How to Get Started and Follow Through
As a person with diabetes, you have probably thought a lot about your lifestyle and how it might affect your health. You are likely aware that a balanced diet, regular exercise, and daily stress management can help you manage your blood glucose levels and avoid many of the complications of diabetes. But if these healthy habits are not already established parts of your lifestyle, it may take more than knowledge and good intentions to adopt and maintain them.
If you are having difficulty making and sustaining changes in your lifestyle, there are a number of resources and tools you might turn to for help. Diabetes educators are often skilled at a variety of coaching techniques and can help people overcome some challenges. Books and Internet resources offering guidance and support abound, as do therapists of various types who counsel individuals through personal obstacles toward making lasting changes. You might check out a number of different resources to find what helps you the most. Here are a few ideas and tips to think about as you get started.
Celebrate past successes
Many people doubt their ability to adopt new habits, especially if they have had difficulty making and sustaining changes in the past. If your confidence is low, it may help you to remember any milestone or goal you have accomplished and the steps you took to achieve success. You may have, for example, made big changes to raise your grandchildren, give up smoking, or go back to school. Alternatively, you may have changed your habits just enough to walk a mile every night after dinner. Remind yourself of the big changes you have made as well as the small, then give yourself proper credit and a big pat on the back. Ask yourself a few questions about the changes you have made. Why did you decide to do things differently? What motivated you to change and to stick with a new lifestyle? Who did you turn to for support? The answers to these questions may help you adopt new habits today.
According to Dan Heath and Chip Heath, authors of the book Switch: How to Change Things When Change Is Hard, many people remember failures in life more vividly than achievements. But if you focus only on past failures, or on what is not working in your life today, you may doubt your ability to make and sustain changes, and that doubt may seriously dampen your enthusiasm to try anything new. Therefore, when facing new challenges and considering how you might approach them, it’s important to acknowledge the challenges you have already overcome. Remember that what you did is less important than the steps you took along the way.
Involving heart and mind
How many times have you heard people say they “know” they should do something to improve their health or their lives, then not do it? Why do you suppose this is? It could be that knowledge isn’t enough: Emotion, or some involvement of the heart, is often needed to get people to actually do something about the change they know they need to make.
As you reflect on the lifestyle changes you have already made, notice how knowledge and emotion influenced your actions. Did the motivation to alter your habits or plans generally arise from your head (your logical side) or your heart (your emotional side)? It is likely that one side or the other initiated the desire to change, but in the end, you probably needed both your head and your heart to make the change occur and stick.
Getting in touch with your emotions can be challenging. One way to explore how you feel about the behavior changes you’re considering is to ask yourself the following questions:
• Why do I want to make this particular change at this point in my life?
• Why is the change I am thinking about important to me?
Your answers will be unique to you. A new grandfather with longstanding diabetes might suddenly recognize his desire to watch his grandchild grow into adulthood. A middle-aged woman struggling with obesity may remember the joy she had when she was fit enough to go horseback riding and discover that, more than anything, she wants to feel that way again. If you can connect the things that are deeply important to you with the lifestyle modifications you wish to make, making those changes will likely be easier and more rewarding.
Once you gain an awareness of what truly motivates you to change, it can be helpful to select some object to symbolize your reason to change or your desired outcome. The object can be anything that is meaningful to you: a photograph of a loved one, a family heirloom, or an inspirational quote. Once you’ve selected an object, performing a simple daily ritual such as briefly looking at or holding the object can serve as a way to repeatedly get in touch with what matters most to you. This simple reminder can help you overcome the obstacles to change that you will encounter along the way.
What, where, and when
When you are ready to adopt a new habit, it is important to identify exactly what you will do differently, where you will do it, and when. If your plan or goal is vague, or if the new habit you want to adopt involves making too many daily decisions, you might be tempted to toss the new lifestyle aside and go back to your old ways. For example, if your goal is to eat less fat and you go to the grocery store with that in mind, what will you buy? The average supermarket offers over 40,000 products for sale, not all of which are low in fat. You will need to read the product label on every item you’d like to buy and decide whether it fits into your meal plan – a task that will quickly become overwhelming.
Alternatively, you could identify lower-fat alternatives to a few, specific foods that you normally buy and put them on your shopping list. For example, 97% fat-free ground turkey could take the place of ground beef, and low-fat plain yogurt might replace the sour cream. Over time, you can make more food substitutions, ultimately lowering the fat content of your meal plan overall.
By simply limiting the number of daily decisions you have to make, including those made at the grocery store, you will be more successful at adopting any new habit.
Few people would attempt to climb Mount Everest unless they had great confidence in their ability to succeed and survive. That same degree of confidence is necessary when making changes in your lifestyle. This is especially important if you have tried to adopt healthier habits in the past and have not attained your goal or been able maintain your new habits over the long term.
The questions in “Rate Your Readiness to Change” can help you assess your potential success with any new routine. They ask you to rate how important it is for you to make a particular change in your life at this time and how confident you are that you can carry out the necessary steps. If you discover you are trying to change something that is really not that important to you right now, focus on something else that is. Likewise, if you don’t have much confidence that you will succeed, alter your plan in a way that gives you a greater likelihood of success.
If a particular goal, such as taking a daily 30-minute walk, seems overwhelming, think of something that seems more manageable, such as a daily 10-minute walk. Succeeding at a smaller goal is more motivating than failing to achieve a larger one. Your new routine need not become a permanent part of your life. Instead, think of it as an experiment, or something you can try for a defined period of time to see how it feels. At the end of that period, you can decide whether to continue it, add to it, or do something else entirely.
Working with a diabetes educator
Diabetes educators spend a lot of time encouraging people to make healthy changes in their lives. But where many educators once saw their role as primarily giving people information and advice, many have now come to use a variety of counseling strategies aimed at enabling people with diabetes to identify their priorities and what they are willing and able to do to care for their diabetes.
One of the strategies that is often used is called motivational interviewing. A practitioner using motivational interviewing views his interaction with a patient as a joint effort, or collaboration, in which the agenda for care is set by both parties. The conversation during any given visit is tailored to the patient’s immediate needs and focuses on those behaviors a patient is willing to consider changing.
A primary feature of motivational interviewing is the use of open-ended questions (questions you cannot answer with a simple yes or no). For example, an educator may ask you to talk about your experience with diabetes or to share what is most difficult for you about having this disease. The educator’s goal in posing such questions is to help both parties understand what is important to the patient at that moment. When the educator understands your most pressing concerns, he can offer information or advice that addresses those needs or help you work out strategies to overcome any obstacles you may be facing.
Your answers to open-ended questions can also help shed light on any ambivalence, or mixed feelings, you may have about changing your habits. For example, you may want to adopt a healthier diet, but there may also be a number of reasons it would be easier and more satisfying to continue eating what you currently enjoy. The educator can help you explore the pros and cons of changing your dietary habits versus the pros and cons of maintaining your current habits. He would not, however, try to convince you to change. The intention of motivational interviewing is to help people sort out their internal arguments for and against change and then decide, based on their own values and goals, how to proceed.
Meeting with an educator who utilizes motivational interviewing or similar coaching strategies may feel unfamiliar and possibly strange, at first. If you feel uncomfortable with the questions you’re being asked, or you’re unsure of what’s expected of you, feel free to say so. Your educator should be willing to explain a bit about his approach and also respect your comfort level with it. Ultimately, your diabetes educator should be working in a way that is effective for you to help you adopt a lifestyle that supports your health and well-being and also suits who you are.