Managing diabetes stress is part of living with the illness.   That is just a fact.  By its very nature it’s unpredictable and doesn’t play fair, so even on a good day it can present challenges.  But add to it the stress of the current COVID19 pandemic and we see all new levels of stress and frustration.  Just like the dragonfly in this illustration, we are travelling in rough conditions.

Recent Studies

Recent studies show that the pandemic is creating individual stress on unprecedented levels.   It comes packaged in two lovely forms – 1) stress about real events and 2) worry about future events.

1. Many people have experienced true casualty from covid such as disrupted finances, job loss, strained or broken family relationships, and actual infection and illness.  Dealing with these hardships can be all consuming with real and tangible threats to one’s livelihood.  Each of these stressors poses significant challenges on their own, but the stakes are even higher with the additional unknowns of our times.
2. There is no clarity about what data is true, when it will be over, and when we can feel safe.  Without clarity, we are stuck in a void of worry and “what ifs”.  Not a fun place to be and these ruminating thoughts and worries increase the likelihood of mental health issues like anxiety and depression.  We all have good reason for concern simply because we just don’t know.

“When is it safe to go out?”, “Will a mask protect me?”, “What will happen if I get it?”, “Who can I trust?” , “Will a vaccine be here in time?”,   “Will it work?”,  “How much longer?”, “What about the elderly who have no visitors?”, “What about our kids who need socialization?”, “What are the long term impacts?”,  and on and on…..

There is so much we don’t know and the unknown is a scary place for anyone.  And we are all in the midst of MANY unknowns.  You likely won’t be surprised that depression 30% of the population has clinical depression (compared to a normal of 6.6%)

Community Trauma

Not only are we stressed & depressed as individuals, experts say our communities have experienced trauma.  Not the trauma of a specific event like a hurricane or riot, but the collective and ongoing suffering of the fabric of our people’s unravelling.  Businesses closing, lack of access to typical services, differing risk tolerances about wearing masks, being with other people and the crazy that is social media,  have made us unsettled and not sure who to trust.   Neighbors have turned against each other and disputes that otherwise would blow over, blow up.

Most of us can tolerate hard stuff, especially if we know there is an endpoint.  We get through a dental visit, because we know it will be over.  We choke down nasty tasting medicine because the taste lasts just a few seconds.  But stuck in this purgatory feels like hell on earth.

Add Diabetes to the Mix

So yes, we are in stressful times, but add in the normal worries of diabetes on top of everything else, and it’s no wonder people with diabetes are struggling.  Paying for supplies and medicines is affected by income changes, insurance changes and lack of normal access.   Many grocery stores don’t have all the fresh produce they used to have.  Knowing that tight glycemic control is the key to surviving a covid infection raises concern and worry when its harder to stay in range due to stress and atypical conditions.

It’s a worry bonanza and the risks are real and valid when you live with diabetes.  I don’t need to explain that to you.  But what can you do?

Focus and Learn

There are many suggestions about how to manage stress, but these are two that I have found most helpful for developing resilience.  Resilience is a strong predictor for improved diabetes outcomes and  lower levels of stress and depression.

The illustration is from my book, “Dragonfly Lights – Learning About Your Perfect Purpose“.  It shows the dragonfly (your spirit), travelling in a leaking spaceship (your body and its imperfections), on a day where everything is coming against him.  These days happen.  We can’t prevent hard days, but we do have options.

The dragonfly must make a choice about which path to take as the road forks.  It isn’t clear which path will be the safe path, but it is obvious he has options.  Perhaps go right into the unknown, perhaps go left and hide away, perhaps land and stop travelling or perhaps turn around and go back.  Only after the selection, can he look back and learn from his choice – good or bad.  The hardship and his choice becomes his teacher.

As we navigate this most difficult time, focus on those things which you can change: your reactions, your attitude, your activities, your words, your next steps, or your decision to let go of what you can’t change.  And remember, what you have overcome on  your hardest days, has developed your character, taught you great lessons and made you stronger.  There is purpose in your pain if you choose to look at it that way.

I’ll leave you with this wonderful Serenity prayer that I think is fitting as we journey through this valley

God grant us the serenity to accept the things we cannot change,  the courage to change the things we can, and the wisdom to know the difference

Stay safe and be well,

Curious about my book? It’s a beautifully illustrated book for children of all ages who are perfectly imperfect and need inspiration and support.  There is also a companion activity book to explore the topics further.  Both available on Amazon HERE

The post Managing Diabetes Stress When Things Get Tough appeared first on Better Diabetes Life.

Living with diabetes has proven stressful during this COVID19 pandemic.  The media and medical community have made it very clear that having diabetes is a significant risk factor if you become infected.  However, as restrictions are lifted, new worries come to light causing more confusion, worry, and fear.  And not without just cause.  There are many facets to the issue and no clear perfect answer (but if you know me, I don’t believe perfect exists anyway!)

“Is it safe?”

As people head back to work, into restaurants, and book appointments at hair salons, we ask ourselves “Is it safe?”  My answer is quite simply, NO.  Unless you have been tested and know you have antibodies, you are just as vulnerable to infection as you were 2 months ago.  And possibly even more so now.

Quarantining only prevents person to person spread of infection.  This has reduced the number of infected people and as a result lowered the number of transmissions of the virus.  It has allowed time for the medical community and suppliers to prepare staff and facilities, create protocols, and better understand what it takes to battle this virus.  When we start venturing out, we will see more transmission of virus to susceptible people (that is most of us).

Our time in isolation may leave us with an immune system in idle.  Typically, our immune systems constantly react to the ever-changing environment of our daily lives.  Releasing antibodies, white blood cells and a million other small actions to battle the pathogens we encounter.  Without this exposure, our immunity may be left with less to do and our “immune engines” running at a slower pace.

I quick side note, besides the first 3 months I worked in the ER, I was never healthier than during those year at the bedside.  As I was daily exposed to any number of “germs”, I hardly ever got sick.  Maybe once or twice a year.  (OK – there was the weird virus that may have triggered my diabetes, but that was not the norm).  Years later when I worked in a corporate office with a lot of healthy people, I seemed to catch any bug that was going around.  In the ER my immune system was firing on all cylinders, in the office I never got out of first gear.

There are several other factors that can inhibit your immune system: stress, being less active, eating less healthy, drinking alcohol, isolation, fear, worry and basically any negative emotion.  Sound a bit like quarantine?   For many people, this change in lifestyle included unhealthy habits that weaken our immunity.  It is possible that while staying at home prevents person-to-person transmission, it may slow down our best defense against the virus

“Is it necessary?”

So, should we be creeping back into society?  Is it necessary?  My answer is YES.  As stated above, being isolated for long periods of time has its downside.  The human animal was not meant to live in isolation nor without purpose.  Our psyche and our immune systems need interaction.

In addition, we may just be moving illness and death (morbidity and mortality) to a different population.  The stress of economic strife, destruction of earning potential, job loss, and failing business also lead to problems. I first heard about it in nursing groups and now we are hearing it in the news.  Hospitals are seeing higher numbers of psych patients, child & spousal abuse cases, alcohol related ER visits, suicidal ideation and suicide attempts.   I’m hearing anecdotal reports of more CPR presenting to the ER as patients avoid seeking treatment until it is too late.  A studies indicate a significant lower number of life saving procedures for heart attacks due to patients avoiding hospitals.    While some people are protected from COVID because of isolation measures, others are paying the price in other ways. It is badness any way you slice it.

We are also a consumer driven society, we need workers to produce food, process clean water, make our clothing, and manufacture innumerable goods that we all use.  Including medication, glucose meters and test strips, pump supplies and any number of other things that keep us all healthy and fit.  Although these are essential services, a failing economy is not sustainable to maintain our standard of living and health.  Government money will only last so long.   We need an active society to florish and prosper.

Emotionally people need to be productive as well.  It feels good to contribute, create, produce, and pursue our passions.  It’s healthy.   So, there are good reasons to get back to work.  Yet we need to figure out how to do this in the safest and most prudent way possible.  Unfortunately, there is no one size fits all and no one to protect us completely.  We bear the burden of our own safety.

Diabetes Risk

Common sense and traditional diabetes education dictates that better glycemic control yields fewer complications and more favorable recover in the case of any illness or injury.  The closer we stay to “normal” glucose levels, the less our bodies have to compensate.  Studies demonstrate this holds true with COVID19 infections.  This recent study found that an A1c around 7 or lower had more favorable outcomes that A1C in the 8-10 range.  This study analyzed type 2 patients, but logically tight control is better for all people with diabetes.

Stress has also been shown to drive correlate to less than optimal glycemic control.  Whether it is from emotional stress such as worry and fear, or physical stress from infection or injury, when under duress it takes more effort and diligence to stay in range.

It’s my personal belief that lack of education is not to blame for falling off the “diabetes wagon”.  We all know that diet, exercise, medication and diligent monitoring of glucose levels are the key to tight control.  But that is easier said than done – especially when times are tough and the future is uncertain.   What we lack are coping skills, new motivation, emotional support and guidance on how to navigate change.  Investing in yourself with some new tools can have big payoffs during these stressful times.

Coaching Tip

While this may appear simple (some of the best tools are the easiest), getting quiet can give you a whole lot of answers.  Things like sitting outside and appreciating nature, meditating, praying, day dreaming, a bubble bath, or taking a walk can all help turn off your “worry brain”. Just find something pleasant to focus on for 10-15 minutes. It may seem like you are doing “nothing”, but you are actually doing a lot!

First your body needs balance.  Worry zaps your energy.  Peaceful moments can fill you back up.  Second, this peaceful state boosts your immune system.  When you are calm, you ignite your “rest and restore” system which includes your immune system.   Third, when you tune out the chatter in your mind, you can tune in to your very wise intuition.  It’s that quiet voice inside that whispers to you and knows what you need.

It may take a few practice sessions to figure out how to let go.  Three or four deep breaths are a good start.  Then simply ask  yourself a question and then get quiet for a moment and consider your thoughts. Ask your wise intuition things like “What do I need right now to feel better?”, “How can I stay on my diabetes plan with more ease?”. “What is keeping me from my best?”.  Then relax your shoulders, unclench your jaw and feel your blood flowing through your body.   Something just might bubble up that surprises you!

As our society opens back up, each of us will find different levels of comfort and different ways to negotiate this uncharted territory.  Tune into your inner wisdom and trust that it will guide you.

You got this!  To peace and good health!

The post Diabetes Stress Continues as Communities Re-open appeared first on Better Diabetes Life.

I wrote this blog post shortly before the coronavirus pandemic and it didn’t seem like the right time to post it.  But now knowing how much we are all at risk, I believe it is a good time to share the prevalence and incidence of diabetes.  With no prevention or solid treatment for COVID19, we are among the most vulnerable.  Our best strategy is to be as healthy as possible.  Yet the isolation, lack of normal access to resources (gym, childcare, work, full grocery, hospitals, CDE, providers) can send stress levels soaring, which cause blood sugars to rise and burnout to escalate.   

Diabetes care has never been more critical or more difficult.  And we must do the best on our own.  You know I focus on the mind/spirit challenges of diabetes. Without those pieces in place, care of the physical body is essentially impossible.  If you are struggling, my online courses can help you with new coping skills, perspectives and ways to stay motivated.  I have enacted discounted pricing so the course is affordable to everyone.  Stay safe everyone and be well!  PD

Original Blog

I am a numbers girl.  Always have been.  So, I thought we’d have some fun digging into the latest diabetes stats.  According to the CDC’s 2020 Report on National Diabetes Statistics over 10% of the US population had diabetes as of 2018. That’s 1 in 10 of all of us.  Look around, do you see 10 people?   Everyone knows someone who has diabetes.  As a former coworker of mine used to say, “that is not trivial”.

Methodology

The most curious thing I noticed was that the figures for people diagnosed with diabetes were “self-reported”, meaning that if a person said they had diabetes, that was all the proof they needed.  For those they considered “pre-diabetes”, inclusion criteria were based on self-reporting of A1c and fasting lab reports of people who said they didn’t have diabetes. So basically, people self-reported lab values that indicated pre-diabetes, yet didn’t know they had pre-diabetes……head scratcher for sure.

Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes

I also had a hard time wrapping my head around the date ranges.  Data appears to be collected in 2013-2016 with “crude estimates” for 2018 so what we know is based on data that is at least 4-year-old.  With all the claims data we fill out for insurance claims, why isn’t that information used to paint a picture of diabetes in the US??  If insurance plans can “adjust” my premium rates because they know I have diabetes as of any given month, wouldn’t that data be worthy of reporting??   Just a thought.

Terminology

The report categorizes the statistics according to prevalence and incidence.  Prevalence is defined by Merriam Webster as “the percentage of a population that is affected with a particular disease at a given time”. While incidence is defined as “the rate of occurrence or influence”.  So, the prevalence of diabetes in the US is 10%, while the incidence is 1.5 million new cases per year as of 2017.  No matter which way you slice and dice it, diabetes is rampant in the US.

Prevalence

The report has an abundance of statistics, but these were a few numbers I thought worthy of sharing.  The numbers I am sharing below include those not diagnosed. To me they are in the same boat as the rest of us whether they know it or not, assuming that the elevated glucose levels will cause damage at some point.  Just because you don’t have a diagnosis, doesn’t mean damage isn’t being done.  That scares me!

• 10.5% of the US population had diabetes (all ages)
• 13.0% of all US adults had diabetes
• 26.8% of people over 65 years old had diabetes – 1 in 4 – OMG!!!
• While undiagnosed statistics remained rather flat, the prevalence of diagnosed diabetes continues to rise (see graph).

If those numbers aren’t enough to paint the picture, the following progression of the prevalence of diabetes from 2004-2016 illustrate the facts in graphic detail.  Whatever we are doing to combat diabetes in the US isn’t working.  At all.  It is getting worse!

Incidence in Children and Teens

While the report shows some modest flattening of the incidence of new cases in adults, that is not the case for our younger citizens. Type 2 diabetes is on the rise in kiddos, especially black children.   And that same group of kids are now showing higher incidence of Type 1 as well.  That aqua line should scare us all.  What the heck is going on?
(*A note on those adult number – we see the prevalence of diabetes increasing because the group “adults” spans many years, so all new cases add to the total number even though the incidence is less as fewer are diagnosed year to year.)  

Impact

The total direct and indirect estimated costs of diagnosed diabetes in the United States in 2017 was $327 billion.  Billion with a B!  Based on this nifty website, with $327 billion dollars you could buy almost 11 MILLION cars!  If you lived 327 billion minutes, you would be alive 622,146 years.  It’s a lot!

And despite a lot of new treatments and technology, the medical costs per person have risen from $8,417 to $9,601 (not accounting for inflation, so it is actually higher!)  This report from January of this year shows that all this money is not showing better outcomes.  Neither do the CDC graphs!

Lifestyle considerations

Smoking, obesity, and lack of physical activity continue to be risk factors as are high blood pressure, high cholesterol and elevated A1c.  These are also key findings in metabolic syndrome which I still believe is part of the chicken/egg conundrum.  Why do some people get away with high risk choices and don’t get diabetes, but others try their best to make changes but have such a hard time?

In my years of clinical practice focus has always been on getting the numbers “in range”, which in theory is good, but to do that requires a LOT of lifestyle change.  And this is where people struggle – making healthier lifestyle choices become lifelong habits.  It is not breaking news that eating healthier, losing weight and exercising more offsets diabetes complications. You don’t have to have diabetes to benefit from living healthier, yet knowing this information is not enough.  The graphs tell the story.  If education were enough, the numbers would be going down!

Lasting Change

Willpower is not enough to make lasting changes, yet that is what is expected.  People should just change because they know better.  But we are a complex system of mind, body and spirit with many needs competing for our attention.   Things like the need to fit in, the need to be comforted, the need to enjoy life’s pleasures, the need to avoid pain, the need to pursue ambitions, the need for autonomy and on and on.   These “needs” compete with healthy choices sometimes and we “fail” to do diabetes perfectly.

The inevitable failures that come with diabetes can lead to burnout and feelings of “why bother?” which is a slippery slope into diabetes complications.  So, with all the money and research why isn’t there something that works?  There is.

Psychosocial Support

Studies going back over 15 years show improved diabetes outcomes:

• when people feel supported
• when they have more control and ownership of their bodies
• when they feel understood
• when their unique needs are addressed
• when they have adequate tools and training to manage stress
• when they feel empowered

These bullets show what psychosocial support looks like.  Psychosocial support is about the wellbeing of your emotions, your relationships and your purpose in the world.  When you feel better on those levels, you practice more self-care.  Self-care reduces burnout and includes choices that make you healthier.  And they are little choices overtime that become habits.   A lack of self-care leads to burnout and neglect.

Perhaps diabetes treatment should start with strategies to prevent burnout and not just chasing numbers?  Maybe then we’d see these graphs change??

It was the game changer for me…

Thanks for reading…. peace and be well,

The post CDC Shows Diabetes Increasing. COVID19 Threat. appeared first on Better Diabetes Life.

I was recently asked to present at the Greater Dallas Chapter JDRF Type One Summit on the topic of diabetes burnout and stress. It was an amazing event so I have to share with you!

JDRF hosts this one day event, bringing people with type 1 diabetes together to learn and share.  It is always a bit surreal to be in the company of so many who “get it”.  It’s very humbling actually, but I was with my peeps!  The event was set up in three parts.   In the morning there were all the standard diabetes vendors with latest pumps, CGMs and other gadgets.  Fun to mill about and snap some selfies!

Lunch was a showcase of fun kids sharing JDRF events and initiatives, followed by Keynote Speaker Kyle Cochran, a four time American Ninja Warrior who lives with Type 1. He was super inspiring!  In the afternoon, kids got to hang with other T1D kids their age, while parents and adults made their way to education sessions.

Presenting on Diabetes Stress & Burnout

I was the first presenter after lunch in the adult track on the psychosocial aspects of diabetes (that’s just a big medical word for how diabetes impacts your emotions, motivation and mental state).  This was huge for me on so many levels 1) That JDRF sees me as an influencer and expert diabetes coach; 2) that JDRF understands that it takes a whole lot more than diet and exercise to live well with diabetes and; 3) the acknowledgement that no matter how long you have lived with diabetes, you still need support.  Diabetes burnout can happen to anyone , at anytime.

Connection

Patricia Daiker Diabetes Coach JDRF Presenter

Everyone who is touched by diabetes knows about burnout and stress.  It’s a lifelong challenge that is “As Unpredictable as the Weather” as the name of my presentation indicated.  Since we can’t control the weather nor the nuances of diabetes, our best approach is to be prepared. That idea seemed to resonate with attendees.  The event planner said my session was a popular sign up, and I was thrilled that the room was nearly at capacity!  Obviously, we all shared a connection with diabetes, but I was taken aback by some of the applause I received.  Just for sharing my story (and to be honest, a tear or two), my ‘diapeeps” knew my struggle and their support was palpable.  But most importantly, I was able to provide some insight and ideas about new ways of preparing for the stress of diabetes.

Truth about diabetes

If I had to provide you with the cliff notes version of my presentation it would be this.

• Despite all the money and innovation, people with diabetes still struggle.  Research shows that outcomes haven’t improved in the last decade.
• Research also shows that mental and emotional well being and support improve outcomes.  This knowledge has been around for over 15 years.
• The battle call of diabetes is to “fight”, but our bodies cannot stay in fight/flight/freeze mode.  We need rest/digest/restore time to stay in balance.
• Our bodies love balance.
• We can trick out bodies into rest/digest/restore with intention and new tools, thus creating more balance to combat with the stress of diabetes.
• Change is inevitable, we change every moment of every day.  We will be different in a year from now, just as we were different a  year ago.
• With intention and some new tools, you can introduce more peace and feelings of control, and those intentional changes will change you for the BETTER!

Recommendations

So what is my take away from the summit?  If you have the opportunity to attend a diabetes gathering, no matter how large or small, do it.  The connection is healing and there is so much comfort in being around so many who know your struggle  The atmosphere literally “feels” different.  #Amazing!  And you are sure to learn something.  I learned from the presenters, from the people who sat next to me at lunch (a 6 year old and a 42 year old who both were diagnosed in the past 18 months – the disease knows no age), and from those who shared their stories with me after my presentation.

I also suggest that if you are NOT dealing with the “psychosocial” aspects of diabetes very well, better known as burnout, reach out;  to me, to a support group, to a counselor, or anyone else you trust to listen to you, hear you and help you.  That positive act of reaching out  is a self-care step that changes your path, if only a bit.  And just a bit in a better direction is all it takes to get started.

Peace always,

Be sure to check out my new Program – its a great way to battle burnout in the privacy of your own home!

The post Diabetes Burnout Presented at JDRF Summit appeared first on Better Diabetes Life.

As I settled down in my yoga class this morning, our instructor brought up the difference between intention and expectation. Where intention is something you aspire to be, a value, a direction or a plan you want to put into place, expectation focuses on the needing things to be a certain way, an assumption, or the ever-dreaded thought that things “should” be a particular way. With intention, you head in a particular direction but are flexible in how you get there. The expectation, on the other hand, has a much more rigid, defined path and outcome.

So what does this have to do with diabetes?

One of my key beliefs is that we should strive for persistence instead of perfection in our approach to diabetes management. Persistence aligns with intention (a value, direction, way to be), whereas perfection is a strictly defined expectation. In yoga, if you have the expectation you can bend over and touch the ground, you will be disappointed if it doesn’t happen. If you have the intention that you will be diligent in your practice, but not hurt yourself, you will be proud and accepting of almost reaching your toes.

Likewise for diabetes, if you have the expectation that every blood sugar will be perfect, frustration and disappointment show up when you have done everything right, but the number still isn’t where you want it. But if your intention is to do the best you can each day, with what you have, then those occasional (or even more persistent) out of whack numbers won’t cut so deep into your sense of worth. You are still living up to your intention and moving in a positive direction even when diabetes isn’t playing fair.

Motivation

Staying motivated in a diabetes life can be hard, especially if you are grading yourself by your expectations. If you feel you are failing, it can be harder and harder, to keep you ahead in the game and your eye on the ball. But if you persistently move in a direction of curiosity, self-care, grace, and diligence you develop a greater sense of ownership and achievement even when the numbers aren’t perfect. Following an intention builds motivation, whereas trying to live up to expectations can kill your motivation.

Intentionally Moving Forward

One of the best ways to follow your intention and manage expectations is to focus on what is true or speaking what you want to be true. What is true doesn’t have to be earth-shattering, but it helps you find stability and peace. I am trying something new this time. I want you to listen to this audio clip. It is an example of how you can bring to life your intentions and stay in a place of peace when parts of your world seem out of control. Listen and repeat. Or make up your own!

So, if frustration and struggle are getting to you, see what you can do to manage your expectations. Set an intention. It may be just the thing you need!

Not sure how to get started?  I can help!  Sign up for  free 30 minute discovery call!

Peace,

The post Diabetes Expectations – The Cause of Your Woes? appeared first on Better Diabetes Life.