I'm Dr. David Hite, a member of the American Association of Diabetes Educators.
I provide Diabetes Education classes for a large non-profit healthcare organization in Sacramento, California. I know that most of you can't attend my diabetes class in person at the clinic, so I've created an educational DVD and this e-book "Type-2: Straight Talk About Diabetes Self-Care" to help you understand Type-2 Diabetes, and learn how you can Take Control of Your Diabetes or offer needed help to a friend or loved one who may be struggling to avoid the medical complications that often come with this disease. This information is also perfect for those of you who have pre-diabetes and want to reverse those symptoms and avoid progression to diabetes. If you have not already done so, I encourage you to get my complete Diabetes Basics-Take Control DVD presentation and learn even more about your condition. Good health. Live well.

Type-2: Straight Talk About Diabetes Self-Care

Diabetes is a chronic condition. It’s not yet curable. But we do know some secrets to help you stay healthy and avoid diabetic complications. Your doctor is a very important part of staying healthy, so visit and have blood tests 2-3 times each year so you can spot potential problems early and to make sure you're still on track. But also remember what you do for yourself when you leave the doctor is just as important as anything your doctor can do. The secret involves Taking Control of your diabetes by following my 5 M’s of diabetic care. Sounds simple, but you all know that diabetes is a complex and frustrating medical condition. There’s a lot to learn, but the more you know, the easier it will be to stay healthy. I hope this section specifically on the topic of Motivation will help to answer some of your questions and set you on the road to good health.

MOTIVATION

I know that stress isn't good for your health, but will it affect my blood sugar?

Yes it will. Unrelieved stress is one of the things that will not only have an effect on your emotions and overall health; it will have a direct effect on your blood sugars.

The body views stress as an attack or challenge, and responds by preparing our bodies to fight or flee. Adrenalin and the stress hormone cortisol are pumped into the blood from glands just above the kidneys; your heart begins to beat faster and blood pressure goes up; and blood sugars rise, all to help you escape the danger at hand. In a more natural situation, real danger would pass and our bodies would return to a normal state. But in today’s world many "dangers" do not pass, so instead of the action found in fight or flight, our response is to freeze, leaving ourselves in a state of constant anxiety. These modern day "dangers" in fact, don’t even have to be a real or immediate threat. If we perceive it as threatening in any sense of the word; fear, anger, even frustration or uncertainty; in any case, we’re left with the continuing feeling of anxiety, and fear. This lack of resolution of distress leaves us literally “stewing in our own juices”. This type of unrelieved stress is one of the most insidious factors negatively affecting our health and well-being. Cortisol, also known as the stress hormone, may be responsible for the increase in belly fat seen in many type-2 diabetics. Studies show that when a person is overly stressed, the body reacts by storing away extra fat in anticipation of the coming danger.

Before we leave this point I want to be sure you understand what I mean by unrelieved stress. In his book "Stress without distress" Hans Selye describes stress as not a single thing, but rather a continuum that starts low and continues to high. Some stress is necessary in our lives. In fact stressors are what give our lives richness and meaning. If we had no stress in our lives, we would have no reason to get out of bed in the morning; no reason to live. A research study was done in Florida to determine how stress affected the health of retirees in an “old folk's home”. The term was used purposely because it implies the conditions they found; an old, run down facility where people simply sat out their last years with very limited stimulation. When the researchers changed the environment by opening windows to let in more light, playing music, taking the patients out into the garden, bringing in a box of puppies and letting them play, things began to change. Patients’ depression lessened and moods became brighter, they had more energy and began to get themselves up and take better care of their hygiene, they slept better and laughed more and most importantly they lived longer. All of us need some stimulation in life, some reason to live. This level of stress is termed eustress, which means normal or good stress. It gives our lives meaning. When we fill our lives with activities and things that are meaningful, we increase our stress, but in a healthy way.

Each of us has the ability to deal with stress in life, but everyone has limits. When we exceed our limits we move into another zone of stress termed distress. This term is more common to us and we all know that distress is a bad thing. Most of us, however, don’t appreciate just how damaging it is on our health. To further complicate things, none of us enters this zone of distress at the same time. Some people are able to perform quite challenging, even frightening activities with no apparent distress. Take a racecar driver for example, or a mountain climber, or bungee jumper. Most of us would not be having fun if we were hanging from a cliff by a single thin rope. Why do some people have the ability to stretch their limits? Well, we simply don’t know, and for our purposes, it’s really not important. What's important is that we acknowledge that all of us have limits, and honor them. What each of us must do to avoid distress is know when we enter the distress zone. There will likely be signs if we pay attention. When we have too much on our plates, and become overwhelmed, sleep patterns might be affected. One person might sleep too much, another, not at all. You might lose your appetite or eat compulsively. Bowel movements may change from constipation to diarrhea and back again. Some people might have headaches or difficulty concentrating. Accidents are common from not paying attention to the moment, or from moving too fast before we look. Depression, anger, and resentment are often present when a person exceeds their emotional or physical limitations and falls into a state of distress.

Our bodies are built for action, so fight or flee as appropriate, just don't freeze. Take Action. Go for a walk, read, listen to soothing music, meditate or pray, there is no one best way. The best way is your way, the way that works for you. Find healthy ways to relieve your distress, and do it often. The comedian Lily Thomlin says it simply: "For fast acting relief, try slowing down".

Many years ago one of my patients reminded me of our mortality by suggesting that regardless of the state of one's health we are all just a heartbeat away from eternity. She then said "I'm grateful for today, and hopeful for tomorrow. In the meantime I enjoy the time I'm given".

When I’m feeling low and overwhelmed I like to re-read the wise and comforting words found in Max Ehrmann’s famous poem Desiderata. In part it reminds us: "But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself."

This humorous adaptation was offered to me by one of my friends at Diabetic Connect. I hope it makes you smile.

Desiderata for Diabetics

Go placidly amid the noise and the haste,
And remember that stress and cortisol may raise your levels.

As far as possible, without surrender,
be on good terms with health care professionals of all types.
Speak your truth quietly and clearly;
and listen to others,
except to the diet and diabetes police;
they just don’t get it.
Avoid loud and aggressive persons;
they are vexatious to good glycaemic control.

If you compare your HbA1c with others,
you may become vain or bitter,
for always there will be greater and lesser numbers than your own.
Enjoy your achievements as well as your plans.
Keep interested in your own blood sugar diary, however humble;
it is a real possession in the changing fortunes of time.

Exercise caution in following fads and online cures,
for the world is full of trickery.
But let this not blind you to what virtue there is in GI and GL diets;
many persons strive for perfect control,
and everywhere life is full of Joslin medalists.

Be yourself. Especially do not forget your insulin.
Neither be cynical about the bond between fellow sufferers,
for in the face of all aridity and disenchantment,
it is as perennial as the grass.

Take kindly the counsel of the old timers,
remaining optimistic about the future for the young.
Nurture strength of spirit to shield you should your retinopathy scan not be perfect.
But do not distress yourself with dark imaginings.
Many fears are born of looking at the wrong sites on the internet.

Beyond a wholesome discipline,
treat yourself from time to time.
You are a person with diabetes
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.

Therefore be at peace with your endocrinologist,
however lacking in knowledge you perceive him to be.
And whatever your labors and aspirations,
in the noisy confusion of life,
make sure you have enough test strips.

With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful. Strive to be happy.

I know that motivation is important, but that's the one I'm having trouble with. I sometimes get really discouraged. Besides your diabetes DVD can you recommend any books or websites that will help me stay on track?

Your condition, diabetes, is considered chronic, it's not yet curable. This means that you'll probably live with diabetes the rest of your life (remember, your sugar cruise control is broken). Proper management is the secret to living well with diabetes, and to do that you need to have knowledge about your condition, support from your doctors; your friends and loved ones; and the motivation to carry on even when you are weary.

Remember that what you do to maintain good health when you leave the clinic is just as important as anything the doctor can do. In fact, you are the most important part of the process of staying well. So find a natural balance and don't try to be everything to everybody.

The serenity prayer offers wisdom on the subject:

Give me the serenity to accept the things I cannot change;
Courage to change the things I can,
And the wisdom to know the difference.

Here are some other helpful books and websites that will help you stay motivated and on track.

Diabetes Burnout by William H. Polonsky, is a supportive guide to keeping you on track during tough times.

For healthy eating tips I think the Mayo Clinic Healthy Weight Pyramid is a good guide to follow, but remember you will have to limit your intake of fruit.

Michael Pollan's book In Defense of Food: An Eaters Manifesto is a fantastic book and will make you reconsider everything you thought you knew about food. His advice is simple: "Eat food. Not too much. Mostly plants." Follow his motto: "If it came from a plant, eat it; if it was made in a plant, don't."

The South Beach Diet is a lower carbohydrate diet that encourages eating lean protein, healthy fats, and high fiber natural "good carbs".

Check out Toma Grubb's website and new book Toma's Diabetic Diet - A Layman's Guide to Controlling Blood Glucose with Diet.

He includes a trial version of CyberSoft's Nutribase-7 Personal Plus Nutrition and Fitness Software that helps you make healthy eating choices and track the results.

One of the early pioneers of diabetes information online is David Mendosa. His website is an excellent source of information on all things related to diabetes. Toma and David are both living well with diabetes and are an inspiration to others wanting to control their blood sugars and avoid health problems by adopting a healthy lifestyle.

A good book and resource for understanding glycemic index and healthy eating is The New Glucose Revolution. by Jennie Brand-Miller.

I also think you should get a calorie-counting guide and begin to learn about the foods you eat. I recommend Allan Borushek’s The CalorieKing Calorie, Fat & Carb Counter. This book is full of great ideas and explanations about how to make healthy food choices.

For those of you who like to chat online, I will recommend a wonderful website where you can network with other people with diabetes, ask questions and get ideas and support at Diabetic Connect.

Finally, if you would like to get involved with community-based programs that increase awareness about diabetes, the American Diabetes Association website can help get you connected and active locally.

I hope my explanations in this e-book have been helpful. If you have not already, I encourage you to get my complete Diabetes Basics-Take Control DVD presentation and learn even more about your condition. Be your own advocate, your own best friend, and most importantly, don’t beat yourself up over small setbacks. Believe in yourself and in your ability to take control of your life and control your diabetes; then take the first step toward living a healthy life. Remember, knowledge is powerful only if it leads to positive change. If this e-book was helpful or if you have suggestions to improve it please email your comments to: Doc@healthdoc.org. Good health. Live well.

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