You have to love Dr. William Polonsky. He's the author of Diabetes Burnout, and founder of the Behavioral Diabetes Institute in San Diego, CA. He's also one of the smartest and most empathetic people you'd ever hope to meet. And he seems to "get" life with diabetes like no other non-diabetic ever has. Today, some insights from his treasure trove.
A Guest Post by Bill Polonsky, PhD, CDE
Managing diabetes effectively means you must do at least a million different things, and do them correctly and at the right time each day. Well, maybe it isn’t a million, but it seems like a lot, doesn’t it? You should be eating fewer bad fats and more good fats, fewer bad carbs and more good carbs, more fruits and vegetables, but watch those blood sugars! Eat smaller portions, but eat everything in moderation, drink more water, or perhaps drink less. Don’t forget your vitamins, but which ones? Take medications faithfully, check blood sugars regularly, don’t forget to exercise, quit smoking, don’t drink too much alcohol, see your doctor often, lose or perhaps gain some weight, keep your blood sugars down but be careful about hypoglycemia, don’t forget to watch your blood pressure and cholesterol, and the list goes on and on.
The ugly truth is that most people—despite their best intentions-- can’t do it all. Whenever I speak to large groups of people with diabetes, I ask for a show of hands, “How many here take care of their diabetes perfectly every day?” While there is always one or two who proudly raise their hands, there are hundreds of others who sit quietly with their hands at their sides.
Why can’t most people follow all of their diabetes recommendations day in and day out? Unfortunately, good diabetes care must compete with other priorities in your daily life—taking care of your children, working at your job, errands around the
house, and so much more. There is just too much to be doing. So almost everyone compromises with their diabetes care, doing as much as they can with the limited time available. You must choose what is important, and let the rest go. But of the million-plus tasks that diabetes requires, which are the most important? Which ones will give you the most bang for your buck? In other words, which will have the biggest impact on your long-term health? If you don’t really know, you may be working hard on your diabetes management and still not getting the results you want. After a recent diabetes education program, one woman told me that she was now going to concentrate on drinking more water, while another fellow mentioned that he was going to focus on eating less junk food. Unfortunately, neither of them was taking their diabetes medications regularly, and they didn’t see this as critical to their health. Their well-intentioned efforts were not likely to improve their health, especially if they were not taking their medications. These were not stupid people, but no one had helped them to think thru their diabetes priorities. To be fair, even health care professionals don’t agree on this issue, because—at least until now-- it was hardly ever discussed.
To start the conversation, here is my own list, in order, of the top ten diabetes-related tasks likely to give you the biggest bang for your efforts. Please, please, please don’t take this list as gospel. Different patients have different needs. Your physician knows you best and he may have his own opinion:
- Know your own numbers (at a minimum, A1C, blood pressure and cholesterol), know what they mean, and get these tests done regularly. When you know exactly how well you are doing, this can provide the enthusiasm you need for all the tasks to follow.
- If you smoke, find a way to quit.
- Make sure you’re on the right medications, and take them faithfully.
- Engage in regular physical activity.
- If you are overweight, focus first on reducing portion sizes.
- Identify and reduce the fat in your diet, especially saturated and trans fats.
- Eat more fruits and vegetables.
- Check your feet daily.
- Monitor blood sugars regularly
- Stay educated about diabetes
Given your own circumstances, you and your doctor might set these priorities in a different order, and might even include different items. If you have Type 1 diabetes, for example, you might put blood sugar monitoring higher on the list. If you are not overweight and your blood sugars are well controlled, you might not worry about reducing portion sizes. In any case, since no one can do it all, sit down with your doctor and determine your own self-care priorities. Learn which of your many tasks will give you the biggest bang for your buck. You are already putting out plenty of effort, so let’s make sure it counts.
Thank you, Bill. Getting the most out of our efforts is always the name of the game, of course!