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What is the trigger or motivation to make you change a behavior? If I had the answer to that question, my job would be easy. Health care providers send people to me so I can straighten them out and get them to do what they're supposed to do to manage their diabetes.
Currently, the term "noncompliant" isn't politically correct for many reasons. Often, you want to change but don't know where to begin. Sometimes, it's not the right time or you're in denial. So what's the answer?
As a diabetes educator, it's my job to educate, answer questions, offer encouragement, demystify misconceptions, direct, assist, teach self-management skills, and plant that the initial seed or idea for change in your mind. This is the process of empowerment.
I can't change your behavior; you have to do it yourself. The touchdown for a diabetes educator is to have the light bulb go on for a person during an education session. He'll say: "I get it or I now know what I have to do."
The icing on the cake is to see the person at the next visit with improved blood glucose control, feeling better, and happy about what they've done and where they're at with their diabetes management.
What about scare tactics? Do they work? I'm personally not a believer.
The Center for Disease Control (CDC) is running anti-smoking and tobacco use commercials. After graphic anti-smoking ads were shown, a CDC survey said that before the campaign started, 31 percent of smokers said they had tried to quit for at least one day in the previous three months. This went up to 35 percent after the campaign, and 13 percent said they succeeded.
Research also has shown that your belief in your ability to carry out actions to reduce the threat and/or fear is very important in leading to any change. The use of scare tactics in health communication is complex and controversial and the current research literature on scare tactics reflects this.
What do you think? Can you be scared into changing your behavior?
Have a great week.
Nancy Klobassa Davidson, R.N.
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I struggle with Type II and with mental health as well and it works hand in hand. I have the desire to change for the betterment of my life but the motivation is short lived. It comes in spurts and disappears just as fast. But for right now yes my numbers may not be ideal but they are better from last year at this time and I have hope to see better each day.My mood is not 100% but I have to do this - all the positive parts of living - for me and ... I want that. As for scare tactics yes they scare me but the biggest thing it does to me is give me the feeling of despair, hopelessness and the feeling all these potential problems are my own doing - my own fault.... equaling binge eating, poor self care and lower mood. But for now I focus on what I am capable of doing now. Take care
I always tell myself that I am lucky that I can do things to control my situation unlike persons with cancer who have no treatment or harsh treatments that make you very sick.
I also ask myself if the sweet foods are worth the loss of a finger or toe .It helps me to be very real like the pictures they have on the cigarette packages.
I am at a point in my treatment where I am trying many different types of pill and the side effect and results are not what I want. I have not been doing my exercise lately and that is most likely why my latest efforts are not working . I have no one to blame but myself.
It is time to get real!!!
how much does smoking effect your chance of getting diabetes and if yes what are the actual effects both short term and long term
Overeaters Anonymous is helping me change my compulsive eating behaviors to control my Type II. Based on the AA model, it helps me take it one day at a time. Changing many decades of eating patterns is not easy, but I am getting there!
But you could have mentioned the important technique of developing new habits by gradual changes. At some point you use the word "seed", that could directly lead into a discussion of how to form new habits, another technique different from the abrupt decision to change completely on the spot, in a radical turnaround, changing "cold turkey". Both methods are valid and can be efficient, depending on circumstances.
I am usually scared until the termination of the office visit. It rarely lasts longer than that; I get on with my life.
My first response, as a person with diabetes, was insulted and offended. As a nurse, saying yes but. I have struggled with weight for 37 years or more. My Mom asked and had her doctor give me some type of pill for 10 days for weight loss when I was probably 14. I hated shopping for husky clothes. After a throidectomy I noticed more difficulty controlling weight and was told by the doctor, "Just push away from the table!" I asked for professional advice, but never went back to him. I tried several ways of cutting calories, different types of diets. I would do great for awhile but would tire of coworker and family sabotage and slowly regain the weight loss. I worked tahe usual 40-45 hours per week, but nursing requires many more hours beyond the work hours. I came home, all motivation gone. Stress and exhaustion did me in. Now at age 63, I have diabetes. I know the diabetes information. I had the motivation. I am tired and retired. I am meeting with a dietician - everything she is telling me to do, I am trying to do. Nothing she has told me is nothing new to me. The motivator is myself as it was before. Have excepted that my husband just does not get it at all. My motivation now comes by positive feedback from my one and only doctor that has helped me and the weight loss I see on the scales.
Diabetes are not a self inflicted disease and I do know that many individuals with diabetes do not follow guidance, however nurses and doctors that I am familiar with, including you make me feel like if it is my fault that I have diabetes.
Education should always start with the fact that diabetes are not self inflicted followed by the best guidance so the individual can opt to follow or not to follow.
Many of us need to be recognized as have BOTH diabetes II and heart disease. Reason? Most suggested diet healthy meals for one, counter the needs for the other. The obvious consequences are disturbing and have been for over a decade for me personally. I think I'm doing well, but don't really know for certain. I don't smoke, I watch my glucose and fructose, fats, and etc. Nine meds everyday. I'm 76 and struggle with my weight; mainly because I live alone. Thanks for you interest.
My A1C is down to 6 and my glucose is below 100, this I have done in about 3 months without any education, just common sense. I have 2 siblings that are diabetic, both are on meds. I am trying to lose weight by staying off carbs and getting plenty of exercise. I am 73 years old, weight 170 (down from 175) trying to get down to 150. I read a lot and self educate myself. Thanks for your site
Yes, you can be scared into changing your behaviour. My case! I lost 3 kg and managed to change my diet, all because a doctor said (before it was exactly true): Madam, you are a diabetic!
My blood tests look better, but I still have 50pc chances to have diabetes in the next years (age & heredity).
How can you find a Diabetes Educator if your doctor does not give you a name? Sounds like the MD only wants to prescribe medicine. In New Jersey near Manhattan
Scare tactics work very well on me, so bring them on.
Awkward. I'm not a fan of people who teach using the first person "I" when speaking of helping others. Sorry but it comes across self-absorbed/self important. Many of us do better with the royal "we."
What is the best drink, low, or nil. sugar. Nutritious, don't leave a a dry or other after taste. And I don't have a headache in the morning after 1/2 dozen + trips to the toilet.
I believe there is a healthy balance in empowerment and the realities of the disease of diabetes (or scare tactics). I think if people really saw what could happen in different areas of the body due to diabetes and the holes in wounds not healing and amputation after amputation, then they go in with healthy appreciation for treatment. Personally I am on the side of empowerment because people tend to want to do things for themselves.. And some don't.. Education is key and absolutely the negatives.
No, but I definitely want to change my eating behavior. However, I quickly become overwhelmed by what seems like a blizzard of recommendations from many sources, including Mayo Clinic. I feel like I would have more success with some plan that is extremely simple to follow. Too many choices confuse me with the result that progress is very slow. I work in the health care business as a psychotherapist in a medical clinic.
I recently developed Type 1 last year as a direct result of a severe infection. Fear of losing more of my freedom (lost my health and ability to eat whatever I want/whenever I want) is what motivates me. My A1C was 12.8 when diagnosed and it went down to 7.8 then to 6.6 and to most recently 6.0. I'm very proud of this, but if I could only be Type 2...I wouldn't be diabetic as I eat well and exercise. My reality is that I'm lucky to be alive but losing toes or fingers or a limb due to this autoimmune disease is out of question to me. Ultimately, my goal is to be as healthy as I can be, stay alive and continue thriving as best I can. By keeping my blood sugar under control I can/will be healthier than if they are out of control...
For me what works best is getting into a good pattern -- I'm retired, and that's easier for me now than when I was working (and stressed). I do things at the same time each day -- sounds stupid, but works for me. Meals roughly the same time, same kinds of stuff, walking/exercise also roughly same time. The advantage is that I don't think about it. (FYI, we sleep from 2 am to 9 am -- we're not early risers.)
I also have a mental list of meals and snacks, diabetes friendly, so I don't think much about meals when I'm hungry. (That is, for lunch, do I want cottage cheese & fruit? Cheese sandwich and salad?) I think about meal options when I'm headed for the grocery store, making a list so I have everything I need.
Being retired can lead to letting the time get away and/or frequent snacking. So it's important for me to have enough stuff to do -- I don't think about when lunch will be, but what I need to do in the next hour until lunch time, now that I've read my emails.
For me, boredom and not knowing what to do next is an invitation to eat, a lifelong bad habit that's it's still easy for me to slip into.
Nothing succeeds like success. I was 'sorta' watching my diet and 'planning to' get more exercise, with average fasting (morning) blood sugar readings in the 160s until I had a chat with another Type 2 diabetic while waiting for a diabetic education course. He had nerve damage in his feet and serious kidney problems after ignoring his diabetes diagnosis. I resolved not to become 'that guy', so really watching my diet got me down to 135, but I plateaued out there. Exercise (30 minutes a day) has brought me to a 14-day running average of 119 and a recent A1C of 6.1. If I can do it, so can you.
Yes, I believe we can be "scared" into healthier behavior! Recently, after being prescribed an additional diabetes med, I decided to try my hardest to get control over my diabetes Type II and REVERSE it if at all possible.
Have now lost about 15 pounds, going to gym class 3 x week, eating very carefully, I am looking towrard a much lowered A1c when I go back to the doc in about 4 weeks.
Well - I read all the comments.
Nobody mentions sabotage.
The nearest an dearest.
"Look what I got for"YOU"!
From another diabetic!!
No solution for this exists!
But apparently it IS very common.
Left foot...right foot... repeat...
Scare tactics or rudeness make me want to rebel against the Doctor, even though I am 41 I still have the mental attitude of a stubborn teenager it seems. I also get upset and tend to 'give up' on my Type 2 Diabetes management often when I get confused by how to manage it the 'right' way. Educating me in a way that I can grasp what you are saying, is the best way to personally help me battle diabetes. I find I still barely understand diabetes or how to manage it even though I have had it for roughly 10 years now.
My daughter had me watch "Weight of the Nation" a documentary on HBO. It was a big motivator.
Not much help. Can't we get at least am
idea we can use now. like add a food with fiber. or .......
A man that I have loved all my life is in hospice now, dying of diabetes related illness. Liver/Kidney failure. 55 years old. I am a type 2, A1c 8.9, fasting blood sugar 200. Bad neuropathy in my feet and hands. 240 lbs. Life feels hopeless. I feel doomed.
Fear worked at the start, but it wore off and I gradually slipped into past eating behaviors. It's taken 2 years since diagnosis, but I've finally become fed up (pardon the pun) with the consequences of my behavior and have been eating consciously.
My diabetic educator says that managing diabetes is simple. It is not. There are some uncontrollable factors, like stress.
In addition there seems to be little support for Type 1 Diabetics. Medicare will not cover new technologies that may assist in lowering your A1C. (Sensors, Wireless pumps, new series of standard issue pumps)
So with such insensitivity and no cure on the horizon Diabetics are frustrated.
I WAS scared by an emergency room physician, and she was so rude to me about being diagnosed with diabetes at that time, that she turned me into denial for several months. I had gone to the ER thinking I had a blood clot after a long flight, and she said, no you don't have a blood clot, you have diabetes and came at me with a long needle, and jabbed me with it. No compassion, almost as if she was mad at me about not knowing. Since that time, 3 yrs ago, I have found a wonderful nurse who is very understanding, and counsels and encourages me that this is manageable and it does not need to control my life, I control it, instead. Magical words to someone very frustrated and discouraged. At the same time, I did need to see the seriousness of denial, and what could happen if I don't look after myself, and that it is a serious disease.
Scare tactics don't work for me. I lost my first 10 pounds recently and my motivation is how I feel. I feel so much better and am motivated to continue biking and eating better based on how much better I'll probably feel 50 or 100 pounds from now. I want to see how THAT feels! At 52, it's no longer about vanity because the turkey neck and gray hair are not going to be resolved with diet and exercise. My focus is on good health and feeling my best.
I enjoy the information that you share and it does help. My doctor did use one scare tactic that worked when he said that if I let my continue uncontrolled I do try so hard to do it. Now that I retired I thought it would be easier, but it is harder. Anybody have suggestions, I do appreciate any help.
Paragraph 5 "icing on the cake" might be considered an unfortunate choice of phrase considering the topic.
This is a fight, a battle with diabetes and very personal as you pointed out Nancy. Do I need to be scared? No, but I am always in need of being educated. 16 years of type II with the past year as IDDM. I have my ups and downs with this just like in life in general. What I appreciate the most is my PCP, my Endo, and my wife not giving up on me...therefore I will continue to fight the fight with this support. Chris F.
I had a heart problem begining of Jan 2014.
During my stay in the hospital I was told I am a Type 2 Diabitic And need to follow a healthier diet and also quit smoking after 40 years. I am using 12 Step Principle of One Day At A Time.Blood sugar levels are good and haven't smoked in 36 days and have lost 20 lbs.I would never have done any of this if someone had tried to force me.I needed a bottom and mine was heart issues.
I have been a type 1 diabetic for 60 years. I agree with the statement that it is up to the diabetic not your health care worker, spouse, child or parent if older than 13, to monitor what you eat. I do feel diabetes affects people differently and that there is not a one size fits all solution to this horrendous medical condition.
So many of us know exactly what to do, but the ability to do it is not based on knowledge, though knowledge is necessqry. Nor is it based on self-control alone. The best information I've ever heard on diabetes and obesity was in a recent talk by Peter Attia at TED conference last year: http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html . We just don't know the answer yet, but it's not a character flaw when people fail, so scare tactics or shame usually backfire. It sounds like you're doing all that science has realistically discovered you can do at this point.
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