How to get back on track with diabetes care
By Natasha Persaud
Diabetes has its challenges and frustrations: You need to juggle eating well, exercising, taking your meds as well as navigate the ups and downs of blood pressure, glucose and cholesterol levels. To help you navigate the trouble spots, Hope Warshaw, R.D., and Joy Pape, R.N., authors of The Real-Life Guide to Managing Diabetes, offer these savvy tips:
Problem: At a party or barbecue, you often feel tempted to eat or drink more than you should. You feel annoyed that you can’t eat the way you did before developing diabetes.
If you’re newly diagnosed with diabetes, handling food temptations is really no different than dealing with temptations when you’re trying to prevent weight gain or shed a few pounds, says Warshaw, a registered dietitian and diabetes educator. No foods are forbidden, but you do need to account for your choices and keep an eye on fat and calories.
Real-life strategies: When possible, try not to arrive to the party hungry. At the buffet table, take a look at the options and plan what you’ll eat. Think about filling up on the healthier foods, such as salads, cooked or raw vegetables and fruit. Then enjoy small samples of less-healthy dishes that you want to taste.
Many people with diabetes use the plate method, which is recommended by the American Diabetes Association: Fill half of your plate with non-starchy veggies such as grilled portobello mushrooms, vegetable slaw or carrots and broccoli; one quarter with starches such as toasted quinoa salad, whole grain couscous or beans; and the remaining quarter with lean protein such as grilled salmon, grilled shrimp or pork loin. The plate method also leaves room for a serving of fruit on the side and milk or yogurt. What about dessert? It’s usually fine to have a few bites in place of other starchy foods, fruit or milk. But make sure it’s something really delicious, so you’re not wasting your calories on anything less than spectacular!
Of course, not everyone manages diabetes the same way. Certain blood glucose–lowering medication may cause low blood glucose, also known as hypoglycemia. If you’re taking this type of glucose-lowering medication and you drink an alcoholic beverage, be sure to nibble on food to avoid low blood sugar. After one or two drinks, switch to a non-caloric beverage such as club soda with a splash of cranberry juice and lime. If you take insulin, you may need to adjust your rapid-acting insulin to the amounts of carbohydrates you’re eating.
Finally, mix and mingle with other guests far afield of the buffet table; you’re less likely to think about food and more likely to enjoy yourself.
Problem: You want to get in shape to better manage your glucose levels, but you have a hard time sticking to an exercise routine.
Ask yourself, “What’s getting in the way?,” says Pape, a certified diabetes nurse educator. Perhaps you don’t like going to the gym or you can’t find extra time in your day for exercise. Often, the problem is that your goals are too ambitious. Many people with diabetes have an all-or-nothing attitude. If they can’t exercise for an hour every day right out of the gate, they quit.
What’s more effective over the long term is taking one step at a time. Use your current activity level as your benchmark. Instead of blocking out an entire hour every day, make a plan to wake up a half-hour earlier to exercise three days a week, since that’s more realistic and reachable.
The American Diabetes Association recommends working up to 150 minutes of aerobic activity per week and resistance training three times a week on nonconsecutive days to prevent and manage diabetes. Think that’s difficult to achieve? It can be as simple as taking a brisk half-hour walk five times a week and doing resistance exercises such as wall pushups and squats three times a week. Why is regular physical activity and exercise so important? It improves insulin action, lowers blood glucose, reduces blood pressure and improves cholesterol.
If you’re on diabetes medications, pay attention to how exercise is affecting your blood glucose levels. If you take blood glucose-lowering medication that can cause hypoglycemia, keep your blood glucose levels above 90 mg/dl to avoid a low; if you take insulin, keep your levels above 110 mg/dl. Some people on blood glucose-lowering medication experience high blood glucose levels, or hyperglycemia, following exercise. If that’s you, talk to your doctor about starting insulin therapy.
When you need to work on other areas of diabetes care, such as improving your eating habits or monitoring your glucose levels, use the same step-by-step approach. Start with your current habits, and take an honest look at what you are—and aren’t—doing. Then, identify two to three concrete goals and work on those. Also make sure that your goals are SMART: Specific, Measurable, Attainable, Realistic and Time-frame specific.
Problem: Your partner is constantly nagging you with “Did you take your medicine?” or "Don’t eat that!” In other words, acting as diabetes police.
Though you might feel angry, find an opportunity to talk to your partner calmly about better methods of support, says Warshaw. Avoid being accusatory: Don’t say, “I told you not to pester me.” Come from the perspective of “I,” and gently state what you need. You might say, “I know you’re telling me these things because you love me, but it makes me feel upset and frustrated. What I really need from you is to ask me, “What can I do to help?” Perhaps, your partner could take notes during doctor visits, exercise along with you or simply lend a listening ear.
Managing diabetes may feel similar to a fish swimming upstream; it takes hard work and willpower to deal with the tide of things you now need to manage. Don’t let anyone try to convince you that managing diabetes is easy—it's not! There will be days when you handle your diabetes more successfully and others when you don’t. What’s most important is that you don’t beat yourself up for not doing it all every day. On good days, give yourself a pat on the back. On bad days, forget about that day and move forward–tell yourself, "Onward!"
Research shows that having support improves your chances of successfully managing the disease. Beyond family members and health-care providers, consider joining a diabetes community online and/or in person to share your feelings and get tips. You also get so much from seeing how well others are doing. There’s a lot of good support out there, including health-care organizations, websites, message boards, e-newsletters, magazines and more.
Problem: No matter how hard you try, your glucose levels are always too high.
Realize that many times erratic glucose levels are not your fault, says Pape. Even if you did overeat, or you've been underactive, and your numbers are high, don't play the blame game. Start thinking of your glucose readings as information for learning rather than as value judgment. You are not your numbers. You are not a good person if your numbers are within your targets, or a bad person if they are not.
Many factors can affect your glucose levels, including medication, diet, your activity level and a host of other factors such as sleep, illness, oral health, hormone levels, your mood and even the weather. It’s possible that your pancreas, liver or intestine is simply not regulating your glucose levels well enough or that your cells are failing to respond to glucose due to insulin resistance. You may need a larger dose of your current medication or you may need to add another type of medication to better manage your glucose levels.
Understand that type 2 diabetes is a progressive disease. One out of two people with diabetes will need additional lifestyle interventions and/or medical therapy to reach A1C goals. Talk to your doctor or a diabetes educator (typically a nurse, dietitian or other health-care provider) to learn how to improve glucose control. Keep a record of some sort, whether it’s a paper journal or one that’s online, to share with your health-care provider. Jot down what you eat every day, your exercise routine, blood glucose readings, illnesses and anything else that may be affecting your diabetes care. It can also help to write down your thoughts and feelings. Keeping records helps you and your doctor understand how diabetes is specifically affecting your body; every person responds differently to the disease. Use the records to understand stumbling blocks, actions that you find helpful and the effects of tweaks on your diabetes-care plan.
Problem: What you dreaded has happened: You need to take insulin.
The biggest issue with insulin is the fear factor, says Warshaw. You worry that the needle will hurt; you think that your days are numbered because your grandmother passed away soon after transitioning to insulin—when in fact she probably died of the complications from having uncontrolled diabetes for many years. There are a lot of myths and old information out there about insulin.
The truth is, there’s nothing about taking insulin that means you have “worse” diabetes. In fact, many people would benefit from starting insulin therapy earlier. Experts estimate that people with type 2 have already lost at least half of their insulin-producing beta cells by the time they are diagnosed with diabetes. Your body’s ability to make your own insulin will continue to dwindle over time. The earlier you start on insulin, the more likely it is that you’re going to have a better outcome.
Today, there are many convenient methods of storing and taking insulin: you don’t need to keep it refrigerated; it comes in convenient forms such as cartridges for insulin pens; and the needles are tiny and virtually painless. It actually hurts some people more to prick their finger to test blood glucose levels than to take insulin. Getting correct and current information will put a lot of your fears to rest. Your doctor or diabetes educators should be able to answer your questions.
Problem: You’re taking multiple medications—for diabetes, high blood pressure and high cholesterol—and you can’t tolerate the side effects. You’re thinking of skipping one or more of your meds.
People with diabetes may be on blood glucose-lowering medication, insulin, blood pressure medication, cholesterol drugs and/or other medications, says Pape. No one wants to take multiple medications, but sometimes doing so is necessary to keep your numbers in an optimal range.
Before you decide on your own to stop taking one or more of your medications or to skip a dose, consult your doctor, who can often suggest alternatives. Today there are more medication choices for diabetes management than ever before. Finding the right mix may require some trial and error, but don’t get discouraged. Once your numbers are on track, you’ll start to feel better and enjoy more energy and better health. What’s more, you’ll help to prevent or delay diabetes complications, such as heart disease, damage to your eyes or nerve damage to your digestive tract and/or feet. Research clearly shows that early and aggressive action can slow the progression of diabetes.
The Attitude Factor
Keeping a positive attitude is essential to managing diabetes, says Pape. Know that you can manage this disease, and that you’re not alone. While you may find it challenging, taking these steps may help you stay positive.
- Find a reason why you want to be healthy and let that motivate you to stay on target. For example, “I feel better when I stay on track with my healthy eating plan, exercise and medication” or I want to be able to stay active and independent.” Rehearse your reason aloud or write it down on an index card and post it where you’ll see it every day.
- Surround yourself with positive and encouraging people, such as friends, family and, if applicable, members of your diabetes support group and spiritual community.
- Rather than resent the fact that you have diabetes, be glad you have a condition you can manage.
- Look at the real facts of diabetes, including the potential to lead a healthy life with this disease.
- Try to think of the glass as half-full instead of half empty. Many people say being diagnosed with diabetes was their wake-up call to start making healthier choices—and that now they feel better than ever.
- Think of fitting diabetes into your life as a creative challenge, not an impossible task.
Finally, don’t beat yourself up for not doing things right every day. Give yourself positive strokes for all the positive actions you do take. Try to maintain a perspective of balance and enjoy your real life!