Recently I had the opportunity to visit The Joslin Diabetes Center in Boston, MA. As a certified diabetes educator and clinical specialist since 1980, I have always considered the Joslin Diabetes Center an amazing place for people to go for treatment of diabetes. The center began it’s journey of “conquering all forms of diabetes” in 1898 and over the years has served as a role model for many health care providers, patients and diabetes programs. In many ways the Center has relentlessly mentored the efforts of many to find answers to the very difficult questions diabetes raises. 

As I was pondering that morning all the magnificent advances in diabetes, I walked onto an elevator and was greeted by a large photograph of smiling faces. Under the picture was the caption explaining that the people in the photo had been living with diabetes for 50-75 years! I missed my floor twice just staring at the faces of the people who looked back at me. Every single one of them beamed. What was looking back at me was not the face of a person who had just had the paramedics and fire department in their bedroom in the middle of the night helping them to recover from a severe low blood sugar reaction. I did not see the face of the person struggling to determine what to eat at the dinner table or the person who was angrily asking the question “Why?,” “Why me?,” and “Why now?” 

 But as I studied the faces of each of those individuals, from experience I know that each one of them have had similar situations befall them. They have struggled for 50-75 years to earn that seat in the picture. My question as I finally got off the elevator was “How?” How did they overcome the disappointment? How did the know what to do? How did they know how to do it? How did they keep the faith, when everything around them had to change to simply live a life of fullness and health?

Not a day goes by that I do not encounter someone who has been affected by diabetes. It may be a person recently diagnosed with the disease, a family member seeking advice on how to motivate a loved one “to do what is right”, a school teacher frightened by the 4^th grader who has come into her class wearing an insulin pump, a truck driver afraid to go onto insulin for fear of losing their job, the CEO of a company afraid to keep blood sugar levels in normal range for fear of having a low blood sugar reaction during a very important meeting. The friend who tells me of the blindness that has just taken the sight of a lifetime friend. The list is endless. The disease discriminates against no one. 

One of the reasons I have stayed in this field for 25 years is that each day offers to me an opportunity to help a person obtain enough information about the disease to manage it. The expected role of the healthcare professional is to give people enough information to assist them in developing the determination and belief that they can achieve goals they have set for their health and well being. An obstacle I often encounter when trying to fulfill this role, is that the patient who has come to me to get help has not yet defined the goal they seek. They have simply been told that they have diabetes, they need to change their lifestyle that involves eating and exercising in ways that are unfamiliar to many; taking medications that are costly and have side effects and they need to do it immediately if they wish to avoid devastating complications we know without doubt occur when diabetes is not well managed. The journey is daunting. My experience has taught me that the daunting nature is the result of not having stopped long enough to develop personal goals, but rather the immediate embarking upon a journey defined by others.  

A second obstacle I encounter is the vast array of “information” available to my patients. From supermarket tabloids, to folklore shared around a common family dining table, I am constantly amazed at the information that is provided to the person seeking help. On numerous occasions, patients have forgone accurate information provided by their doctor or educator, and instead chosen to believe of the miracle drug advertised in the back of a magazine. Nothing is more distressing to me as an educator than the person seeking “the magic bullet” to cure diabetes. I have the difficult task of informing patients that no such bullet exists. It is a disease that requires a significant amount of attention and money to care for correctly. In today’s society both of these things are in short order. Coupled with the knowledge of complications right around the corner, the person faced with managing this disease are often left overwhelmed, discouraged and frustrated. I sincerely believe that 99% of my patients want to take care of themselves. They do not get up every morning and look in the mirror and say, “Gee, today I think I will not follow my doctor’s advice.” Instead I believe they look into that mirror with every intention of doing what is right, but simply not knowing where to begin. And for some it is where to begin, again. This disease is long-standing and it is understood that there will be times of success and times for redirection. In order to help my patients I share with them 4 things to consider.

1. Have you set a specific goal? I don’t care how small it may be, but without specific goals, there cannot be specific actions. Without specific actions there cannot be outcomes that fulfill life.
2. Do you have the right information to set the goals and determine the actions? Your greatest opportunity for success is having the right information to use.
3. Do the right people to help you achieve your goals surround you? Are you an active partner with your doctor and health care team, or are you simply being “led” down the road?
4. Are you looking at yourself as a whole person and not simply a “diabetic”?

I have never met anyone in the photo I viewed in the elevator. But I am willing to bet that each one of them has in some way embraced this quote by Ralph Marston:

“When you have a reason, you can find a way. When you know why, you can figure out how. With a strong reason, the obstacles cannot stop you. With a strong reason, setbacks will be unable to dissuade you. Get clear about the reason for whatever you set out to do. And you will indeed get it done.”

None of them did it alone. All of them did it one day at a time. Each of them found the resources they needed. If you are reading this, and need additional resources consider these:

1. To find a certified diabetes educator in your area go to www.aadenet.org and select “Find an Educator.” This site represents the national organization of diabetes educators in the U.S. Partnering with a diabetes educator will help.
2. Often tapping into your spiritual strength can help you redirect your goals for your health. I am of the opinion that we need to use all your resources to keep you healthy. A few books I have found helpful over the years in guiding patients to consider other resources are the following:

• Meditations on Diabetes: Strengthening Your Spirit in Every Season by Catherine Fester
• Diabetes Burnout: What To Do When You Can’t Take It Anymore by William H. Polanski, PhD, CDE
• Zen and the Art of Diabetes Maintenance by Charles Creek more
• Diabetes: A Guide to Living Well by Gary Arsham and Ernest Lowe

1. If you enjoy television check out the diabetes talk show dLife. It airs every Sunday evening on CNBC, 7:00 P.M. (EST) 6:00 P.M. (CST); 4:00 P.M. (PST)

If you are someone living with diabetes or someone supporting someone who lives with the disease you are on a lifetime journey that will require ongoing attention. I urge you to stay current with the advancements in treatment and to make certain that the advancements you place your hopes on are ones that have truly been shown to do what they claim. 

The final obstacle I want to discuss before closing is the obstacle of “false hope.” I estimate in my practice that for every accurate statement regarding diabetes or its treatment I have to correct 3 that are outdated, inaccurate or potentially dangerous. This misinformation comes from several sources. Well intending family members who remember someone from years earlier who offer advice that is outdated. This leads to frustration on the part of the patient as they consider what to believe and use. Do they believe information from a health care provider they barely know or information from a beloved family member. My advice to family members and friends: provide your loved ones with information that has a solid source. If it is folklore or the experience of another, preface the information with “I am not sure if this applies to you, but you might want to check it out with your educator or doctor.” Another source of misinformation comes from industries that are selling products that have not been studied to show improvements. On many occasions I have seen patients discard medications proven to control the disease and replaced them with herbs and other products that do not keep the disease under control. There is a place for holistic medicine. I support it in any way I can. But I want to caution those I have dedicated 25 years towards helping to consider the source of your information and balance it against the goal you have set for yourself. 

It works, I know it does. I’ve seen it in the faces of people in the photo. I have seen it in the tears and smiles of my own patients as they have accomplished the goals they have set. You can do it too.