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Avery: The lessons we’ve learned

After more than a decade of intense attention to diabetes, including funding for new programs and services, what have we learned? We have learned the risk factors associated with diabetes; that diabetes is a costly yet controllable condition; and there can be serious consequences from not treating it. We have learned diabetes can be prevented with a low fat diet and 150 minutes of exercise each week. We have learned of our amazing capacity for gaining new knowledge and how effective diabetes research in Indian country can be. We have learned how to quickly align ourselves with one another to collaborate around diabetes and other health promotion programs. We have learned that diabetes spares no one; directly or indirectly, we are all affected.

We have been reminded of how formidable our people remain in the fight against diabetes. We have learned the value of motivational interviewing and the “old-is-new-again” concept of self-management. What is self-management? It consists of the knowledge one gathers about health, the decisions made based on this information, and the actions needed to care for oneself. It requires setting priorities and can involve difficult choices. It requires discipline and an action plan. Self-management involves reassessing one’s progress and having the flexibility to adjust and refine one’s choices. The freedom to build on success can make self-management fun and enriching.

Self-management skills can be learned and it’s never too late to begin learning. For some, it’s a relatively easy process developed through a lifestyle in which the individual works consistently to build their knowledge of health, nutrition and physical fitness.

For others, it takes more work to learn about health and wellness. We have all seen people for whom staying active and healthy seems to be effortless. For those who struggle with weight and other health concerns, it seems a never-ending challenge. Often we need the help of others to achieve or maintain our best health; others such as friends, family members, health professionals, or coaches.

To get started or to improve upon your efforts, there are numerous books and online resources on building self-management skills. “Living a Healthy Life with Chronic Conditions” by Kate Lorig and others is a popular resource. Free self-management tips and toolkits are plentiful at the National Diabetes Education Program Web site There are other reputable health-related Web sites to guide you. The materials offered on government-sponsored health Web sites are generally free of charge and very useful.

Often, a patient will tell me that diabetes made them realize they needed to change their life. Diabetes and other chronic diseases are indeed an opportunity to change one’s life for the better. Taking immediate action will help to avoid complications, so enjoying a longer and healthier life becomes possible despite the presence of a medical condition.

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The key to success in establishing a pattern of positive change in your life is setting health-related goals. Make them specific. Break old patterns of “I will lose weight this year” to “I will lose five pounds in the next two months by not eating french fries and walking six days of the week. I will start this plan today; I will check my weight every week to track my progress.” Your specific plans could include someone who can help you stay on track; list the ways in which you will get around common barriers that have prevented you from achieving successful weight loss in the past. And remember to ask “what can I do differently to get a different (or better) result?”

Try putting your health first – your peace of mind, your sleep, good nutrition and exercise; this kindness to yourself will spill over into kindness toward others as you experience more rest, alertness, gratitude, peace and happiness. If you need help, seek out your local health care facility or diabetes program. Ideally, you want a person skilled in Motivational Interviewing to help you clearly identify your values and reasons for change, as well as the barriers that prevent you from making healthier choices. It will not always be easy and you may lapse back to old, less healthy habits. A skilled support person can help you to overcome these lapses and maintain a positive attitude. Virtually every health facility or community center has a resource to assist you.

If these self-management concepts sound familiar, it’s because they represent our elder’s teachings. The concepts are ancient and well elucidated in our oral traditions. Our oral traditions teach about wellness, health maintenance, disease prevention, and the importance of harmony and balance in our lives. Some may scoff at these notions but when examined closely for their meaning, these terms are all-encompassing and applicable to what we strive to achieve.

The teachings include messages about self-reliance, responsibility for one’s own health, the obligation we have to do our part in taking care of ourselves and the world around us, the emphasis on initiative and decision making, and the specifics of avoiding harm – or disease-inducing behaviors and how to treat various ailments.

Tending to self-care needs on a regular and sustained basis was always critical for survival in harsher times and is no less needed today. Planning ahead for the next season and for the next generation was essential as was investing time and wisdom and precious resources to benefit not just a family, but an entire community. Having values as clear as day – family, health, education, employment, garden, livestock and traditions, and doing all that one could to protect these were all part of our traditional teachings. Tending to our values fosters peace of mind and creates readiness for health and healing. Skillfully harnessing all that we know about how to protect our bodies, minds, spirits, and the world around us will help our people to move beyond merely surviving, to thriving.

Charlene Avery, M.D. is a Navajo physician working in Albuquerque, N.M. Dr. Avery serves as chair of the National Diabetes Education Program American Indian Work Group and is president-elect of the Association of American Indian Physicians.