QUESTION TIME

MAKING DIABETES DECISIONS SIMPLER

Last winter,

Caroline Dorn looked down at her left hand to find it riddled with pen marks. Two hundred and forty-seven to be exact. The American teen had decided to run a little experiment in which she put a pen mark on her hand every time she had a thought related to her type 1 (such as calculating carbs, dosing insulin or checking her Dexcom).

“I’d had some frustrating days where making decisions about diabetes was constantly interrupting my train of thought, my homework, my classwork,” says the 18-year-old, who was astonished by the number of marks she’d tallied that day. She took a photo of her pen-riddled hand for a Facebook post that went viral, with more than 7100 shares and 1100 comments. “I did it to prove to myself that it’s OK to be tired or tell people no when they invite you out,” says Dorn. “But it touched a lot of other people too.” The silent burden of decisionmaking for people with diabetes can often feel downright overwhelming. That’s exactly why so many experts preach the ‘three Ps’ when it comes to managing it: planning, planning and more planning. But anticipating and avoiding challenges can’t be the only tool in your arsenal for dealing with diabetes, as unexpected challenges will always come up.

“Blood glucose regulation is affected not only by activity, diet and medication but also by stress, infections and pain,” explains Mario Skugor, an endocrinologist with the Cleveland Clinic. “Sometimes it’s very, very hard to predict what is going to happen.

You have to always be ready for surprises.” That’s why problem-solving is such a valuable skill to sharpen. The next time you find yourself facing a choice about your self-care, try asking yourself one of the seven questions that follow – they can help you go from feeling exhausted to empowered in no time. ➤

1 What would 80% success look like to me?

It’s not uncommon for people with diabetes to strive for perfection in monitoring their BGLs, eating healthy foods or hitting the gym regularly. “Sometimes there’s a stigma that if you have a disease, you’re not as good as other people,” says Karen Lau, a nutrition and diabetes care specialist at Joslin Diabetes Center.

“It can drive people with diabetes to aim for 100 per cent or even 150 per cent perfection when it comes to their disease management.”

But an all-or-nothing attitude can sometimes leave you feeling like a failure – not to mention more stressed, which can then impact your BGLs. That’s why experts advocate taking things down a notch from aiming for an A-plus to being happy with a B when you’re grading yourself on the health choices you make.

Maybe on stressful days, instead of half an hour on the treadmill, you give yourself kudos for 20 minutes of walking. Perhaps instead of chastising yourself for a carb miscalculation, applaud yourself for all the other maths you nailed today.

Theresa Hastings, 37, type 1, finds this strategy helpful in managing her care. “I’d love to have a day when I’m 100 per cent in range – but I also know diabetes doesn’t play fair,” she says. “I can try the same thing two days in a row and get different results.” Rather than judge herself, Hastings tries to focus on her numbers. “My blood [glucose is] just data. It’s data to review and analyse [to use to] make changes and hope they have the result I’m looking for. If they do, great and I move on. If they don’t, I go back and see what else I should adjust. It’s a daily fight to not allow the judgement back in, but it is essential for my mental health.”

2 WHAT’S MOST IMPORTANT TO ME ABOUT THIS SITUATION?

You might use this question to move away from the strict idea of ‘right’ or ‘wrong’ when making a choice. Instead, it can help you to factor in your personal values. “This question is about prioritisation and the impact those priorities can make,” says Kat Porco, a board-certified health and wellness coach and co-founder of Attain Health, a US-based telehealth coaching and education non-profit. It might cause you to realise, for example, that speaking up to your doctor and advocating for yourself is more important than worrying that you’ve questioned their authority at a medical appointment. Or that being patient is more important to you than inaccurately dosing your insulin when you’re in a rush.

For author Carol Gee, 70, this question helps her prioritise happiness and fellowship – rather than sticking to a strict meal plan to manage her type 2 – at holiday dinners with her loved ones. “If I’m denying myself, I’m not going to be happy,” says Gee. She’ll typically have a small portion of turkey but avoid over-indulging in the trimmings at Christmas. “During holiday get-togethers, it’s important to me to be able to enjoy whatever is going on,” she says.

When you find yourself stuck at a crossroads moment, take a second to ask what’s important to you so you can arrive at to your ideal outcome.

3 Where could I go to squeeze in a quick walk?

This question gives new meaning to the phrase ‘exercising your options’. Research shows brief bouts of exercise (even a five-minute walk) can benefit your problem-solving skills by helping to increase creativity or boost brain function. “Sometimes we’re too deep into a tunnel of thoughts and we just can’t find an answer,” says Lau. “You have to take a step back, look at a bigger, different point of view, and then you see things [more clearly]. Taking a walk can help you do that.”

The next time you’re trying to figure out what healthy options to have for lunch, how to squeeze exercise into your day or when to reschedule a doctor’s appointment, go for a stroll (or find another way to move, such as doing a few yoga stretches). As an added bonus, you’ll get all the regular benefits of exercise: getting your blood flowing, burning some kilojoules and lowering your stress levels.

Sydney Williams, 34, knows all about the power of walking when it comes to decision-making.

When she was diagnosed with type 2 diabetes in 2017, she started going on morning walks to squeeze exercise into her busy day. She worked in a high-stress agency job, where she held a corporate communications role for a major television network, and she was worried about how her hectic job was impacting her health.

“I had a six-figure job with upward mobility and unlimited vacation days but I was sick, tired and sad,” says Williams. “‘What do I do now?’ I’d ask myself on those walks.” The answer eventually came to her on one of her strolls: she decided to quit her job, transition to entrepreneurship and start her own non-profit organisation, Hiking My Feelings, which helps people heal by spending more time in the great outdoors. The transition eventually helped her lose 32kg, better manage her BGLs and go off her diabetes medications. ➤

4 WHAT’S MOST IMPORTANT TO ME ABOUT THIS SITUATION?

So often we convince ourselves a problem only has one correct answer. But in reality, you could probably come up with a list of 5-10 options for every dilemma you face. For example, if you’re feeling down about having a chronic illness, you have more choices than finding the time to meet with a therapist in person or not meet with one at all. You could speak with a therapist using a telemedicine app or participate in a support group instead. Brainstorming can not only help you see possibilities, it can also empower you to make a realistic choice.

“People come up with new ideas around disease management when they get out of the mindset of control and take the opportunity to brainstorm,” says Porco. She suggests writing your dilemma down on paper and putting a circle around it. Then draw lines from the circle and write all possible solutions to the problem.

Stacey Divone, 43, needed to get into a regular exercise routine. But she also knew spending an hour at the gym wasn’t going to work with her motivation or her schedule as a busy senior manager at a bank. “I brainstormed ideas with my husband around activities I could do for 15 or 30 minutes,” says Divone, who has chronic back problems and type 1. After working on a list of options, she identified a few that suited her: riding her indoor bike for just 20 minutes instead of longer rides, and short bouts of yoga using on-demand videos.

5 What technology can I lean on?

If you’re not letting technology lend you a hand, you may be missing out on some added ease in your day. Diabetes technology has improved immensely during recent years, and many people with diabetes find it helpful to use a CGM, smart meter or app to help them with monitoring their BGLs. Take Jeremy Jackson, 42, type 1. “I have a continuous glucose monitor and an Apple watch. With the Dexcom, if my levels start to drop, my watch and phone will give me an alert,” he says. Jackson has further downloaded the MyNetDiary and RapidCalc apps onto his iPhone to track his food and carb intake.

It can also help to think outside the box – especially if you don’t have access to, or can’t afford, a CGM. Adrian Gibbs, type 2, decided to use tech to help give him reminders through the day, as he lives alone. “My Google Nest Home reminds me to check my BGLs and take my meds and can control the lights to make me realise when it’s getting late and I need to shut it all down and get some rest. There are times that I’m [working] and just lose track of time,” he says.

Belinda Justice, 46, leans on the virtual assistant Siri to help her count carbs. “I’ll ask her how many are in an apple or an avocado so I can stay within my 60g of carbs per meal,” says Justice, who is a cosmetologist with type 2. “I also keep a list of fast-food options

I like in the notes section of my smartphone so I don’t have to keep looking up the carbs in my favourite salad or taco.” Even the smallest of decisions can be made easier with the help of technology.

6 WHAT IF I DID ?

Here’s how many of us approach problem-solving: We wonder “Should I do X or Y?” We ask “Should I eat that or not?” Or “Should I check my blood [glucose] now or not?” But that phrasing usually leaves us “shoulding” all over ourselves.

If you start a question with “What if I …” you change the way you look at a situation by removing the dread of a wrong decision and instead creating the possibility of an amazing outcome. “When you approach a problem from the mindset of ‘Here are my options,’ you’re in control,” explains Porco. “When you’re asking a question like ‘Should I?’ that has a black-or-white response, that takes control away.”

While she’s coaching her patients, Porco goes a step further as she’s checking up on their daily habits. “I always ask, ‘How many times did you choose to check your blood [glucose] this week? How many times did you choose to exercise this week,’” she says. “It’s all based on this idea that [you are] choosing to be in control of your own outcomes.”

7 Who can help me figure this out?

You don’t have to be the only person working on a challenge. Confiding in a friend that you wish you could afford a continuous glucose monitor might lead you to find out she knows where you can get a free one. Sharing with your diabetes care and education specialist that you’re frustrated because you go to bed with normal glucose levels but wake up in a spike could lead to them easing your anxiety with an explanation. One solution: ask your doctor, “How can I communicate with you if

I have questions after our appointment, or if I need help between appointments?”

“One of the essential parts of our job is to be able to have those communication channels,” says Skugor, who takes all sorts of questions from patients through Cleveland Clinic’s MyChart system. “Patients will ask, ‘I’m going to have a steroid injection, what should I do about that?’ or ‘I have a colonoscopy next week, so I’m not going to eat for 24 hours. How do I adjust my medication?’”

Sometimes you can lean on your doctor and sometimes you can lean on other pros – people with diabetes. “While I trust and respect my endocrinologist and her team, the women in my DiabetesSisters online community are such a valuable resource,” says Hastings. A few years ago, she grew frustrated with her weight, and was puzzled about why she had started to put on weight despite her eating and exercise habits. So, she asked for help.

When she shared this with her community, she learned more about the complex relationship between her type 1, insulin, the hormone amylin and weight gain. She received a suggestion to talk to her doctor about adding a type 2 medication that might help with managing her weight. Since posting about her frustration in her community, Hastings has changed her medication regimen, lost

9kg, seen reduced fluctuations in her BGLs and feels as though her memory is improved. “It is truly refreshing to feel like myself again after 21 years with this disease,” she explains. “I never would’ve considered talking to my doctor about adding a med if I hadn’t asked my community.” Opening up to others not only gave her options, it also gave her solutions.

If you start a question with “What if I …” you change the way you look at a situation by creating the possibility of an amazing outcome.