One Step at a Time

Change is hard. We know that. It’s easy to be overwhelmed by the demands of trying to stay healthy with diabetes. But if we take small steps and don’t give up, we can improve our own lives and the lives of people around us.

I had one client named Ingrid who proved this to me a few years ago. Ingrid was 48 years old and weighed about 320 pounds. She had had Type 2 diabetes[1] for roughly 15 years. Although she had no significant complications, her most recent HbA1c[2] was listed in her chart as 12.1%.

Ingrid wasn’t doing much of anything to help herself. So the clinic offered her a couple of sessions with a nurse/health coach, which is how I met her.

She walked in shyly and sat on a bench we kept along one wall. She had bright eyes and a warm smile, but she was also breathing rather heavily.

“What can I do for you?” I asked.

“I don’t know. I’m scared of diabetes,” she said. “I don’t want to go blind. I don’t want to die young. I’ve got two teenage children.”

“Well, there are dangers to running blood sugars as high as yours. Fortunately, there are many things you can do to help yourself. Where do you want to start?”

“I don’t know where to start. Could you show me some choices?”

We started to go through some possibilities: diet[3], self-monitoring[4], medication[5] use. When we got to exercise[6], she said, “I can’t exercise.”

“What do you mean you can’t exercise?”

“Well,” she said, “I know I need to walk three miles a day. And there’s no way. I mean, I got tired just coming from the waiting room to your office. I almost never leave the house except to go to the doctor. I could never walk three miles.”

“OK,” I said. “How far could you walk?”

She hemmed and hawed for a minute, and I could tell she was embarrassed to say. That’s where my wheelchair comes in handy. “However far you can walk, it’s probably farther than I can,” I told her.

Finally, she said, “I guess I could make it to the mailbox, down by the curb. Then I could rest for a minute and walk back.”

“Great,” I said. “Sounds like a plan. But first, please run it by your doctor to make sure it’s safe for you.”

(That was protocol. I knew it was safe, but they wanted us to cover ourselves.)

Two days later, Ingrid called back, and she was crying.

“It won’t work,” she said.

“Why not?”

“Well, the doctor said it’s safe. I could do it. But it won’t do any good. I won’t lose any weight. And my blood sugars won’t be better controlled. It’s ‘physiologically silly,’ was the term that he used.”

I hate it when doctors destroy people’s confidence and hope like that. I think Ingrid was a bit angry too. It wasn’t hard to convince her that she didn’t have anything to lose, and that doctors don’t know everything. She decided to give it a try.

So for two weeks she’s walking down to that mailbox every day, including Sundays when there is no mail. Then she calls up and says, “I think I can make it to the corner.”

I think I can make it to the corner. Some people, maybe including Ingrid’s doctor, might find that pathetic, but I knew what a huge change that was for her.

Anyway, she did make it to the corner. And over the course of a year, she made it to three miles a day! And she lost some weight, although not as much as she wanted. More important, her A1C came down to 7.9% and is still dropping.

But just as important as her numbers is that Ingrid now has her life back. She now sees herself as a person who can do things, who can make some changes, who has some control. Who doesn’t have to just sit in front of the TV all day. And that’s priceless.

But more than that even, consider the effects on her family. Her kids and her husband went from being worried about her, sad for her, and maybe a little ashamed of her, to being proud.

And what about her neighbors, who used to see her as someone to feel sorry for or to laugh about, and who now see her as an inspiration. If she can do it, they can do what they need to do!

It’s amazing what you can accomplish if you start small and take small steps. It took Ingrid a year to get to three miles a day. But that year was going to go by anyway. So you might as well start where you can.

Next week I’ll go into more ways to make successful changes and have them stick.

  1. Type 2 diabetes:
  2. HbA1c:
  3. diet:
  4. self-monitoring:
  5. medication:
  6. exercise:

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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is His blog is

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