Eating, minding our ‘inner voices’ and mental health
Irecently saw a patient with a long history of pre-diabetes and then diabetes; he has had high sugar levels and multiple complications, including nerve damage. After starting a new diabetes medicine a year ago he was much improved, but still not quite at target. He reported that he had developed an ulcer on his right great toe that required amputation. He realized then that he needed to change his outlook and “stop listening to the voices in his head” that were telling him to eat. He changed his diet, started exercising more, and lost 28 pounds. He was able to stop all medications except one, and his sugar level is now at the goal we set.
So, what is diabetes mellitus? There are several different types; This patient has Type 2, complicated by obesity, which is also called “diabesity.” It is a state of disordered metabolism, including elevated blood sugar levels, which leads to damage in the nerves, eyes, kidneys, brain and heart. Most people with Type 2 diabetes have a family history going back many generations.
Behavioral changes can conquer the consequences of diabetes
Behavioral and lifestyle changes are the basis of successful treatment for people with pre-diabetes and Type 2 diabetes. Modest changes in diet and increased exercise are twice as effective as the best medication in preventing progression to diabetes. Effective behavior management and psychological well-being are foundational to achieving treatment goals. These include diabetes self-management education and support, medical nutrition therapy, routine physical activity, smoking cessation and psychosocial care.
Taos is fortunate in having a fully certified Diabetes Management and Medical Nutrition Therapy Service sponsored by Holy Cross Hospital. Their services are covered by Medicare and almost all commercial insurance; your primary practitioner can make the referral. Diabetes Education helps people to identify and implement effective self-management strategies to cope with diabetes.
Why do so many people persist in behaviors that harm instead of help? Psychological barriers get in the way, as do misconceptions and misinformation concerning nutrition, exercise and medications. One barrier is labeling a person as “a diabetic.” We are all people, none of us are a disease. To accept that you are a person above the disease enables you to have positive thoughts about yourself and to implement positive lifestyles.
Talking back to your ‘inner voice’
Another major barrier is our own self-confidence and our concept of “self.” Who talks to you the most: Your spouse? Your partner? Your best friend? Yet we all talk to ourselves too; there is that little voice in your head saying that you are hungry when you are not, or that you need that second serving when you are already filled, or that you should choose the fried chicken when the rotisserie chicken has many fewer calories. Our inner voices reflect our inner selves, in both their positive and negative aspects.
The concept of “mindfulness” helps to teach us how to work with our inner selves, and promote emotional well-being and selfcontrol, which are so important in self-care. Mindfulness can be defined as the ability to attend in a nonjudgmental way to one’s own physical and mental processes during everyday tasks. We all have the capacity to be more aware of what is occurring in the present moment: This includes when, how and how much we eat! Psychologist Jon Kabat-Zinn sums up mindfulness nicely: “You can’t stop the waves, but you can learn to surf.”
We each can be our own best helper
As a physician, I can offer medications and hormones and advice to people with diabetes mellitus and their families. It is up to each person, with the support of families and friends, to incorporate these tools into their lives and learn how to “surf” the changes, overcome their own internal or external barriers, and lead a healthier and happier life.
Dr Neal Friedman is an endocrinologist at Taos Medical Group and serves as Medical Director of the Holy Cross Hospital Diabetes Program and as Medical Director of the Zia ACO.
TBH has the largest licensed and credentialed behavioral health staff in Northern New Mexico. We can be reached at 105 Bertha in Taos for scheduled appointments, at 575758-4297 or taosbehavioralhealth.