6. Behavior change works best when not done alone. Diabetes distress often occurs when diet and physical activity goals are not achieved. In fact, of all the behavioral tasks associated with diabetes management, people with diabetes report that they experience the most distress about these two components of their management plan. A number of studies, however, have shown that for most people, behavior change works best when others are involved. People tend to reinforce each other, and joint actions are usually sustained far longer than actions taken by individuals alone. A related study showed that a weight-reduction program worked best for marital partners when both spouses sought to lose weight together. Studies of smoking cessation have shown similar results.
Some ways to involve others in your diabetes management routine include soliciting members of your household to help remind you to take medicines or monitor blood glucose levels (as long as these individuals are helpful and not critical); walking with friends or family members at a set time each day; and joining a physical activity program at a nearby neighborhood center, school, or gym. By engaging with others, the probability increases that a person’s behavioral goals will be achieved and sustained, and distress about this portion of the management plan will be reduced.
7. Focus on behavioral goals. No person with diabetes can directly control his weight or blood glucose level. A person can consume fewer calories, take blood-glucose-lowering drugs, and expend energy through physical activity, but these are indirect behaviors, not direct methods of weight or blood glucose control. Many people with diabetes become very frustrated with how difficult it is to lose weight, for example, and their frustration increases when difficult diets are adhered to over time with relatively few pounds shed.
The reason is that many factors play a role in weight loss, just as many factors play a role in reducing blood glucose levels. Body size, age, sex, ethnicity, and medicines taken for blood glucose control all influence weight and blood glucose levels. Setting a goal of losing 25 pounds, therefore, is far more frustrating and difficult to achieve than setting a goal of staying on a 2,000-calorie-a-day diet. A person cannot directly control his weight, but he can control the number of calories consumed.
This is an important distinction that can help reduce frustration and distress: Focus on goals that can be directly controlled with behavior. A person with diabetes can control the number of calories he consumes, the amount of physical energy he expends, how regularly he takes his medicines, and how frequently he monitors his blood glucose. Completing all of these tasks regularly as part of an overall management plan will affect his diabetes control if his plan is designed properly. A focus on behavioral goals, then, rather than goals that are less directly controllable, helps people with diabetes stay focused on things that they can do and the goals that they can achieve and sustain. If a person’s behavioral goals have been achieved but his HbA1c, cholesterol, or blood pressure levels remain high, it is time to review his management plan with a health-care provider.
8. Take responsibility for your diabetes. Even though health-care providers play a crucial role in managing diabetes, fundamentally, management is up to the person who has it. This fact can be either overwhelming or empowering, acknowledging full well that it is a tough job in either case. It can be empowering by motivating people with diabetes to be proactive in gathering new information, devising experiments to test how different behaviors affect their blood glucose levels and other important measures, and addressing diabetes management difficulties both on their own and with their health-care providers. Being proactive may involve using a health library, the American Diabetes Association Web site (www.diabetes.org) and other Internet resources, and others in the diabetes community so that information about alternatives and strategies for care can be gathered. It may also involve raising concerns with practitioners and seeking out educators, nurses, physicians, and other health-care providers who specialize in diabetes. Studies clearly show that people who are engaged in their care, who take responsibility for their diabetes, and who are often one step ahead of their health-care providers do much better over time than people with diabetes who remain passive and uninvolved in their care. They are less frustrated, more inquisitive, and more upbeat about having diabetes than those who simply “go along” with what they are told. Holding back and feeling afraid to ask questions or pursue problems independently increases the probability of struggling alone and feeling overwhelmed and overburdened, since far fewer of the tools needed for success will have been obtained.