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Many of us with diabetes run numbers in our heads all day. We balance carb counts, insulin units, exercise and increments of time as if we were computers, sometimes making extraordinary calculations to safely incorporate 35 CHO of birthday cake into an afternoon.
But the diabetes police can't see our internal computers or our extraordinary effort. They see only fluffy yellow cake and half a pink frosting bud zooming toward a mouth. "How can you eat that?" they exclaim with horror. "You have diabetes!"
Unfortunately, misinformation about diabetes and its management is widespread. The general public, especially, is unaware that flexibility is part of today's trend in diabetes management, that insulin and meds are changed to match an individual's lifestyle, not the other way around. For example, although all people with diabetes are different, an occasional sweet is completely okay for some especially vigilant individuals.
Nevertheless, misinformation that leads to harsh judgment persists. "You have diabetes because you ate too much sugar when you were a kid," I've been told. "You wouldn't have diabetes anymore if you would only drink spring water and walk every day," an insurance salesman said.
The Gloom Squad
There's a special subdivision of the diabetes police—the gloom squad.
These are the people who say, "Such a shame, you could have accomplished so much more if only you didn't have diabetes." They describe the gory details of their Uncle Harry's complications and believe it's their duty to forecast the worst possible outcome, even though it is within your power to create a much different future—a long and healthy one.
The people who really love us and want to help us manage our health don't police our behavior. They know that we're striving to do the best we can. They forgive our occasional mistakes, trust our judgment and offer help instead of criticism.
I was truly impressed with the relationship I witnessed with one couple. Several times a day, the woman asks her husband gently, "Honey, what's your blood?" He responds immediately by testing his blood glucose and telling her the number. If the number is low, she offers a snack; if it's high, she offers to go with him for a bike ride. These are acts of loving kindness that benefit both partners and build intimacy.
But policing behavior hurts feelings and destroys cooperation, motivation and relationships. Policing occurs when people around us lack knowledge about diabetes, lack communication skills and are fearful of bad things that could happen to the people in their lives who have diabetes. Frequently, the police are really trying to be helpful. They just don't know how to do it without being offensive.
Sometimes the diabetes police are overwhelmed with their own weight or health problems and, without realizing it, project their self-criticism at people with diabetes.
When others make uninformed judgments, tell horror stories or attempt to police another's behavior with snappy critical comments, it can be more than annoying—it can really hurt.
Good Intentions or Not?
Run-ins with the diabetes police can be painful for both sides.
Those of us who try hard to stay in good control but often cannot do so may suffer from tremendous self-criticism. This is when we find critical comments from others especially hard to take. We may have no idea how to respond in a positive way, and so we start an argument, retreat behind a wall of silence or fume inwardly.
Significant others have their own needs. They might fear that they won't be able to cope if their loved one has a hypoglycemia emergency. They worry about being alone or having to take care of the other person if a crisis occurs. Doctors worry about their patients; and if the person with diabetes seems to be ignoring medical advice, their fears escalate.
Run-ins with the diabetes police can be subtle or intense. Perhaps a co-worker gives you a dirty glance when you're seen eating half a muffin in the company kitchen—even though you have carefully considered your decision to eat the muffin and have even gone the extra mile to call the manufacturer to get the fiber and carb count.
Maybe your spouse keeps questioning your reality: "How can your blood sugar be low? You just ate!"
"You might die out there!" a doctor scolded me when I told her that I was happily planning a backpacking trip. "Hypoglycemia can kill you!"
These types of judgmental interactions leave people with diabetes feeling angry, put down and sometimes inclined to hide their behavior rather than to work things out with the people in their lives.
The STOP Technique: A Simple Solution
When we're fuming and frustrated after encounters with the diabetes police, we'd often like to change the situation. But most of us have no idea what to say or do to stop the behaviors we find hurtful and also preserve or even improve the relationship.
Lenora Billings-Harris, author of "The Diversity Advantage" and an expert at coaching others to deal with inappropriate behaviors in the workplace, developed a four-step process for giving feedback that she calls the STOP technique.
Using the STOP technique (see sidebar) not only stops the diabetes police in their tracks. It also teaches them, by our example, how to behave in a more loving manner while encouraging individuals living with diabetes to take action to educate others.
Fuming inwardly about the behavior of others—while outwardly tolerating it—teaches others that they can get away with treating us badly and allows negative attitudes and misinformed opinions about diabetes to continue.
Stop fuming and be assertive.
Before and After: My Experience
Two years ago, I felt my blood glucose diving low a few minutes before I was due back in the office. Rather than running up the stairs in my weakened state to tell my boss I would be five minutes late, I decided to remain where I was, chomp down some glucose tablets, and hope for a swift recovery.
However, when the boss spied me from her window, she stormed down. Although I was pale and sweaty and explained quietly that I was having a hypoglycemia emergency, my boss yelled, "If there is a problem, you need to report it to me immediately, and I will handle the problem!"
I felt uncomfortable around her from that moment on. Had I known about the STOP technique at the time, I could have addressed her strange behavior, cleared the air and prevented future problems.
Step one: "I noticed that you reacted strongly while my blood glucose was low."
Step two: "I felt hurt and angry."
Step three: "In the future, when I'm having a problem, I would prefer it if you could ask me whether I am all right and whether I need anything."
Step four: "If you would do that, I would feel more comfortable complying with your request to tell you when my blood glucose is low."
Can you feel the power in these statements? Saying these words is easy, and it takes only a moment. Imagine the problems you could easily iron out with other people if you approached them using the STOP technique. The most difficult part might be finding the courage to communicate—and believing that you deserve to be treated well and receive help from others.
When I was offered a better position at a magazine publishing house, I decided to prevent any problems by discussing my needs—in advance—with my new boss. I had learned the hard way that I should have taken time to do this with my panicky former employer.
I decided exactly how I would like my new managing editor to treat me if I should have an episode of low blood glucose at the office. I explained that I would prefer to be left alone while I'm feeling foggy-headed. I assured her that if she could allow me to just disappear for 10 or 15 minutes to eat glucose tablets, I would return to my work as soon as possible. I also offered to do whatever extra work was necessary to make up for any lost time.
My new boss was truly relieved and grateful to get a clear explanation of what I needed from her, and she was more than willing to cooperate.
Initially, people might be startled by your directness and might need time to digest what you've said. Let them know you're open to feedback at any time. Having a structure for communication makes approaching uncomfortable subjects so much easier!
Avoid Criticizing the Offender
Effective use of the STOP technique depends on your ability to be very specific in describing the behavior, without criticizing the other person.
"Don't let the other person interrupt you or tell you that you shouldn't feel the way you do," Billings-Harris says. "You want the other person to respect your feelings."
If the other person's behavior does change, give positive feedback as quickly as possible. If the other person doesn't stop the behavior, you might need to consider other options, such as a visit to human resources or, with loved ones, family counseling.
Remember that it's hard for everyone to make significant behavior changes, diabetes or not. Know that people will slip back into bad habits, even when they are trying to change. Forgive them for their mistakes, as you expect them to forgive you for yours. Gently remind them again of the change in behavior that you'd like to see.
Most People Willing to Change
Most people are more than willing to change once they understand how important it is to you and once they know the new options.
"When we are powerful and assertive in saying what we need, people who care about the relationship will at least make an attempt to change," Billings-Harris says.
Think about the ways others in your life are treating you. Resolve to take the responsibility to eliminate situations you find hurtful. Then decide exactly how you would like to be treated. You might never have taken time to think about this before—perhaps you hadn't gotten past feeling simply annoyed or hurt.
This time, however, go through the four steps of the STOP technique and come up with a simple statement. Write it down and practice a few times before speaking to the other person. Make sure you are concise and noncritical.
If you take the time to decide how you want to be treated and work up the courage to communicate that information to others, they're likely to be relieved and more than willing to respect and support you, your needs and your life with diabetes.
The STOP Technique
S—State objectively the behavior that bothers you
Describe in an objective manner the behavior that you don't like. Don't let excessive emotion surface, as an outburst can cause the other person to become defensive or start an argument that will damage the relationship further.
T—Tell the person how you feel when she or he behaves this way
State your emotional reaction and be honest. Bring emotion into play by simply stating feelings rather than by attacking the other person.
"You want to make this very personal so the other person has to decide if the relationship is important enough for them to try to change their own behavior," Billings-Harris emphasizes.
O—Options, options, options
Give suggestions for an alternative behavior that you would prefer. Don't just tell the other person to stop doing something; explain exactly what could be done instead. Frequently, the other person wants to change the situation too, but doesn't know any suitable options.
Describe the positive results that the other person will enjoy if the policing behavior is changed. This provides incentive to change.
0 comments - Sep 1, 2002
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.