Seeing the Big Picture

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To insure good health: Eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.

– William Londen

Achieving any big goal usually involves taking many small steps. Certainly that is true when your goal is to maintain good health with a chronic illness such as diabetes. The routine tasks that you carry out daily, weekly, or in some cases less frequently to keep your blood glucose in target range all contribute toward your goal of good health with diabetes.

But sometimes it’s important to take a step back from the actions you’re taking to reach your goal and take a look at the goal itself: Is the goal still a reasonable one for you? Do you still feel motivated to work toward it? Or might you need to redefine what you’re aiming for?

It’s also important to assess the effectiveness of the steps you’ve been taking to reach your goal: Are they having the desired effect? Can you fit them into your life reasonably well, or are you struggling to carry them out?

If you feel motivated to care for your diabetes most of the time, and the actions you take to care for your diabetes seem to work well in the majority of situations, you probably have a good plan in place that doesn’t need any major changes. On the other hand, if good health seems like an impossible goal, and you’re struggling to carry out the tasks your diabetes care providers have recommended, your plan isn’t working and needs to be revised so you can feel that your efforts are doable and worth doing.

This article presents some of the basic elements for staying healthy with diabetes (see “Take-Away Tips“). As you read, think about how best to fit them into your life, what you can do on your own, and where you might need some help from your diabetes care team or from the other people in your life.

Eat lightly

People with diabetes have two good reasons to eat lightly: weight control, and blood glucose control. Overweight – particularly excess fat in the midsection of the body – contributes to insulin resistance, which makes it harder to keep blood glucose levels in target range. While most people with Type 2 diabetes have some degree of insulin resistance, it can also occur in people with Type 1, particularly if they become overweight.

Even with good reasons to eat lightly, however, doing so can be difficult in today’s food-centric society: Large portions have become the norm at most restaurants, and many events and celebrations are centered on eating. For people with diabetes, it’s also easy to get caught up in the details of eating – such as the proportions of carbohydrate, fat, and protein in each meal – and to lose sight of the overall importance of choosing healthful foods and eating enough but not too much of them.

If you’re gaining weight or having high blood glucose levels after meals, take a look at how much you’re eating. The average American adult eats 2700 to 3700 calories per day, which is two to three times what he actually needs. By simply trimming your portions, you are likely to slow your weight gain and lower your after-meal blood glucose levels. (However, if you match your premeal insulin doses to the carbohydrate in your meal, you will need to count the carbohydrate. Also, if you continue to have high blood glucose levels after meals even after cutting your portions, you may need to check in with your diabetes care team to discuss an alternative treatment plan adjustment.)

While the advice to “eat lightly” sounds simple, food issues can be complicated. That’s where a registered dietitian (RD) who specializes in diabetes can help. An RD can give you basic information about good nutrition and healthy eating and can help you design a meal plan that will help to control your diabetes. Checking in with an RD at least annually is ideal, since your needs and your diabetes treatment will likely change over time. Usually with a physician referral, most insurance plans, as well as Medicare, will pay for at least an annual visit with an RD.

Breathe deeply

Breathing deeply is associated with a relaxed body and a calm state of mind, while shallow breathing is associated with stress, anxiety, and pain, as well as with some serious medical conditions. Learning to breathe deeply is at the center of many relaxation techniques, including the Relaxation Response, developed by Herbert Benson, MD, and based on traditional forms of meditation. Practicing a relaxation technique not only slows breathing but also lowers blood pressure, heart rate, and muscle tension.

The benefits of learning to relax are obvious when dealing with a condition that requires as much care as diabetes. Having to regularly monitor your blood glucose level, make decisions about healthy food choices, fit in time for physical activity, and take one or more medicines can get stressful. Add to those responsibilities things like maintaining a household and coping with job and family stresses, and on occasion, life and diabetes care may start to become overwhelming.

While learning and practicing a relaxation technique may sound like one more thing to do, in fact, it can make your entire to-do list easier to face. It may also help you feel less anxious about asking for help when you need it. For example, if your diabetes needs extra attention, you might want to ask a family member to help out with chores around the house to free up some of your time. Or, if possible, you might want to request a day off from work once in a while to catch up on your diabetes care appointments.

A diabetes support group can also be a source of social, emotional, and practical support. Each group is different, and some may emphasize presentations by experts at meetings while others focus more on group discussion. (Many groups fit in some of both.) But all should provide the benefits of connecting with other people facing the same challenges and learning new coping skills through sharing experiences and information.

Live moderately

The advice to live moderately can be applied to many parts of life, including eating, drinking alcohol, and being physically active. But while moderating one’s food and drink often means cutting back, being moderately active means increasing activity levels for most people.

A sedentary lifestyle is common among American adults, including those with diabetes. That’s unfortunate, because regular, moderate physical activity can be very effective at lowering blood glucose levels and improving heart health – a benefit everyone could use.

The general recommendation for exercise for adults with diabetes is at least 150 minutes a week of moderate aerobic exercise and three weekly resistance training workouts. If you currently do no exercise at all, start by checking in with your diabetes care team to see if you should be screened for heart problems or other diabetes complications. Also ask your team to advise you on the type, amount, and intensity of exercise that is right for you. No matter what your ultimate goal, you will need to build up slowly (again, practicing moderation), increasing the length and intensity of your activity sessions by small increments at a time.

Cultivate cheerfulness

You may think that cheerfulness is an inborn personality trait, but in fact, cultivating an attitude of cheerfulness can be learned like any other habit – even if life often feels stressful or difficult. Exactly how it’s done depends on the person, but here are some ideas for cultivating cheerfulness in your life:

  • Look for opportunities to laugh. Not only does it feel good to have a hearty belly laugh, it’s literally good for your health, lowering the stress hormones that can raise blood glucose levels. So seek out people, pets, TV shows, YouTube videos, joke-a-day calendars, or anything else that makes you laugh.
  • Smile more often, even if it’s just at yourself in the mirror, and even if you don’t really feel like it. Sometimes smiling when you don’t feel particularly cheerful can make you feel a little more cheerful. And if you get a smile in return from another person, so much the better.
  • Get outside, particularly if it’s sunny out, but even if it’s not. Being out in natural light is a known mood booster, and being active while you’re outside is even better.
  • Pay attention to your environment. Have you chosen colors for your living spaces that cheer you up or bring you down? You’ll feel more cheerful if you surround yourself with colors that feel cheery, not dreary. And don’t forget that the lighting in your home affects the appearance of the colors. Get light bulbs that are bright enough to show off your cheery color selections.
  • Find something to be grateful about every day. It doesn’t have to be something huge, and it doesn’t mean that you have everything you want or need in life, but it can help to remind yourself that there are some things for which you’re grateful.
  • Expect the best. Without becoming Pollyanna, try to expect that you will be able to work out problems and that your interactions with other people will generally be positive and constructive. Taking this attitude can help you to feel less anxious and/or defensive, which can in turn raise the chances that you will get the outcome or response that you want. It can be particularly useful at your diabetes care appointments: Rather than assume that your health-care provider is going to scold you for some slipup in your care, assume that he wants to help you succeed – by identifying the barriers you face and finding ways around them.

Maintain an interest in life

While it’s important to be engaged in caring for your diabetes, it’s equally important to have other interests and activities in your life. In fact, the desire to be able to pursue your other interests may be what motivates you to care for your diabetes. After all, the better you feel physically and mentally, the more likely you are to partake of activities you love, whether it’s attending sports events or playing sports, going to the theater, or doing crafts.

So how do you prioritize your diabetes care so you have time to pursue other things?

Monitoring your blood glucose level on a regular schedule can help you stay on track by alerting you to problems early. If you have a week of unusually high blood glucose numbers, for example, you know that something’s up, and you may need to seek help to find the cause or to make adjustments to your diabetes plan to bring your numbers back down. Making sure you get an A1C test two to four times a year can also help you stay on track. The A1C test gives you a snapshot of your blood glucose control over the past 2–3 months; for most adults with diabetes, the recommended goal for A1C is less than 7%. If your A1C is higher, ask your diabetes care team what actions on your part are necessary for lowering it.

Taking any prescribed diabetes medicines at the right time(s) of day in the right dose(s) will go a long way toward keeping your blood glucose level in target range. Work with your diabetes care team to come up with a medicine schedule that works best for you and your daily schedule. Then use any tools – such as weekly pill boxes or automated reminders – you need to help you remember to take your medicines. Filling your prescriptions on time is important, too, to avoid disruption in your routine. If you need help remembering, many pharmacies and suppliers offer free phone or e-mail reminders to refill or renew your prescriptions.

Having the flu can wreak havoc on your blood glucose control and keep you out of commission for weeks or even months, so be sure to get an annual flu shot. While most insurance plans and Medicare will pay for the flu vaccine, even if you have to pay for it yourself, the flu vaccine is a bargain compared to being away from work and other obligations (as well as the things you enjoy) for days on end or, worse, developing flu complications (such as pneumonia) and having to pay for additional medicines or even a hospital stay.

But what if nothing feels enjoyable, meaningful, or worth the effort that daily diabetes care requires? If you feel that way, you may be depressed. Depression is common among people with diabetes, and it can suck the joy and meaning out of life. The symptoms of depression include the following:

  • Persistent sadness
  • Lack of interest in activities that used to bring pleasure
  • Changes in appetite (eating more or less, sometimes resulting in weight loss or gain)
  • Changes in sleeping habits (sleeping more or less)
  • Feelings of guilt or worthlessness
  • Low energy
  • Difficulty concentrating or thinking clearly
  • Sluggishness or agitation
  • Thoughts of death or suicide

When a person has experienced five or more of these symptoms for most of the day nearly every day for at least two weeks, he can be diagnosed with major depression. People who are experiencing some of these symptoms but fewer than five may be diagnosed with minor depression or a depressed mood.

If you think you might be depressed, speak to your diabetes care team. There is help that is safe and effective, including counseling and antidepressant medicines.

Give yourself credit

When all is said and done, you should be proud of yourself for all the things you do to stay healthy with diabetes. Taking some time to plan and make sure you stay on top of your diabetes will prove to be beneficial in the long run. While attention to the detail you are so familiar with is important, don’t forget to take time out to look at the “big picture”; you and your diabetes will be better off as a result.

Originally Published August 9, 2011

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