Keeping good company

If you have diabetes, you’re not alone. Quite a few famous people live with diabetes every day, just like you. Here are just a few actors that you may recognize:

• Tom Hanks: This actor has played numerous roles since he was diagnosed with type 2 diabetes in 2013, including Captain Phillips, Saving Mr. Banks, and others. Diabetes hasn’t slowed his career at all. In addition to acting, he also produces, directs, and writes screenplays.
• Wendell Pierce: If you enjoyed The Wire on TV, you enjoyed watching this actor, who played Detective Bunk Moreland. He has been in more than 30 movies and has played many roles on TV including Treme. Pierce has tried to help others with his disease by starting a chain of groceries that sell quality food in low-income areas.
• Sharon Stone: No one could say that this actress with type 1 diabetes has failed to obtain any roles or to play them with the greatest skill.

People with diabetes also successfully perform in every professional sport. Here are a few sports and the athletes who live with diabetes and still perform at high levels: (To read about the role of sports and exercise in your life, see Chapter 10.)

• Football: Kyle Love of the Carolina Panthers and Jake Byrne, who played with the San Diego Chargers, are football players who don’t let their diabetes slow them down. Love has type 2 diabetes, and Byrne has type 1 diabetes.
• Baseball: Sam Fuld plays baseball for the Oakland Athletics and Brandon Marrow plays baseball with the San Diego Padres.
• Basketball: Gary Forbes plays basketball for the Toronto Raptors and Adam Morrison recently retired from professional basketball after playing for the Los Angeles Lakers and the Charlotte Bobcats.

If you think that diabetes might prevent you from a career in the sciences, just consider these modern day researchers with diabetes performing at the highest level in every field:

• David Cummings, MD: A professor at the University of Washington, he is exploring the place of metabolic surgery in type 2 diabetes.
• Martin Gillis, DDS: He is clarifying the effect of diabetes on the oral cavity.
• Nicholas Mayall: He added to science’s knowledge of nebulae, supernovae, spiral galaxies, and the age of the universe, and he’s in no way limited by his diabetes. And neither should you be.

Realizing your potential

The names in the preceding paragraphs are just a few examples of people with diabetes who have achieved greatness. Here is my point: Diabetes shouldn’t stop you from doing what you want to do with your life. If you follow the rules of good diabetic care, as I describe in Chapters 7 through 12, you will actually be healthier than people without diabetes who smoke, overeat, and/or don’t exercise enough.

Experiencing denial

Your first response was probably to deny that you had diabetes, despite all of the evidence. Your denial mindset may have begun when your doctor tried to sugarcoat (forgive the pun) the news of your condition by telling you that you had just “a touch of diabetes,” (an impossibility equivalent to “a touch of pregnancy”). You probably looked for any evidence that the whole thing was a mistake. Perhaps you even neglected to take your medication, follow your diet, or perform the exercise that is so important to maintaining your body. But ultimately, you had to accept the diagnosis and begin to gather the information you needed to help yourself.

When you accepted the diabetes diagnosis, I hope you also shared the news with your family, friends, and people close to you. Having diabetes isn’t something to be ashamed of, and you shouldn’t hide it from anyone. You need the help of everyone in your community: your co-workers who need to know not to tempt you with treats that you can’t eat, your friends who need to know how to give you glucagon (a treatment for low blood glucose) if you become unconscious from a severe insulin reaction (see Chapter 4), and your family who needs to know how to support and encourage you to keep going.

Your diabetes isn’t your fault — nor is it a form of leprosy or some other disease that carries a social stigma. Diabetes also isn’t contagious; no one can catch it from you.

Feeling anger

When you pass the stage of denying that you have diabetes, you may become angry that you’re saddled with this “terrible” diagnosis. But you’ll quickly find that diabetes isn’t so terrible and that you can do something to rid yourself of the disease. Anger only worsens your situation, and being angry about your diagnosis is detrimental in the following ways:

• If your anger becomes targeted at a person, he or she is hurt.
• You may feel guilty that your anger is harming you and those close to you.
• Anger can prevent you from successfully managing your diabetes.

As long as you’re angry, you are not in a problem-solving mode. Diabetes requires your focus and attention. Use your energy positively to find creative ways to manage your diabetes. (For help managing your diabetes, see Part III.)

Bargaining for more time and feeling depressed

The stage of anger often transitions into a stage when you become increasingly aware of your mortality and bargain for more time. Even though you probably realize that you have plenty of life ahead of you, you may feel overwhelmed by the talk of complications, blood tests, and pills or insulin. When you realize that bargaining doesn’t work, you may even experience depression, which makes good diabetic care all the more difficult.

Studies have shown that people with diabetes suffer from depression at a rate that is two to four times higher than the rate for the general population. People with diabetes also experience anxiety at a rate three to five times higher than people without diabetes.

If you suffer from depression, you may feel that your diabetic situation creates problems for you that justify being depressed. You may rationalize your depression in the following ways:

• You can’t make friends as easily because diabetes hinders you.
• You don’t have the freedom to choose your leisure activities.
• You’re too tired to overcome difficulties.
• You dread the future and possible diabetic complications.
• You don’t have the freedom to eat what you want.
• You’re constantly annoyed by all of the minor inconveniences of dealing with diabetes.

All of the preceding concerns are legitimate, but they also are all surmountable. How do you handle your many concerns and fend off depression? Following are a few important methods:

• Try to achieve excellent blood glucose control (see Part III).
• Begin a regular exercise program (Chapter 10).
• Tell a friend or relative how you are feeling; get it off your chest (Chapter 20).
• Recognize that every abnormal blip in your blood glucose is not your fault (Chapter 7).

If you can’t overcome the depression brought on by your diabetic concerns, you may need to consider therapy or antidepressant drugs. But you probably won’t reach that point.

Moving on

You may experience the various stages of reacting to your diabetes in a different order than I describe in the previous sections. Some stages may be more prominent for you, and others may be hardly noticeable.

Don’t think that any anger, denial, and depression are wrong. These feelings are natural coping mechanisms that serve a psychological purpose for a brief time. Allow yourself to have these feelings — and then drop them. Move on and discover how to live normally with your diabetes.

These phases of coping may not occur in the order given, may not occur at all, and/or may last a long time. If one phase inhibits your ability to cope with your diabetes for more than a few months, you may need outside help.

Here are some key steps you can take to manage the emotional side of diabetes:

• Focus on your successes. Some things may go wrong as you find out how to manage diabetes, but most things will go right. As you concentrate on your successes, you will realize that you can cope with diabetes and not let it overwhelm you.
• Involve the whole family in your diabetes. A diabetic lifestyle is a healthy lifestyle for everyone. For instance, the exercise you do is good for the whole family. By doing it together, you strengthen the family ties while everyone gets the health benefits. Also, should you need your family to help you, for instance, during a particularly severe case of low blood glucose, their early involvement in learning about diabetes will give them the peace of mind to know they are helping you, not hurting you. (See Chapter 20 for ways to enlist help from people around you.)
• Develop a positive attitude. A positive attitude gives you a can-do mindset, whereas a negative attitude leads to low motivation preventing you from doing all that is necessary to manage your diabetes.
• Find a great team, pinpoint problems, and set goals. Determine the most difficult problems that you have with your diabetes and then consider how you can solve them by yourself or with a great team of supporting players like a primary care physician, a diabetes specialist, a diabetes educator, a dietitian, an eye doctor, a foot doctor, and so forth. Set realistic goals to get past your problems. (Chapter 12 tells you everything you need to know about getting help from the supporting players.)
• Don’t expect perfection. Although you may feel that you’re doing everything right, you may experience blood glucose levels that are too high or too low. This uncontrollable situation happens to every person with diabetes, and it’s one of the biggest frustrations of the disease. Don’t beat yourself up over something you can’t control. Keep doing the things I suggest in the treatment section, and you will be very gratified at the end.

Exercising regularly

People who do regular exercise often describe it as addictive. They find it so pleasurable that they look forward to the next session. And the benefits for the person with diabetes are enormous.

In one long-term study on quality of life for people with diabetes, a factor that contributed to a lower quality of life rating was a lack of physical activity, which is one negative factor that you can alter immediately. Physical activity is a habit that you must maintain on a lifelong basis. (See Chapter 10 for advice on exercise.) The problem is that making a long-term change to a more physically active lifestyle is difficult; most people become more active for a time but eventually fall back into inactive routines.

Another study demonstrated the tendency for people with diabetes (and for people in general) to abandon exercise programs after a certain period of time. This information was reported in the New England Journal of Medicine in July 1991. In this study, a group of people with diabetes received professional support for two years to encourage them to increase physical activity. For the first six months, the study participants responded well and exercised regularly, resulting in improved blood glucose, weight management, and overall health. After that, participants began to drop out and not come to training sessions. At the end of the two-year study, most participants had regained their weight and slipped back into poor glucose control. However, the few people who didn’t stop their exercise maintained the benefits and continued to report an improved quality of life.

Factoring in the (minimal) impact of insulin treatments

If you’re in the small group of diabetics who require intensified insulin treatment, perhaps you’re afraid that intensified insulin treatment, which involves three or four daily shots of insulin and frequent testing of blood glucose, will keep you from doing the things that you want to do and will diminish your daily quality of life. (See Chapter 11 for more information about intensified insulin treatment.) Your fears are not justified by the facts.

A study published in Diabetes Care in 1998 explored whether the extra effort and time consumed by such diabetes treatments had an adverse effect on people’s quality of life. The study compared people with diabetes to people with other chronic diseases, such as gastrointestinal disease and hepatitis (liver infection). The diabetic group reported a higher quality of life than the other chronic illness groups. Interestingly, the people in the diabetic group were not so much concerned with the physical problems of diabetes, such as intense and time-consuming tests and treatments, as they were concerned with the social and psychological difficulties.

Another report in Diabetes Care in 1998 stated that insulin injections don’t reduce the quality of life; the person’s sense of physical and emotional well-being remains the same after beginning insulin injections as it was before injections were necessary.

Teenagers who require insulin injections don’t always accept the treatment as well as adults do, so teenagers more often experience a diminished quality of life. However, a study of more than 2,000 such teenagers, published in Diabetes Care in 2001, showed that as their diabetic control improved, teens felt like they were in better health, experienced greater satisfaction with their lives, and therefore believed themselves to be less of a burden to their families.

Managing stress

A study described in Diabetes Care in January 2002 showed that lowering stress lowers blood glucose. Patients were divided into two groups, one of which received diabetes education alone and the other of which received diabetes education plus five sessions of stress management. The latter group showed significant improvement in diabetic control versus the former group.

Whether stress raises the blood glucose directly by causing the release of stress hormones or raises it indirectly by causing overeating, under-exercising, and failure to take medications, managing stress certainly helps to manage your diabetes. Here are some of the things you can do to help manage stress in your life:

• Identify the source of the stress. Are you adding to stress yourself by accepting it as an unchanging part of your life or blaming others or outside events that you can’t control?
• Examine the way that you cope with stress now. Do you smoke, drink too much, overeat, spend too much time in front of screens, sleep too much, or overschedule yourself so you have no time?
• Replace unhealthy coping mechanisms with healthy ones. Avoid the stress you’ve identified or make a change in your life. Adapt to the stress or accept it. You can’t avoid your diabetes, but you can make it less stressful by following my recommendations in Part III.
• Take time out for fun and relaxation. Here are some of the things you might do:
  • Have a picnic lunch
  • Get a massage
  • Take a long bath
  • Work in a garden
  • Play with a pet or go to the zoo
  • Listen to your favorite music
  • Go to a comedy show or rent a funny movie
  • Stay in bed with your significant other

Considering other key quality-of-life factors

Many other studies have examined the different aspects of diabetes that affect quality of life. These studies show some useful information on the following topics:

• Family support: People with diabetes greatly benefit from their family’s help in dealing with their disease. But does having a close family help people with diabetes maintain better diabetic control? One study in Diabetes Care in February 1998 addressed this question and found some unexpected results. Having a supportive family didn’t necessarily mean that the person with diabetes would maintain better glucose control. But a supportive family did make the person with diabetes feel more physically capable in general and much more comfortable with his or her place in society.
• Quality of life over the long term: How does a person’s perception of quality of life change over time? As they age, do most people with diabetes feel that their quality of life increases, decreases, or persists at a steady level? The consensus of several studies is that most people with diabetes experience an increasing quality of life as they get older. People feel better about themselves and their diabetes after dealing with the disease for a decade or more. This report shows the healing property of time.

Following are some other factors that improve quality of life for people with diabetes. Though I can’t cite any particular studies here, doctors and patients alike can vouch for their importance.

• Blood glucose levels: Keep your blood glucose as normal as possible (see Part III for tips).
• Continuing education: Stay aware of the latest developments in diabetes care.
• Your attitude: Maintain a healthy attitude. Remember that someday you will laugh about things that bug you now, so why wait?