Ever feel like you’re making the same New Year’s Resolution over and over and over again? I know I do. I have several changes in my life that I’m planning to make this year, but the No. 1 thing on my Diabetes List is logging my blood sugars.
Ack!
I feel like a broken record! Wasn’t I just talking about this a few weeks ago? Don’t we spend loads of time here at the ‘Mine talking about all the shiny new apps I could download on my iPhone? Haven’t I had diabetes for going on 18 years?! Making New Year’s Resolutions is the easy part; it’s sticking with them that’s hard. In fact, I make the “New Year’s Resolution” of logging my blood sugar at least 48 times during the year. And yet somehow it never sticks.
Why is that? I just had to do some research into why I seem to be “failing” all the time…
It’s all part of the puzzling process called behavioral change. When it comes to changing health habits for better outcomes, you would think that simply knowing something would make you a healthier person would be enough. A common belief is that having a good motivation is enough to make and maintain a behavior change. But unfortunately that’s not the case at all, as illustrated by the Stanford Tech Lab in their humorous slideshow presentation on the Top 10 Mistakes in Behavior Change. Relying on “motivation” and “willpower” appears to be the No. 1 mistake people make!
Instead, Stanford’s suggestions for making meaningful, lasting change is focusing on small, incremental changes within a fixed time period. Makes perfect sense. After all, the idea of doing anything forever is daunting, even when you know it’s something you should do. Instead, creating a plan of action that involves doing something for a fixed period of time can help you “get into a habit” without feeling like it’s a life sentence. There’s really no scientific proof that a certain period of time develops a habit, but in general, most experts suggest three to four weeks of commitment before a habit starts to form.
Zen Habits, a terrific blog dedicated to sharing simple “lifehacks” for living better and happier, has a great list of suggestions for how to either incorporate a new habit or replace an old one. The first suggestion is: Do one habit at a time. This is crucial, I believe, for people with diabetes. So often I see folks in the diabetes community who want to lose weight or lower their A1c, but there are multiple components to each of those goals and it can be overwhelming to try to do all of them all at once.
Last Spring, when I lost 15 pounds before my wedding, I did it by calorie counting. That’s it. If I found time to exercise, that was great, and I didn’t even focus on changing my eating habits explicitly. I just counted calories… and everything else kind of followed along.
Another suggestion offered by the Zen blog: Write down your obstacles. Wow — where to start?! Distraction with work / life, not having access to the tools / technologies when you need them, and worst of all, mental stumbling blocks, like burnout and depression. But if you can define your own challenges, only then can you begin to find ways to work around or work with those issues so you can still accomplish your goals.
See how small the lines are? One goal at a time!
One of the things I most enjoy about being part of the diabetes community is the constant support and frequent suggestions that we give each other. Turns out, support is a crucial component to behavior change. D-journalist Riva Greenberg recently interviewed Dr. Michele Heisler, a research scientist focused on giving people with chronic illness the flexible, long-term support they need. She was involved in several studies on the concept of peer mentoring in behavior change. In one study, a group of type 2 patients were paired with other type 2 patients of similar backgrounds, and the study showed that those who worked with a peer mentor had an A1c about one percent lower than those just working with a nurse practitioner.
“Patients who aren’t on insulin often have a lot of fear about it, that it’s going to be this horrible thing. But when patients in the partner group heard from a fellow patient, ‘Oh, it’s only one shot a day, it’s actually not so bad,’ that carried a lot of weight. More weight than their doctor haranguing or threatening them with what would happen if they didn’t start insulin,” Dr. Heisler explained. (This is old news to us DOC’ers, right?)
Not only can peer support be encouraging for people who need to start or stop a habit (like smoking), it can also be helpful just to have public accountability. And of course, it’s great to have someone to pat you on the back and say, “Good job!” We often don’t see our endocrinologists or diabetes educators more than a few times a year, so it can be difficult to self-motivate at home.
Although it’s January 3, I’m still working out details on my plan for becoming a better blood sugar logger. I know that if I can get a handle on writing down all my information (or uploading it, or organizing it, or whatever I decide!) I’ll be in a better position for wrangling in my blood sugars. What I’ve learned from writing this post is that I could really use some community support as I take these baby steps. Because trying to make big changes, all on my own, clearly isn’t a recipe for success.
What are your New Year’s Resolutions for this year? And what strategies are you using for making sure your “behavior change” sticks? I’d love a little DOC peer mentoring right now!
Whoa Allison, you’ve helped me tremendously with this, and have inspired me to make some real change in a way that I think might actually work for me. I’m off to start my plan….
great post! I have followed Leo Baubata’s (of Zen Habits) 6 changes method for years (6changes.com) and had much success with it while documenting it on my blog (so true that writing helps!) I also like the thought of making changes or creating new habits versus just tossing a resolution up in the air and hoping (fingers crossed) that it happens
I log 2 different ways: Smart Charts from Diabetes Mall ( I like the daily graph) and CareLink, which I do every few weeks. While CareLink uploads, I play solitaire (reward). My pump has a bolus history thingy and my meter has an all results thingy; if I don’t write things down immediately, I can go back there. I use them to tweak my basal/bolus every couple of weeks. I see where I’m tending to go out of line, and try to bring them back toward normal. OCD runs in my family.
I rely heavily on my CGMS for spur of the moment decisions – no logging! What I DO do is commit to some sort of ‘test’ every couple of months. Whether I decide to verify my morning carb ratio, or fast to test my basal rates – during those periods, I write *everything* down. But unless things are suddenly off-kilter (always high overnight or some such), I found it groundbreaking to let go of the supposed need to log. I met someone on insulin-pumpers.org that had this philosophy, and it’s been so liberating to let go of something I never successfully achieved.
The question you have to ask yourself is what the desired outcome is. Is the desired outcome to find the perfect dose for a meal you eat all the time? Is it to log caloric intake? Sometimes you can solve those problems without a commitment to daily logging. How do you plan to USE the logs? What problem are you trying to solve?
My a1c is usually right around 7.0; given my hypo unawareness, I think this is a reasonable outcome.
I have LADA, so my rates vary depending on what my beta cells are doing, which also varies. By logging and graphing everyday, I can make the needed changes before they get too out of whack. My CGM is sometimes accurate, sometimes very difficult to get calibrated, especially when my blood sugar is highly variable, so I rely more on the log book of metered numbers and graphs.
I use the cgms report – modal periods – to look at ‘chunks’ of time that are too high or too low. I then run specific experiments to figure out why.
The average sensor reading from my cgms always 100% matches my a1c.
So for example, today, I am doing a basal rate test (no carbs, no exercise) because I feel like I’ve been getting low at dinner a fair amount. So for weeks, I haven’t written a thing down, but today, I micromanaged – testing every two hours, having the cgms on, and writing down anything that went in my mouth (in case I falsely assumed something had no carbs or some such).
Assuming I can successfully complete the test, I may make an adjustment, repeat the test, and then I am back to no logging.
Never logged for the sake of logging, never will. I never stop and write down what I eat, how far I walk, how many tiny doses of insulin or tiny basal alterations I give myself all day long. It’s been a long time since I even felt guilty about that. Back when I used to try logging, nothing ushered in burnout faster, and I can’t afford burnout. I’d rather practice improving a specific aspect of my control, or cook, exercise, study, read blogs or train my memory and awareness than write down my life each day. (See also: http://scottsdiabetes.com/2011/12/clipboard-lanyard)
What I’m willing to do that seems productive–I download CGM weekly and keep a simple chart of average BG, % of BGs in range, standard deviation, and also the average daily insulin intake from my pump. I also test ratios and basals now and then and tweak them often, based on paying attention and reviewing CGM data, not based on my clipboard-on-a-lanyard!!
Love the “sticky habits” ideas though. Still working on ways to make real exercise stick…
great post! what has worked for me has been attaching a personal side to writing in my logbook. i use at least one log a day to make a note or comment about that reading/checkup. an example from just this afternoon as i sat in front of my local b&n bookstore with a 44 bg;
my eyes rolled way back
waiting for the sweetness to retuen
i sit here just like the other addicts
Lo que dices es muy cierto y de gran ayuda, cuando yo empece a cambiar mis habitos, me costo mucho a un principio, pero cuando me propuse metas, fue como una fuerza que me empujaba a llegar a ellas, y fue mucho mejo aun cuando me comprometi con alguien, es decir le prometi a mi esposa, que lo lograria, y gracias a eso pude, ahora soy una mejor persona, y en crecimiento constante, gracias, por este espacio y por la gran información que brindas en este blog
great post!
when i talk to others about monitoring their bg’s i emphasize making it personnal , add a note or a short comment or as i did today by adding this quick poem;
my eyes rolled way back
waiting for the sweetness to return
i sit here like the other addicts
a personnal note makes and keeps this yours
just change 1 small thing eash day and it all adds up to something bigger