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Home    Services    Diabetes    Tips from a Diabetes Counselor
Tips from a Diabetes Counselor

How can I get friends and family involved in my care?

Can diabetes cause depression?

What's so tough about monitoring blood glucose?

Can I eat all I want of a food that is labeled sugar free?

How do I fight the isolation of diabetes?

What are some simple changes I can make to my diet?

How do I set goals for myself?

Should I pay attention to what I drink?

How do I move from discouraged to encouraged?

Will eating three meals a day help me manage my blood glucose?


How can I get friends and family involved in my care?

To be more successful at managing your diabetes, it's important to have the support of the people in your life. While your diabetes care will ultimately depend on you, we all need a helping hand. In addition to the support of your medical team you also need the help of the people who love you.

Diabetes is a family disease because it affects every member of the family. Food selection and preparation are important parts of family life. The need for eating regular meals and taking your medication as well as avoiding low blood glucose can take away some spontaneity from meals. Dining out is another challenge families face when living with diabetes. Your diabetes management can affect your family in other ways, too. Family and friends may have varied feelings about your health including concern and sympathy, some fears, guilt or resentment. It’s helpful to recognize that the more your family members and friends know about diabetes control, the more everyone benefits. To get your support network involved:

  • Ask them to attend diabetes education classes and diabetes support groups with you. This will help them understand what you need to do to manage your diabetes and in many cases family members find that they are helped by adopting many of the behavioral changes themselves.
  • Provide your family with information and encourage them to participate in activities like those sponsored by the American Diabetes Association and the Juvenile Diabetes Research Foundation.
  • Practice skills at home with your family and discuss the treatment for low blood sugar so family and friends can understand what you go through and how to help you if needed.
  • Share with your support group your meal and medication schedule. Tell them how you plan to handle any schedule changes so they're prepared in the event of complications.
  • Encourage any family member who is having trouble coping with your having diabetes to seek counseling to discuss his or her feelings and/or anxieties.
  • Let others know how they can help you: "It really helps me when I see you order healthy foods off the menu first." Let them know how you feel about them eating sweet foods and desserts in front of you. Some people find it difficult to not eat what everyone else has; others don't mind at all when their friends have sweet foods. Clear the air with your friends, and cast off everyone's uncertainty about what to do.
  • Ask a family member or friend to join you in an exercise or weight control program.

We all need the support of family and friends. Ask them to get involved.

Can diabetes cause depression?

It’s a normal part of life to feel down on occasion. But for some, a sadness that just won't go away or losing interest in the things that once brought happiness might be a sign of a more serious depression.

Studies show that people with diabetes have a greater risk of developing depression than people without diabetes. This does not mean that because you have diabetes you are certain to have depression, but it does suggest that it is important to be knowledgeable about depression.

The daily stress of diabetes care can sometimes take a toll. You may feel lonely at times having to manage your diabetes. Complications such as nerve damage or blood sugar levels that are difficult to control can add to the emotional burden you feel. Depression can make diabetes care even more difficult. When we are depressed it’s harder to care for ourselves – our eating habits can change, we feel less motivated to exercise and blood sugar control can become even more challenging.

Signs and symptoms of depression:

  • Loss of interest in doing things you usually like to do
  • Loss of pleasure
  • Change in sleep patterns
  • Change in appetite
  • Trouble concentrating
  • Loss of energy
  • Nervousness
  • Guilt
  • Suicidal thoughts or thoughts of death.

Experiencing a couple of these symptoms for at least 2 weeks suggests the presence of a clinical depression, and reaching out for help is important. Talk it over with your doctor. There may be a physical cause for your depression.

Poor control of diabetes can sometimes cause symptoms that look like depression. Other health problems can also look like depression as well. Your doctor can help determine if a physical problem might be the cause. If you and your doctor decide there is not physical cause, referral to a mental health professional is often the next step. Generally there are two types of treatment – psychotherapy or counseling and/or antidepressant medication.

If you have symptoms of depression, reach out for help and talk it over with your doctor. Don’t go it alone – get the support you need.

What's so tough about monitoring blood glucose?

Most people who have diabetes agree that checking blood glucose is fairly easy to do and realize that it provides useful information. So why do so many people struggle with taking their blood glucose? Is it a lack of will power? Is it that they just don't care?

Turns out most people are pretty reasonable. They stop checking blood glucose when they believe the whole process involves a lot of hassles and see few benefits. And unfortunately, there are quite a few hassles associated with checking your blood glucose – some big hassles, some little, and maybe some are even silly.

William Polonsky, PhD, CDE, in his book Diabetes Burnout, shares the top 10 reasons people hate checking blood glucose. Number one on his list is: Your meter makes you feel bad about yourself. For some a meter can become how they judge themselves. Depending on the results of testing, it is common to feel like you're failing if your meter is reading high, or feel like you're a good person if your meter is low. 

When you see a high reading, what is your response? It is common for people to have an inner dialogue almost as though the meter is speaking to them. "What did I do wrong this time?" "Oh great, another high reading. I am such a loser." At times like this, it is easy to lose sight of the fact that the reading is only a number and does not reflect who you are as a person. You may be having a wonderful day and an unwanted number ruins the day and affects your ability to be a good problem solver. It probably doesn't help that checking blood glucose is often referred to as "testing your sugars."

What might help? Turns out, those who are successful with monitoring come to view their readings as simple pieces of information and an opportunity to take action, not as a way to judge themselves. As Dr. Polonsky suggests, "Think of the gas gauge on your car. When it nears empty, do you avoid looking at it? Do you yell at yourself for being so stupid as to allow it to get low? Do you feel like a failure because you allowed this to happen? Do you resent your car because you now have to stop for gas? Probably not. You don't think of the amount of gas in your tank as good or bad; instead the gauge is just providing information that allows you to make the best decisions."

Some helpful tips:

  1. Stop referring to the process as "testing your glucose." Think of it as monitoring. Sometimes it can be helpful to take a little piece of paper and write "It's only a number" and tape this reminder to your meter.
  2. Avoid referring to your readings as good or bad. Instead, think high or low.
  3. Remind yourself how silly it is to let your blood glucose reading determine your self-esteem. Challenge these automatic thoughts and replace them. Instead of saying to yourself, "How did I mess up this time?" you might say "What can I do about this right now?" or "What would help me today?" By focusing on problem solving, you empower yourself. You free yourself from self-blame.
  4. Be reasonable about blood glucose expectations. Work with your doctor to determine what is reasonable and remember diabetes cannot be managed perfectly, it can only be managed well.

These strategies can help you begin to make peace with blood glucose monitoring. Find support, join a support group, talk with others, be supportive of yourself and take time to care for your emotional, social and physical needs.

Can I eat all I want of a food that is labeled sugar free?

Foods that have less than .5 grams/serving can be labeled "sugar free." However, we know that ALL carbohydrates affect blood sugar, not only simple carbohydrates. When a product is labeled "sugar free" it usually does not mean that it is carbohydrate free or calorie free.

It is extremely important to look past the label "sugar free" and go directly to the nutrition facts label. This panel is a gold-mine of important information in choosing healthy foods and understanding controlled portion sizes. The first data point you want to look at is the serving size. Serving sizes are not standardized from label to label, so it's important to look at this first. Secondly, check out the total carbohydrates. This will give you the most information on whether this food is appropriate for you to eat, and how much will be equal to one carbohydrate choice.

Finally, check out the fat and sodium. Many times, when sugar is removed from a food item, fat and salt are added. Make sure that this food does not have additional fat, especially saturated or trans fats and sodium.

How do I fight the isolation of diabetes?

Have you sometimes felt alone with your diabetes as though no one around you really understands what it is like to live 24 hours a day, seven days a week with diabetes? Even in the midst of loving family and caring friends, you can sometimes feel a bit isolated. As helpful as those around you might be at times, there is a missing element of personal understanding.

Support groups can help provide that missing piece. A support group can be a place where wisdom dwells and encouragement is provided. A group can be a place to connect with others who are dealing with the same challenges and to share with one another ways to live well with diabetes. A dose of humor, a sharing of stories and a time to join with others who also live daily with diabetes can help soften the rough edges of feelings that sometimes go along with the journey.

We offer support groups at the Diabetes Center. Please consider joining us.

What are some simple changes I can make to my diet?

Eating healthy doesn't have to be complicated. Simple substitutions to our everyday food choices can lower calories and fat and increase fiber, vitamins and minerals. Benefits include better control of blood sugar, feeling more satisfied after meals and having more energy. Here are some ideas:

  • By skipping the medium fries at a fast food restaurant and instead having a side salad with low fat balsamic dressing and apple slices, you save 260 calories, 16 g. fat and 25 g. carbohydrates.
  • By taking the skin off your chicken, you save 50 calories and 6 g. of fat per serving.
  • By substituting a no-sugar-added ice cream sandwich for 1 cup of regular ice cream, you save 250 calories, 14 g. fat and 22 g. carbohydrates.
  • By choosing a can of diet soda instead of regular soda, you save 150 calories and 40 g. of carbohydrates.
  • By choosing 1 cup oatmeal with ½ cup blueberries instead of 2 pop tarts, you save 160 calories, 7 g. fat and 20 g. carbohydrates.

How do I set goals for myself?

Setting a resolution is just like setting a goal. Sometimes we need a little nudge in the right direction to take action. Take a moment to ask yourself what you really want and in what direction you want your life experience to move. It might be something seemingly small, like walking an extra 10 minutes a day or maybe trying to commit to eating 3 servings of fruits and vegetables each day. Whatever you commit to you'll be amazed at how much even small changes add up.

Choose just one or two and do them. Don't choose dozens, it's overwhelming to your brain and often leads to failure in accomplishing any of them. Choose your few and step into your life anew. Try it, start it, step into a new beginning. If we don't stop to inquire and plan, take action and "do the doing" of the new, the old will easily keep us stuck and buried in our past.

Here are some suggestions; maybe one of these is right for you:

  • Aim for three servings of veggies every day. The goal is to eat at least five servings of vegetables every day, but if you can get three servings in, you're doing great.
  • Sneak activity in whenever possible. The next time Dancing with the Stars is on, get up and move – dance, march in place, lift weights – every little bit counts.
  • Catch some ZZZ's. Too many of us are sleep deprived. We're learning more and more about how important a good night's sleep is. Lack of sleep affects blood glucose control and body weight (and not in a good way), and puts you at risk for illness, infection and even heart troubles. If you aren't getting 7 to 8 hours of sleep each night, talk with your physician about what you can do.
  • Clean out the cupboards. Cleaning always makes you feel good anyway, but now's the time to get rid of not-so-healthy foods (cookies, chips, salty soups). If you can't bring yourself to throw them out, move them to a section of the cupboard that's not too easy to get to.
  • Stress less. Too much stress can have a negative impact on our health and wellbeing. Maybe there are things in your life that are no longer working for you and it is time to let them go. Find ways to relax and enjoy your life and avoid focusing on things that you have no control over.

Should I pay attention to what I drink?

Calories and carbohydrates in our food can add up easily enough – we don't want additional calories and carbohydrates in our drinks also. So it is important to make sure you are not having any sugary drinks. Drinks that are high in sugar and calories will spike your blood glucose and do not fill you up. A lowfat milk is the only drink that should count as a carb choice and you should still watch your portion size.

It is also important to make sure you drink enough water throughout the day to stay hydrated. Often our bodies may feel hungry when we are really just thirsty. So if it is not a meal or snack time and you are feeling hungry, drink a big glass of water, wait 10 minutes, and see if you are still hungry. Drinks that have caffeine in them will actually dehydrate us, so keep caffeinated beverages limited to 3 cups per day. A general goal for water consumption is eight 8-ounce glasses per day or 64 ounces. It is surprising how much of a difference this simple change can make. Buy a water bottle that you will only need to fill up 2 or 3 times in order to reach your goal and keep it with you throughout the day.

Drinks to Avoid

Drinks to Enjoy

Fruit juice
Sweet tea
Regular lemonade
Kool-Aid
Fruit punch
Regular soda
Gatorade

Water
Sugar-free tea
Sugar-free lemonade
Sugar-free Kool-Aid
Flavored water
Diet soda
Powerade Zero


How do I move from discouraged to encouraged?

The day-to-day challenges of diabetes can sometimes get you down. Managing diabetes can be a lot of work and sometimes it can seem like even your best efforts aren't paying off. At times likes this it's easy to get discouraged. There are ways to move from discouraged to encouraged.

  • Set clear, specific, short term goals. Make your goals realistic and don't try to juggle too many things at once. Changing habits can be tough so it is important that you work on only one or two goals at a time. Maybe you want to change something about the way you eat. Be specific-- "I will eat three fruits/vegetables each day" or " I will drink 8 glasses of water each day" By clarifying your goals you will be able to measure your success.
  • Don't let blood sugar readings determine your self-esteem. Sometimes when blood sugar readings are not what you hope, it's common to be critical of yourself. Remember, blood sugar results are neither good nor bad; only helpful information to let you manage your diabetes better. If you forget this and start making negative comments to yourself, put a piece of tape on your meter and write, "It's only a number".
  • Measure your success in a realistic manner. Remember, some days will be better than other days. Sometimes the stresses of life can be challenging. If you find you are having a bad day try to be realistic and do some simple things to take care of yourself. And remember, if you've lapsed about some behavior you are working to change-forgive yourself, learn from the experience, don't beat yourself up, and then find a way to get back up again. On those days it may also be important to reach out to others. Talk to family members or friends. Share what's going on with others.

Will eating three meals a day help me manage my blood glucose?

Eating three meals a day, and having about the same amount of carbohydrates at each meal, will help keep your blood sugars stable. Ideally, keep your meals about 4-5 hours apart. If they are going to be further apart than that, or if you just prefer to have snacks, a carbohydrate choice can be moved from a meal out into a snack. If you are not currently eating three meals a day, that could be a good goal to work on. 

Breakfast doesn't have to be anything too complicated. Here are a few suggestions:

  • small bowl of high-fiber or whole grain cereal with skim milk
  • light yogurt, some fresh fruit and a granola bar
  • 2 pieces of toast with peanut butter and a cup of skim milk
  • oatmeal and 1 egg 
  • whole wheat English muffin, light yogurt and fresh fruit

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