Changing Behaviors to Help Self-Manage Diabetes

Shelley G. Jeanfreau, RN, MN, FNP-BC

Diabetes is a condition that must be dealt with 24 hours a day, seven days a week, 365 days a year. There isn't a vacation from taking care of a person's diabetes. There is no, "I'll take care of my diabetes tomorrow or next week." The person who has diabetes must make numerous decisions every day as to what is healthy or the best way to self-manage or taking care of themselves and their diabetes daily. A person who has diabetes must see a health care provider (doctor, nurse practitioner, physician assistant, etc.) on a regular basis and probably more often than many people. However, most people with diabetes are the real caretakers of themselves and their diabetes. That is real self-management.

Diabetes is also a condition that has the possibility of causing numerous complications such as cardiovascular (heart and circulation), kidney, neurological (nerve), and eye problems. Additionally, conditions such as hypertension (high blood pressure) and various forms of hyperlipidemia (high cholesterol, high fats in the blood) commonly occur with diabetes. So, when we look at all of these conditions together, we can see that what is done to protect hearts will also help self-manage diabetes. For most people that means changing behaviors (the way we do things) and habits.

Change is hard for most people. We become very comfortable in what we do, such as eating ice cream every day, or in what we don't do, such as exercising. We like what we do. Even when we really want to change a behavior, there is usually hard work, determination, and some degree of discomfort. So in order to make a change in our behaviors, or way of living, something is usually given up. It might be something enjoyed or be just a habit that has served well in the past, but is no longer useful, or you may be giving up time or energy that has been used for other things. Some people grieve or feel sad about giving up an old habit. Changing how to do things, like eating healthy foods, means breaking a habit or finding something new to enjoy. OLD HABITS ARE STUBBORN - JUST LIKE A MULE!

Knowing WHY you want to make a change is just as important as knowing WHAT to change. Remember, the final goal is to lessen, hopefully prevent, complications. Try to think of what you would like your life to be like in 5, 10, 15 years. What you do today affects your future. I would much rather be an old grandma, wearing a purple hat and enjoying my grandchildren, than for my grandchildren to have to take care of me!

Whether you are changing your diet, exercise, smoking, footcare, medication, or some other behavior, there are some hints that can help you do so more easily:

1. Get informed: The more information you have about your habit and the changes you want to make, the more successful you will be.
Example - If you want to change your meal plan or the foods you eat, talk to your health care provider, talk to a dietician, read a book, look on the Internet, go to lectures. Get as much good information as you can. Get information you understand; ask questions. Be sure to get your information from good sources - not just the person ahead of you in the grocery line.

2. Only work on one or two changes at a time: If you try to do everything at once, you can stretch yourself too far.
Example - Even if you do need to lose weight, increase your exercise, stop smoking, and take your medicine regularly, pick the area you are most ready to handle. Then work your way down the list once the first habit or behavior is under control. So, maybe you think that by setting an alarm you could get up in time to take your medicine before going to work, do that until you are absolutely not missing any medicine. Then go to the next habit - maybe walking. Do this until all behaviors are changed or managed.

3. Start small: Plan to make little steps toward your goal.
Example - Start with baby steps. You can't make it on the Olympic team your first day of exercising. For some couch potatoes, getting up and moving is a good start. Remember, if you are overweight, that weight didn't just happen overnight; it isn't going away overnight either.

4. Get help: If you work with a buddy who is also trying to change, the two of you can support each other.
Example - Get a walking partner. Walk with your children. Join or start a support group. Share recipes and ideas. If you can see your feet, find a foot checking partner.

5. Add something new: It is always easier to add a new habit than to take something away. So, try to change your behavior by adding instead of subtracting, especially at first.
Example - Instead of thinking, "I can never eat ice cream for dessert," make a plan to eat fresh fruit for dessert at least two times each week. Instead of thinking, "I can't stay here in bed sleeping," make a plan to walk 15-30 minutes three times each week.

6. Keep a record: The first step to changing your habits is knowing yourself well. Keep a list of what you are doing on your behavior, now before you really get down to changing it. That way you will know when things start to change.
Example - If you are trying to lose weight, write down your weekly weights. You might even want to make a chart or graph. If you are trying to stop smoking, write down how many cigarettes you smoke each day, or write down the time you smoke each cigarette in the pack.

7. Reward yourself: Since you are doing something hard, you deserve a reward. Decide ahead of time how you will "pat yourself on the back" while you are changing your habit - don't expect others to reward you. Be your own reward system.
Example - Choose something you enjoy or something you would like to have. If you are trying to lose weight, give yourself a non-food treat each day or each week to reward yourself (a nap, the movies, a bubble bath, go fishing). Every person does better when rewarded - it doesn't matter what the task or job is.

8. Tell others: If you are trying to make a big change, get your family and friends on your side. Tell them what you are trying to do so that they can be your cheerleaders.
Example - No man is an island. Let your family know you are trying to cut down on ice cream, so they don't offer it to you. Let friends and family be your support system. Involve others in the deal.

9. Be positive: Getting angry at yourself for not changing faster doesn't help. Remind yourself that you can do it - even though it might be really hard.
Example - Instead of telling yourself, "I'll never get to my goal," tell yourself, "I'm working hard at it, and I'm healthier for it!" Be kind to yourself.

10. A slip is not the same as a fall: You will have time where you don't quite meet your goals. Stick to the plan, anyway. Even tiny steps toward your goal are better than no steps at all. 
Example - If you don't exercise on an exercise day, don't give up. Think of the times you have exercised. Just regroup - get started moving again. A little exercise is better than no exercise.
 

So, remember, although changing behaviors can be hard, it also can be done. Others have done it, so you can also - with a commitment to change and some work. In order to do that, just get started. I know you can do it.

 

For more information on changing behaviors, contact: 
Your local hospital's diabetes program

A behavioral psychologist or other professionals - often available through hospitals behavioral medicine departments or diabetes programs. Local colleges or universities may also be sources.

As always, the American Diabetes Organization is an excellent source of information regarding any aspect of living with diabetes. You may contact your local chapter or go to http://www.diabetes.org

The above information was adapted with permission from How to Make a Change by Michele Larzelere. It is an unpublished educational handout used in the Daughters of Charity Health Center Disease State Management program.