Dear Self at 16

(HAWMC writing prompt for today)

photo of self at about 16 - courtesy of Andy VanDyke

Dear Self at 16,

As I think about where you are in your life right now, I'm overwhelmed with emotion.  I know that you are in the midst of all sorts of changes and decisions - parents divorcing, colleges sending you colorful brochures, friends, drugs, sex.  I want to write something kind and wise that will make you feel lighter. You are so funny and your smile is so bright. And you are beautiful. And smart. And strong. And sad.

I'd like to be able to list out all the places "we" made a wrong turn in the 30 years that have elapsed in this time space continuum (hehe - continuum doesn't look like a real word, does it?).  However, there are so many things for you to look forward to, and your life at age 46 will be rich and filled with people and experiences that "we" may not have if I were truly tell you things that could alter your course.

So there you go. You will make a lot of mistakes. And my advice to you? Get over it!  I don't know if you already have the habit of internalizing everything - to be honest, I can't remember - but I suspect you've started by now. I do know that you already spend a lot of time feeling guilty and obsessing about things that you cannot change.  Please try to treat yourself like your own best friend rather than your harshest critic. Please give up on the notion that you should be able to fix everything if only you had more discipline and were paying attention and taking action. Not only can you not fix everything - it isn't your job to fix everything!  Every person in your life is responsible for their own fixing, just like you.

I know you've already had diabetes for two years, and you feel like a terrible person for not being in control of this disease.  You should trust Dr. Hohl more - he is a really compassionate person, and he knows that you are making up your glucose numbers in that log book, and he knows that you are a perfectionist (which you will NOT know for a very long time, btw)(oh, btw means by the way - for reasons I will not get into here, people use a lot of acronyms in the future).  High blood sugar does not equate to a moral deficiency. Hypoglycemia not your fault either. Your pancreas quit working and that is not your fault.  The really good news is that this will get ever so much easier for you. Remember just 2 years ago when you were diagnosed and the only way to monitor how you were doing each day was to test your urine? Sheesh.

Now, 30 years in your future, I've got a continuous glucose monitor giving me a bG data point every 10 minutes that talks to an insulin pump I wear with an infusion set. I don't have to eat the same thing every day at the same time. I can sleep in (well, in theory if I didn't have kids of my own and a job!) I don't have to exercise the same time with the same intensity every day or try to predict the future 4-12 hours at a time because I can adjust my pump to give me different amounts of insulin whenever I want to.  This system works so much better for you - you will see.

I know that you also still wear a brace at night for scoliosis, and you still have braces on your teeth. And that you joke around about being a genetic mutant.  Your sense of humor will serve you well over the years!  The bad news is that you are going to really need it because you haven't seen the last of medical challenges and physical limitations. And I want you to know that it is perfectly okay to be pissed off about this from time to time!  The good news is that throughout the years you will find yourself surrounded by people who care about you and would love to help and support you if only you would ask. So go ahead and ask once in awhile. Oh, but do try to ignore the judgemental assholes out there. You won't be around as many of those 30 years from now (or maybe you'll just get really good at ignoring them - either way works for me).

I'm sure you have a lot of questions - I too have questions about what will happen in the next 30 years! I'll just end with this: Your love of music and games, your goal oriented work ethic, your analytical tendencies, your tenacity, your humor, and the fact that you are tall - all of these things and much more of what you've got going for you - mean that you will be able to achieve the things you barely dare to dream of today. Like traveling all over the world. And having children. And love. And you may in fact be a genetic mutant! We know so much more about the genetics of diseases these days. But you will never be alone in that.

With much love from your closest friend and admirer,
You at 46

7 Habits of Highly Effective People with Diabetes

Are you a Covey fan? No?

Well, usually these things seem like common sense, but I guess it never hurts to read such guidelines again.  If you are anything like me, you just get into the (crazy) rhythm of life with all it's other priorities, and diabetes habits can fall into a rut. And that's at it's best "autopilot" mode - sometimes I find myself back full on the rollercoaster of blood glucose, getting more and more demoralized every day, hour, minute...

So I saw an ad for home HbA1C tests in the Diabetes Forecast this month. These things have been available, then unavailable a couple of times over the past decade. I love having the option to test my A1C more frequently, especially if I have little other reason to see my endocrinologist every 3 months rather than, say, every 6 months.  There is supposed to be a coupon for $5 off on the Bayer website according to the ad.  I still haven't found the coupon, but I saw a link for "7 Habits", so I surfed on through to a free (short) ebook you can download and/or print out by Steven Covey specific to diabetics. Apparently Covey's wife was diagnosed, so they turned that misfortune into an opportunity (one of those Covey values).   The 7 Habits described are meant to coordinate with the AADE7 (another thing I'd never heard of - what kind of diabetic am I anyway?!).

AADE is the American Association for Diabetes Education, and the AADE7 are a framework of behaviors for managing diabetes: Healthy Eating, Being Active, Monitoring, Taking Medication, Problem Solving, Healthy Coping, and Reducing Risks.  They write a forward to Covey's little tome explaining how the 7 Habits serve to form a strategy for deploying these tactical behaviors.

I started thinking about all this and reading through the 7 Habits with these questions in mind: What differentiates a behavior from a habit? How do I translate these things into goals specific to my needs? How would this translate for someone less goal oriented? How about keeping good behaviors and habits a priority when juggling so much?

I won't be rewriting all of this since you can download your own copy here.  Also, the principles are exactly the same as the original book and all specialized version (like for Teens). There are also links at this site to some activity modules for the first 3 habits that you can check out on that website.

Habit #1: Be Proactive
In general, I am a very proactive person. I hate getting into a reactive mindset in any situation (not just health), because I feel like I'm just putting out fires to stay where I'm currently at - I'm not progressing toward a goal.  To be proactive with diabetes requires a lot of re-framing of our mindset. It's hard to always think of the choices we make about what to eat, how to monitor bG, etc. as choices. We often say we have to do this or that and if we don't do this or that perfectly, then we've failed, or we are back in firefighting mode (for me that's when the bG rollercoaster rides happen).  The Covey booklet basically says that we can't control a lot of things that happen to or around us, but we can control how we respond to those things. We choose.

Habit #2: Begin with the End in Mind
This Habit is based on the idea of visualizing what you want and then making it happen. Your personal vision or mission for your life. I have to admit that I don't have this habit as it applies to diabetes.  I tend to think of my health issues as a separate challenge (set of) that I need to address in order to achieve what I want in this life.

The booklet advises to use this approach for the 7 AADE Health Care behaviors - using them as a roadmap and setting milestones for each of the behaviors. Probably this is something I should put some effort into.  The online activity for this Habit involves writing a personal Mission Statement. I haven't done this yet, but I plan to give it a try (after Easter tomorrow, for which I'm preparing a feast for 20+ people, so no time for visions today!)

Habit 3: Put First Things First
It's all about prioritizing. Personal management, time management, assigning value to the priorities that involve your health - again, not something I've done well with in the past. But this is the major focus of my blog and I am actively prioritizing my health.

The booklet advises to choose the behavior on the 7 Health Care Behaviors list that you have the most difficulty with and tackle it with your vision and values (from Habit #2) in mind.  I suspect I'm already doing this, but it would be good to organize my thoughts and strategy to be sure I'm not avoiding something or missing it.

Habit #4: Think Win-Win
Okay, so this is starting into the interpersonal relationship management part of the Covey system. For sure I don't do a good job with this. The idea is to be more open to advice, ideas or support from others in problem solving or acquiring new skills and knowledge. I tend to think that I need to manage this myself - although I do confide in Mr. Wonderful and can be open and honest with him. He doesn't judge me. Also the Diabetes Angels at the Ed center are great that was too. So can I can build off of these relationships to turn my diabetes and health management into a team sport?  I'm not sure. But it's good food for thought.

Habit #5: Seek First to Understand, Then to be Understood.
This is a habit that I've worked on a great deal in my professional life.  It has a lot to do with listening skills.  With regard to diabetes and healthcare, this is sort of like #4 for me.  I'm not sure whether there are people in my life - doctors, friends, family - who are trying to listen to me or trying to tell me things I'm not open to listening to. Knowing me, this will apply - but I need to pay more attention to see if there are ways I can communicate better.

Habit #6: Synergize
I love that word - synergize. synergize.  It just sounds like something everyone would want to do.  It's about creating something that is greater than the sum of its parts.  Again - this Habit follows the train set up by the previous 2 and focuses on working with other people to build synergy in our diabetes care.  I can see how this works for the example of exercise, for example - but as I need to examine Habits 4 and 5, perhaps other interpersonal synergy opportunities will be apparent.

Habit #7: Sharpen the Saw
Heh, yeah - we can't just keep cutting the edge of our meaningful lives with the same dull knife, right?  We need to balance all the parts and continually strive to improve not just the results, but the efficiency with which we achieve them.  When I think of this, I want to hope that acting as my own pancreas will get easier and more efficient as I work on the various behaviors and habits.

Stay tuned!