Prevention | Support Strategies
Taking Charge of Your Diabetes Without Feeling Overwhelmed
Feeling overwhelmed can make it harder to take charge of your diabetes
People often tell me that the biggest barrier of all is feeling overwhelmed -- overwhelmed by having to deal with diabetes on top of everything else they have to manage in their lives. So if you feel this way, you are not alone. Most people who have diabetes feel overwhelmed a lot of the time. They suffer from a condition I call “diabetes overwhelmus.” And it's no surprise why. Bluntly put, diabetes is a hell of a disease. I don't need to tell you that, but sometimes other people lose sight of this fact.
There are no vacations from diabetes; it's with you 24 hours a day, 365 days a year. One of my eight-year-old patients pointed out to me a few years ago that since it was leap year, he actually got 366 days of diabetes that year. And diabetes affects absolutely every aspect of your life. Not only that, few of things you're supposed to do to manage your diabetes are what you could honestly call pleasant. Like sticking yourself to test your blood or give yourself insulin, for instance. Some of my patients do that 10 or more times a day. Or how about exercising regularly? It's true that some people actually like being physically active, but it's perfectly clear that most people don't feel this way. The same for eating right. Most of us would agree that the tastiest, most satisfying foods aren't the healthiest choices. Yet, if you have diabetes, you're supposed to do all these things and more, regularly, for the rest of your life.
And of course that's not all. Even if you did everything exactly by the book every moment of your life with diabetes — an impossible thing, naturally — that would not guarantee that your blood sugar control would be perfect or that you would never develop any of the possible long-term complications of diabetes. How can that be? The answer, unfair as it is, is this: Nobody can do perfectly the job their pancreas was intended to do. So no matter how hard you work, your blood sugar will always fluctuate out of the normal range to some degree. People with diabetes and their health care providers all wish that there were some nice, neat formula for calculating exactly the mix of exercise, food and medication required to keep blood sugars normal all the time. Unfortunately, a few health care providers even act as if this were possible. But everybody should know that it's not. There are things other than food, medication and exercise that affect blood sugar levels.
Take stress, for instance. Studies show that stress of any kind, physical or emotional, causes the body to release certain hormones which, among other things, tend to raise blood sugar levels. Physical illness or injury can stimulate the release of these hormones. Women release similar hormones in the days just before their periods begin. Adolescent blood sugar control is also often undermined by these same pesky hormones. They help our children grow into adulthood, but they do a number on blood sugar control at the same time. Emotional stress can also stimulate this hormone release.
One of my patients, who used an insulin pump, told me that he had to double the insulin delivery basal rate on those days when his regional supervisor (known as “the boss from hell”) was in town. Even with all this extra insulin, the added stress still left his blood sugars much higher than on those days when the supervisor was not around. Do you think that your blood sugars are affected by physical or emotional stress?
Not only is it impossible to predict exactly what your blood sugar level will be at any given moment, it's also impossible to predict exactly the long-term consequences of any particular level of blood sugar control over any particular length of time. Don't get me wrong; I believe in good blood sugar control. I'm convinced by the overwhelming evidence that people with better blood sugar control have a much better chance of living long, healthy lives. But that's a statement about people in general, and you are an individual.
The question I hear most often is, “If I do all this stuff we're talking about, will it guarantee that I won't get complications?” I give the only honest answer I can: I wish I could say there is a guarantee, but there's not. The real situation is more like safe driving. If you drive at a safe speed, wear your seatbelt, and don't drink and drive, your chances of getting home safely are much higher than if you drive too fast, don't wear your seatbelt, and are drunk. But that falls pretty far short of a guarantee, doesn't it?
Adding to the emotional burden of diabetes is the fact that, along with its clear and compelling benefits, tight blood sugar control also has a downside. In fact the study that firmly established the complication-reducing power of intensive self-care and good control for people with type 1 diabetes also demonstrated this downside. Those who were in the intensive treatment group had three times as many low blood sugars and gained about an additional pound a year compared with those who received standard treatment over the 10-year course of the study.
These findings make sense. The better blood sugar control of the intensive treatment group left these folks closer to the edge blood sugar-wise, because a small drop was more likely to create a true low. Better blood sugar control also means the body is able to metabolize more consumed calories, and spills fewer into the urine to pass unabsorbed. Unfortunately, anything that improves your blood sugar control, short of eating less or exercising more, is likely to contribute to weight gain.
That's what makes diabetes so demanding: the fact that you are supposed to make big changes in your life, and you are supposed to maintain those changes every day, forever, even though they are continuous, unpleasant, have a serious downside and don't guarantee good health. No wonder diabetes overwhelmus is so common! And once diabetes overwhelmus kicks in, things tend to get even worse. Feeling overwhelmed makes it even harder to take charge of your diabetes self-care. Giving up some of your self-care efforts generally leads to less good control, which can make you feel guilty and can also lead to immediate health problems, which makes you feel more overwhelmed.... Round and round it goes, in a downward spiral.
I'm sorry to paint such a gloomy picture, but many people with diabetes have told me that it's actually kind of comforting to be reminded of just how much they are managing, or at least trying to manage, every day. And I want to be clear with you that it doesn't have to be a constantly overwhelming struggle. I've talked in previous columns about some effective approaches to managing the emotional side of diabetes. Over the next few months I'll introduce you to my favorite technique for banishing diabetes overwhelmus. I call it “reframing.” It's fun, it works, and I think you will like it.
