By Steve Hamburger, as told to Hallie Levine
Life with type 2 diabetes is a balancing act. It’s even more so when you have a related condition such as heart disease. I was diagnosed with type 2 diabetes 25 years ago and with peripheral artery disease (PAD) a decade later. PAD is a disease of the blood vessels outside the heart. It causes reduced blood flow to the affected area, in my case, my right leg.
When you have chronic conditions, everyone wants to give you advice. I’m guilty of that, too. As a former marketing executive turned patient advocate, I have a lot to say! But when there’s so much advice out there, you must tune out some of the noise and really focus on what speaks to you.
Right now, the only person I really take advice from is my wife. She knows me, so she always knows the right thing to say. But for those of you who aren’t lucky enough to have her in your life, here’s what I want to share with you.
Advice That Helps
People who live with PAD and type 2 diabetes, like all people who live with chronic conditions, are usually hungry for information. Unfortunately, they don’t often get it from their doctor.
It’s common for a person with type 2 diabetes who is recently diagnosed with PAD to walk out of their doctor’s office with no clue what the disease is or how to manage it. They may be handed a couple of prescriptions, told to exercise more, and sent on their way. But they have no idea how to begin a workout program, especially if they have leg pain that makes it hard for them to stay active.
That’s the main reason I started a Facebook group that focuses on walking, exercise, and wellness support for PAD. When I was diagnosed with PAD, my cardiovascular surgeon suggested a bypass, which is a procedure that reroutes blood flow around a blocked artery in the leg. But he also told me that I’d need another bypass in five years.
I was shocked, so I got a second opinion from another surgeon who recommended that I start an intensive walking regimen. That’s exactly what I did, and it gave me a new lease on life.
I wanted to provide a safe space for people with type 2 diabetes and PAD, where they could get advice and motivation. When people first join the group, they often have a sense of panic. They feel alone, and it helps them to hear how other members have dealt with their dual diagnoses, and how they have managed both diseases. Here are some of the most helpful bits of advice I’ve seen on that board:
Take it slow and steady. Fifteen years ago, when I first laced up my sneakers and began to walk, I couldn’t make it more than two blocks before I had overwhelming leg pain. I didn’t push through it, and I didn’t get discouraged. I gradually increased the distance until finally I was able to walk at least 45 minutes a day. I also play tennis and work out in a gym for 30 minutes, three times a week.
Do I still have days where I experience pain? Yes, and I stop. Even if the distances I walk are shorter, I still aim for at least 7,000 steps on my watch each day.
Find your rock. When I was diagnosed, my wife said to me, “I won’t push you in a wheelchair, so you’d better start to walk.” She motivated me to get moving.
Over the years, she’s become my biggest supporter. When I get busy, she reminds me to take a break and go for a short walk. She encourages me to eat a healthy diet and never complains that our kitchen is stocked with foods that don’t have any added salt or sugar. She doesn’t lecture me, but she’s always there to suggest a healthy dinner option or an earlier bedtime if I’m tired. I wouldn’t be here today without her.
Share what helps with stress. Stress is a part of daily life, but it can make it harder to manage your type 2 diabetes. Stress hormones raise your blood sugar levels, so it can worsen your diabetes. People with diabetes are also 20% more likely than people without the condition to have anxiety.
One thing I love about my Facebook group is the fact that people routinely share what helps them manage their stress. For me, it’s regular exercise, and doing mindfulness exercises on my relaxation app each night before I go to bed. But everyone is different. It’s good to know what others find helpful to see if it can work for you, too.
Embrace technology. Today with technology, there’s lots of things that you can do to monitor your health. I have a 24/7 glucose monitor, for example, where I can track my blood sugar levels in real time. This helps me figure out what causes it to spike, and what helps it get better. I use my watch to clock my steps every day and to monitor my sleep at night. I also have a good relaxation app, which I log into any time I feel anxious or stressed.
In fact, the best way friends and family can support a loved one with type 2 diabetes is to recommend their favorite apps to them. Chances are, we’ll find their suggestions useful.
Assemble a whole care team. People with type 2 diabetes are often surprised to learn that it takes a medical village to manage their condition. They need an endocrinologist to manage their diabetes, a podiatrist to check for foot ulcers, an ophthalmologist to monitor their eyes, a nutritionist to help them make healthy eating choices, a nephrologist to keep an eye on their kidneys, and a primary care provider to handle their day-to-day care.
If you have PAD, you’ll also need a vascular specialist, too. Remember, diabetes is more than just your blood glucose numbers. You’ll need to manage the health of your whole body, too.
Advice That Hurts
Social support is very important for people with diabetes. But sometimes well-meaning advice can go sour. It’s easy for folks who don’t have the condition to offer good-intentioned, but inappropriate advice. Sometimes it’s just frustrating for patients. Sometimes it can be downright dangerous. Here are a few scenarios that boil down to just plain bad advice:
“You’re just out of shape.” About one-third of people with diabetes over the age of 50 have PAD. Unfortunately, it often goes undiagnosed until the condition becomes quite severe. The main early symptom of PAD is calf pain. But when people with type 2 diabetes complain of sore calves when they walk, they’re often dismissed by well-intentioned folks who just reassure them that it’s from being out of shape and sedentary. This is one situation where the old motto “no pain, no gain” doesn’t apply.
“You’re overreacting.” Foot ulcers are a classic example. People with diabetes often have nerve damage in their feet that can lead to foot sores. If you also have PAD, it's a double whammy, since there’s also reduced blood flow to your feet. People who don’t have either condition often don’t realize that these foot ulcers can lead to infection and even amputation. If you have diabetes and you notice foot sores, you should call your doctor right away. No ifs, ands, or buts.
“You just need surgery.” People with diabetes who have PAD are often advised to go straight to surgery. There’s no doubt it’s necessary for some patients. But many of us aren’t counseled about the power of lifestyle, too.
A few years ago, I posted a video on social media of me walking. Seems harmless, right? It got a fair amount of pushback from others who thought I was overhyping the benefits of exercise. I recognize that it’s not a miracle cure. But I’m a walking example of what one can do with an exercise regimen without medical intervention.
“Just stop smoking!” If you have type 2 diabetes and PAD, it’s very important that you stop smoking. It makes it harder to manage your blood sugar levels and impedes blood flow. But smoking cessation strategies are so individual. Some people can do it cold turkey, others need to do it gradually with the help of over-the-counter nicotine replacement products. Still others need even more support.
It can be so hard for people who really struggle: Some post in our group wanting advice minutes before they’re being rolled into surgery. What they’re really looking for is support, not judgement.
The Takeaway
At the end of the day, you need to ask yourself: What’s most important to you? For me, it’s being able to move around and enjoy life with my children, grandchildren, and future grandchildren. That’s what has led me to seek out information, monitor myself, and focus so much on lifestyle changes. It’s what gets me up in the morning and motivates me to be a patient advocate.
I want to get the word out and let people know how some simple changes — daily exercise, dietary tweaks, and making sure you take your medications — can make a big difference with the quality of your life. Don’t be afraid to be your own advocate and ask for help every step of the way. This will help you manage not just your type 2 diabetes, but any related conditions, like heart disease, as well.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Steve Hamburger, type 2 diabetes and PAD advocate, Westlake Village, CA.
American Heart Association: “What is Peripheral Artery Disease?”
CDC: “Diabetes and Mental Health,” “Your Diabetes Care Team,” “Smoking and Diabetes.”
Clinical Diabetes: “Good to Know: Peripheral Arterial Disease.”
