Monday, April 07, 2014

Annual Schedule for Doctor Appointments

As part of any effective wellness strategy, you should meet with your doctor(s) and other members of your healthcare team on a regular basis.

You should ensure that you set up the necessary doctor appointments during the calendar year as specified by your doctor (Primary Care Physician). 
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If possible, try to schedule your appointments during the same time period each year. 

The following is a list of the key doctor visits that you should complete during the year if you are diabetic. 
 
Visit
Purpose
Frequency
Primary Care Physician/ Endocrinologist
Check blood glucose, hemoglobin A1C, kidney tests, nerves (foot exam)

Every 3 to 6 months
Primary Care Physician
Physical exam; Other tests: blood pressure, cholesterol, kidneys, liver

Annual
Ophthalmologist
Eye tests for retinopathy, cataracts, glaucoma

Every 6 months or Annual
Health coach;
Dietitian/Nutritionist
Wellness planning;
Nutritional planning, etc.

Once a month or
As required
Dentist
Cleaning of teeth and gums, dental examinations

Cleaning: Every 3 mos.
Exams: Annual
Podiatrist
Examination of feet for nerve damage
Every 3 to 6 months or As Required

You should visit your primary care physician and/or endocrinologist on a regular basis to review your progress, your blood glucose readings, corrective actions, and other notes – at least until you have your blood glucose level under control. 

Depending on your health needs and your health goals, you should get a complete physical and set of blood work every 6 to 12 months to identify any trends that may be getting overlooked, especially if you’re not making any significant improvements.
Note 1: Your healthcare team may include one or more of the following healthcare professionals: cardiologist, neurologist (nerves), nephrologist (kidneys), physiotherapist, naturopathic doctor, or psychiatrist. Other members may include a health coach, diabetes educator, pharmacist, community health nurse, or social worker.

Note 2: If you really want to get more out of your doctor appointments, read Chapter 11 of Death to Diabetes or read the next post for guidelines that you can perform before, during, and after your appointment.

Doctor Appointments: Annual Schedule for Type 2 Diabetics


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Guidelines for Doctor Appointments


If you want to get more out of your doctor appointments, stop complaining about your doctor and use the following guidelines before, during, and after your appointment. This will help you to get more out of your appointments and ensure that you and your doctor are on the same page towards meeting your health goals.
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Before Appointment
Work with your diabetes health coach (and doctors) to determine your overall health goals. Write down your primary health goals.

Keep records of your meal plan, blood glucose readings, blood pressure readings, exercise regimen, drugs/dosages you're taking, etc. 

Note: Use the Death to Diabetes  tracking chart, journal, meal planner, and drug chart to help you track and record your all of your data.

Research any medical conditions or concerns you may have, by gathering information from reputable websites. Generally, government health websites and those maintained by medical associations, large nonprofit groups dedicated to a single medical condition, and university medical centers have the most trustworthy, up-to-date medical information. 

Make notes and write down any questions. However, don’t hand your doctor a huge sheaf of printouts and expect him/her to respond to them during your visit. And don’t try to diagnose your symptoms or self prescribe your remedies. It’s still up to your doctor to do that (along with your approval).

If you're using a non-drug therapy, verify that it works before you mention it to your doctor. Otherwise, your doctor will either pooh-pooh the non-drug therapy or be offended that you are implying that you know as much as they do.

During Appointment
One of the best ways to manage your diabetes is to develop an effective working partnership with your doctor. Your doctor’s role in this partnership is to provide medical advice, offer treatment options and recommend resources. Your role is to monitor your symptoms and blood glucose readings, report them accurately and do what you can to manage your disease on a day-to-day basis.
Doctor-Patient
Doctor appointments are very important, but most people come ill-prepared to take full advantage of the time with their doctor. Then, they complain about the doctor not taking enough time with them. 

Or, they don’t ask the doctor any pertinent questions; or, they don’t bother to take any notes and forget what the doctor told them. The doctor could spend more time with them, but they must first take full advantage of the time that they have with their doctor. 

Then, they will be pleasantly surprised how well their doctor responds when they take a more active role in their health.
The following is a set of guidelines to help improve the effectiveness of your appointments and the relationship with your doctor. If you are unable to establish a better partnership with your doctor, let him/her know your concerns. 

If there is no improvement with your health, or if you have a concern with taking drugs, consider talking with a doctor in the field of alternative medicine, e.g. a naturopathic doctor (www.naturopathic.org); or, work with a diabetes health coach who has a medical background.
General Planning
  1. Take responsibility for your own health. This may include making necessary lifestyle changes, eating healthy foods, getting enough exercise, maintaining a healthy weight, stop smoking, stop drinking alcohol, and stop using recreational drugs.
  2. Ensure that you understand and are completely comfortable with the doctor’s diagnosis of your health, your diabetes, and any other disease/ailment that you may have at this time. A proper diagnosis will enable you to focus on the proper actions that need to be performed to improve your health. An improper diagnosis will lead to incorrect actions, frustration, doubt, and eventually hopelessness. Ensure that you have obtained all the necessary medical diagnostic tests that will provide a correct diagnosis. 
  3. Key Point: Ensure that the treatment is being designed to repair and heal your body, specifically, the defective sick cells in your body – not just to treat the symptoms of high blood glucose levels.
  4. Post the phone numbers for your primary care physician, endocrinologist and other healthcare professionals by your telephone, along with a list of your current medications, other medical conditions and allergies. Call the doctor right away if you experience a sudden change or your symptoms get worse. 
  5. You should bring your records to the appointment. What if the electronic medical record is down? What if we can’t find your chart? What if you see a doctor in a different system? Although exceedingly rare, problems do occur. 
  6. Bring organized records of your meal plan, blood glucose readings, blood pressure readings, exercise regimen, and drugs/dosages along with any specific questions that you may have about your numbers. Although your doctor may not care to see this information, it will show how serious you are about your health.
  7. If possible, have doctor appointments and the applicable tests performed at regular intervals to prevent confusion and complications. If you have not had a specific test within the recommended interval, ask your doctor about it.
  8. Your family doctor will manage most of your diabetes care, but you may be referred to other medical specialists when necessary. For instance, you may be referred to an ophthalmologist for a dilated eye exam or a podiatrist for foot care. You may be referred to an endocrinologist if managing your diabetes is particularly difficult. Your family doctor and other medical specialists work together as a team. Don’t hesitate to ask for a referral if you think it is necessary.
  9. Work with your doctor to set reasonable goals for your blood glucose levels, A1C, blood pressure, cholesterol, and homocysteine (if applicable).
  10. If you need to find a new doctor or you need information about your doctor or local hospital, go to one of the following websites:
  • Contact information for your state’s board of medical examiners (address, phone numbers, website): www.fsmb.org/members.htm
  • Information about the rating and performance of doctors, hospitals, and nursing homes: www.healthgrades.com
  • Government and nonprofit health and human services information, with links to 1,500 health-related organizations: www.healthfinder.gov
Doctor Appointments
The relationship between you and your doctor is a special one based on trust and mutual respect. It is important to ask questions that concern you — up front. It is normal to feel uncomfortable about discussing certain topics, but, if you don’t tell your doctor, he/she can’t help you.
During the appointment, become an active participant in your health planning. Communicate your health goals and concerns at all times. If you show interest, your doctor will be more inclined to provide more help and information. But, if you don’t show a vested interest, why should your doctor?
Doctor-Patient
Be honest about whether you’re following recommendations about diet, lifestyle and taking medications. Your doctor can usually tell when you’re not telling the truth. Also, your doctor can suggest strategies to help you get on track.
Start with your major concern first. Waiting until the end of an appointment to discuss an important problem may mean it won’t get proper attention.
Be specific about your symptoms and pay attention to details. Things that don’t seem important to you may be important to your doctor. The American Society of Internal Medicine has concluded that 75 percent of correct diagnosis depends solely on what you tell your doctor.
Speak up but be respectful. Make sure from the outset that your doctor knows you have questions and concerns and expect to be listened to. Don’t be afraid to be an active and assertive patient. If you don’t understand a word, idea or direction, ask your doctor to explain.
Ask specific questions. You can’t make good health-care decisions if you can’t understand the information provided or aren’t given enough information. If a question is crucial, ask politely but firmly for an answer before you leave. At a minimum, you should ask your doctor the following questions:
What is my diagnosis or what is my current state of health based on my physical exam, blood work and other health information?
Note! If you have multiple diseases/ailments, ensure that your doctor has taken that into account concerning your diagnosis. For example, a person with high blood pressure and high triglycerides should be evaluated for root causes that are common to both ailments instead of being given separate drugs for each ailment.
What are the root cause(s) of my current diseased health state? (It is very important to understand what is causing your health problem!)
What specific corrective actions do I need to take to improve my health through natural means (without drugs/medications)?
Note: If you decide to take drugs, ask your doctor how long you have to take them and what are the long term effects of the drugs.
What is my prognosis? In other words, what is the doctor’s projection of your future health state given his knowledge, expertise and the corrective actions you plan to take or have been taking?
Request additional tests if your doctor is puzzled with your health state. For example mineral tests, hormone tests and hair analysis tests (although controversial) can be invaluable in many cases involving fatigue, chronic pain, cognitive/memory, emotions, hyperactivity, violent behavior, learning disabilities, attention deficit disorder, high blood pressure, cardiovascular disease, osteoporosis, arthritis, neurological disorders, weakened immunity, hypoglycemia, diabetes, weak finger nails, and unhealthy skin and hair.
Ask your doctor to be honest with you about what you can expect to happen over the next few weeks, months and years.
Ask your doctor to tell you the three most important things you can do to manage your health condition.
Work with your doctor to develop an effective treatment plan. There may be times when you just don’t think you can do what your doctor advises. Don’t walk out in frustration and ignore it all. Work with your doctor to find an alternative that is acceptable to both of you.
Bring all your medications including over-the-counter drugs, vitamins and other supplements to your next appointment. To avoid drug interactions and over-medication, make sure that your doctor knows about every drug, vitamin and other supplement that you are taking.
Before you leave the office, know what you should do when you get home. It’s difficult to recall everything a doctor tells you, especially if you’re nervous or worried. Ask your doctor to write down the important points. Know who to call, and when to call, if you run into any problems.
Ask for copies of your lab results at your visit. This way, you can keep an accurate health history.
Understand how well you are progressing and what actions to take, based on your doctor’s diagnosis.
Don’t forget to follow up with your doctor after the appointment, especially, if there was something that you didn’t understand.
If this isn’t working to your satisfaction, don’t sit around and complain about your doctor. In most cases it’s not your doctor’s fault, so make sure that you are doing everything in your power to improve your health. Discuss your concerns honestly with your doctor. If you are doing your part, and the relationship with your doctor has not improved, or your health is not improving, then, find a new doctor.
 
Doctor-Patient

Doctor Appointment Guidelines: Working With Your Doctor




Why Doctors Behave the Way They Do

Many doctors are heroes because they save lives every day. So, why are so many of us unhappy with our doctors? 

According to a recent study, 21% of patients were dissatisfied with the care they received from their doctors.

To make matters worse, health issues such as high blood pressure, high cholesterol, diabetes, and obesity are on the increase. 


This, in turn, creates a bigger workload for most doctors, who complain that they don't have enough time to provide the quality of care that most patients expect to receive. 

For example, a disease such as Type 2 diabetes is a very difficult disease for most doctors for several reasons. 


First of all, your doctor doesn't have the time to ask you a lot of questions about what your meal plan and exercise regimen. In most cases, your doctor is running behind schedule, so he/she needs to make a snap decision concerning what to do about your diabetes.

Doctors are trained to provide solutions in the form of prescription medications and, if necessary, surgery -- that's what your doctor and all the other doctors have been taught in medical school. 


So, we should not get upset with our doctor when he/she cannot provide a better alternative (non-drug) solution for your health problem.

Also, that doesn't mean you should totally ignore your doctor and stop seeing him/her. In many cases, it's simply poor communications.


In addition, there are certain things that Western Medicine does very well. So, it would behoove you to take advantage and reap the benefits of Western Medicine and its technology.


If you want to get more out of your appointments, there needs to be better communications. To help you with better communications, it is important for you to understand how your doctor thinks and how to use that to your advantage.


And, even though we may not enjoy our visits to the doctor, we know that it is a necessary practice if we want to be proactive in taking care of our health.

It seems that no matter our age, gender, or position, while we're waiting anxiously in the doctor's office, we feel like we're back in high school, waiting in the principals' office to find out what you did wrong. Smile

Finally, your doctor shows up (usually late) and says something innocuous  like: "Well, how are we doing today?"

We're not sure what to say, so we usually say something just as innocuous, like: "I'm fine."

After reviewing your medical history and your most recent lab work, your doctor pulls out his little notepad, scribbles out a non-readable prescription, and hands it to you, saying something like: "This should take care of your problem. See my secretary on the way out." 

Or, your doctor may say something like: "We need to run some more tests. Please see the nurse on the way out."

You try to say something or ask a question, but, you're either ignored, interrupted or  your doctor says something like "Time's up." as he/she skates out of the room onto the next appointment.

And, that's it! You've just spent anywhere from $50 to $200, depending on the amount of lab-work, the scope of your exam, where you live, and whether or not you have insurance. For a 15-minute appointment, that works out to a nice hourly rate of $200 to $800!
And, more than likely, you're not happy with the appointment. But, who's fault is it that things didn't go the way you wanted? 
It's easy to blame it on the doctor, but, in most cases, it's our own fault for not getting prepared before the appointment. We try to "wing it", but winging it just never works.
Instead, you should do a little planning before the appointment, i.e. write down 1 or 2 questions that you want to ask, carry a little notepad with you -- that will show the nurse and the doctor that you're taking responsibility and accountability for your health. Refer to the previous blog post (Doctor Appointments & Tips) for more ideas about what to do before your next doctor's appointment.
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We want to trust our doctors and believe they are superb at what they do. The alternative is too unnerving to consider. Yet the thriving medical malpractice industry proves that our doctors don't always deserve our devotion. 
Sometimes they disappoint us, endanger us, treat us like children, and ignore our input. Or do they? Maybe the problem is with us. Maybe we just don't know how to talk to them. 
Whoever is to blame for the miscommunication, both sides pay dearly in health and money: 70 percent of all medical malpractice suits are filed not because of technical negligence but because the patient misunderstood the doctor.
Medical schools have been paying more attention to this problem lately, and the new generation of doctors is supposedly trained to listen, be empathetic, and look beyond the most obvious diagnosis to see if a patient's problems might be more complex. But while doctors are trying to improve their bedside manner, reality is undermining them.
Doctors today have far less time to spend with patients than they did twenty years ago, mostly because of the paperwork demanded by HMOs and insurance companies and the patient load required to make ends meet. In the typical practice, a visit with the doctor lasts 7 to 15 minutes—and is interrupted within the first 27 seconds by a nurse or a telephone call.
And, if you’re diabetic with a bunch of blood glucose readings, you find that your doctor doesn’t have the time to really pay attention to your data and your health concerns. This can be a little disconcerting, since your doctor was the one who told you to collect the data in the first place!
Meanwhile, doctors who think they are improving their communication skills are often mistaken. One study asked physicians how much time they spent educating their patients. "Nine to ten minutes" was the most likely response. 

In reality, it was about one minute. And patients clearly need the education. Another study highlighted the sorry state of patients' "medical literacy": more than 40 percent of patients couldn't understand instructions that indicated they should take a certain medication on an empty stomach.
Even the most well-meaning doctors regularly fail their patients by overestimating their knowledge of medical terminology and rushing through the exam. Patients complain that doctors don't ask their opinion, don't explain the side effects of drugs, don't take an adequate medical history, don't warn them properly about the difficulty of recovery, don't take their pain seriously, and discourage questions—and that's just a short list of grievances.
Complaining is useless. Waiting for your doctor to change is futile. Your only choice when it comes to dealing with doctors is to change your own behavior in order to influence theirs.  Again, refer to the previous post for a list of specific things that you can do to get more out of your appointment.
Behind the Scenes: They're Not Gods, They're Overworked Humans with Godlike Powers
As a group, doctors don't inspire much sympathy, yet in order to get the best treatment you must be able to see things from their point of view. Like all of us, doctors have feelings and fears that influence their work.
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First, consider your doctor's mission: to heal you. If he can do it, he is a success. If he cannot, he thinks he is a failure—and doctors hate to fail. You may feel powerless in his presence, but in fact his self-esteem depends on you. 
Will you heed his advice or ignore it? Will you refuse his treatment? Lie to him about your symptoms? Snub him for another doctor? 
Occasionally, even if you follow the doctor's instructions, you won't get well. His skills will fail you and so will the medications. This is a doctor's greatest fear and a source of constant anxiety – especially when it comes to a disease like diabetes.

Doctors assume that the medication is going to work. That's what they were taught in medical school. If the medication doesn't work, the first thing that the doctor thinks is that you didn't follow the instructions, not that there was a problem with the medication.

When the doctor looks at your lab work, he/she quickly surmises that you need a medication for something -- usually for high blood pressure, high cholesterol, or high blood glucose.
Although you brought your blood glucose readings data with you, your doctor doesn't have time to review your blood glucose readings. In this particular scenario, the diabetic patient has more data than the doctor! Doctors are not used to this! This makes them uncomfortable, so they tend to ignore your data -- because they've already determined what medication to put you on or whether to increase the dosage, or switch you to a new medication. 

And, because diet is so important to diabetics, this is also unnerving to most doctors. Why? Because most doctors know very little if anything about diets and nutrition. In medical school, most doctors end up taking at the most a 3-hour course in nutrition – a course that most of the doctors skip or ignore.
Doctors are schooled to diagnose illnesses and prescribe some kind of pharmaceutical treatment as quickly as possible. With most internists logging about 150,000 office visits in their careers, speed and accuracy are highly valued. Being right is important, but being fast is the mark of a real pro. 

In surveys, medical literature, and interviews, doctors repeatedly admit to diagnosing the typical patient within just 30 seconds of walking in the examining room. "It is subsequently quite easy to go on autopilot," writes Victoria Maizes, M.D., in American Family Physician. 

Instant diagnoses, followed by formulaic, half-interested questions, thus become their normal mode of operation. Maybe it's not the way Marcus Welby would have done it, but it effectively propels them through their overpacked days.
The doctor is primarily focused on your symptoms so that he can quickly map your symptoms to a specific prescription drug. 

As a result, most diabetic patients end up on at least 2-3 medications: a drug for the diabetes, i.e. metformin (Glucophage), glipizide, glucotrol; a drug for the high blood pressure, i.e. Lisinopril, hydrochlora-thalizide; and a drug for their high cholesterol, a statin such as Liptor, Zocor or Crestor.
Another more troubling aspect of doctors' training is the well-known desensitization that takes place in medical school and during a physician's internship. It is a grueling trial by fire as the student is thrust into a world of pain, suffering, and death with very little emotional support. Barbara M. Korsch, M.D., who has devoted much of her career to studying doctor-patient communication, wrote a book on the topic: The Intelligent Patient's Guide to the Doctor-Patient Relationship (Oxford University Press, 1997). 
In her book she explains that in medical school the emphasis is on anatomy, chemistry, and other hard sciences, with little or no attention paid to the human aspect of attending to the ill. "When third-year students have their first intense encounter with real patients, they are faced with sickness and death in very large doses." 

As the years of training continue, "students' inner conflicts with facing illness and death become more and more acute. Their role models, the attending physicians, often behave toward them (and their patients!) in ways that are not very human....One of the goals in the education of physicians is to 'professionalize' them, to toughen them up."
When the training is finally over, relatively few doctors emerge with their empathetic equipment intact. Korsch says that doctors "turn away from emotion. They are not trained to deal with feelings." This detachment is very hard to unlearn. 
It doesn't have anything to do with a doctor's talent, but it does affect the way he treats his patients and the success of his practice. On the one hand, doctors with lousy people skills have trouble keeping clients and attract more lawsuits; on the other, doctors who aren't emotionally tough are likely to burn out and become unable to function.
Today's physicians, then, are constantly grappling with opposing forces. They want to solve your problem but must do it quickly, which automatically increases the likelihood that they will make a mistake. They depend on your compliance but you can defy them at will, which undermines their chances of success. 
Theirs is a people-oriented profession, yet they learn few social skills and have much of their natural empathy squeezed out during medical school. They must operate within ever-shrinking time and money constraints, even as patients are becoming more proactive and demanding more attention. They are expected to take control but are constantly being second-guessed by insurance companies, HMOs, and the patients themselves.
The result is that doctors are under a lot of stress. The power, respect, and money that once compensated for the tensions of the job are eroding. They spend more on insurance and keep less for themselves than they once did. Some doctors are even forced to change specialties because they can't afford the malpractice insurance. 

These healers, who at one time held themselves above the fray of commerce, are now neck-deep in it—resentful, frustrated, and concerned about the level of care they are able to provide their patients. So when the doctor walks into the examining room and you're laid out on the table like a piece of pastry, remember: underneath the trappings of power, he too may feel anxious and vulnerable.
Patient, Know Thyself
Physicians constantly complain that patients don't share crucial information about their symptoms and lifestyle. This is ironic, since patients' number-one complaint is that doctors don't seek their opinion. It seems as if patients are forever waiting for the doctor to ask just the right questions, while doctors are waiting for their patients to go ahead and spit out the facts already. 
It is up to you to break the impasse and start speaking up in the doctor's office whether or not he asks you the right questions. In fact, speaking up is the single most powerful thing you can do for your health. About 70 percent of correct diagnoses depend solely on information the patient tells the doctor, according to an analysis done by the American Society of Internal Medicine.
Talking to Your Doctor
Once you understand the mind-set of doctors, you can choose behaviors that will put them at ease while you draw information out of them. The most important strategy is to keep your voice steady and calm. Doctors are afraid of emotion, so the less you show, the more comfortable they will feel. 
Angry Doctor
Barbara Korsch explains: "If you put drama in your voice, it will turn the doctor off. Be quantitative and objective instead of saying how you feel. This is unfortunate; doctors shouldn't be that way, but in my studies we've learned that they are." 
When you seem desperate or panicky, when your voice is trembling with anxiety, the doctor's first reaction will be to try to tone it down. "Your emotional reactions engage doctors less than describing what it is you're reacting to," says Korsch. 

In addition to using a neutral tone of voice, the following words and deeds will keep you in the doctor's good graces.
Use neutral words to describe feelings. Be concerned instead of scared. Be apprehensive instead of a nervous wreck. In everyday life we tend to exaggerate to get results, but with doctors you have to go to the opposite extreme. Even if you are in agony, try not to use those words. Instead say, "I have a lot of discomfort." 

Use specific words to describe symptoms. "I haven't slept a wink," doesn't tell a doctor much. Instead say, "I've been averaging only four hours of sleep a night, and I usually get seven. I've been waking up every hour or so, and it takes me at least 20 minutes to fall asleep again."  
Talk about the most important things first. Doctors are very time-sensitive and will (understandably) be annoyed if you wait until the end of your visit to bring up a problem that requires some time to address. 
Make your expectations clear. At the beginning of the visit, tell the doctor exactly why you are there and what you hope she can do for you.
Acknowledge the doctor's situation. If the office is jam-packed and everyone seems stressed out, let the doctor know you're on his side: "It must be hard for you today, so I'll try to be concise." 
Be clean. Personal hygiene does matter. If you smell bad, the doctor will want to get away from you, just as anyone else would.
Keep in mind that most doctors believe that patients have a lot of misunderstanding about medicine, because their information is based on what they've heard from a friend or read on the Internet. Most doctors are offended when patients start to "play doctor" and provide their own diagnosis.

So, when a patient arrives at the doctor's office armed with information, this can create unnecessary tension especially if the doctor pooh-poohs the information without any rational reason. 

In order for your doctor appointments to be more productive, read our next blog post, which discusses some steps that you can take before, during, and after the appointment. This information is also in Chapter 11 of the Death to Diabetes book.
   
      
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Emotional Support for Diabetics

Emotional support is a key component of any wellness program in order for any of us to improve our health and achieve optimum wellness.

Whether you are ill or not, emotional support is important to all of us.

But, if you're ill with a disease like diabetes, emotional support is even more important because this disease and all the things you have to do can be overwhelming.

Author's Perspective About Emotional Support:
When I was in the hospital, I remember the first time when one of the nurses started explaining all the things that I needed to start doing to manage my diabetes. Having to keep track of my meals and blood glucose readings wasn't that bad, but I had to come to grips with having to prick my finger and give myself insulin shots 4 to 5 times a day! Are you kidding me??

Luckily for me, my daughter and mother were there to help me. In fact, my daughter went to the pharmacy to obtain my glucose meter, test strips, insulin syringes, bottles of insulin, and the other drugs that the endocrinologist had prescribed. In addition, she (along with my mother) did the grocery-shopping and prepared my meals.

Every few hours, I had to psyche myself up to prick my finger and measure my blood glucose and write it down. Then, before each meal, I had to psyche myself up again to inject myself with insulin. After the meal, I recorded what I had eaten and about 1-2 hours later, I pricked my finger again to measure and record my blood glucose level.

Initially I didn't have much energy, so I was always tired and sometimes I felt sleepy. But, I forced myself to exercise (by walking) at least twice a day. Grocery-shopping with my mother was torture, but, ironically, all of the walking around the stores helped me in the long run.

Finding out that I had diabetes was a shock. Seeing what I had to do every day just to manage my diabetes was a little overwhelming. Given the large amount of reading information that I had been given by the doctors, nurses and dietitian in such a short amount of time was intimidating and also overwhelming.

Ironically, being an engineer made it easier because a lot of the tasks were similar to what we as engineers do, i.e. recording information, reading, doing research, collecting data, analyzing the data, etc. In many ways, managing my diabetes was a lot like starting an engineering project for myself.

Besides the support I received from my family, I also received support from my Xerox managers, who ran the organization in my absence. This was very important to me although I don't think that I ever thanked my managers. Part of the reason for this was due to the embarrassment I felt that I needed their help.

I also received emotional support from other diabetics, who shared their stories with me. This was a little uncomfortable at first because I thought that talking about one's health was a little too personal to share with other people.

While trying to come up to speed on diabetes management and incorporating it into your life, it's perfectly natural to go through some emotional upheaval. You may feel some anxiety, anger, depression, sadness, and other emotions. Consequently, you will need some time to adjust and some support from your family and friends.

Discuss your feelings with your doctor or a diabetes educator; or, join a local diabetes support group. If you are having a hard time getting through your day because of depression, anxiety or other overwhelming feelings, you may need to see a counselor or other mental health professional. It's okay to seek professional help to assist you through this difficult time.

Emotional support comes in many forms from a variety of people including your family, friends, co-workers, doctors, dietitian, health coach, support group, counselor, organizations, church, pastor, etc.

How to Handle Your Emotions
The tendency to dwell on anger, resentment and other uncomfortable feelings can negatively affect your health, including increasing your blood glucose levels. So it’s important to listen to your emotions and then take steps to let them go. Here are some things that you can do:

Understand Your Emotions: Look within and try to pinpoint the situations that are creating the stress and negative emotions in your life. Negative emotions can come from a triggering event; for example, feeling overwhelmed with your diabetes, or feeling angry about being diabetic. Negative emotions are also the result of our thoughts surrounding being diabetic; the way we interpret being diabetic and whether or not it causes stress. The key job of your emotions is to get you to see the problem, so you can make necessary changes.

Change What You Can: Only focus on what you can change. Don't dwell on what you can't change. Cut down on your stress triggers, and you’ll find yourself feeling negative emotions less frequently. This could include learning more about diabetes, taking a walk during lunch with a co-worker, joining a diabetes support group, avoiding stopping by the pizza place on the way home from work, bringing your lunch to work instead of going out to lunch, cutting down on job stress, and eating healthier meals more often.

Find An Outlet: Making changes in your life can cut down on negative emotions, but it won’t eliminate your stress triggers entirely. As you make changes in your life to bring about less frustration, you will also need to find healthful outlets for dealing with these emotions. Regular exercise can provide an emotional lift as well as an outlet for negative emotions. Meditation can help you find some inner "space" to work with, so your emotions don’t feel so overwhelming. Finding opportunities for having fun and getting more laughter in your life can also change your perspective and relieve stress. Find a few of these outlets, and you’ll feel less overwhelmed when negative emotions do arise.

Take a Break: If you're feeling stressed out, take a break! If you're under a lot of pressure at your job, talk to your manager about leaving early for the day; or, maybe take a half-day vacation. Don't continue to overwhelm yourself -- that's only going to drive your blood glucose higher!
Note: Read our future post or DTD web page about stress for more detailed information concerning stress.

Get Help if Depressed: Depression and diabetes are two conditions that can sometimes go hand-in-hand. First, diabetes can increase the risk of depression, according to a growing body of research. In fact, having diabetes doubles the risk of depression, compared to people who don't have the disease. Conversely, depression also can increase the risk of Type 2 diabetes, research shows.

It's often a vicious cycle. Depression can get worse as the complications of diabetes get worse, and being depressed can stop people from managing their diabetes as effectively as they need to, which can lead to increased incidence of long-term complications such as retinopathy, neuropathy or nephropathy.

The key is to get your diabetes under control and seek professional help for your depression, if necessary. Getting help for your depression not only improves your quality of life, but, it also can help you manage your diabetes better by giving you a more hopeful outlook.