Take Care and Be Well, My Friends

It is with some regrets and some relief that I begin this last blog entry for DiabetesSelfManagement.com. It has been a very challenging exercise to continue to find new things to write about every week. I will be relieved that that pressure to perform will be lifted. As you see from my 40+ blog entries, emotional issues are plentiful, yet sometimes difficult to put into the words that all can benefit from. I hope that I’ve at least given you something to think about, even if you didn’t agree with what I’ve said.

Keep on Keeping on

During the last session of the TCOYD (Taking Control of Your Diabetes) conference I attended yesterday, the moderator, Steve Edelman, M.D., asked those of us on a panel what messages we thought were most important to give people who live with diabetes. To summarize all five responses from the panel would be difficult, since each came from a different medical bias, but the essence of all the responses had to do with encouragement to “keep on keeping on.”

Heal Thy Self

Today I have met with several people, some of whom have diabetes and some who don’t. When we interact, we often start by looking at the things that seem outside of the person’s power to control—things like work deadlines, anger from others, behavior of other people, or the numbers on the blood glucose meter. As the conversations continue, they provide an opportunity to identify how to manage those things outside of a person’s control. They also provide a chance to look at what can we do as individuals to heal ourselves.

What is Mental Health?

May is apparently Mental Health Month. I learned this from a presentation last week called “How Harley Davidson Saved Me From the Asylum.” It was presented by a man named Pete Feigel, who did a wonderful job of telling the story about his own depression and his struggles with multiple sclerosis (MS).

Trying to Get Diabetes Right

I read an article today on perfectionism and its impact on blood chemistry. As you may guess, people who want to do things perfectly tend to have more stress around whatever their areas of focus might be.

The Wisdom and Courage of Children

It’s been about 25 years since I worked at Camp Needlepoint, a camp for kids who have diabetes. It was and still is a great place for kids who have diabetes to experience the outdoors in a safe and supportive environment. All of the campers have diabetes as do many of the counselors, and those who don’t have diabetes still take injections of saline and check their blood glucose.

Anger! What Do You Think It’s Good For?

Over the last few weeks, I’ve had the opportunity to work with some teenage boys who have diabetes. The reason I was working with them was because some people in their lives thought that their behavior with their diabetes and their attitudes when asked about it were less than pleasant. The people who brought the kids to me were doctors and parents, and the kids were not happy to be here.

The Weight of Work Gets Heavier

Stress is one of those things in life that you can’t live with or without. A life with no stress may sound inviting, particularly after a 10-hour day with an expectation of another tomorrow, but the absence of stress begins to resemble death.

The “Terrorism” of Diabetes

Since the fall of the twin towers on 9/11, we who live in the United States have collectively experienced a new way of life—one that is affected by the possibility of something horrible happening.

Getting the Group You Need

In an ideal world, we would all have friends and family members who would provide the support we needed whenever we needed it. In an ideal world, we would have no need for self-help groups or support groups. The reality, however, is that at times most of us need a type of support that requires acceptance from others who are struggling with a similar issue.

Depression, Diabetes, and Heart Disease

It seems that, with some medical conditions, there is a domino effect that is easy to recognize only when we are at the end of the process. For instance, we noticed that many people who develop heart disease have had diabetes for quite some time, so we finally began to do some prospective research that indicated that having diabetes was a risk factor for developing heart disease. It may seem kind of like an “Oh, duh” experience now, but there was a time when we only knew about the connection intuitively.

Attitude of Gratitude

Minnesota finally got some snow this past weekend. It is beautiful and fairly deep, about 10–12 inches. Our usual bragging rights are simply about the cold, but now we have something we can play in. I like the snow today, but the other night I didn’t feel so kind.

Depression in Men

As a middle-aged man, I am at a point in my life when the idea of seeing a doctor for any reason has become a bit threatening. I am frightened of what the doc may find when he starts poking and prodding my aging body. As with any machine, the body begins to break down, and even with regular maintenance (exercise, meditation, and good food), it is still going to develop some minor problems.

The Times They Are A-Changin’

So what was Bob Dylan referring to when he sang that song in the 1960’s? At the time he was singing about war, racism, relationships, and politics; aging and how it was necessary to do something or get left behind. The 60’s were years of testing out new ways of looking at and living life. Those of us who were emerging into adulthood then were often engaged in struggles over how we were going to act and what we were willing to risk to have the life we felt good about.

Some chose to keep up the fight, but some of us found our way into a relatively conventional and risk-free lifestyle. The irony is that now we are reaching midlife and finding that “the times they are a-changin'” again.

The Cost of Therapy

I have written a few blog entries lately related to barriers to getting the mental health therapy you need. But I haven’t yet touched on one of the biggest obstacles to getting treatment—the price tag.

Guided Imagery – Complement to Conventional Therapy

During the last 10–15 years, many of us involved in the world of health and healing have been intrigued by alternative medicine and complementary therapies. Some of these therapies have been embraced for a long time, even though they haven’t been researched for effectiveness. They are often used by people because we believe that are going to work, and in some instances they actually do work to help us feel better. But because they often haven’t been fully researched, we’re not totally sure if they seem to work because of a placebo effect or because they are actually doing something to make a difference.

When Therapy Doesn’t Help

Diabetes is a condition that can make people feel like they have done something wrong even when they haven’t. The unpredictable fluctuations and frustrations that come with diabetes, even when you behave the way health-care professionals have suggested, can make you think that you messed up. For instance, when someone like me suggests that if you go to therapy you will feel better, and you follow my advice, you expect that you will feel better. However, sometimes that isn’t the outcome. So what might interfere with effective therapy, and who is at fault?

Barriers to Therapy

A few weeks ago, I wrote a blog entry called “When Therapy Makes Sense.” Since then, some discussion has taken place regarding barriers to seeking therapy. In the weekly Diabetes Self-Management e-mail newsletter, our editor, Tara Dairman, asked for responses to a survey question about obstacles to seeking therapy. I’d like to address some of these responses.

Independence vs. Dependence

In my practice, I’ve seen some married couples lately that remind me of my own family of origin: the man has diabetes that he controls with insulin and has great pride in his ability to deal with it without depending on anyone else, for anything. These men do not tell anyone they have diabetes unless they are forced to do so (by severe hypoglycemia, or low blood glucose levels, for example), and they believe they need little advice on managing the condition.

When Therapy Makes Sense

Those of us who chose to make our livings as mental health professionals probably didn’t do so because we had so much good mental health that we wanted to share it. Most of us likely started the process as seekers of mental health services and, somewhere along the way, discovered that we had something to offer as well.

Back on Track

This past week, I have been at a conference called the “Psychology of Health, Immunity and Disease Conference.” This conference is held in South Carolina, on Hilton Head Island. Not a bad spot for a conference—40° warmer than Minnesota, beaches to walk, golf courses, and a connection to individuals who see the world of health care with somewhat different eyes.

A Nod of Acceptance

Giving someone a nod when we see them is often a means of recognizing their presence. It’s not like stopping full-out and saying “How are you?” which can lead to a longer conversation, but it is a recognition of another person and an acceptance of their presence.

Struggles with Panic Attacks

First, I want to address a question that Envoy posted on my blog entry from two weeks ago. Envoy asked if I thought that depression was more common in people who have diabetes. The first answer is that I have always believed it is more common, and research has also indicated that it’s twice as likely to occur in people who have diabetes. That is part of the reason I suggest a yearly mental health checkup in conjunction with your annual physical.

SAD and Sleepy in Minnesota

There always seems to be a new virus going around this time of year. The symptoms consist of fatigue, low energy, down mood, no motivation, and a general desire to just sit and watch TV and eat lots of carbohydrate. I was convinced it was a virus because so many people have been complaining of these symptoms that it has got to be more than coincidence. So I asked one of my physician friends about it, but he said he wasn’t aware of any new viruses going around. It turns out that this isn’t a virus, but it may have something do with some factors to which we are all vulnerable: light and sleep.

Meditation 101

This week, I was struggling to figure out what to write for my blog entry. I’ve written about emotions, support, dealing with depression, and the process of change. These are just some of the issues I consider vital aspects of living well with diabetes. As I was meditating on a subject for this week, it occurred to me that what I was doing was a great idea for the entry: meditation.

Women’s Sexual Health

It’s been a number of weeks since I wrote about sexual health, and I was reminded that my first blog entry on the topic was primarily about men. Someone commented that women have sexual problems too, but often seem to be left out of these discussions. Historically, this has been true, but over the past few years women’s sexual health has started to receive more attention.

What’s Your Wild Card?

Yesterday, I spoke at a conference called TCOYD: Taking Control of Your Diabetes. It’s a great conference devoted to helping people who live with diabetes do it better. I gave two talks: one about “Emotions: The Wild Cards in Diabetes” and another on “Dealing with Diabetes Related Stress, Burnout, and Other Emotional Issues.”

When Support Isn’t Enough

To Cathy W, who commented about her friend with diabetes on last week’s blog,

It certainly sounds like you’re feeling frustrated about your friend’s lack of self-care and a bit powerless to help her. The interactions you have reported with your friend make it sound like her health is more important to you than it is to her. This type of relationship keeps you on edge about something you cannot control and lets her off the hook about something she needs to address.

Support, What Do You Think It’s Good For?

On October 4, I wrote a blog entry proposing a “day off” from diabetes. This suggestion evoked some strong feelings—mostly anger at my lack of sensitivity about life with diabetes. I accept responsibility for irritating those of you who responded. Your responses have helped me clarify my ideas about the psychic weight of living with diabetes.

Diabetes is a Marathon, Not a Sprint

Medical problems are often treated as brief events that need immediate, short-term treatment. A problem is diagnosed, a treatment is chosen, then the person with the problem follows through with the health-care professional’s recommendation, gets better, and all is well and good.

Taking a Vacation From Diabetes

Many people who live with diabetes struggle with the effort it takes to keep up with all of the related tasks. They get frustrated with the “forever-present” nature of diabetes care and often settle into a type of self-care that is “just enough to get by.” This goes on until about two weeks before their next doctor visit, at which point they become far more serious about following their meal plan and checking and recording their blood glucose levels.

Taking the Risk

Last week, I wrote about the courage I witnessed in some of the people I’ve worked with over the years. Someone asked me if I would follow that entry up with a note about how courage can be developed. I really think that courage is a combination of several factors converging at the same time.

The Courage to Live With Diabetes

I was recently working with a teenager who was struggling with managing his diabetes. He was struggling with school and his family as well and used a technique of avoidance to get through life. This technique is tempting to use, since no effort is made and no new skills are necessary. However, avoidance is also the most likely to have severe consequences and, ironically, lead to the most difficult challenges anyone might face: diabetes complications.

The Stages of Change

Dear S.,

For the last two weeks, I have responded to your letter by addressing issues related to mental health and emotional eating. This week, I’d like to discuss the final area of concern you identified: motivation.

Q&A: Depression and Diabetes

Last week, the DiabetesSelfManagement.com editors received the following letter via e-mail and asked me if I could answer it on this blog. The letter touches on many issues related to mental health and diabetes, and I’ll address them in my next few blog entries.

Taking Charge of Feelings

I was playing golf the other day and found myself getting really mad at one of my opponents. On one hole, he reported a six when he actually had an eight. I confronted him about his error and we had a small argument. For rest of the round I ruminated about this interaction, and I didn’t play well, either. I blamed him for my bad round of golf, but my partner reminded me that I was the one hitting my ball and I am responsible for my own reaction and feelings.

Sex and Diabetes: A Complex Issue

I just finished reading an article in a consumer magazine about sex and diabetes. In my experience as both a diabetes psychology specialist and a sex therapist, the article was what I expected. The issues discussed were related to physical problems common in men and women who have diabetes. The solutions offered in the article were fairly simple and focused on medical treatments. These are definitely important areas for people with diabetes to be aware of and important solutions for them to understand. Bravo to this article for addressing such a sensitive area. However, I do have something to add. Sex, whether or not someone has diabetes, is not a simple topic.

Opening Up

I don’t have diabetes, but it has played a major role throughout my life. My dad had Type 1 diabetes and had it before I was born. Some of my earliest memories are of him playfully spraying alcohol across the room before he would fill his glass syringe with insulin. That was 20 plus years before disposable syringes, blood glucose meters, and insulin pumps. Those days were also long before anyone was focused on their feelings about diabetes, so like everyone else in my family, I stayed silent.

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