Staying Motivated With Diabetes Part 1

Part One of Three

How do we Find The Motivation we Need?

| Aug 12, 2011

The piece of cake sits there on the plate, daring you to eat it. The blood sugar meter rests on your nightstand, an obstacle formed of lancets and test strips. Life with diabetes is a parade of challenges, from diet temptations to healthcare hassles. You know--we all know --that the only way to say "no" to the cake and "yes" to the blood sugar check is through consistent self-motivation.

But how do we find that motivation? And what benefits does self-motivation offer us? Scientific studies and the everyday experiences of people with the disease offer some answers.

Diabetes -- both type 1 and type 2 -- is notoriously difficult to manage consistently. The reason is simple: It's a chronic disease, and humans are not built to handle chronic problems. Acute, or short-term, illnesses fit our mental make-up best. When we have a broken bone or gaping wound, we immediately know that something is wrong. We take action. We go to the emergency room and address the problem.

But diabetes affects us slowly. The complications and health risks accumulate over years, sometimes decades. Our immediate instincts are much less helpful when dealing with a lengthy time scale. When profound complications or health problems finally arrive, much of the damage has already been done.

We have to take a more rational and sustainable view of our health if we're to reduce these long-term risks. A couple of studies from the last few years demonstrate the benefits and challenges of this approach. We'll look at one of the studies in this piece and the second in a follow-up article.

In March 2005, the Journal of the American Society of Nephrology published a study that followed 141 patients with type 2 diabetes and other cardiovascular risk factors. The patients were divided into two groups -- those who simply visited the doctor once a year, and those who received more intensive, lengthy training sessions that produced individualized plans. The researchers followed the patients for eight years. Notably, they did not prescribe any course of treatment--they simply observed.

The two groups did not receive significantly different advice. Cholesterol and blood pressure-lowering drugs were prescribed for both groups, and all patients were urged to keep their A1C, cholesterol, and blood pressure at healthy levels.

But the patients who received more intensive coaching did much better. They saw their healthcare providers more often -- an extra visit a year, on average -- and made those visits because they wanted to achieve the previously set goals. They also received higher doses of helpful drugs, prescribed as part of a more aggressive treatment regimen.

The results speak for themselves. There were 80 "cardiovascular events" in the standard group, as opposed to 47 in the motivated group. Those events killed eight people in the first group, as opposed to five in the second. The first group saw 17 strokes, while the second group saw eight. And 14 patients in the first group developed kidney disease, while seven in the second group did.

It's important to note that both groups saw overall improvement in health: Dropping by the doctor for a quick visit once a year is better than nothing. But extra education and individual attention had clear and lasting benefits.

The researchers wrote: "Every intensive intervention has a dual effect: A direct effect of the trial intervention itself and an indirect, perhaps not less powerful, effect of improved general motivation and compliance. The present study isolates and highlights the indirect effect because there was no direct pharmaceutical intervention in either of the groups."

The study was conducted by Rita Rachmani, Inna Slavacheski, Maya Berla, Ronni Frommer-Shapira and Mordchai Ravid of Tel-Aviv University and Meir Hospital, both in Israel.

Simple, right? Extra attention and time produces better results. Motivation is simply produced with more and better healthcare. Perhaps not. In the next article in this series, we'll look at a more recent study that highlights some of the challenges of staying motivated.

If you've found any ways of staying motivated, please let us know about them in the comments section.


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Categories: Diabetes, Diabetes, Motivation, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 16 August 2011

Some insurance companies also allow sessions with a diabetes educator. Ones I have seen require a food, exercise, blood sugar and treatment log which helps keep me motivated since I have to write it down.

Posted by DAR on 16 August 2011

I find focusing on what I CAN eat instead of what I can't makes it much easier to stick to my very low carb plan, which enables me to avoid diabetes complications without meds. (My last A1c was 4.9.) I love to dream up recipes using the ingredients my body (including my taste buds!) likes and to share them with others. I don't feel deprived when I can have my own safe, healthy meals to eat, including treats.  

Posted by TracyK on 16 August 2011

I know it's difficult to stay motivated but the one thing I have found is that after 45 years with Type 1 diabetes support from family and friends cannot beat any medications or technology out there. BTW--no major organ complications to date so I must be doing something right even though I am brittle.

Posted by Anonymous on 16 August 2011

Wow 4.9. I'm type 1 I have to be happy with the 6.2 I just got. I'd love to be type 2 but that is just a pipe dream. Us type 1s just go day by day. There is no reversal or off meds for us. 4.9 is a non diabetic a1c. I have virtually no insurance now (and can't get any on my own being type 1) so it's a real challenge.

Posted by Anonymous on 16 August 2011

Since I turned 65 and went with a HMO Dr., she only wants to see me 1xa year, states I have it pretty well controlled! Yes I do because prior to her, I was seeing my Dr. 3-4x a year....This is our great HealthReform!!!

Posted by Ellenresnick on 16 August 2011

@DAR: you are very wise and provide good inspiration for others! Sounds like you found a way to not just tolerate DM, but to thrive and live happily with it. Good for you!!!

Posted by Anonymous on 17 August 2011

I see my Dr. every 3 months and have a cbc every 6 weeks. I have Conn's syndrome and stage II kidney failure as well as type II diabeties.

my last a1c was 5.2 and all meds are for Conns, diet alone controls the diabeties, I am on a low carb Moderate protien, high fat diet and all is well.

Posted by seashore on 17 August 2011

A key requirement for effective control of blood sugar by all diabetics is to ignore the cholesterol in the food. The body makes its own cholesterol, the equivalent of 6 to 8 eggs per day. If one eats 4 eggs per day, the body simply makes less cholesterol, and so there is no effect in the cholesterol in the blood. This is easy to prove.

Probably the best step for control of blood sugar is to eat two eggs for breakfast every day. The eggs contain healthy fat and protein, and no carbs. Diabetics should never eat cereal for breakfast, including oat meal.

For a half century we have been brainwashed to believe that cholesterol and saturated fats clog arteries, producing coronary heart disease (atherosclerosis). There is no evidence to support this theory. Fats are heart-healthy and protein is heart-healthy. Arteries are clogged by elevated blood sugar produced by excess carbs; arteries are not clogged by fats.

To control diabetes, minimize your A1c and ignore your cholesterol level. Keep your A1c below 5.5% and ideally below 5%. If diabetics stop worrying about cholesterol and fats in the diet, these goals are readily achievable.

Posted by Anonymous on 20 August 2011

I have played around with this stinkin desease for 5 years trying to control blood sugars but not being able to focus on it as I needed to. Work pressures, living, being a "foodie" who loves to creatively cook all crouded out focussing on the decease. My doctor had me keeping a log, but it was haphazard—I couldn't remember to log or even takey blood glucose before meals because I got so caught up with the cooking.
But I just got an iPhone app called Track3 that has provided the focus I needed. It tracks all the categories of the FDA food label and is so comprehensive that any cheating sticks out like a sore thumb. Now my sugar is down from mid 200s to 90s and low 100s. And I'm aware of my calories and losing weight (with my cheating I must have been wating

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