Gum disease and Type 2 diabetes

February is Gum Disease Awareness Month. I want to share with you the importance of taking excellent care of your teeth and gums, especially if you have Type 2 diabetes; this is a very personal issue for me.

an illustration of how gum disease works

I have always had beautiful, strong teeth, partly due to my twice-daily brushing routine and partly due to good genetics. During my college years, I stopped going to the dentist regularly because it was a pain to schedule the appointments and because I never found a practitioner that I liked.

I was a good brusher, so I didn’t worry about not keeping up my dental visits until one day, quite suddenly (or so it seemed), my gums were bleeding and my front tooth was a little wobbly. I still tried to ignore it and hope it would go away, but, much like the Type 2 diabetes I was also ignoring at the time, nothing good comes of burying your head in the sand about gum disease (also known as gingivitis or periodontitis).

Once I’d started dealing with my diabetes and had a better handle on my blood sugar, I decided to deal with the problems with my teeth, so I made an appointment with a local dentist and hoped for the best. Unfortunately, having ignored the early warning signs of periodontitis, I found out that I needed to have 15 of my still-perfect, still-strong teeth removed because the tissue and bone that should have been supporting them had been eaten away by years of untreated infection. If I’d visited a dentist at the first symptoms, I’d probably have saved most, if not all of my teeth; I want you to learn from my mistake.

What are some of the risk factors for developing gum disease?
  • Not following a good dental hygiene regimen, to include brushing twice daily, flossing once each day, and visiting a dentist at least once a year (more frequently if you have any of the risk factors listed below)
  • Family history of gum disease (turns out both of my grandmothers plus my mother all have it although no one ever told me about it)
  • A medical condition that weakens your immune system, like diabetes, HIV/AIDS, or cancer
  • Eating a diet high in processed, sugary foods, which promote the growth of the plaque bacteria that cause gum disease

Some of these are clearly beyond our control – you can’t choose your family – but brushing, flossing, and seeing a dentist are things you can fix right now, and eliminating or limiting processed foods will benefit your health far beyond your gums.

Symptoms of gum disease

So what should you watch for, if you have any of the risk factors?

Normal gum tissue is pink, firm, and stretches around your teeth smoothly without any bleeding when you brush and floss.

In people with gingivitis, gums become red, swollen, and tender. They have a tendency to bleed, too. This should send you straight to your dentist for a chat because things are still very treatable at this point.

Once things progress to full-blown periodontitis (which is what I had), gums will pull away from teeth, your teeth may become loose, and you might experience bad breath and oozing pus. If you are at this point and feel overwhelmed, know that I’ve been in your shoes; you will be OK but time is of the essence. Make an appointment with a dentist or periodontist (if your insurance will allow that) immediately so that you can get things cleaned up and be back on a healthy path.

If the thought of losing your teeth isn’t enough to motivate you to action (and it wasn’t for me, so I’m preaching from experience here) then you need to know that gum disease has been linked to some even scarier health problems, like heart disease, dementia, and rheumatoid arthritis. Scientists haven’t pinned down the precise link but it’s probably related to the inflammatory effect of the uncontrolled bacteria in your mouth. (Inflammation is coming up a lot in the literature I read about many different health conditions.)

Bottom line is that gum disease is highly treatable when caught early and can impact your overall health in less-than-desirable ways if you ignore it, so make an appointment with a dental health professional if you have any of the symptoms.

Setting diabetes management goals

It’s January so perhaps you have been thinking about what you’d like to change in 2016. Now is a perfect time to think about setting diabetes management goals – here are my best tips for how to set yourself up for success in the next 338 days and beyond.

setting diabetes management goals will help you cross the finish line
International Canoe Classic Finish Line by City of Minneapolis Archives, on Flickr
Goal setting best practices
  • Give yourself some time to think about not just what you want to achieve, but also why. When the going gets rough and your initial enthusiasm wanes, remembering why you chose this goal can help keep you focused and motivated. A great suggestion from a trusted coach last year was to write down my list of “whys”, snap a photo, and turn it into the screensaver for my mobile phone so that I always have it in front of me; this works well for me.
  • Break large, lofty goals into smaller, measurable to-do items. Three years ago when I started on a journey to improve my blood sugar readings, I wanted to be able to complete the recommended 60 minutes of moderate intensity cardiovascular exercise on five days a week, but I could barely walk 15 minutes at a very slow pace, so I set my first action item to walk for 15 minutes one day a week. I also wanted to eat smaller amounts of food at each meal and eliminate my binge eating, but that prospect was overwhelming so I decided to focus on adding more fruits and vegetables to my existing way of eating. In both of these cases, I knew I needed to do more eventually but doing something small and measurable that would lay the groundwork for more ambitious goals later on was what worked for me.
  • Track your action items each day and evaluate how you are doing at regular intervals. You can check in on your progress on your own if that works well for you, or you may consider finding someone you trust to check in with, for additional accountability.
  • Adjust your action items as needed to continue growing stronger, healthier, and happier. If walking twice a week is one of your commitments and you find that you are easily accomplishing that then perhaps it’s time to add a third day or a few extra minutes to the existing days of walking. For eating changes, it took a few weeks for me to be ready to start tracking everything I ate so that I could evaluate whether (and where) I wanted to reduce calories.
  • If you’re not sure where to start with setting diabetes management goals, seek professional help. I have a wonderful endocrinologist (diabetes doctor), a registered dietician (for meal planning ideas), a physical therapist (for strength training and flexibility regimens), and a psychotherapist (for emotional support when it all feels overwhelming) on my diabetes management team. If you don’t like visiting any of the professionals who are supposed to help you manage your diabetes then ask around for referrals to alternative providers – you are paying them to help, you are their customer, and they should put your needs first instead of offering generic ideas about how best to manage your life.
  • Remember that anything that takes you in the direction of achieving your long-term goals is progress and should be celebrated. Find something that you love – preferably not food – to use as a reward for sticking with your action items. I rewarded myself with a facial after the first month of eating differently and exercising more. In the intervening months, I have gifted myself massages, pedicures, new running shoes, a cashmere sweater, and perfume as rewards for continuing to make positive changes. Choose something that you know you’ll enjoy, find a picture of it that you can place somewhere prominent in your environment to remind you about what’s waiting for you.

Finally, be gentle with yourself as you start making changes – this isn’t a race and you won’t always be perfect, so settle in and enjoy the journey.

Knowledge is Power: Eye Exams for Diabetics

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The professional support team needed for a person dealing with a chronic disease such as Type 2 diabetes is large. My team includes a primary care physician, an endocrinologist (diabetes doctor), a psychologist, a dentist, a periodontist, and an optometrist. It can feel overwhelming sometimes when I think about all of the visits to these various professionals that are required to ensure that I avoid diabetic complications, if possible, or uncover complications early enough so that they are treatable.

One of the least difficult appointments on my yearly rounds is with my optometrist. Eye exams for diabetics are needed yearly or possibly more frequently if retinopathy is detected by an initial exam. Diabetic retinopathy can be well managed if caught early but sadly many diabetics either do not have access to optometric care or do not know the importance of yearly eye exams for diabetics.

What should you expect at the doctor’s office? Eye exams for diabetics are much the same as for the rest of the population, and should consist of:

  • Glaucoma testing – my doctor uses the “puff of air” test but some doctors use something called a tonometer to touch the front surface of you (numbed) eyes, measuring the pressure inside;
  • Eye muscle movement test – you’ll track moving objects while your doctor watching how your eyes move;
  • Visual acuity test – you’ll be asked to read lines of text that get smaller as you proceed down the chart, while covering each eye in turn;
  • Refraction testing – with that same chart, the doctor will flip back and forth between different lenses, asking you “Which is better?”;
  • Visual field test – the doctor will ask you to keep your head still while tracking how well you can see things at the edge of your visual field (peripheral vision);
  • Retinal examination – after dilating your eyes with special drops, the doctor will examine the back of your eye with a tool called an ophthalmoscope.

My doctor performs the retinal examination as the last item for the appointment; I’m not sure if this is true for all doctors. Since your eyes will be hypersensitive to light and will have trouble focusing properly for several hours after the exam, you should plan to walk to your appointment, ask someone to take you to the office and pick you up afterwards, or find somewhere near the office to sit and wait for the effects to wear off.

Nothing in the eye exam is painful and, when you’re done, it’s a great feeling to know that you can check off another item on the list of required annual appointments for effective diabetes self management.

If you are diabetic, do you have a yearly eye exam? What would you tell another diabetic about why they should have an eye exam as part of their diabetes treatment plan?

p.s. If you’d like to read more about my daily life, visit my personal blog.

Manage Stress: Dealing with Diabetes Fatigue

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Successfully managing a chronic disease like type 2 diabetes requires making hundreds of decisions each day, over and over again, without end; this is exhausting. Some days this is no big deal: I eat well, I exercise, I laugh with friends and family, and I test my blood sugar when I wake up plus before and after one of my meals. Other days (sometimes for several days at a time) it’s all I can do to keep up my exercise routine – the eating, stress management, and blood sugar testing all go out the window. This phenomenon is sometimes known as “diabetes fatigue”: basically, you are burned out from all of the decisions required to successfully manage your disease every day.

So, what can you do to fight diabetes fatigue?

  • Get outside for some exercise at your own pace. You don’t have to run or power walk in order to benefit from exercise, particularly mental health benefits. Moving your body, even at the lightest intensity, will release endorphins inside your body and that will automatically lighten your mood. Besides, changing your surroundings can help change your thoughts.
  • Speaking of changing your thoughts, when you catch yourself painting your diabetes self management efforts with the “all or nothing” paintbrush, change the dialogue going on inside your head. If you’re anything like me, you are your toughest critic. Some days I have to catch myself and stop the negative self-talk. Instead of saying things like, “Managing my diabetes is too much for me, I just can’t do it,” or, “My blood sugar is high so I’m a bad diabetic,” I change my thoughts to something more positive, even if I have to fake it. “I’m doing my very best to make good decisions for my diabetes,” or, “Let me look at my food journal to see why my blood sugar is high right now – more great data that will help me make better food choices.”
  • Take extra especially good care of yourself. In addition to modifying your self-talk to be more nurturing and less perfectionistic, how about going for a facial or pedicure? If spa treatments aren’t your thing, try going to bed an extra hour early – you’ll rebuild your strength and stamina at the same time you turn off your conscious mind for a few hours, so it’s a win-win. If you have a favorite tea or other hot, calorie- and- carbohydrate-free beverage, make yourself a mug and enjoy it mindfully.
  • Chat with your general practitioner, your endocrinologist (diabetes doctor), a certified diabetes educator (CDE), or a psychotherapist. Never underestimate the power of sharing how you’re feeling with someone who can actually help you improve your situation – they’re there to help and they’ve certainly heard the same problems you’re experiencing from other clients in the past.

What you don’t want to do when the disease wears you down is give up on all of the healthy choices you are making. I know it’s challenging to keep making the tough decisions about getting some exercise versus an extra hour of sleep or having a hard boiled egg with part-skim string cheese for breakfast instead of that gorgeous blueberry scone you saw in the pastry case at your favorite coffee bar, but no one has ever regretted making those trade-offs once they are past the immediate temptation; be strong and remember that you’re worth it.

Have you ever experienced diabetes fatigue? What advice would you give someone dealing with this challenge?

p.s. If you’d like to read more about my daily life, visit my personal blog.

Nourish Your Body: What can I eat with Type 2 diabetes?

effective-diabetes-self-management

One of the most common questions I hear when someone finds out that I am diabetic is, “Wow, what can you eat?” I generally say that I try to limit processed foods, foods made primarily from sugar or flour, and white starches (white potatoes, white rice, white pasta) while eating reasonable amounts of fruits, vegetables, healthy fats like avocado, olive oil, and almonds, and lean meats. Of course, that’s not the whole story, but that’s what fits into the average person’s attention span.

The truth is that there is not a single “diabetes diet” because everyone’s body reacts differently to different food. For me, most fruits are fine, even pineapple and bananas, both of which are fairly high in sugar, but that’s not the case for many diabetics. I love black beans but I have to be careful not to eat more than 1/4 cup at a time because they will most certainly raise my blood sugar; others might not have that problem or might not be able to eat even a small amount.

How can you tell which foods work well for your body? By testing before and after meals every time you try a new food, to see what effect it will have on your blood sugar. Testing “in pairs” (both before you eat and two hours after you start eating) is the only sure way to know which foods your body will tolerate without spiking your blood sugar and that is the name of the game when it comes to diabetes self management.

There are some foods that seem pretty universally well tolerated in terms of blood sugar maintenance and those foods tend to be low-to-no carbohydrate foods. Lean meats, healthy fats, some fruits and non-starchy vegetables all fall into that category.

Which fruits and vegetables are unlikely to raise your blood sugar? Specifically:

  • Cherries, grapefruit, plums, peaches, prunes, apples, dried apricots (unsweetened), pears, and grapes*
  • Broccoli, cabbage, lettuce, onions, bell peppers, green beans, tomatoes, cauliflower, eggplant, and raw carrots

*Important note about fruit: keep in mind the serving size when making your choice – generally, one cup constitutes a serving of fruit but one grapefruit is 2 servings of fruit, while two plums are one serving, and one peach or one apple or one pear is one serving; paying attention to how much you’re eating is as important as what you choose to eat.

Are there specific questions you’d like me to answer about food, eating well with diabetes, and how to make good nutritional choices for your body? Leave a comment on this post or send an email so that I can cover your questions in a future post.

Five principles of effective diabetes self management

People sometimes stop me during the day – at work, mostly – to ask what my “secret” is. I used to get embarrassed by the question but now I realize that folks are looking for a blueprint to create their own healthy life and while there’s no secret to it, I do know what works for me in maintaining good control over my diabetes. Today I’ll introduce the basic concepts; my plan is to focus on each one in detail in future articles as I delve into creating a plan for effective diabetes self management.

effective-diabetes-self-management

The first principle is eating well. Sounds simple enough, right? If I had a dime for every self-help book, e-book, website, infomercial, etcetera offering an eating plan for weight loss or disease management, I’d be able to retire to open the organic dog biscuit bakery of my dreams! The truth is that “healthy” means something different for every body. Not everybody but every body. In other words, a food that works really well for my body’s needs might be absolutely lethal for yours. I eat two hard boiled eggs nearly every morning because my cholesterol is in the healthy range and eggs are full of protein and some fat, neither of which will cause a spike in my blood sugar. By eating them after walking or running and before work, I set myself up for a great morning without having to worry about feeling hungry before I can get to lunch. For someone with high cholesterol, though, this eating plan wouldn’t work well; they might be better with Egg Beater omelets or a poached egg white. Experiment. Try different foods and see how your body responds. It’s important to give your body good fuel in reasonable amounts according to what your body needs.

Once you have the right fuel on board, you can look for ways to exercise a little every day to help your body use the calories from what you eat. I remember how much I hated the thought of exercising every day when I started on my journey to better health – mostly because my extra weight made movement painful. If you haven’t been active on a regular basis in a while, start where you are and gradually increase your duration or intensity. For me, I could barely walk 15 minutes at a super-slow pace on the treadmill before I wanted to die. So, I started with that, every other day, for a few weeks and then I added another day of walking 15 minutes. After I’d worked myself up to 5 days a week of 15 minutes of walking, only then did I very slowly increase the duration of each session. The most amazing part to me was that, after only a month of regular walking, my blood sugar readings were already nearly back in the healthy range even while I still had at least 80 pounds to lose. Biking, swimming, skating, an elliptical trainer, circuit training with weights, Zumba, playing hockey, chair dancing – whatever exercise you enjoy that raises your heart rate will work, so pick one and start slowly!

Knowing precisely what’s going on inside your body can be a little scary. If you’re at all like me, you probably don’t see much point in testing your blood sugar since, if it’s high, you can’t really do much about it and it makes you sad (or angry, or scared) to see how high it is. I was equally bad about going to my primary care physician, ophthalmologist, and dentist: I knew the news would be bad, so what was the point? I’m going to let you in on a little secret, though: nothing in my life got better until I stopped ignoring the health team that was waiting to help me manage my disease. Testing your blood sugar allows you to know which foods your body likes and which ones will send your blood sugar soaring – that’s how you start to build a meal plan. Meeting with your primary care physician and discussing the results of your lab work will help you see whether you need to watch your sodium (high blood pressure) or cholesterol; they will also help you set goals for what your blood sugar readings should be and can send you to a dietician or diabetes educator. Seeing the ophthalmologist every year will ensure that any changes in your eyes are caught early while they can still be treated effectively. And if you’re not sure why the dentist should be a part of your diabetes treatment team, I will share that I used to think the same thing until I had 15 teeth removed in a single surgery last year due to advanced periodontal disease caused by diabetes. Keep up the twice-yearly visits to the dentist in addition to brushing 2-3 times a day and flossing at least once – don’t learn the hard way like I did.

Stress is a part of our daily lives: that won’t change no matter how well you take care of yourself. If left unmanaged, stress can negatively affect your physical and emotional well-being, sometimes leading to unhealthy coping behaviors, too. According to the Mayo Clinic, symptoms of stress may include headache, chest pain, fatigue. sleep problems, anxiety, irritability, sadness or depression, over- or under-eating, drug or alcohol abuse, and social withdrawal. Finding healthy ways to handle the stress in your life can be challenging, particularly when your previous coping mechanisms might include unhealthy behaviors such as those listed above. For me, I spent most of my life using food as my stress antidote of choice. Now that I am paying more attention to taking care of my body, I spend a lot of time exploring new ways to navigate stress without turning to food. Yoga, walking, mindfulness, and deep breathing all work well for me on a day to day basis. I still struggle with binge eating in response to stress, but it’s far less frequent now that I have other viable options to turn to instead.

One easy way to handle stress is by consciously bringing as much joy into your life as possible. I was stunned to realize, at the beginning of this journey, that I couldn’t think of anything that I had truly enjoyed for years and years. Two years later, a list of my greatest sources of joy come easily to me: spending time with my husband, our pets, and the rest of my family; walking in our neighborhood; chatting with a friend; reading a book; taking a yoga or Pilates class; traveling. I have consciously chosen to explore new activities to help me figure out what energizes me and what doesn’t, so that I can pull more of the former and less of the latter into my life. The flip side of this equation is not allowing shame – a painful feeling that you (or something you have done) are foolish or wrong – to dominate your life. When my diabetes was out of control and I was 100 pounds overweight and I couldn’t even walk on a treadmill for 15 minutes without dreadful pain, I was ashamed, and that shame nearly kept me right there in that same state forever. Shame robs your life of joy if you let it, and I agree with Dr. Brene Brown who has said that the antidote to shame is empathy – from others and from yourself. Talk to trusted friends about how you feel but also start treating yourself the way you would a friend who was struggling with her own imperfections. As I say to myself at the start of each yoga class, “Inhale joy, exhale shame.”

I hope you’ll find something here of value no matter where you are on the journey to a happy, healthy life. As I said earlier, I’ll be exploring each of these principles more fully through future articles, so let me know if you have questions or additional thoughts to offer.

(Note that these principles apply equally well to effectively managing any chronic illness or, really, to living a healthy, disease-free life.)

Diabetes and exercise: A powerful combination

The biggest factor for me in taking control of my Type 2 diabetes has been making moderate physical exercise – primarily walking – a part of my daily life. While changing what I eat has certainly helped that effort along – it takes less effort for my body to burn off smaller amounts of food than it did when I used to binge eat with every meal – it’s the regular exercise that has made the biggest difference. Alongside eating less, getting exercise in daily makes it easier for my body to metabolize food without boosting my blood glucose levels in response.

This video describes an annual public service campaign aimed at increasing both blood glucose testing and short amounts of daily activity for diabetics of all kinds, including Type 2. Next month, November, is National Diabetes Month and diabetics of all kinds, from all around the world will participate in the Big Blue Test to prove – to themselves, their followers, and the folks who love them.

If you or a loved one are diabetic, please see this link for more information about how you can take part.

Living With Diabetes: Remembering to take medication

I was approached by The American Recall Center to participate in “Talk About Your Medicines” month, a public service effort during the month of October. I received no compensation nor other consideration for this post and the ideas expressed are entirely my own.

Talk About Your Medicines month

For several years, I took between five and nine different medications at a time as part of my Type 2 diabetes treatment plan. While I am currently able to control my diabetes with careful attention to what I eat and a physically active lifestyle, I know how vital it is to take medications as directed for effective diabetes self management.

I used several key strategies that helped me remember to take my medication:

  • Some of my medications – including Metformin, one of the most common medications for treatment of Type 2 diabetes – were to be taken twice daily, with food, so I purchased a small container with 14 separate compartments, to allow me to see at a glance if I’d taken my breakfast and dinner medications.
  • For my injectable medications – including Victoza and, later, insulin – I used a small, pre-filled pen device to inject myself once a day. The easiest time for me to remember to inject myself was at night, as part of my bedtime routine: I washed my face, brushed my teeth, moisturized my skin, and gave myself an injection in my abdomen, all before I went to bed.
  • My husband usually ate dinner with me and, if he didn’t see me take my pills, he’d ask if I’d forgotten about them. (This one can be touchy, depending on how you feel about others being involved in your diabetes treatment plan, but it worked well for us.)
  • I couldn’t take my medications as prescribed if I didn’t have them available, so I took advantage of my pharmacy’s automatic renewal service, which not only filled the orders before I ran out but also called our house phone with an automated reminder when it was time to pick them up. Combine that with the convenient Pharmacy drive-through window and it was nearly impossible for me to run out of my medications.

Living with Type 2 diabetes is stressful, regardless of whether or not you are taking medications as part of your treatment plan, and having strategies that work for you is critical to achieving control of your diabetes symptoms. Do you have techniques you’ve incorporated into your diabetes self management plan to remind you to take your medications as prescribed?

Diabetes & Depression: All in your head

It’s estimated that as many as 30% of diabetics also suffer from clinical depression. While the “which came first”/”which causes which” argument hasn’t been settled at this point, it’s clear that treatment and care plans for diabetes should make provision for the complicating factor of doing what needs to be done to avoid diabetic complications while simultaneously managing a serious mental illness.

For me, I believe the depression came first although the very nature of that disease – the distorted thinking, the lack of desire to do much of anything, the belief that I’m not worth the effort it will take to keep me happy and healthy – make it difficult to say for sure. I’m pretty sure that I was depressed in college, possibly even as early as my teens, and I wasn’t diagnosed with diabetes until age 29, so it’s likely that the depression pre-dates the diabetes for me. Given that I use(d) food to soothe myself when l’m in the middle of a bout with depression and that nearly all physical activity other than chewing and breathing used to stop when I was depressed, I would even call depression out as one of the “causes” of my diabetes.

Regardless of how and when they started, I deal with both diseases regularly: diabetes every minute of every day, depression at least once a month – every month – without fail. As exhausting as it is to keep my diabetes management mojo going on a good day, when I’m depressed it’s a whole lot tougher.

Depression makes everything feel harder

Over the last 19 months, as I’ve focused on Project: Happy/Healthy Me, I’ve learned a few things that help me deal with my depression more effectively. Tactics that work for me include:

  • Recognizing that it’s back and that I’m depressed again is a great first step. When it’s really bad, this can take me anywhere from a few days to a week or more. If you have never experienced it, it’s tough to explain how that happens but remember that depression means that my own brain is working against me, creating thoughts that aren’t true but feel completely valid. Once some part of my brain breaks free to see that it’s just the disease talking, I can implement better coping techniques.
  • Keeping up my healthy daily routines as much as possible. I get quite a lot of physical activity and track my food intake every day, so I try to keep those habits going even when I’m dealing with the crazy thoughts that would have me stay in bed and eat simple, starchy carbohydrates for the rest of my life. That’s not nearly as simple as it sounds but it’s easier now that I make natural and planned physical activity so much a part of my everyday life. When the depression hits, I still go out before work each day but I might take a simple walk instead of incorporating jog/walk intervals. Both diabetes and depression benefit from exercise and walking is such an easy way to get my day off to a healthy start. Once I have a walk under my belt, it’s much easier to continue making good choices for my health even as I put up with my depression symptoms.
  • Calling myself out when I start giving small things more importance than they deserve. I overreact on a good, non-depressed day and it only gets worse when you add in the disordered thinking that accompanies depression. Suddenly, the fact that I haven’t completed any of my duathlon training planned workouts in a week means that I’m a terrible person and am destined to re-gain every pound I’ve worked so hard to lose. The truth is that I’ve been very active in ways other than running or biking and my fitness level will carry me through the event next month even if I never follow through on another workout from the training plan. (Not that I plan to skip another month of workouts, but with depression, anything is possible.)
  • Treating myself kindly, as I would a friend who was suffering with a chronic illness; skip the self-abuse. While it’s easier said than done, taking excellent care of myself while I’m depressed pays off almost immediately with improved mood and cognitive function. For me, this could mean going to bed a little early, using a favorite body wash with my shower, or scheduling a massage. If I pretend that it’s a friend who is suffering, this becomes more natural and less awkward.
  • Incorporating more mindfulness into my daily activities. Whether it’s yoga, quiet meditation, focused breathing, or simply focusing intently on my surroundings with each of my senses, the more I am present in the here and now, the easier it is to keep an even keel.

Even with these strategies, there is no “cure” for depression. Some months the symptoms are worse than others and at those times I call my therapist for a check in – somehow just talking with her brings a better focus on what’s real and what is not.

If you suffer from depression, know that you’re never alone, no matter what your brain might be telling you to the contrary. You are lovable and loved more than you know, so when things get scary, reach out and find help.

  • To find a therapist in your area, use this helpful website
  • Psych Central hosts an online depression support group which includes both message boards and weekly chat sessions. Depression tries to isolate us so being around others – even virtually – is a great way to put the disease back in its bottle
  • If it’s all too much and you just can’t bear another minute of feeling this way, please call the National Suicide Prevention Hotline at 1-800-273-TALK (8255) – it’s staffed 24/7/365 with trained professionals who will help you. Nothing – absolutely nothing! – gets better if you hurt yourself so don’t let this stupid disease win!

Just as with my diabetes, I know I’ll need to continue refining my depression self management plan for the rest of my life. There is no cure for my diseases but with careful planning, strong partnerships with medical professionals, and a little bit of luck, I’m confident I will live a long, healthy life.

Dear Comrades: It’s been a little while since last we spoke

Way, way back, so long ago that it hardly seems real now when I think about it, I used to write blog posts as naturally as if I were casually checking in with a friend every day. Heck, I sometimes posted more than once a day if I had a particularly interesting – at least to me! – day. I didn’t worry about what anyone wanted to read, or about how it all came out, I just let words tumble onto the keyboard and the blog page. Somewhere along the way I lost that mindset and writing here became something I had to do and it had to be done properly, with tags and pictures and search engine optimization and all of that rigamarole.

I have a couple of lovely friends with whom I am supposed to check in every day to report how I’ve done on my Healthy/Happy Me routines, so I wondered if I could use the blog to do that since there can’t be anyone left reading here who isn’t a friend at this point. (Who but a friend would indulge me my long, unexplained absences?) So, with that, I give you my check-in for today:

Dear Comrades,

Where to start? It’s been a tough week, with lots of changes at work and odd pain with swelling in my shin, but I think I’ve done pretty well in staying focused on taking care of myself. The scale at Weight Watchers said that I lost 0.8 pounds this week but more importantly to me, my blood glucose testing results show no rise in my sugar levels even though I haven’t been able to walk or get any sort of real exercise since last Monday’s walking 5K – huzzah!

So, what have I done to keep my sanity – and maintain healthy blood sugar levels – without physical activity?

  • I’ve cut out nearly all carbohydrates other than fruit and vegetables from my eating. It’s not that I eat a lot to begin with but they’re completely gone until I can exercise enough to burn them off.
  • Keep close watch on the sugar content of the packaged foods I do eat. For instance, I have Greek yogurt every morning and used to scarf down 17-20 grams of sugar with the brand I was eating. Since I’ve been paying more attention, I’ve reduced that to 10-15 grams instead. Small changes add up, particularly with sugar and simple carbohydrates.
  • Hydrate, hydrate, hydrate! Water, tea (iced and hot), non-fat/skim milk (at least 8 ounces a day), and decaffeinated iced coffee are all keeping my body humming along nicely without the false hunger cues that can sometimes pop up when I’m actually just thirsty.

TCB and I are off to watch The Book of Mormon this afternoon and I still need to take a shower, so I’ll close here. Hope all is well with you and that you’ll share how you’re doing – any challenges coming up or recently faced? – in the comments.

xoxo Denise