Diabetes Self-Management Blog

If you don’t have a reason to get out of bed in the morning, it won’t matter how healthy you are, will it? If you don’t have pleasures, positive goals, love, or meaning in your life, why bother with self-management? We all need reasons to live, but sometimes we don’t have them or we forget what they are.

I often teach doctors and diabetes educators about the importance of reasons to live. Here’s one of the stories I share with them. I’m blogging about it because reasons to live do us no good if we don’t act on them. When we do, it can change our lives.

I used to lead a six-week self-management program at Kaiser Permanente hospital for people with a variety of chronic conditions. A 60-year-old woman named Iris came to one of these classes. Iris had high blood pressure and Type 2 diabetes, and two and a half years before, she had had a stroke. Since then, she had mostly been moping around, not doing much of anything.

Iris never would have come to class, except her family dragged her. Each week, a different family member would bring her, so over the course of the six weeks, we got to meet the whole family.

In the Chronic Disease Self-Management Program, as it’s called, everyone is supposed to make an action plan for one thing they are going to do for themselves in the coming week. (See ideas for action plans about half way down this Web page.) Every week, Iris’s action plan was the same.

“I’m going to get on my exercise machine,” she would say. She had this LifeCycle at home, and she would say, “I’m going to use it three times, for 20 minutes at a time,” or something like that. And she never did.

I mean, not one single time did she get on that LifeCycle. One week she said her knees hurt. Another week she didn’t have anyone to help her on or off. Anyway, she never did it.

The fourth week, she gives us the same plan —”I’m going to get on my exercise machine.” And I just said, “No. Don’t tell us this same plan that we know you aren’t going to do. Pick something that you WANT to do.”

“Not something your doctor told you to do,” I continued, “or something you think you should do, or something that would make your husband happy. Something you want to do. Because wanting to do something means it’s important to you. It puts some energy behind it. That way, you might actually do it.”

So Iris said, “OK. If that’s the way you’re going to be about it, my plan is, I’m going to cook a meal.” Not really a health behavior at all. But it was a striking thing to say, because in an earlier exercise, she had told us that what caused her the most pain and the most grief was not being able to cook. Cooking had been her main role in life; she cooked for her whole extended family. And she hadn’t cooked for two and half years (since her stroke)!

So we were all pretty excited about this. She came back the following Saturday and I asked, “How did it go?”

“Well, I don’t know if I did it or not,” Iris replied. She said she had started to cook a couple of dishes. Then she got tired on her affected side. She called her husband in, and he acted as her sous-chef. She told him what to do, and together they prepared a dinner. They had such a good time doing it that they did it again later in the week!

Iris was just beaming as she told this story. Her son was with her that day. And he said, “You know, she exercised every day this week.”

She exercised because she had a reason to. I think we all have to find our positive reasons to live and give some time and energy to them. Otherwise, why bother? For Iris it was cooking. What is it for you?

When things are going badly, it’s harder to focus on the good things, but that’s when it’s most important. It’s so easy to sink into despair or depression with the things that are happening to our environment, our economy, our politics, and our bodies. It’s easy to forget the good things, the love, the beauty, the fun, or just to let them go.

But we really shouldn’t ignore the good things. Our bodies need reasons to live. Studies of nursing home residents show that those who have something to do — even if it’s just taking care of a plant — live longer and are healthier than those who don’t.

I’m basically writing this message to myself, but perhaps it might speak to you. As I told Iris, when you don’t know what to do, do something you WANT to do. Give some energy to your reasons to live.

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Comments
  1. I really enjoyed your article. I struggle with diabetes and I have for a long time. I found myself not wanting to live anymore and then I decided that it was time to grow up and “LIVE.”

    -Chris

    Posted by Chris Grimsley |
  2. David,
    thank you for this blog.Depression from diabetes is easier than depression fm low thyroid. The low thyroid makes me hide in bed, or laze around the apartment.
    Keep up the good work!

    Posted by miss kitty |
  3. I do so enjoy your article. 15 years ago now I lost my husband suddenly and had a tough time handling things. I had a 16 year old son to raise still so I had to get a grip on things. One day was very bleak for me and I was driving along and thinking that I could just swerve into that bridge and I would’nt have to worry anymore. I thought just slipped out and scared me. So I started what I called counting my blessings. I out loud told the Lord all the things I had to be thankful for. And it helped me though that time and many more since. I have had diabetes for 6 years now and handle it pretty well but in the last 15 years I have even more things to be thankful for.
    God Bless you for your wonderful message.

    Myfallfromgrace.net

    Posted by Denise |
  4. Thanks for reminding all of us that we only get one chance at life. Doing what we want to do should be a central premise.

    Posted by Carol |
  5. I told my doc about being more depressed in the last 6 months, so he added another anti-depressant. I think I have SAD plus regular depression. My children are all grown and have their own children, and grands. I am 74, 2-time widow. I got through the deaths of 2 husbands, but I was working. I took survivors SS at age 60. I am now 74, and have done everything I ever wanted to do. I think I have reached the bottom of my bucket list (and it has a hole in it). Long time friends have moved at least 200 miles away, some have passed and the last one remaining has dimentia. Thank goodness I have my adorable little dog and she loves me too. I have been trying so hard to lose some weight, but have not been successful. I walk on my treadmill for a few minutes every once in a while. I am type 2, and so far, no meds. Yes, I used to count my blessings the first thing every morning. Sometimes I was blessed to have 2 feet; the birds chirping, rain hitting the metal sunporch roof. I used to love to cook for family and friends, but not any more. I used to love getting dressed for work and loved all the beautiful clothes. That was after losing some weight and looked good. Now I don’t go anywhere but the grocery store and doctors’ offices. I don’t want to depend on my kids; in fact a son said one time that I was ‘too needy’. If he only knew. He also has diabetes and all types of problems that are diabetes related. He still has whatever he wants to eat, and it just kills me to see him go downhill. I manage my food much better than he does. Sure hope the sun comes out tomorrow so I won’t feel so low.
    Hope I didn’t bring someone else down.
    Betty

    Posted by Betty |
  6. In “The Blue Zones” book by Dan Buettner, “a reason to live” is identified as one of the keys to longevity.

    Thanks for this blog post.

    -Steve

    Posted by Steve Parker, M.D. |
  7. Steve, thanks for the book name. When I get out of bed each morning, I wonder why. Same today as yesterday. I must let my dog outside and feed her and give her water and treats. I was a forward thinking/positive person most of my life. Anxious to see what is around the next corner. Mother died 5 years ago in an assisted living/nursing home, at 93. I do not see that as anything to look forward to. Her attitude was terrible, and now I see myself understanding her better. I am thankful that I have not had to take diabetic meds; last reading was 5.6. But the weight won’t budge.
    Thanks again for your articles.
    Betty

    Posted by Betty |
  8. I really enjoyed this article! I sent it to my sister and some of my other friends who are my age and going through the same types of things that age brings to all of us. It is really thought provoking and makes so much sense! I am going to be more open to the things I want to do and lighten up a little. I’ll still be taking care of my depression and my diabetes but I will enjoy life more. Thanks again. I called today and enrolled in a Sunday afternoon art class - something I have always wanted to do.

    Posted by Cathy |
  9. Type 1 diabetes is so difficult; today especially as Michael is suffering from retinal bleeding. Reading your essay this morning meant the world to me and serves as a reminder that there are lovely things out there–many things to live for–and that despite diabetes, we must seek these things out every day. Thank you!

    Posted by Michael and Gracie |
  10. Hi David,
    I just read your Reason to Live and about Iris. I am kind of like Iris, but you know what, I am going to take the time to do the thing I really love, my crafting. I think it will help me go forward. Bless you for this message.

    Thanks again.
    Elaine

    Posted by Elaine |
  11. Thanks for all these great comments. I’m sorry I just saw them today so haven’t replied.

    Betty, I’m glad you have that dog. You also need people in your life, though. Otherwise, as you say, why get out of bed? May I suggest volunteering? You are smart and strong and have a good sense of humor. I’m sure you could help people and start to feel connected to living again.

    BTW, I really liked your line “I reached the bottom of my bucket list, and it has a hole in it.” Don’t quite understand it, but it’s funny.

    Please keep in touch and let us know how it’s going. Oh, one last thing. Stop worrying about your weight. It doesn’t seem to be hurting you. Focus on things you WANT to do.

    Posted by David Spero RN |
  12. My children and wife inspire me to do my best to control my Type 1 Diabetes!I wrote a book to inspire others to carry on their battle. I went Blind from Diabetes and recovered. Believe me you better fight hard to stay healthy!

    Posted by Gregg Milliken |
  13. Thank you, David, for the article. It pointed out to me that everyone gets depressed in their lifetime. The trick is to find the way out of the cave.

    Posted by Mary |
  14. David, thanks for this article. I have had the thoughts of why, but today seems a lot better. I am in the process of a lot of nasty tests because I have started to have LOW blood sugars and LOW blood pressure and LOW weight. SOmething is wrong, but no one knows what yet. What has made me calm is I have put it all in the hands of competent doctors. Somehow I have found that I was taking myself too seriously and that was dragging me down. I am now free to think about things other than me.

    Something else that has made me have a great attitude: I treated myself and went out and bought some nice underwear. So if you will excuse me, I am going to go out and mow the lawn in my old blue jeans and my brand new undies and bra. Just that little bit of pampering did it.

    Keep up the good work. You make a difference.

    Posted by Cathy A, |
  15. Thanks for the inspiration — and a little kick help me realize I’m not the only one out there needing a big swig of ‘normal juice’ once in awhile. Yesterday I forced myself to go to the mall; first time in 5 years. Bought a size 10 pair of jeans and decided I needed to start walking again. I’m going this afternoon and will do some serious thinking about how to turn the blues to pink again. My diabetic team can’t do it for me … Weight loss is only part of the sentence.

    Posted by Nancy |
  16. A reason to live is what everyone needs I have a wonderful wife, she is type two as well. I have two little dogs to take care of. The weather is getting better and I AM GOING TO USE A BIKE THAT I PULLED FROM THE DUMP.

    It is a 21 speed I have repaired the brakes the tires have air in them and I just have a minor adjustment to make. So that is something to look forward to. No if I could get my wife to join me.

    Posted by Robert |
  17. I see so many older people uproot themselves to
    move to be closer to their children. While the
    children may have been the ones to urge this
    move in the first place, once they consider you
    “settled” they go on with their own lives and
    you must learn how to make a new life, in a
    strange place. How much better to stay home
    in a community where you know people and
    are known. Friends can be as good as family,
    if not better, when help becomes necessary. And if you are looking for a reason to live, what better reason
    than being needed by a friend?

    Betty, I have read your two letters, and have a
    suggestion: why not look for some volunteer
    work? If you like children, you can work in a
    school library. In our community we have a
    auxiliary “police force” comprised of older people
    whose purpose is to help others. I am sure there a
    are many opportunities out there.

    I have done volunteer work over the years and
    always found it rewarding.

    Much luck,

    Helen

    Posted by Helen Mueller |
  18. this is the first time I’ve read this articleand I hate having diabetes, plus I;m on an antidepresent, and I have TOO MANY things I want to do, plus my husband needs me as he is starting with dementia and the biggest problem is I LOVE sweets, and ;I love to bake!!!

    Posted by Eveline Dunbar |
  19. Another excellent article, David.
    Those of us suffering from chronic diseases should always keep in mind something I heard a long time ago.
    We don’t “have” to get up in the morning or try to make things better on any given day…we “get to”, and that is a true blessing.

    Posted by David F. Babb |
  20. I am a Registered Nurse and have been for the last 25 years. I also am an insulin pump DM2 pt for the last 10 years. Your article was inspiring !!! I now work for a nuturing doctor who specializes in Diabetes and Lipids here in Montgomery, Al. I am studying to become a certified diabetic educator.
    I have seen alot of sickness and death — worked in ICU and hospice mostly. I have watched people get a terminal diagnosis and throw up their hands and say ” I’m a goner !!” and no matter how hard the families tried, they would die much sooner than later. I have also witnessed the human spirit at it’s best..when someone was told hey had cancer at age 68..he said ” I am going to beat this !! ” his family was supportive and sure enough, he lived way beyond the doctors’ expectations. I believe when we are diagnosed with Diabetes, we go through a grieveing process. We mourn for the food we cannot have, the feeling of doom for our future, and becoming dependant on a doctor for our continued good health. Some of us never get through this grief and that is when you should seek counsel–be it your church leaders or a professional. Make Diabetes a family affair. Teach all you meet about it so that they understand why you cannot eat Aunt Sue’s bread pudding or chocolate cake. And begin this mantra–” If I do not control Diabetes..it is going to control me ! ” Take back your life…. it is nice to know through this site that we, as Diabetics, are not alone !!! And Betty–try a parakeet– you would be surprised how low maintaenance they are and how great a source of comfort they can be !!!

    Posted by Trish |

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