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.
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.
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?
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?
Do you know someone who never seems to react to the craziness around them but rather stays calm and serene at all times? While I want to be more like that, my more common response is to let the energy of my surroundings – whether calm or chaotic – dictate my mood and feelings. In the past, this led to my using food to soothe or distract myself, but after losing nearly 100 pounds and getting my Type 2 diabetes under good control, emotional eating in response to stress no longer serves me well, so I spend a fair amount of time seeking out and practicing new stress management behaviors.
What works for me is:
taking a deep, cleansing breath – it sounds simple, and it is, but this is one of the most effective tools I’ve found for managing stress without turning to food. Not only does it keep me anchored to the present moment (instead of obsessing over every possible bad outcome) but filling your belly, chest, and throat with air before emptying them out with an enormous sigh feels simply decadent.
getting away from the situation – even slipping away for a brief moment provides a reminder that there is far more going on in the world than whatever is preoccupying me. I particularly like to walk laps around the inside of our building at work: I “get away” while still being close by in case someone needs me urgently.
walking meditation – my morning walks are my favorite 20, 30, 45, or 60 minutes of the day. Some days I listen to podcasts but others I simply walk and breathe and enjoy the people, animals, and scenery I encounter. The key is to focus on being really present where you are and holding those feelings of freedom and joy inside to help with perspective when things get rough later on in the day.
yoga – in the last six months, I have fallen in love with my yoga classes and have gained so much inner peace (not to mention flexibility and agility) from my practice. For the 60 minutes I’m in class, I focus on my breath and finding ways to bring more relaxation and joy into my body. (Note that I used to spend a lot of time in class worrying about how I looked in the various poses and what other students were thinking when I couldn’t do everything exactly as described. Now I know that no one cares even a little bit what you are doing or not doing because they are taking care of themselves, their bodies.)
communicating how I’m feeling – it can be verbally or in writing, but sharing what I’m worrying about with another person nearly almost reduces the associated stress.
Do you have any favorite stress management techniques? Are you one of the unflappable folks who don’t seem bothered by anything, and, if so, what are your secrets???