Life is challenging even on the best days, and when you’ve got a chronic illness, it seems like the challenges come harder and faster than they do for other people. You may feel like it’s just not worth the effort to take care of yourself, or you may even want to die. Here’s what I suggest instead:

• If you’re feeling suicidal, call 911, or your local suicide hotline (just dial the operator and ask to be connected). Wanting to die is not a normal part of day-to-day life, even with a chronic illness. And if you don’t already have a health psychologist helping you to deal with your illness, get one as soon as possible.

• Get some spiritual support, if you’re a believer. Pray, read spiritual or religious literature, reach out to your faith community, and ask for support.

• Focus on doing what you can, not what you think you should be doing. Sometimes that means just the basics, like eating (something, anything!), and taking prescription medications. The ideal diet can come later. Supplements can come later. The last one of your 13 physical therapy exercises can come later. Just eat, drink adequate water, and get enough sleep.

• Sleep on it. Both depression and anxiety are exacerbated by lack of sleep. If you’re suffering from insomnia, talk to your psychologist or other medical professional, and get some help. For many people, over-the-counter melatonin is enough assistance. But you may need a lot more – even a prescription medication at times – if you just can’t get any sleep. Lack of sleep wears you down physically as well as mentally.

• Call your friends. All of them. People are busy, they know you’re sick, and they don’t know what to say, or they don’t want to disturb you. Call them and talk about something other than your illness or suffering. The mere act of making a connection is healing.

• Education your friends. On a bad day dealing with diabetes, like when someone’s pressuring you to eat something that you know is really horrifyingly bad for your blood sugar by cajoling, “can’t you just eat it this once?,” you may snap, as I once did: “diabetes doesn’t take a vacation!” We all get cranky sometimes, and it’s hard enough resisting temptation anyway, let alone having it thrown in our faces. And sometimes people need to be reminded that, even though you look normal, you’ve got a medical condition that requires special handling.

• Consider taking a break, preferably in coordination with your medical providers preferably. That may be a medication vacation, a temporary lifting of a particular dietary restriction, a few days off from chemotherapy, acupuncture, or physical therapy, a break from assisted reproductive technology, or a break from any other aspect of treatment that’s wearing you down. There are obviously some things you can’t get a break from, but if you’re creative, you may be able to get a sense of relief from the overwhelming burden of having to do it all.

• Get philosophical. Context this as part of your life, not all of your life. If you think of a week-long hospitalization as “all there is,” you’re ignoring the other 51 weeks a year that aren’t nearly as bad. Look at life in balance.

Ultimately, the business of managing a chronic illness is 24/7, and often a lifetime project. It’s normal to have experiences of rebellion, self-loathing, frustration, and just being plain old tired of the whole darned thing. And, you can re-set your mind and body with rest, support, and creativity. No one wins a race if they sprint and collapse; think of this as more of a marathon. It requires pacing, training, concentration, focused effort, and occasional all-out bursts of high performance. With practice and an emphasis on long-term goals and outcomes, you can integrate the rough patches more easily.