Tips from a Diabetes Counselor

To successfully manage your diabetes, it's important to have the support of the people in your life. While your diabetes care will ultimately depend on you, we all need a helping hand. In addition to the support of your medical team, you need the help of the people who love you.

We say diabetes is a family disease because it affects every member of the family. Food selection and preparation are important parts of family life. The need to eat regular meals, take your medication, and avoid low blood glucose can take away some spontaneity from meals and family time. Dining out can also be challenging.

Diabetes management can affect your family in other ways, too. Family and friends may have different feelings about your health: concern and sympathy, fears, guilt or resentment. It’s helpful to recognize that the more your family members and friends know about diabetes control, the more everyone benefits.

Involve your support network:

• Ask them to attend diabetes education classes and support groups with you.
• Encourage them to participate in related activities like those sponsored by the American Diabetes Association and the Juvenile Diabetes Research Foundation.
• Practice skills at home talk to your family about the treatment for low blood sugar. Let them know what you’re going through and how they can help.
• Share your meal and medication schedule. Tell them how you plan to handle any schedule changes so they're prepared in the event of complications.
• Encourage any family member who’s having trouble coping with your diabetes diagnosis to speak with a counselor
• Let others know how they can help you. Maybe it’s easier for you to order healthy foods when others in your group do so first. If it’s hard when they eat sweets in front of you, let them know. If it doesn’t bother you, tell them. Clear the air, and cast off everyone's uncertainty about what to do.
• Ask a family member or friend to join you in an exercise or weight control program.

It’s a normal part of life to feel down on occasion. But for some, a sadness that just won't go away or losing interest in the things that once brought happiness might be a sign of a more serious depression.

Studies show that people with diabetes have a greater risk of developing depression than people without diabetes. This doesn’t mean that because you have diabetes you are certain to have depression, but it does suggest that it’s important to be knowledgeable about depression.

The daily stress of diabetes care can sometimes take a toll. Managing your diabetes may feel lonely. Complications such as nerve damage or blood sugar levels that are difficult to control can add to the emotional burden. Depression can make diabetes care even more difficult, because when we’re depressed it’s harder to care for ourselves. Our eating habits can change, we feel less motivated to exercise and blood sugar control can become even more challenging.

Signs and symptoms of depression:

• loss of interest in doing things you usually like to do
• loss of pleasure
• change in sleep patterns
• change in appetite
• trouble concentrating
• loss of energy
• nervousness
• guilt
• suicidal thoughts or thoughts of death

Experiencing a couple of these symptoms for at least 2 weeks suggests the presence of clinical depression, and reaching out for help is important. Also understand that there may be a physical cause for your depression. Poor control of diabetes and other health problems can sometimes cause symptoms that look like depression. Your doctor can determine if a physical problem might be the cause. If you and your doctor decide there isn’t physical cause, referral to a mental health professional is often the next step. Generally there are two types of treatment – psychotherapy or counseling and/or antidepressant medication.

If you have symptoms of depression, reach out for help and talk it over with your doctor. Don’t go it alone – get the support you need.

Most people who have diabetes agree that checking blood glucose is fairly easy to do and understand it provides useful information. So why do so many people struggle with taking their blood glucose? Is it a lack of will power? Is it that they just don't care?

Turns out most people are pretty reasonable. They stop checking blood glucose when they believe the whole process involves a lot of hassles and see few benefits. And unfortunately, there are quite a few hassles associated with checking your blood glucose – some big, some little, and maybe some silly.

William Polonsky, PhD, CDE, in his book Diabetes Burnout, shares the top 10 reasons people hate checking blood glucose. Number one on his list is: Your meter makes you feel bad about yourself. For some a meter can become how they judge themselves. Depending on the results of testing, it’s common to feel like you're failing if your meter is reading high, or feel like you're a good person if your meter is low.

When you see a high reading, what is your response? It’s common for people to have an inner dialogue almost as though the meter is speaking to them. At times like this, it’s easy to lose sight of the fact that the reading is only a number and doesn’t reflect who you are as a person.

What helps? Turns out, those who are successful with monitoring come to view their readings as simple pieces of information and an opportunity to take action, not as a way to judge themselves. As Dr. Polonsky suggests, "Think of the gas gauge on your car. When it nears empty, do you avoid looking at it? Do you yell at yourself for being so stupid as to allow it to get low? Do you feel like a failure because you allowed this to happen? Do you resent your car because you now have to stop for gas? Probably not. You don't think of the amount of gas in your tank as good or bad; instead the gauge is just providing information that allows you to make the best decisions."

Some helpful tips:

• Stop referring to the process as "testing your glucose." Think of it as monitoring.
• Avoid referring to your readings as good or bad. Instead, think high or low.
• Remind yourself how silly it is to let your blood glucose reading determine your self-esteem.
• Be reasonable about blood glucose expectations. Work with your doctor to determine what is reasonable.

In addition to these tips, join a support group or network, talk with others, be supportive of yourself and take time to care for your emotional, social and physical needs.

Foods that have less than .5 grams/serving can be labeled "sugar free." However, we know that ALL carbohydrates affect blood sugar, not only simple carbohydrates. When a product is labeled "sugar free" it usually doesn’t mean it’s carbohydrate free or calorie free.

It’s extremely important to look past the "sugar free" claim and go directly to the nutrition facts label. First, look at the serving size. Serving sizes are not standardized from label to label, so this is important information. Second, check out the total carbohydrates. This will give you the most information on whether this food is appropriate for you to eat, and how much will equal one carbohydrate choice.

Finally, check out the fat and sodium. When sugar is removed from a food, fat and salt are often added. Make sure that this food does not have additional fat, especially saturated or trans fats, and sodium.

Have you sometimes felt alone with your diabetes as though no one around you really understands what it’s like? Even in the midst of loving family and caring friends, you can sometimes feel isolated. As helpful as those around you might be, there’s a missing element of personal understanding.

Support groups can help provide that missing piece. A support group can be a place of wisdom, encouragement and understanding. You’ll connect with others who are dealing with the same challenges and share ways to live well with diabetes. A dose of humor, sharing stories and joining with others who also live with diabetes can help soften the rough edges of feelings that can go along with this journey.

We offer support groups at CoxHealth. Please consider joining us.

Eating healthy doesn't have to be complicated. Simple substitutions to our everyday food choices can lower calories and fat, and increase fiber, vitamins and minerals. Benefits include better control of blood sugar, feeling more satisfied after meals and having more energy. Here are some ideas:

• Skip the fast food fries and eat a side salad with low-fat balsamic dressing and apple slices instead. Save 260 calories, 16 g. fat and 25 g. carbohydrates.
• Take the skin off your chicken. Save 50 calories and 6 g. of fat per serving.
• Substitute a no-sugar-added ice cream sandwich for 1 cup of regular ice cream. Save 250 calories, 14 g. fat and 22 g. carbohydrates.
• Choose a can of diet soda instead of regular soda. Save 150 calories and 40 g. of carbohydrates.
• Choose 1 cup oatmeal with ½ cup blueberries instead of 2 pop tarts. Save 160 calories, 7 g. fat and 20 g. carbohydrates.

Ask yourself what you really want and in what direction you want your life experience to move. It might be something small, like walking an extra 10 minutes a day or committing to eat three servings of fruits and vegetables each day. Whatever you commit to you'll be amazed at how even small changes add up.

To get started, choose just one or two goals and do them. More than that is overwhelming and often leads to failure in accomplishing any of them. Here are some suggestions; maybe one of these is right for you:

• Aim for three servings of veggies every day. The goal is to eat at least five servings of vegetables every day, but if you can get three servings in, you're doing great.
• Sneak activity in whenever possible. When you’re watching TV, get up and move – dance, march in place, lift weights – every little bit counts.
• Catch some ZZZ's. Too many of us are sleep deprived. Lack of sleep affects blood glucose control and body weight (and not in a good way), and puts you at risk for illness, infection and even heart troubles. If you aren't getting 7 to 8 hours of sleep each night, talk with your physician about what you can do.
• Clean out the cupboards. Cleaning always makes you feel good anyway, but now's the time to get rid of unhealthy foods (cookies, chips, salty soups). If you can't bring yourself to throw them out, move them to a section of the cupboard that's inconvenient.
• Stress less. Too much stress can have a negative effect on our health and wellbeing. Find ways to relax, let things go and enjoy your life. Avoid focusing on things that you have no control over.

Calories and carbohydrates in your food can add up easily enough – you don't want additional calories and carbohydrates in you drinks, too. It’s important to make sure you aren’t having any sugary drinks. Drinks that are high in sugar and calories will spike your blood glucose and do not fill you up. A correctly sized portion of low-fat milk is the only drink that should count as a carb choice.

It’s also important to make sure you drink enough water during the day to stay hydrated. Often your body may feel hungry when really you’re just thirsty. If it’s not a meal or snack time and you’re feeling hungry, drink a big glass of water, wait 10 minutes, and see if you’re still hungry.

Drinks that have caffeine in them will dehydrate you, so limit caffeinated beverages to three cups per day. A general goal for water consumption is eight 8-ounce glasses per day, or 64 ounces. Buy a water bottle that you’ll only need to fill up two or three times to reach your goal and keep it with you throughout the day.

Drinks to avoid:

• Fruit juice
• Sweet tea
• Regular lemonade
• Kool-Aid
• Fruit punch
• Regular soda
• Gatorade

Drinks to enjoy:

• Water
• Sugar-free tea
• Sugar-free lemonade
• Sugar-free Kool-Aid
• Flavored water
• Diet soda
• PowerAde Zero

The day-to-day challenges of diabetes can sometimes get you down. Managing diabetes can be a lot of work and sometimes it seems like even your best efforts aren't paying off. At times like this it's easy to get discouraged. To move from discouraged to encouraged:

• Set clear, specific, short-term goals. Make them realistic and don't try to juggle too many at once. Changing habits can be tough so it’s important you work on only one or two goals at a time. Also, be specific: "I’ll eat three fruits/vegetables each day" or "I’ll drink eight glasses of water each day." Clarifying your goals will help you measure your success.
• Don't let blood sugar readings determine your self-esteem. When blood sugar readings aren’t what you hope, it's common to be critical of yourself. Remember, blood sugar results are neither good nor bad; only helpful information to let you manage your diabetes. If you forget this and start making negative comments to yourself, put a piece of tape on your meter and write, "It's only a number.”
• Measure your success realistically. Some days will be better than other days, and the stresses of life can be challenging. If you you’re having a bad day, try to be realistic and do simple things to take care of yourself. And remember, if you've lapsed about a behavior you’re working to change, forgive yourself, learn from the experience, don't beat yourself up, and then find a way to get back up again. Reaching out to others can also help. Talk to family members or friends.

Eating three meals a day, and having about the same amount of carbohydrates at each meal, will help keep your blood sugars stable. Ideally, keep your meals about 4-5 hours apart. If they’re going to be further apart than that, or if you just prefer to have snacks, you can move a carbohydrate choice from a meal to a snack. If you’re not currently eating three meals a day, that could be a good goal to work on.

Breakfast doesn't have to be anything too complicated. Here are a few suggestions:

• Small bowl of high-fiber or whole grain cereal with skim milk
• Light yogurt, some fresh fruit and a granola bar
• Two pieces of toast with peanut butter and a cup of skim milk
• Oatmeal and one egg
• Whole wheat English muffin, light yogurt and fresh fruit