Diabetes Basics

Everybody who has diabetes is going to change in the year 2013. The change coming to each of us will be significant or minor, planned or haphazard, for the better or for the worse.

But it’s coming, ready or not.

Change is an integral part of life. Scientists tell us that except for the neurons in our cerebral cortex the very cells that compose our bodies change every few years. Nothing is permanent and whatever lives changes more quickly and profoundly than inanimate objects.

We change our minds and habits a lot more often than our cells change. We can direct the change in what we do by putting our minds to it.

This is reason for the tradition of making New Year’s Resolutions. The trick is to keep the resolutions that we make so for us it’s not an empty, meaningless, and ultimately disappointing tradition.

We can start on the path to a healthier new year but setting aside a few minutes on New Year’s Day for reflecting on where we want to go and how we intend to get there. Each year a group that I belong to starts the near with the “Beginning Anew” ceremony, a ritual that Thich Nhat Hanh created to help us let go of the past and to set a clear, strong intention for the coming year.

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When we make an appointment to see our doctor, it’s because we recognize that we need help with our health. But when we enter his or her office we need to be sure not to abdicate our responsibility.

We have the primary responsibility for our health. Diabetes is a disease that, perhaps more than any other, depends much more on those of us who have it than on the doctor.

Actually, how could it be otherwise for anyone? Few people will get more than 15 minutes of the doctor’s time every three months.

We decide what we eat, how much physical activity we get, and whether we will take our prescribed medicine. While that’s obvious, too often we trade this active role in managing our health for a passive role at the doctor’s office.

Have you noticed that people who are successful in managing meetings almost always prepare a written agenda? We need to do exactly that for each office visit.

An agenda works best when we write it out in our priority order. We need to cover a limited number of points that we can work on together in a quarter of an hour. The agenda should be bullet points, not paragraphs. It works best when we give a copy to our doctor.

When we prepare an agenda, it forces us to think out what we want to get out of our appointment. At the same time it leads our doctor to focus on what’s troubling us the most.

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Diabetes is usually one of the most expensive diseases we could get. But it doesn’t have to be.

If we didn’t have diabetes, the amount that we would have to spend for healthcare would be a lot less. Specifically, diabetes costs us about 2.3 times as much in medical expenditures as it does for people who don’t have it, according to the American Diabetes Association. And that doesn’t even consider the lost income from losing work because of diabetes.

But that’s money under the dam. We’ve got diabetes and we’ve got to figure out how to live with it within our means.

The trick is to manage our diabetes so it doesn’t manage our life. Easier said than done, of course, but it’s certainly possible.

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We all know that diabetes is one of most expensive diseases. But the greatest cost of diabetes is treating the complications that come when we don’t keep our blood glucose levels low enough.

When we manage diabetes well, the cost goes way down. The four cornerstones of diabetes management are diet, exercise, stress reduction, and — if necessary — medication. Two of these cornerstones are inexpensive.

We can get a lot of exercise with just a pair of shoes or boots. In a pinch I once bought an adequate pair of sneakers at a Wal-Mart for $10.

Stress reduction can be even less expensive. The best way that I know to control my stress is meditation, which is free. The title of one book on meditation speaks to me, “Don’t Just Do Something, Sit There.”

But medication is a different story. If you have type 1 diabetes and no insurance, the cost of insulin can be substantial. If you use an insulin pump and/or a continuous glucose sensor to manage your diabetes, the cost can be tremendous, even if you have otherwise excellent insurance coverage. Otherwise, the maximum dose of one of the best diabetes drugs, metformin, is available as a generic for as little as $32 per month.

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We can divide everyone into two types of people — those of us who have diabetes or those who don’t. Or we can divide us into men and women. Or into people who can read and write compared with those who can’t.

“Wait a minute!” you might exclaim. “That’s already a lot more than two types.”

Precisely. And that’s just the problem with all those studies that purport to show that two situations that occur today have a cause-and-effect relationship.

A greater proportion of people in those countries with a high rate of literacy have diabetes than in those countries where people are less educated. That’s a correlation between diabetes and literacy. It doesn’t prove that education causes diabetes.

Maybe the rate of diabetes has gone up in this country because more people live in homes that have air conditioning. Those two variables do correlate. But that doesn’t prove that one caused the other.

We have so many types of people in fact that each of us is unique. And no study can possibly control for every type of difference among us.

Yet scientific researchers continually bring forth new studies correlating one sort of change with another. These studies do have a real value.

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