to Help Self-Manage Diabetes
G. Jeanfreau, RN, MN, FNP-BC
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 take 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 most 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 this means changing
behaviors (the way we do things)
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 just a habit
that has served well in the past
but is no longer useful. 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
Knowing WHY you want
to make a change is just as important
as knowing WHAT to change. Remember,
the final goal is to lessen and hopefully
prevent complications. Try to think
of what you would like your life
to be like in 5, 10, or 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!
You Are Changing Your Diet, Exercise,
Smoking, Footcare, Medication, or
Some Other Behavior, There Are Some
Hints That Can Help You Do So More
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 and
ask questions. Be sure to get
your information from good
sources and not just the person
ahead of you in the grocery
2. Only work on one or two
changes at a time. If you
try to do everything at once,
you can stretch yourself too
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
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,
the weight didn't just appear
overnight; it isn't going away
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't
see your feet, find a foot
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
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.
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
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, 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
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.
remember, although changing behaviors
can be hard, it 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
more information on changing behaviors,
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.
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