Mind Over Mellitus

(I wrote this for Taking Control of Your Diabetes, Volume 28, Q1 2009)

“Self-discipline?” Self-discipline sounds so remarkably un-saucy. In fact, it seems downright counter to happiness… a recipe to steal my “mojo,” rain on my parade, and turn me into some kind of cheerless robot. I want to do what I want to do, when I want to do it, and nobody is going to tell me how.  Hmph!!

That’s my small mind talking.

And there have been so many more occasions for my small mind’s protests and gnashing of teeth since my diabetes diagnosis twelve years ago: Time to test… Surrender to the three-month Endo visit… Pass up on the carbolicious scones… Exercise without fail to keep my numbers even and my heart ticking… Hold off on the hot, yummy dinner before me because I’m at 212 mg/dl… Eat some carb when I’m full and at 56 mg/dl… “Poor me!”

Yes, the list goes on. In fact, today I counted 37 “diabetic occasions” that thwarted my self-will and made me want to cave-in to little desires (and in a few cases I did).

The Surprising Source of Unhappiness

The one big constant across all my little complaints, minute-to-minute unhappiness, and blaming of diabetes seems to be me. More accurately, so much of my daily suffering is literally in my head - driven by my outlook and what I choose to focus on.

Certainly our feelings are influenced by body chemistry, life experiences, and trauma from the past, but “happiness is more determined by one’s state of mind than by external events,” observes Howard Cutler, MD, co-author with the Dalai Lama of The Art of Happiness.

David Burns, MD, author of The Feeling Good Handbook, is even more emphatic, declaring, “thoughts and attitudes - not external events - create our feelings…(and)… the messages we give ourselves have an enormous impact on our feelings.”

I can vouch for that. Looking at a high number on my glucose meter and thinking, “I failed! I’m a bad diabetic!” can ruin part of my day. It feels entirely different from when I’ve got a better hold on myself and ask, “Okay, that was a learning experience. How can I prevent this from happening again?” And I move on. Two different habits of mind. Two different results.

Not only does our thinking play a big role in our own unhappiness, it’s also the key to feeling much better.

“Bulk-Up Those Happiness Muscles!”

But here’s the exciting implication for those of us with diabetes: With every additional self-care challenge comes the opportunity to strengthen exactly the muscles we need in order to create happiness - we flex our will and take autonomy over our thinking.

Self-discipline puts us in a position of strength, action, cause.

Seeing the connection between self-discipline and happiness is empowering and exciting. It’s also unspecific.

A Few Tips: Clearing the Way for a Happier Life

I’ll share three of my best practices for using mental discipline to clear the way for a happier life - learned over the last twenty-five years, and put to the test by diabetes.

1. Focus on what you have control over (don’t worry about the rest).

Life gets far simpler and less overwhelming when we center on the few things we actually can control. Everything else will manage just fine without us.

I can’t always control my blood glucose numbers, but I can control what goes on my fork.

When I’m frustrated with someone, it’s a huge relief to ask myself what can I really control in the situation?  That gives me back my power, helps me return my attention to my own behavior (which is sometimes the whole source of the problem), and helps me stop obsessing.

2. Don’t believe everything you think.

Most negative thoughts are distorted by our mind’s natural tendency to manufacture dramas in which it can play the leading role. Some of our mind’s favorite dramas are blowing things out of proportion, jumping to conclusions (also known as making things up), personalizing events that are not personal.

To my mind’s complaints like, “But I don’t feel like…” testing, exercising, whatever it is, I reply, Thank you for sharing. Then I do what needs to get done. My “feelings” always want a vote, but they’re usually not relevant to what needs to be accomplished when it comes to my self-care.

3. Re-anchor your attention on what you care most about (with a mantra).

Athletes, advertisers, and educators understand the power of repetition. Self-talk gives star athletes the power to break world records. Self suggestion returns our focus to what matters. It cuts past the excuses, complaints, fears, and self-doubts, bringing what we care about into sharp focus, and establishing it as our reference point.

Recalling one of my mantras, “I choose to be happy”, often saves the day for me (or at least the hour). There’s something soothing about this choice. It’s a reminder that I care for me, and just as importantly, I am in charge of my happiness! Let that sink in. It feels pretty good … and it happens to be true!

“I deserve normal blood sugars,” is a mantra that comes to my rescue at other times. When I want to surrender to my impulses to go “off-road” on my diabetes self-care, it reminds me what I really want, and what the tradeoff is. When my blood sugar is on target, my thinking is clearer, I’m more energetic, I’m less distracted, and I feel better. I’m willing to give up a lot for that.

Staying Happy With Our Feet on the Ground

That we should be happy all the time is not realistic, nor even a healthy approach to all situations. There are times when anger or mourning is totally appropriate. Nor are self-discipline and mental toughness a replacement for therapy or medication when either is warranted.

The important point to remember is that there are steps we can take to improve the mental side of our happiness equation. By learning to change our thoughts through discipline and persistence, we take charge of our happiness and shape how we feel. For me it means initiating small “causes” now that will have big “affects” on my happiness in the future. It also means loosening the grip of unhappiness when it inevitably comes.

Summary

As diabetics we face extra challenges to our joy and well-being. Few diseases exercise so well the “muscles” needed to change our patterns and invest in happiness. Dealing with the countless interruptions, inconveniences, and indignities of diabetes management is arguably the best gym on the planet to improve our capacity to manage our minds and reap the returns in health and happiness again and again.

Self-discipline is ultimately about making a tradeoff, not a sacrifice - we accept short-term effort in exchange for long-term joy.

Hypoglycemia probably causes me more day-to-day suffering and frustration with diabetes than anything else. It triggers a cascade of counter-regulatory or “stress hormones” - adrenaline, cortisol, epinephrine - activated by our “fight or flight” reflex when something really bad happens. “Yikes!”, my body responds.

The vice tightens in my gut. My face and shoulders become involuntarily tense. It make me more emotional, unable to concentrate, and almost always less able to tolerate external stress, with so much coming from within. So I get impatient and cranky - two things that cause major internal conflict for me, as someone who sincerely wants to contribute to the happiness of people around me!

The horrible, hypo feeling doesn’t go away once blood glucose returns to normal. No, it takes a while to shake out of my system. (Ever notice that?)

Add to that, that our brains aren’t getting enough glucose to function properly when hypoglycemic - and presto, we have the recipe for making colossal mistakes in relationships by saying the wrong thing we don’t at all mean.

If you and your love are both hypo, it’s that much harder. For those of us with a partner with diabetes and pre-diabetes, here’s the catch: That shared empathy and understanding can quickly and compassionately protect from and heal the biggest mistakes of unskillfulness. That’s the loving gift Joanne gives to me. And that’s the present I always have waiting for her.

What do you do to curb this tough side-effect of diabetes (and pre-diabetes)? Please share! I’ll walk you through what works for me next time.

Take care of you and your honey. Stay level.

(This came from my blog on www.YourBestSugar.com)

Recently, I wrote my first letter to a small circle of friends interested in diabetes-friendly dating online. (Drop me a line if you would like me to share it with you.)

What amazed me was how much I enjoyed writing to them. I felt the same way when I wrote this article for Taking Control of Your Diabetes, when I normally sort of dread writing and putting myself out there.

What changed?, I asked myself. I tapped into the love I have buried inside of me, underneath all the distractions, self-concern, and unconsciousness that I carry around every day. I want more of that love, and I think we’re all drawn to it when we put all the “stuff” we carry around aside.

More amazing is that love in our hearts can be cultivated and grow no matter how young or old we are. If you have diabetes or any other difficulty, give yourself dearly needed loving-kindness. It is especially helpful in coping with strong, wrenching emotions that come with chronic illness and wildly swinging blood glucose levels. Love doesn’t undo what’s wrong, but it transforms suffering like nothing else.

Here are a four suggestions for growing in love:

1.    Learn Metta Meditation, the practice of loving-kindness. Sharon Salzburg’s book Loving-Kindness provides a wonderful explanation of what it is and how to fundamentally grow in our capacity for love - for ourselves and others. She shares very specific and practical insights and actions to grow in love.

2.    Seek loving influences. Spend more time in the company of the most warm-hearted, loving people in your life. Avoid the opposite, even in entertainment. Violence slips into our consciousness the same way love does. It’s up to us how we want to shape our character.

3.    Refuse to repress any generous impulse (provided you don’t throw your safety and security to the wind). Love becomes so much easier to uncover and express when our self-concern drops away while caring for others. Volunteering also reminds us of the suffering out there and of how much we have to be thankful for.

4.    Find your life-partner and love if you don’t have one. (Your Best Sugar can help.) And if you do have a partner, practice lovingly putting him or her first each day as a gift to your love’s heart and your own.

Though love doesn’t undo the physical reality of diabetes, it trumps it. Love is bigger. Love is more important to our happiness. The love in our hearts can be expanded and expressed, and the world needs all we’ve got!

If you have any suggestions or ideas I hope you’ll leave a comment and share!

If you live in Los Angeles you may see me running down the street with a big package under my arm, at the bank or hardware store in my running shorts, jumping rope on top of a parking garage, walking in circles with my luggage at LAX, or biking to a meeting. And it was no different during the four years I lived in Washington, D.C., though a lot colder at times!

A No-Exceptions policy - the gift that keeps giving

I found that exercise is so critically important to my blood glucose control, as well as my feeling of well-being, my happiness, my resistance to colds, my hearth-health (and yes even my vain childhood wishes to be built like a superhero - hasn’t happened yet), that I made a no-exceptions policy to exercise daily. And there are more reasons that keep me motivated. It is a cheap health insurance plan that extends our vital years and statistically cuts way back on our likelihood of needing nursing home care. So this policy is both a discipline and a gift to me.

The problem with any no-exceptions policy is that it’s not always convenient, especially if you too are super-busy. So I’ve learned to combine efforts. I save up my errands - going to Borders for a book, depositing a check, visiting the hardware store - and include them in a run or bike ride. On top of saving time, I conserve gas, avoid parking fees, and minimize wear and tear on my car and the environment, not to mention that I have more fun.

Travel: Getting a workout on the run

If your job or life involves traveling, new obstacles AND opportunities to exercise crop up. If you are visiting friends or relatives or are flying at odd times, it can be difficult to get a good workout. My solution?  - the portable, universal gym also know as the jump rope! I’ll show up to the airport early and find an inconspicuous place like the roof of a parking garage or an outdoor courtyard to jump. 20 or 30 minutes is a great work out! When I worked in India and Central Asia for the World Bank I often went to the roof of my hotel to jump rope and enjoy the view.

A colleague at the World Bank used to take a folding bike on every trip abroad - work or pleasure.

When traveling in business clothes I’ll set aside time to walk the airport carrying my bags for extra resistance if I know I won’t see a gym.

I also depend on a pedometer. Some days traveling or attending a conference involves so much walking that 10,000 steps goes by without my realizing it. That’s good enough for me. No need to work out. In fact it is valuable for me to wear the pedometer daily so I understand if I got more exercise than usual and should back off on my insulin to accommodate, or if I need to supplement with a little more exercise.

If you’ve been a diabetic for long, you’re probably accustomed to standing out a little in order to follow through on your self-care. My hat goes off to you! Fight the compulsion to look good by putting your well-being first. You’ll end up earning respect from the one who matters most.

So back to the Colorado mountain biking trip…

I was eating like a cross between a chipmunk and a bear, given the five or so low-carb options in our food stash.  Night five I was ready for a change.

I took my insulin and tucked into a BALANCE BAR like a starved hyena. With 20g of carb, it was out of my range, but given all the protein and fat in it, plus my roaring metabolism by that time, it proved to be no problem… until midnight food poisoning.

 It was a spoiled, expired BALANCE BAR I had eaten.

TIGAN, TAKE ME AWAY!

I was severely nauseated and certain to succumb. BUT HERE IS THE AMAZING PART, my endocrinologist prescribed Tigan, to prevent vomiting and dehydration. Dehydrating illness can be absolutely perilous for people with diabetes, especially in the Rockies miles from medical attention. (A cascade of effects can lead to severe DKA or hyperosmolar coma. Bad.)

I took 80 units of Tigan in my two shoulders in three injections (I use 30 unit syringes). It demolished my nausea and rescued me from a world of hurt within twenty minutes. Food poisoning is “death”.  Dread left and I rejoiced inside. Delivered. Saved. I tanked-up again with more in four hours.

That morning I was a little better but the mild fever and the burning, persistent Strep throat remained. Just two days left to go. Ahead, a huge, scenic, 4,000-foot climb out of Gateway, Colorado. The cliffs and steep, angular rock formations were like a Road Runner cartoon. Then the descent of a lifetime - a 6,000-foot single track trail dropped into the red rock canyon lands of Moab. An awesome crescendo to our trip.

ACCEPTANCE OF THIS DIABETES THING CAN BE LIFE-GIVING

In my hard-headed days I would have tried to tough it out. But the biggest adjustment after getting diabetes in my 20’s was acceptance of my vulnerability. Before, I identified as invincible. I had loved the feeling of freedom. No gear, no jewelry, nothing in my pockets or hands…

My new identity as a diabetic HAD to incorporate my new vulnerabilities to steer clear of the emergency room. I’m totally dependent on the little vial of insulin I carry, and on the glucose tablets that protect me from severe hypoglycemia. This was a tough adjustment for me, and I’m still adjusting.

So, torn about parting with my friends and letting go of this lifetime opportunity, I made the humbling and difficult decision to bail. Circumstances were kind to me, though. We were near an isolated resort and I got a ride to Grand Junction and from there back to Telluride.

That turned out to be a great decision and a character-building experience, putting my ego behind my health. The success, the breakthrough for me in that situation was choosing to quit.

My mountain bike trip from Telluride, CO to Moab, UT (almost) was as spectacular as it was uncomfortable.  11,000 foot views. Huge descents and climbs. Great company. Strep throat and food poisoning.  Not quite the story of triumph I hoped to bring back, but a great lesson for me.

View from the “kitchen”, Last-Dollar-Hut, CO Rockies

I am a bone-headed “finisher” when it comes to tough challenges - to a fault. Ever since I was cut from my Pop-Warner football team at twelve (entirely deserved, as the smallest, most inept player), returning at sixteen to complete two varsity football seasons at Davis High and win the Coaches Award. I had to prove to myself that I could do it.

The first day out of Telluride was an amazing climb, from 8,500 feet to 11,000 feet, to the first hut, used in winter for back country skiing. Though we felt our thirty pounds of gear each (clothes for all weather including snow, bike parts, tools, water for the day, basics for a week), without the stocked shelter we could have been carrying twice that.

The last third of the climb was a bear. My heart was pounding in my ears - probably scaring small animals. The air was ever so thin. But none of this was the issue.

Reclining after an epic ascent from Telluride

That night my sore throat was the sneak preview of what became full-blown strep throat.

Our trip was charted from ski hut to ski hut along our route. Eight bunks were crowded into each tidy little shack with canned food, cooking fuel, and fresh water tucked underneath. Perfect for our group of eight friends. NOT perfect for a low-carb diabetic diet however, and I ended up subsisting mostly on nuts, canned fish, cheese, plus bacon and eggs for breakfast.

Typical ski hut decorated by our mountain bikes…

More soon about the trip!

My new friend Amy Tenderich, the award-winning blogger behind DiabetesMine, posted a fun, revealing interview about yours truly, my diagnosis, this blog, and other hidden secrets of my private, personal life as a diabetic.

I was also thrilled to announce a soon-to-be-launched project I’m creating with my wife Joanne and our friend Eric — www.YourBestSugar.com, a diabetes-friendly dating site. We’ll “open” on November 14th! 

We hope you’ll visit. Leave your email if you want to stay in the loop. (Thank you.)

And thanks, Amy! Your blog has such great energy!

(This article also appears in Diabetes Wellness News, September, 2008)

If, “We are what we repeatedly do…” as Aristotle said, then it’s no surprise that habits shape our lives.

If we don’t choose our habits consciously, the worst ones may have a profound impact on our health outcomes as diabetics. Many risk factors can be controlled by making a few key behavior changes - transforming your worst habits has a life-giving effect.

Research confirms that even our most destructive habits can be transformed. Here are the steps.

1. Set a goal that focuses on a specific BEHAVIOR rather than outcomes

“No problem can be solved from the same level of consciousness that created it.” ~ Albert Einstein

Stop for a moment. What’s the biggest way you sabotage your health and happiness? Is it neglecting your blood glucose? Flaking on your workout? That donut in the office kitchen? Do you know? Your spouse, long-time friend or parents will. Ask them.

Fortunately, just a few of our behaviors account for the majority of our problems. Focus on the specific behavior(s) most responsible for the outcome you want, rather than on the outcome itself.

Mendosa gives us a great example:  John wanted to lose weight. Rather than fixating on his waist size or pounds lost, he transformed the key behavior that caused most of his weight problem, snacking after dinner, and lost 40 or 50 pounds.

Our worst habit does take thought and effort to change. There’s no magic bullet, no lottery win, so leave nothing to chance. A “dream” becomes a goal when you WRITE IT DOWN. Put the desired behavior at the top of your calendar. Stick it to your refrigerator.

Transforming your worst habit involves complex issues. A single strategy is too limited to shift a deep-seated pattern. For example, The National Weight Control registry data shows four habits of people who lose 66 pounds on average and keep it off for more than five years - exercise an hour each day, eat breakfast, weigh in regularly, and watch less than 10 hours of television per week.

So stack the odds overwhelmingly in your favor. Employ a combination of behaviors to make the new habits prevail. Use strategies that go well beyond the minimum you think necessary to make change. “If you’re trying to flatten an ant, push the refrigerator over on it.”

2. Monitor your progress and renew

If a habit matters to you, monitor it daily. Use a pedometer to track your activity. Check your weight and post it if want to lose it. Use your calendar to mark progress. Make it a game - remember grade school when the teacher put a star by your name? Monitoring refocuses and rewards us, and smart minds love games.

Some additional guidelines

• Take on only one or two habits at a time so your efforts are focused
• Set small milestones for gradual, steady progress (i.e., go from 2,000 steps per day to 3,000)
• Develop the habit for at least 30 days, or until it becomes natural
• Practice, because habits become more entrenched the longer we do them
• Make a “no-exceptions policy” for habits that protect your health.

You don’t have to be perfect. Habits are about what you do more often than not.  Consider these tips.

• Know that there will be slip-ups and plan your comeback strategy from the start
• Consider how you’ll handle vacations and sick days, when good habits can wither
• See errors as learning opportunities - pinpoint what happened, adapt, and recommit without guilt
• Keep in mind that we succeed in spite of our guilt, not because of it

Experts conclude that any effort you make in the right direction is worthwhile, even if you encounter setbacks from time to time. Replacing a bad habit with a good one establishes new neural pathways. Each time we practice the desirable habit we rewire our brains to work for us.

3. Arrange your environment for success

“Things” are far easier to change than people; our environment has a major influence on how we behave, so change the world around you to seal your success.

Psychologist Brian Wasnik finds that cues in our environment tell us when we’re full more so than our stomachs. Get smaller plates if you want to eat less. Don’t eat straight out of the refrigerator or bag, or in front of the TV or computer. Also, avoid multitasking during a meal so you really understand what you’re eating.

Make it easier to follow through. Abolish temptations. If you want to be more active buy an exercise DVD, get some home exercise equipment or put your daily walk on your work schedule during lunch. Put out your workout clothes in advance. Schedule exercise dates and times on your calendar.  Create an inspiring screen saver to represent your goal.

Tap your huge latitude for creativity as you consider how to orient your world for success.

4. Recruit a support team and be accountable

Our social network influences us continuously. Social psychologists know that if you make a commitment and share it with friends you’re much more likely to follow through.

Better yet, team up with a friend (or four) with similar aims to make the human desire for companionship and acceptance work for you. Or, get a furry pal - yours or a neighbor’s - to provide daily motivation to get moving.

Be vocal about your goals and ask for support. Request that your best friend be your “committed supporter” by checking in with you routinely about your progress.

When you win over your behaviors everyone shares in the success and inspiration.

5. Treat yourself and celebrate small successes

Your most powerful motivators are, in order of effectiveness, (1) the meaning you attach to your own behavior, for example, exercise is boring vs. exercise makes me feel good; (2) social motivators, especially committed support; and (3) rewards that you give yourself when you succeed.*

The best and most effective rewards come from inside.  Tie what you really want (e.g. a sense of accomplishment, self-mastery, good health) to the behavior that takes you there.

It requires faith and cultivation to develop new behaviors until they become a reward unto themselves. In the meantime, focus on your ideal rather than on what you’re giving up - walking past the donut is the opportunity to become who and how you want to be.

Reinforce the behavior you want to cultivate. Be generous and don’t wait until the final goal is met. Celebrate each mini-success and milestone and be sure to tell your committed supporters.

Final Thoughts

“What we do for ourselves is more important than what medicine has to offer,” according to Harvard Medical School, Women’s Health Watch.

Our worst habit is as personal as it seems hard to change. However ugly, messy, and deep-seated your worst habit may be, knowing you’re not alone only goes so far.  The principles used by genius change-agents, brilliant influencers, and social scientists are ours to use.* They provide a strategy to accomplish what no one, even ourselves, thought possible.

What will your life be like minus your most self-sabotaging pattern? I hope this question gets you more than a little excited to begin. I encourage you to get your calendar and your marker, and start now.

* The author wishes to acknowledge Kerry Patterson, et al, who wrote Influencer: The Power to Change Anything, Joshua Klapow, and Jack Canfield, et al, The Power of FOCUS; and Joanne Minerbi for her editing genius. 

The five principles of this article are from Living SMART, Five Essential Skills to Change Your Health Habits Forever, by Joshua C. Klapow, Ph.D. and Sheri D. Pruitt, Ph.D., (DiaMedica, 2008) and are used by their permission.

Andrew R. Young is a Type I diabetic and editor of www.MindOverMellitus.com

So I was stressed, depressed, and down on my body after my diagnosis with Type 1. Not just from my doctor’s “educational” pamphlets about all the ways I am going to die, lose limbs, go blind, droopy, on dialysis, and all those other fun things. It was also from the huge highs and lows and their affect on my thinking — as I also figured out how to eat, take insulin, and function in a high-pressure job.

Okay, not to keep any of the three people following my blog in further suspense, I’m going public on this. After twelve years of diabetes, I’m ready to share the biggest influences that make my life with diabetes work:

Tai Chi and Qi Gong – By undoing the knots and tensions in my body through the slow, steady, meditative movements of Tai Chi and Qi Gong, those same constrictions eased in my mind and emotions.

My heart lightened. I got funnier, more prone to laugh, less stiff. Each day I practiced helped me break the 24-hour cycle of anxiety and stress that I couldn’t seem to escape. Finally I took off the heavy, heavy coat of anxiety.

Loving Relationships – For me, accepting diabetes and the way it affected me was a major hurdle. The subsequent loves of my life focused on me, and accepted my diabetes when I had been doing the opposite. Their acceptance of diabetic-me contributed to my own.

Hanging with Other ‘betics – What to do if you feel like an alien here on earth? Find and hang out with other aliens from your own planet. Do it long enough to get the perspective, advice, and humor necessary to stay sane and happy. We diabetics have challenges and issues no one else completely understands. Be understood and understand. That’s huge.

Zen Meditation Practice – While it provides many of the benefits of Tai Chi, Zen meditation – known as zazen – helped me recognize and de-fuse a lot of the “poor me, I’m damaged goods” stories I had made up about having diabetes. At some point it was possible for me to hold these two thoughts together: I love my body and I have diabetes. Totally inconceivable before.

A “Low-Insulin” Diet – Some people call it “low carb,” but the real point is that the less insulin you need to take (or make if you’re Type 2) the less estimation error you’ll get AND the less volatility (ups and downs) you experience. That means more stable, more predictable blood glucose, which makes me feel SO MUCH MORE IN CONTROL. I can recommend Dr. Richard Bernstein’s book, Diabetes Solution, if you feel like you’ve had enough debilitating highs and lows that you’re willing to change how you eat.

These are my five. They’re not for everyone. Some people will cope best by getting a job as a wrecking ball operator, while others might find that knitting works. What are your five? Keep returning to them.

As soon as this gets posted I’m planning to do a little Tai Chi to relax before bed…

My self-acceptance took a big hit when I got diabetes at 26. While I was depressed for the first 6 months, it took seven or eight years to completely include diabetes in my overall identity in a healthy (and even fun) way. So I’m a slow grower.

Prior to that I felt profoundly let down by my body. I was balled up in my underwear - stuck on all the stigma and stories I made up in my head about what having diabetes means. “There is something wrong with me”, showed up in my mind in one way or another again and again. That happened when my numbers were out of whack, when my memory was hammered by hypoglycemia, even when I considered inviting someone into my life. I didn’t like my inner world, so why make it crowded in there?

But five important things made the difference for me. Five factors transformed my experience of myself and this disease, which I will share in my next post…