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Excerpts from Defeating Diabetes
by Brenda Davis, RD & Tom Barnard, MD

Self Care: A Daily Maintenance Routine

Now that you have a treatment plan in place and are regularly monitoring your blood sugar, it's time to begin another important part of your care -- daily maintenance. All of us should be in the business of caring for ourselves. This is true whether we have a health challenge like insulin resistance or diabetes, or whether we simply are interested in a sensible lifestyle for the maintenance of high-level wellness. But, without a doubt, those of us with diabetes are at increased risk of nearly every major complication that we would normally face, so a helpful self-care checklist used daily can be a real life saver. For example, a person with diabetes and without known heart disease has a risk of heart attack and sudden cardiac death equal to a nondiabetic person of the same age who has had a heart attack. As well, diabetes raises one's risk of eye disease, kidney disease, nerve damage, autoimmune disease, dental problems, infections, and arterial disease resulting in a stroke. Therefore, not only are the lifestyle changes we have emphasized in this book vital, they are especially important if you have diabetes and need to recognize problems before they become something to worry about.

An honest daily self-care routine employs a dose of common sense, combined with a genuine interest in one's own being. Our bodies and minds are marvelous tools and wonderful machines which require, in general, fairly minimal maintenance. But a little attention now and again is warranted and pays off big dividends. Did you ever want to win the lottery? Well, all of the lottery money in the world will not purchase a return of your health, once you have lost it. Our health is our most precious possession. And we can protect it with simple daily routines and choices.

Before going on to the details of the daily safety check, let us take a moment to remind ourselves of two very powerful facts. First, smoking is a disaster for the health of any human being, and most especially for those with diabetes, and second, excessive use of alcohol is harmful. The mortality risk associated with smoking is simply a rising straight line until a certain threshold of exposure is reached, then the risk rises exponentially. Even secondhand exposure is deadly, as evidenced by the mortality and poor health suffered by the spouses and children of smokers.

Alcohol intake is more complicated. While the excessive use of alcohol is the leading preventable cause of fatal motor vehicle accidents, and while if wrongly used, alcohol intake ruins lives and relationships, it must be said that with control and moderation, alcohol can improve cardiovascular health. One drink a day for women, and one or two a day for men, has been associated in the largest epidemiological studies that we have analyzed with a decrease in mortality from heart attack and stroke. Clearly, this assessment of risk versus benefit varies from person to person; however, it is very clear that excessive alcohol intake is harmful.

Your Daily Safety Checklist -- Steps to Self-Care

Start the day and end the day with a safety check. In the still quiet of the morning, perhaps getting up with a few minutes to spare so you are not rushed, run a quick inventory check of "all systems." Begin by taking several deep breaths, training yourself to expand the abdomen, then bring the breath up into the chest and expand it fully. Finally, lift the collar bones a fraction of an inch for the fullest inhalation. Hold your breath at the point of greatest expansion in the chest cavity, then slowly release it through pursed lips, closing the back of the throat a little so that there is a bit of a hissing sound. It will sound as if you were breathing through a "Darth Vadar" mask, with a slight resistance to the exhalation and a slight hiss in the back of the throat. In general, breathe in through the nose to warm and condition the air entering the lungs, so that the ciliated nasal cells can remove bacteria and other contaminants in the process.

Breath control is closely associated with evenness of temper and emotion as well, so practicing full, even breaths is cleansing both in terms of physiology and emotion. It is a beneficial way to both start and end the day. Often, especially as people become less aware of their physical condition, they forget how important it is to breathe fully and deeply, and eventually may lose that capacity. So, remind your body and mind how important your vital capacity really is and prevent the development of restrictive lung disease by this simple self-maintenance tool. Now, you are ready to begin.

Muscles and Joints

Any areas where muscles are tight? Any pain in the joints, any swelling? Think back over the last few days; are any joints particularly bothersome? Pain in the knees when going upstairs, etc.? If so, look at ways of reducing stress on the joint. For example, if you are overweight and have problems with you hips, knees, feet, ankles, then losing weight may be a major part of the solution. Certainly, having high insulin levels does raise the risk of joint inflammation where there may be some wear and tear, and a change in diet toward plant-based foods will lessen this inflammation, even while it helps you with weight management. The most common form of degenerative joint disease is osteoarthritis, a degrading of the protective cartilage that cushions the impact of bone on bone in the joints. This cartilage allows stability with flexibility, working with the structure of the ligaments and tendons that hold the joint structures together. As we age, we may notice some broadening of the finger joints, along with stiffness, especially in the morning. Maybe our safety check will reveal a particular pattern of wear on a joint so that we can review what activity we are doing that may contribute to the problem. In general, exercise is actually beneficial for joints afflicted by osteoarthritis. However if we are putting specific repetitive strain on a particular joint, we should consider changing the pattern of activity that we recognize as damaging, wherever possible.

On the other hand, if you notice red, hot, swollen joints, especially if this process is persistent and symmetrical, that is, involving the same joints on both sides of the body (both knees or both wrists), you may be suffering from an autoimmune or infectious arthritis, such as rheumatic arthritis. Depending on exposure and location, the possibility of arthritis related Lyme disease from a tick bite should also be considered. In either case, your personal physician should be consulted to give you an informed diagnosis.

The nonweight-bearing joints, such as the elbows and shoulders, should be checked for range of motion, noticing any restriction or pain, and the skin and the shape of the joint should also look normal. Anything out of the ordinary should be addressed with exercise or massage. If the situation worsens, check with your physician; it is important to prevent the joint from stiffening, as that will require more dramatic intervention.

Eyes and Ears

Is your vision crisp and clear, and equal on both sides? Unfortunately, diabetic retinopathy (damage to the retina of the eye) is one of the more serious complications of high blood sugar and high blood pressure over a long period of time, as it damages the tiny blood vessels of the eyes. We know that the better blood sugar is controlled, the less the damage there will be to the retina. If damage does occur, it is best discovered and treated early, so it's important to see an eye specialist who can check your eyes every six months. In many cases, there are laser therapies that will stop the damage before it gets too severe. However, the best treatment continues to be prevention -- keeping blood sugars as close to normal as possible.

Other very common eye problems seen in people with diabetes are cataracts and glaucoma. Cataracts may initially impair night vision, making driving more dangerous. They appear like a haze in the lens of the eye and can be caused by high blood sugars or oxidative damage from sunlight. Smoking and poor diet both accelerate cataract development. Cataracts are easily repairable and should be treated promptly. Protect yourself by practicing good diabetic control, eating a diet rich in antioxidants, and wearing protective sunglasses to prevent overexposure to strong ultraviolet (UV) rays.

Glaucoma is the result of pressure building in the eye that damages the optic nerve. Initially, it causes loss of peripheral vision, so you have trouble seeing to the side when you are looking straight ahead. Glaucoma is a progressive disease and requires correction, or it puts you at risk of early blindness!

Another common vision problem is macular degeneration, the most common cause of blindness in the developed world. It used to be considered an inevitable disease of aging. Now we know it is related to a lack of protective phytochemicals in the diet over a lifetime. As we mentioned in chapter 3, colorful fruits and vegetables contain secondary nutrients, like zeaxanthin and lutein. These yellow and orange pigments concentrate in the macula, the central focusing area of the retina. There is scientific evidence to suggest that an antioxidant-rich diet can even curb macular degeneration after it has begun, especially if the disease is recognized early. You may want to supplement with a multivitamin that contains lutein in order to get additional ocular protection. Prevention of light-related damage to this area of the eye is also critical, as this is where vision is the most accurate and sharp.

Have an eye professional who is experienced with diabetes examine your eyes at least yearly, more often if necessary. Eye diseases from diabetes are the leading cause of blindness in North America, so they must be taken very seriously. Watch for blurry or double vision, dark or floating spots, or flashing light that appears to some people like lightning. Flashes may be a sign of detachment of the retinal membrane, a serious condition that needs immediate medical care. If you feel pain or pressure in your eye or begin to notice your peripheral vision disappearing, visit your eye doctor!

Is your hearing good? The eighth cranial nerve, which is responsible for hearing, is also involved with balance. It can be affected by aging and diabetic nerve damage, so any change there should be addressed early. Ringing in the ears, or tinnitus, is bothersome and a potentially worrisome sign if associated with hearing loss in one ear, since it may indicate a rare but dangerous cancerous tumor of the acoustic nerve. Usually tinnitus is the result of high-frequency hearing loss from noise exposure over the years, but requires careful checking to rule out more serious problems. There are good options available to treat even severe hearing loss, so check any hearing difficulties you might have with your physician or audiologist. Don't just grin and bear it!

Skin and Hair Take the time to note the condition of your scalp, hair, and skin. Is the skin dry and flaky, or full of moisture and resilience? If you notice changes, first check to see that the soaps, shampoos, and cosmetics you're using are gentle and free of detergents (like sodium lauryl sulfate) and coloring agents and preservatives, such as diethanolamine (DEA), which has been linked to cancer. Ideally, use only the simplest, natural products with the fewest ingredients, as contaminants in these preparations are absorbed through the skin and are potentially harmful. If the scalp is red or bleeding, or there is hair loss, especially in defined round areas, check with you physician. Persistent sores may represent skin cancer, and areas of hair loss may be a sign of a scalp fungal infection or an autoimmune disease called alopecia areata. Both of these may be more common in people with diabetes, so they should be checked by your physician.

Is the skin too oily, bordering on greasy? The incidence of thyroid disease is higher with diabetes, and this might promote excess oil on the skin and hair. Is your complexion rosy or pale? If flushed, consider infection or hormonal changes with midlife, or a reaction to some food. If pale, consider anemia or a lack of iron, and be sure there is a good reason for your anemic condition. Unexplained anemia, in the absence of menstruation or accidental blood loss or surgery, must be considered a sign of underlying serious disease. Have your red blood cell count checked; if it is low, find out why.

It's important to protect the skin by keeping it moist and prevent cracking that may lead to infection. When blood sugar is high, the skin tends to be drier, putting you at risk for sores that are difficult to heal. Keep your skin moist and supple, especially on exposed areas such as hands and particularly the feet. (See more in the foot care section that follows.)

Feet Now, focus on the feet. When you have diabetes, your elevated blood sugar literally bathes the nerves and vital organs of the body in a sweetened, syrupy blood and lymph fluid. This results in injury to the nerves, especially the longest nerves of the body, in the legs. As a result, you may not feel damage or injury to your feet that may have occurred during the day. As well, tiny arteries carrying immune cells to the periphery of the body become clogged with arterial plaque, so the possibility of infection is increased. Also, watch for the development of athlete's foot, a common condition that occurs when feet sweat in shoes or boots, creating a perfect atmosphere for the growth of fungal infections.

At the beginning and end of every day, massage the soles of your feet with your thumbs, separating the toes and moving them through a full range of motion. Take special note of any wounds, cracked skin, or redness (and upward spread of that redness), which might mark an early infection. If you are at all concerned by any problem, have it looked at by a physician, podiatrist, or you health care provider as soon as possible.

Mouth, Teeth, and Gums Look at your mouth, teeth, and gums. Floss and brush your teeth carefully at least daily, ideally twice a day. Are your gums red, sore, or swollen? Do they bleed when you brush them? Are your gums pulling away from your teeth? While dental diseases are very common for everyone, people with diabetes experience more of these problems, especially if blood sugar control is poor. High blood sugar encourages the growth of bacteria, increasing plaque buildup on your teeth. This contributes to redness, swelling, and bleeding of gums.

As well, there can be a greater incidence of dry mouth resulting from a lack of saliva. Since saliva protects against bacterial growth, this can be a cause for concern. If you notice an increase in dry mouth, be sure that you are not dehydrated, as many of us, especially those of us with high blood sugar, do not drink enough water. Water intake is remarkably protective, so it is vital to include a review of water intake in your safety check. Ideally, drink six to ten glasses of pure, clean water daily. Finally, dry mouth may be an indication not only of poor blood sugar control, but also of an underlying autoimmunity disorder affecting the salivary glands. If this is a persisting issue for you, see your health care provider.

If you wear false teeth, it is important to keep them clean too. And remember that with false teeth, you don't often feel objects like bones or poorly chewed chunks of food that may cause either pain or obstruction when swallowed. So, take the time to thoroughly chew your food, whether or not you have your own "chompers." The process of digestion, and indeed the quality of your saliva itself, is influenced by how well you chew your food.

Stress Level

Like our IQ, or intelligence quotient, we have an SQ, a stress quotient, that measures our ability to handle stress. What tools are there for assessment of our stress quotient?

1. You personal stress monitor. Do a self-check for stress every day, especially in the early morning just on arising and just before retiring in the evening. When you first wake up, what comes to your mind? Are you angry, upset, or worried about something? Write it down and address it that day if possible. Consider the worst-case scenario. Then allow yourself to devise a game plan for that worst case, understanding that, in all likelihood, nothing that bad will happen. Then remember to always end your self-stress monitoring session with a list of three things for which you are thankful and grateful!
   
2. Just before retiring, think of the day with gratitude, and also write down any unfinished business, promising yourself that you will take care of these issues the very next day. Not all unfinished business will be resolved the next day, but you can begin to address the issues. Often, during the night, your unconscious mind's vast resources will come up with a solution.
3. Your relationship focus. Again, for a moment on awakening and just before retiring, think about your closest relationships. Are there any things left unsaid or undone? If so, when can they be said or done? The sooner the better! It is enriching, enlightening, and healing to address issues as soon as they are in your mind's eye. And remember, be positive, be positive, be positive. There is an ancient wisdom that states that before anything is actually said, a statement would have to pass three gates: is it true; is it kind; is it necessary? Once those criteria are fulfilled, then perhaps the comment is worth sharing with another. That having been said, the key to reducing stress in a relationship is to communicate, constantly, relentlessly, and honestly.
4. Lowering the stress level. Applying the practical tools of meditation and relaxation for a few minutes a day will provide a resiliency of body and that will serve you well. Repeat a favorite prayer slowly in your mind, allowing each word to drop from your thought into the calm space in your mind's eye, as it if were a pearl dropping into a still pond. Allow enough time between the words of the passage for a few "ripples" to flow outward from the first word before adding the second. Slowly work your way through the passage. If your mind strays, bring it back. The practical results of this type of practice are a remarkable reserve of strength and the ability to handle the challenges of life with aplomb.