THINKING AND LIVING PRO-ACTIVELY
WITH DIABETES

by William F. Schley

Living with diabetes is no longer the struggle it once was. Living well with diabetes, even with diabetic complications, is now possible through advances in medicine and technology, but your mental and emotional condition will also affect your diabetic health. It is possible to live a fulfilling life, to define and accomplish important life goals, and to have a happy and healthy family life as a long-term type 1 diabetic; but you need to know what to do, how to do it, and above all, you must be willing to do whatever it takes to attain maximum results. I'm still reaching for some of life's brass rings as my diabetic history nears its 45th anniversary, but I've attained a number of my objectives, and you can, too.

1. If you've got a glucose monitor, USE IT. If you don't have one, GET ONE. Many doctors will give you a high-quality monitor, and some pharmacies even have 100% rebate coupons available for the asking when you purchase one. Check out the special offers! Test regularly, keep track of your tests, and adjust your insulin according to your diabetic specialist's orders. This step is imperative for good control and to help avoid long-term neuropathic damage.
   
   
2. See your doctor regularly. Make sure your MD orders the appropriate blood tests, including a glycoslyated hemoglobin test every three to four months. If you can't have your doctor test your blood pressure regularly, buy a good quality blood pressure cuff, called a sphygmomanometer, and do it yourself. High blood pressure is common in both types of diabetes and a root cause of many circulatory and neuropathic problems. If you are already on blood pressure medicines, don't forget to take them as prescribed. Take a good diabetes "patient education" course, often available at your local hospital and usually covered by medical insurance.
   
   
3. Monitor all your physical changes carefully. If you have a wound that doesn't heal, don't delay—call your doctor. If you gain or lose weight suddenly, you may need to make changes in diet, lifestyle, or medications. If your vision changes, especially if you see floating or moving particles within the eye, or you have persistent eye pain, see an ophthalmologist immediately.
   
   
4. Quit smoking! Along with all the other reasons not to smoke cigarettes, you should be aware they cause rapid and often irreparable damage to capillaries in the eyes and extremities. If you smoke cigars or a pipe, do so ONLY IN STRICT MODERATION, and only in a well-ventilated area, to avoid inhaling second-hand smoke.
   
   Moderation goes for alcohol consumption as well. Small amounts can be factored into your diet, but remember that it is especially difficult for insulin dependent diabetics to digest alcohol without experiencing a rapid rise in blood sugar, generally followed by a rapid lowering of blood sugar. Ask your doctor for the latest information on moderate alcohol consumption in a diabetic diet.
   
   
5. See a dietician. You'll be surprised at recent advances in dietary medicine. If your blood sugars tend to run high, you may need to increase consumption of both water and dietary fiber, since high BGs can dehydrate the lower tract. High protein diets were once considered fine for newly-diagnosed type 1 diabetics; but if you have any sign of kidney trouble, your doctor should instruct you on how to lower the amount of protein in your diet. A high protein intake is very hard on impaired kidneys, so a weight loss diet that's all meat and fat should be avoided.
   
   
6. Exercise at least five days each week. If you don't want other complications of long-term diabetes to occur, exercise is imperative. If you're saying "Well, that's not going to happen, " just remember that 30 to 45 minutes of fast walking can often take the place of more strenuous workouts. Someone once quipped, "Whenever I feel the urge to exercise I lie down until it goes away." I hope he wasn't diabetic!
   
   Park your stationary bike directly in front of the TV. When you snack try grapes, celery, cucumber slices, or popcorn without butter. Drink at least eight ounces of water for every ten pounds of body weight every day, and more if you're working up a good sweat. Take a good quality multi-vitamin with chelated minerals, one that's high in anti-oxidants.
   
   I recently took the ANSCORE test, available from Boston Medical Technologies. This unique test monitors the cardiac autonomic nervous system. Ask your endocrinologist where you can have this important test performed. I recommend it highly to ALL diabetics, as it measures responses of the heart muscle over timed and painless stress periods. It then gives a quantified measurement of any neuropathic damage in the cardiac autonomic nerves. The autonomic nervous system is responsible for involuntary bodily functions, things like keeping your heart beating, adjusting the heart rate to match your level of stress, telling the body when it's time to sweat, sexual response, and other functions that aren't consciously controlled. After 44 years as a diabetic, some in which I was not maintaining good control, my test showed that my cardiac autonomic neuropathy response was abnormal for all three tests. When ANSCORE results are abnormal, it may mean that the diabetic patient is at risk for silent heart attack, coronary infarction without normal symptomatic warnings. The good news is that there are positive steps that can be take to maximize one's ability to avoid myocardial infarction. No one wants to have a heart attack.
   
   If you've just been diagnosed diabetic, you need to exercise each day, every day, if your doctor says it's okay. If you're an old hand at diabetes and need to increase your exercise, see your cardiologist and have him adjust your regimen.
   
   
7. Watch your feet. Keep them clean, and don't trim nails too short. Wear comfortable shoes that fit properly and provide good support. Since diabetic circulatory problems usually first develop in the lower extremities, it is wise to get acquainted with a good podiatrist as soon as possible.
   
   
8. Enrich your spiritual life. The first stage of any program designed to end habitual destructive behavior is to surrender your care and concern to a higher power. Poor self-management of your diabetes can be a lot like a chemical or behavioral addiction, since it can cause chronic damage. You need to be actively involved in a diabetic health maintenance program, one with a positive outlook. It's important to not only stop destructive diabetic behaviors (the activities and inactivities that keep your blood sugars too high), but to replace bad habits with good ones. Prayer and meditation have been positive influences for me and other diabetics I've interviewed. For the nearly 20 years that I've been visually impaired, I have done all that I am able to introduce spiritual light into my daily life and practice. It doesn't cost anything, it doesn't require special equipment, and it absolutely can't hurt you, so why not give it a try?
   
   
9. Stay positive! No matter what life throws at you, each time you wake up breathing you are better off than the 1,500,000 humans each day who will not live to see tomorrow's dawn. Be thankful! Every day we are blessed with life is another gift. If you don't believe this, go out and give some of your life to someone else. Once you get involved with helping others you'll find you have more to give.
   
   Don't sit. If you're not regularly active, employed or as a volunteer, get a part time job. Visit somebody who's lonely, volunteer at a retirement center, a veteran's center, or offer to mentor a child. Go talk to a friend, and never miss an opportunity to tell them why you care for them. If you are dealing with depression, do not be afraid to seek professional counseling. Those seeking counsel are not weak, but smart enough to know when they need assistance. One of the best habits you can develop is to quit depressing yourself by incessant complaining.
   
   In your leisure time, read a good book. Studies show that you'll burn more calories reading a good story for one hour than you will watching three hours of television.
   
   Diabetes isn't the end of your life. You have many options and lots of choices to make. Choose to be alive, to be thankful, to be positive, and to get involved. Even with long-term type 1 diabetes, I live a very full life. I lost my eyesight to my disorder, and yet I'm a professional writer, writing two columns monthly, the manager of a prosperous machine vending company, a part-time "house husband" who does most of the shopping and cooking for my wife of more than 21 years, and an active lay minister. I am totally blind, and have mild neuropathic damage in my toes and kidneys, yet I hunt deer, elk, or antelope each fall. I play and teach drums, rough-house often with my three dogs, and read an average of 1.5 books from the Talking Books Library each week.
   
   Remember, even if you are dealing with diabetic complications, it is still your responsibility to determine your own mental attitude. Follow the steps I've mentioned, and compare how you feel about your situation after just one month.
   
   Those who believe nothing can be done to improve their situation, and those who believe there is always something they can do to improve things are both right.

(c) Copyright 2003 William F. Schley All Rights Reserved.