providers. They may have suggestions for making the transition go more smoothly or advice about what to look out for in your diabetes control.
Because diabetes can cause complications that develop over time, it’s important to think beyond daily care at times and to focus on prevention. Part of that is having regular medical appointments, which can be stressful in itself since appointments require planning, time, and money. Ideally, though, if you stay on top of getting the checkups and screening tests that are recommended, your medical visits will remain minor stresses instead of major ones.
Health-care visits. People with diabetes are generally advised to see the medical professional who provides most of their diabetes care two to four times a year. This might be a physician, physician assistant, or nurse practitioner. These checkups are opportunities to assess a person’s general health, see how his diabetes care regimen is working, and head off any long-term problems by checking his blood pressure, feet, and sometimes cholesterol level and kidney function. It’s a good idea to prepare for these visits with a written list of your top concerns and questions. The information and care that you receive should help you focus on your personal diabetes health needs, determine if changes need to be made to better meet those needs, and also give you some feedback on how well your self-care efforts are paying off.
People with diabetes are also advised to have an annual eye exam and to have professional dental cleanings and exams regularly.
Meeting with a diabetes educator on a regular basis can be helpful for answering questions related to your diabetes care and for learning to problem-solve any issues that have come up.
Changing your regimen. Every year, new devices for diabetes care are developed, and periodically, new drugs are released. Would any of them improve your control or make managing your diabetes easier? Your doctor and diabetes educator can help you stay informed about new technology and medicines and advise you on whether any of them might be helpful for you. Looking for new options is particularly important if your current regimen is not keeping your blood glucose level in target range or you’re having trouble carrying it out. But even if this is not the case, you may be interested in trying something new if it promises less discomfort, more convenience, or better control.
Specialist care. You may also need to see one or more specialists if you develop problems that are beyond the scope of your primary-care provider’s practice. For example, you may need to see a cardiologist if you develop heart problems or a nephrologist if you develop kidney problems, and visits to these specialists may become a regular part of your care.
Developing diabetes complications or other serious health problems has emotional as well as physical effects. It’s important not to ignore those feelings, since they can have a negative effect on both your quality of life and your physical health. How you address them will depend on your personal preferences and resources, but it may include talking with a trusted friend or counselor or seeking out a mental health-care professional for therapy. One of the medical professionals who cares for your physical health may be able to recommend a therapist for you.
The emotional side
It’s not just being diagnosed with a complication that can stir up emotions. Being diagnosed with diabetes in the first place often brings up feelings of shock, fear, anxiety, anger, and sadness. And at any time along the way, diabetes may sometimes cause feelings of resentment, annoyance, anxiety, anger, etc. Such feelings may be triggered by having trouble keeping your blood glucose level in range. They may come up when diabetes or its care interferes with some other part of your life. Or they may be triggered by other people’s reactions to your diabetes — with unwanted advice, scary stories, or intrusive questions about your lifestyle choices.
While it’s impossible to totally get rid of negative feelings, it is possible to change how they affect you. And it may be possible to change your lifestyle or environment so that you experience negative emotions less frequently. Here are some ideas on how to do that:
Put yourself first. You may spend a lot of time taking care of the other people in your life, and you may enjoy doing it much of the time. But you can only care for others effectively if you’re also taking care of yourself, and that means sometimes putting yourself first. Taking care of yourself is not being selfish; it’s a way of making sure you’re at your best — at home, at work, and in all of the relationships you care about.
Sometimes putting yourself first means asking others to do so, too. For example, there may be times when you need to ask your family members to change their plans to accommodate your needs. Maybe you need a different mealtime or restaurant selection than they’ve chosen, or you need someone else to perform a certain chore that you usually do.
If you find it hard to make requests such as these, remind yourself — again — that you’re not being selfish. Don’t apologize for making healthy choices. Keep in mind that your family members will ultimately benefit too from the healthier choices you make. You might also practice formulating your requests privately so you feel more comfortable making them. Or you may want to enlist the help of a friend or therapist in learning to be assertive about your needs.
Ask for help. Asking for and accepting help is an important part of coping with chronic illness. The members of your diabetes care team are among those who can provide both practical help and emotional support as you make the effort to cope with your diabetes. Your family and friends can help, too, although they may need you to tell them how. For example, they may need to know that you’d like for them to take on certain household responsibilities, help with certain diabetes care tasks, be willing to listen sympathetically when you say you need to vent, or be willing to leave you alone at times.
If the stress of coping with chronic illness becomes more than you can deal with on your own, or you think you might be depressed, ask your physician to refer you to a mental health specialist. Meeting regularly with a mental health professional gives you the chance to express yourself without being judged, to feel understood, and to learn how to better cope with the challenges you face.
Seek out others with diabetes. Knowing that there are other people dealing with the same feelings and frustrations that you have can be a big help, and a good way to connect to other people who have diabetes is through a support group.
Support groups can provide information, allow for personal contact, and offer a way to compare experiences and share problem-solving skills with others who live day-to-day with diabetes. Most formal support groups are coordinated by a health-care professional and attended by people with diabetes and sometimes their family members or friends. They may meet in a clinic or hospital meeting room, church, YMCA, community center, or some other public setting.
Online forums and message boards are another option for seeking support. Online groups have the appeal of being available at any time and from virtually any place. Most forums and boards have a moderator, to maintain certain standards and keep out disruptive users, but they may not have the involvement of a health-care professional. The American Diabetes Association (ADA) hosts a variety of message boards on its Web site, www.diabetes.org, and the Juvenile Diabetes Research Foundation (JDRF) hosts a social network for adults with Type 1 diabetes called Juvenation, at http://juvenation.org.
To locate local, in-person, support groups, talk with your diabetes care team, and look for announcements in local newspapers or other outlets for community information, such as local radio stations. You can also try calling your local health department or clinics or hospitals in your area to see if they have a support group that is close to you. Also check with your local chapter of the ADA; call (800) 342-2383 for contact information. For support groups for children or parents of children with Type 1 diabetes, search on “support groups” on the Web site of the JDRF, www.jdrf.org, or call (800) 533-2873.
Use relaxation techniques. Practicing a relaxation technique regularly can help you cope with life’s stresses. Meditating, praying in a meditative fashion, or practicing the Relaxation Response can all lower your overall stress level. Other techniques and activities can have a similar effect: Aerobic exercise, yoga, tai chi, visualization or guided imagery, massage, and other mind-body techniques, when done regularly, can provide a regular dose of stress relief. (Click here to learn more about controlling your stress level.)
More to life than diabetes
No matter how long you’ve had diabetes or how much time you spend on your diabetes care, there’s more to you than just diabetes. You have likes and dislikes, talents, interests, and activities you enjoy. Most likely, you’ve had successes and disappointments in life that have nothing to do with diabetes, and you have friends and acquaintances whose regard for you similarly has little or nothing to do with your diabetes, although they may also admire your efforts to live well with it.
Part of coping with diabetes over a lifetime may be recognizing that it is only a part of your life. It influences what you do, but it doesn’t completely define who you are.
So when the going gets tough, congratulate yourself for all of the efforts you make to take care of your diabetes, and remind yourself that there is much more to you than diabetes.