Advice, please, on motivating a diabetic to make diet changes and exercise

Dr Gary
By Dr GaryCA Latest Reply 2012-12-29 15:03:27 -0600
Started 2010-09-18 22:04:46 -0500

Hi,

I have some clients with Type II diabetes who I really want to get motivated to get serious about taking care of themselves. One client, for example, is overweight, takes her diabetes meds in the morning without, I suspect, an adequate breakfast, and then is terrified that she will lose balance and fall on the way to work. Another is living alone, not eating well, and often isolates himself because he doesn't feel like going out.

I give them gentle encouragement and make suggestions that they changing their daily lifestyle habits could make a big difference, and I encourage them to work closely with their physicians. But I'm not sure if I'm getting through sometimes.

Any suggestions? Did anyone ever say the right thing — or the wrong thing — to motivate you to take better care of yourself? I don't want to be a tough guy!

I would be happy to hear any suggestions you might have. Thanks!


63 replies

Young1s
Young1s 2012-10-28 01:36:51 -0500 Report

I was with you till your last sentence, Doc. The reason I love my doctor is because she never sugar coats anything. She has been in my corner since pre-D so was an easy transition. Here's the thing though. I'm a very sensitive person. Meaning, my feelings get hurt quite easily. Hard to say but true. But, I would rather be told things straight and be giving the chance to work things out in my own head, than walk around in the dark. Thinking things are always hunkydorry don't work well with me. While I am admittedly a "glass half full" type of person, I hate to be left in the dark.

I am trying to convey way to many thoughts in one but I hope you get what I'm trying to say. Only you know your patients, the ones who are lying to you or just not being real with their feelings. The ones that you opened up about are of concerned for a reason. My thinking is just be as honest as you can with them, without being too harsh. They may stop coming to see you, I did it with my doc, but if they are really honest with themselves, they'll be back.

I'll end this with something that I'm sure you already know. You can only help the ones that truly want to be helped. My hope for you is that there are plenty of them on your roster that want it.

jayabee52
jayabee52 2012-10-28 00:25:00 -0500 Report

i am watching this discussion closely since my gf is newly Dx'd with DMt2. So far I haven't had much success with getting her to eat right. She only will eat corn and sauerkraut as far as veggies, and will eat some veggies in beef/veggie soup.

She is so very stubborn. She is also depressed and is on an antidepressant.

James

BeBopBaby
BeBopBaby 2012-12-29 14:53:11 -0600 Report

Don't get married to her!!! You will regret it…just sayin'…

jayabee52
jayabee52 2012-12-29 15:03:27 -0600 Report

well thank you for your opinion but I've already figured that out. We are now friends but little more. Talked to her today and she is the same old - same old.

I am sad for her really.

TsalagiLenape
TsalagiLenape 2011-11-13 14:28:47 -0600 Report

Well I know how frustrating that is. Yet each person has to make a choice. They are apparently in their comfort zones. So tell them to be adventurous and step out. Give them a challenge perhaps. Or just let them know that if they dont, life will continue but they could be a major factor in what is going on. Personally have too many who dont want me to be strong moving forward doing what makes me happy and etc. Well today isnt good and tomorrow isnt better. Now mind you I have my days and this morning was the first time I really lost my temper in so darn long. Not proud of it but glad its out now. Time to refocus and turn that into a positive for myself. Yet not sure what else to tell you for these people. Good Luck!

Dr Gary
Dr GaryCA 2011-11-13 19:56:49 -0600 Report

Hey Lisa!

It sounds like you got some tough love from your doctor, some useful advice along with a look into the future with the consequences of not taking better care of yourself. And it sounds like you took this to heart! I am glad that you are getting out and doing some thngs you enjoy. I hope you will be patient with yourself, it's one step at a time. Glad your doctor is so encouraging -- you're are fortunate to have her.

Thanks a lot for checking in! Have a good week!

Gary

Libby121
Libby121 2011-11-12 14:44:44 -0600 Report

It has been a few months now. Were you able to find anything motivational?

Dr Gary
Dr GaryCA 2011-11-12 15:35:59 -0600 Report

HI! Thanks for checking. Yes, I got a lot of great advice, from the gentle encouragement perspective and from the tough love perspective, and in between. Lots of it really helpful. Thanks for asking. Hope you are doing well!

mranmish
mranmish 2010-12-04 04:42:59 -0600 Report

I also cannot resist sweets. How can I do that! I have recently lost a lot of fat around my waist and look gaunt

Dr Gary
Dr GaryCA 2010-12-04 21:03:50 -0600 Report

Hi! I am not a physician but I know what you mean about sweets, especially this time of year when they are constantly being pushed at you. Is sugar free candy on your diet? It might be worth a conversation with your physician or CDE to learn some alternatives for satisfying your sweet tooth.

connie886
connie886 2012-10-27 11:38:59 -0500 Report

You really need to watch out for sugar free candy…a lot of it is made with sorbitrate, which can give you terrible gas if you eat much of it…just sayin'…from personal experience!

jayabee52
jayabee52 2012-10-27 16:09:12 -0500 Report

sorbitrate, Connie? Is that another name for sugar alcohols? Sugar alcohols, in general, produce those gassy and "laxitive" effects

HisTxLady
HisTxLady 2010-12-04 04:22:56 -0600 Report

Howdy Dr Gary, I know its been a while since you asked this but I thought I might jot down a few thoughts. I wonder why do you not want to be the bad guy? I was the bad guy with my Mom, I love you Mom and miss you everyday Amen, she was a Diabetic and she was a RN. She knew what was in front of her and what road she was headed down. But did that matter to her? At that point in time no it did not! But I had to bully up and get her to realize this was going to happen to her weather she wanted it to or not and if she wanted to be around for any length of time she needed to start playing by the rules. I know being a Diabetic is hard!! Shoot even being the boarder line, or pre-Diabetic I think is what they call it now, is hard. I tended my Mom for a number of years with her Type 2 and my Pre-Diabetes and things were way different then than they are now. They have changed so many things that I feel like a novice at this again and I am having to relearn the rules all over again. But sometimes there is no choice but to play the bad guy and bully up and tell them…as Mom would say…how the cow ate the cabbage. lol I love my Mom a lot and I know other family members thought I was being mean because I would make Mom walk on her own as much as possible and would not let them "baby" her ( for a lack of a better word ) but it had to start somewhere and someone had to start it, now I did tell her I did it because I love her I just hope she understood. But after a few years her feet had drawn down like a ballerinas, they pointed down, so she could not walk. I ended up putting her in a hospital in Houston and I told her and myself it was for rehab but when she got there she never left ICU. I truly hope she forgave me for that!! Anyway I kinda like Diane's idea of the points that might be a good try. But as far as not being the bad guy think about it like this…if it was YOU that they were trying to motivate, would it matter to you if they used a little tough love and bullied up to get you going or would you rather them sit there and drop there hints and watch you roll down your hill? I don't like to be the heavy in a situation but if I need to I will…to show just how much I care. Well I hope you find some help here but I must move on for tonight. God Bless you and the ones you are trying to motivate maybe he can help also.

God Bless ya'll, 0:o)
Lori

Dr Gary
Dr GaryCA 2010-12-04 20:59:53 -0600 Report

Hi Lori,

It's been awhile since we have been in touch. It is great to hear from you, as always.

I totally understand what you are saying and appreciate your honesty. My mom had Type II diabetes, and passed away last summer. She had a very hard time of things during her last two years of life, due to a fast decline in her ability to walk, and otherwise take care of herself. I remember doing some of the same kind of pushing that you did, including pushing her to work hard to get better during a couple of months in rehab. It's not easy to be the adult child, is it?

Before she went into decline, I also tried to push her to take care of herself, to walk as much as possible, to eat healthy, and on and on. Sometimes she did okay, other times not. Getting her motivated was always a challenge when she didn't have much in life to get motivated about. And yes, I also tossed out some warnings to try and get her "scared straight." Mixed results.

Tough love is a good term. And you're right, I would also want someong to tell me how the cow ate the cabbage (I love that!). To pretend that the stakes aren't high, that with diabetes and any chronic illness self care is not critical to staying healthy, is to do someone you care about a disservice.

Thanks a lot! I really enjoyed reading this, and hope it helps other members just like it did me!

We will stay in touch!

annesmith
annesmith 2011-11-14 00:36:30 -0600 Report

HI…Nice to talk to you again…this is Anne. I have the opposite problem…for YEARS, I bent over backwards to keep my A1c low…then ended up with nurses that went too far with it and told me adamantly " the lower the better"——I understand that, but I got so low at one point, I was very very weak…yet, they were pleased as heck it was that low——no offense to you at all…just sharing my experience—-I even ate pure greens, no meat, almost zero carbs, and berries for a whole year. I wish there was somebody out there that can relate to my experience——anybody out there? Sincerely, ANNE

BandonBob
BandonBob 2010-12-01 23:44:02 -0600 Report

I have a great incentive and motivation. My mother, brother and sister all have diabetes and were all diagnosed before me. None of them would try to control themselves and all three have had multiple surgeries on their eyes and feet. When the doctor told me to lose about 15 pounds I immediately lost those plus another 65. That was 22 years ago and I have weighed the same now 155 plus or minus 2 pounds for the last 21 and a half years. Originally control was diet and exercise but about 5 years ago things changed and I had to add oral medications. It doesn't matter even if I wind up eventually having major problems I will still go down fighting with all flags flying.

annesmith
annesmith 2011-11-14 00:38:34 -0600 Report

Thank God I found someone that can relate —-I too have bent over backwards for a long long time to keep my A1c low——I am scared of blindness, losing a limb or two, etc——write me back—-sincerely, ANNE

Shileigh
Shileigh 2010-12-15 21:13:39 -0600 Report

I know how you feel. I was admitted to the hospital in May of this year with DKA. I didn't even know I was diabetic until then…only to find out I am LADA and insulin dependent!! What a shock. Anyway, it was quite easy for me to make choices from that point on. I lost 20 pounds from the DKA, which made me feel great. Diet and exercise has become something I look forward to because I know it is key to my health from here on out. I also survive knowing I can eat anything I want, within limits.

Dr Gary
Dr GaryCA 2010-12-02 22:08:02 -0600 Report

Hey Bob!

Wow, you have had what I would call the best worst examples, unfortunately. Very sad to hear what has befallen your family members. Just terrible. But as you said, you have seen firsthand what not taking care of yourself might realistically lead to, and you've decided to take an alternate path. Congratulations!

You are a true Fighter. This attitude is going to help you to stay as healthy as possible on this journey of diabetes.

Thanks! And nice to hear from you as always!

Lisa07
Lisa07 2010-12-01 23:06:18 -0600 Report

Hi Dr.Gary,Yes i have a good advise from my doctor. My doctor told me to loose weight not much just 10lbs then 20lbs and so on. I have problem walking alot because i have a knee injury wnen i was really young. Both of my knee are in a bad shape now just like the football player. Basically i will need a total knee replacement surgery pretty soon. Thats why i need to loose some weight. She said no excuse if you want to be a healthy old lady, you need to exercise. You will be stronger and healthier when you get older. She also want me to thight control my blood sugar level. She wants to see a better number… the next time she sees me. Anyhow i did try my best walking with my dog and doing yoga for arthrithis. I did loose some weight but still need to loose more. My doctor is very proud of me because i take her advise seriously. That's all for now! Have a good one:-)

Dr Gary
Dr GaryCA 2010-12-02 22:05:23 -0600 Report

Hi Lisa,

Thanks for adding your perspective here. Sounds like you have a great doctor. But it also sounds like you are an ideal patient. You stay active in your own treatment and you work on taking her advice. Doing the exercise and yoga is major, it always takes some hard work and discipline to stay active. Hope you are not only feeling better but enjoying the process.

It sounds like your doctor gave you a positive image to work toward, being a "healthy old lady." That is a great image to hold in your mind and keep working toward. None of us is in any hurry to get old, but we do want to look and feel our best as we approach those golden years.

Your doctor definitely has a good reason to be proud, as do you.

Thanks again!

CaliKo
CaliKo 2010-11-29 15:23:28 -0600 Report

Grim statistics are good motivation for me. The unvarnished truth of this ugly disease and the complications of uncontrolled blood glucose levels. Simple as that. [Of course, after that they need the tools to achieve control if they haven't been properly educated.] My two cents for the day.
Hope you had a good Thanksgiving Dr. Gary.

Dr Gary
Dr GaryCA 2010-11-30 12:52:50 -0600 Report

HI!!! Great to hear from you. I had a good Thanksgiving and hope you did too! There is a lot to be said for being "scared straight." Fear is an effective motivator. I think of the numbers of people who finally quit smoking because they were afraid of the consequences. Human beings are all about avoiding pain, in whatever form it may come.

Have a good week!

ELDER GREEN
ELDER GREEN 2010-11-29 15:18:51 -0600 Report

I was told by my pastor after consulting her about my health issues. that I needed to lose the weight. She stated that's what she was hearing from God. I immediately began modifying my diet. I have stopped eating fried foods, Cutting back on my portions, eating more fruit and I have been walking. I have lost 13 POUNDS in less than two months. You may not be able to tell them what I was told, but it kind of come down to life or death issue sometimes.

Dr Gary
Dr GaryCA 2010-11-30 12:22:14 -0600 Report

Briliant! That's great. Those were certainly wise and life-saving words that she passed on to you! And you're right, taking care of your health is ultimately a life and death issue. Sometimes we need to scared into taking action.

Antique-Dave
Antique-Dave 2010-10-01 14:01:42 -0500 Report

How much responsibilty are you willing to take for your clients health?

They need to see the value in keeping healthy, need to see that they are worth the effort to become healthy, there is a limit on what you can do though and you are limiting yourself by limiting the techniques you have available.

sometimes shock and awe is what gets their attention, my brother told me about his physical report and his numbers, he didn't seem concerned but asked me what I thought, I told him I'm suprised you're not dead (and why) a few weeks later I heard that he threw out all of the processed foods he had and completly changed his diet.

It was good that he took the reins and made the changes but the odds are that most diabetics make few if any changes and they lose limbs, eyesight, and their lives. It is not my choice, I choose life, but not everyone can get there and despite our best efforts will die.

Its not the big changes that make the most difference with our disease, its the hundreds of little ones, eat this, no that, have an egg and sausage or whatever else for breakfast every day, cut out bread for a week and compare numbers. I'd have them pick one thing a week to change, journal it and report back. If they are unable to do that are you doing them or you any favors?

I'm of the belief that those who die help buy (for the lack of a better word) recovery for others who see what happens and make the choice to do something different.

Depression as one person pointed out may be the issue, low D3. low B12, and poor circulation could be contributing to that, taking a cocktail of anti depressants may not be the answer they need.

On the other hand the people that come to these forums are the exception and not the rule, there is a desire to learn here and a need for support within a community to share what works and cry sometimes about the things that are not working.

I would want to know what your clients hopes and fears are, what types of motivation has worked on them in the past, I would have already asked them if they are suicidal, if they haven't embraced life, they must be flirting with death.

Sometimes like the proverbial Missouri Mule a person needs to whacked in the head with a 2x4, if you are not willing to do that then eventually God will, you can wait for an event to try and facillitate change or you can create one.

Dr Gary
Dr GaryCA 2010-10-07 19:11:58 -0500 Report

Hi,

Thanks so much for your insiightful message. Sorry I didn't see it earlier.

You have a very interesting and also realistic perspective on compliance. It makes a lot of sense. Focus on feeling well but also focus on avoiding the debilitation that can occur if you don't take care of yourself. Kind of approach-avoidance. It certainly is a good way to keep yourself motivated.

I have also experienced a high degree of depression among clients who are facing chronic conditions. When I first meet with them, I also ask them about depression to see if this is something we need to be focused on. As you said, not taking care of yourself is a form of self-destructive behavior.

I do want to know about hopes and fears. I try to help them to create a vision for the future, and to hold that vision in mind as they travel on the road ahead. We careat goals around their vision. And yes, learning about their strengths, and how to leverage those strengths in coping with their condition, is also very important.

I have clients tell me that their diagnosis was a wake up call in many ways, that they realized that nothing was promised, and that they needed to take care of themselves, and to embrace life if they wanted to have a future.

I like the story about the Missouri mule. A great analogy.

Thanks again for checking in. I appreciate your wisdom. Stay in touch!

Antique-Dave
Antique-Dave 2010-10-07 21:44:17 -0500 Report

I was asking how much responsibility you were taking for your clients health, you had said "I" really want to get them motivated. That statement concerned me, the desire for change really has to come from within, its not something that someone else can do for us. It's not something you can take responsibilty for.

You want to give them gentle encouragement and not be the tough guy, why not be the tough guy if that is what is needed? Maybe you need to be the 2x4 sometimes.

The risk of course in trying to get them out of their comfort zone is that they won't come back, and alternatively if they are too comfortable in their sessions they won't ever leave. Some of the mental health counselors I know don't think its unusual to have a client come for 10 years straight through without any clear progress.

Personally I see that as a destructive relationship.

I tend to be direct, are you feeling crappy? do you like it? well you must because you haven't done anything to change your life. what do you want, how are you going to get it, what are you going to do over the next week to help you get what you want?

marla50
marla50 2010-09-26 19:20:18 -0500 Report

Hi Dr. Gary, I have type 1 diabetes. I've had it for 44 years. When I was around 11 my endo took me to the hospital and let me talk to a diabetic patient that was on dialysis. He wanted me to see an exaqmple of what could happen to me if I didn't continue to take as good of care of myself that my mom had done. I wish I had listened.
Right now I am gaining motivation from education. So many things have changed since I was diagnosed. I was always cautioned on the complications, such as blindness,losing limbs etc. But no one ever cautioned me on the simple stuff. Like my hair falling out and loosing my teeth. I am female, so these things have been traumatic for me.
So maybe being a tough guy isn't so bad. Pointing out the things that can happen if you don't take care of yourself, in my opinion, is giving them education to help them make that choice.

Dr Gary
Dr GaryCA 2010-09-26 20:30:34 -0500 Report

Hey Marla!

Thanks for checking in!

I was really interested in your story about being asked to talk to a patient on dialysis. I guess your doctor was trying to use the fear factor in a postive way with you, as a means of motivating you. But the fear factor doesn't always work, especially when someone is in denial. At the age of 11, thinking that 'it won't happen to me' would certainly be natural. You just weren't ready to think about that possibility. Don't beat yourself up.

I agree that education is really important. I think the negative side -- fear of complications -- needs to be balanced by the positive side - feeling good, being abe to stay active, being able to participate in activities with friends and family. And yes, also looking as good as possible. Sometimes being presented with negative images just turns someone off, even if there are good intentions behind it.

I wish everyone would listen and take control of their health, but we are still human and sometimes we don't listen and take action when we should. We all move at our own pace, based on our own individual readiness to listen and make changes.

What's imporatnt is that you are taking care of yourself now. Maybe you can take opportunities to reach out to others who need to hear the message of self care -- not only telling them what might happen TO them, but also what can happen FOR them.

Either way, this is education!

Thanks again for your honest words! I wish you a beautiful week!

Dev
Dev 2010-09-26 13:18:53 -0500 Report

motivating somebody for making lifestyle change is a super difficult job. I can give one thing that demotivates. May be avoiding it is a battle half won.

- My husband's dietician had no clue about what it means to be vegetarian for an Indian. The first time he asked her a question about how to increase protein she suggested fish. That didn't go well with him. she wasn't able to help him at all as she knew nothing about his eating habits before dx and did not bother to probe him about it. Not having a clue and not giving a damn is how he interpreted it. None of what she would say after that would make any difference in anything he does I am sure. So that is one pitfall to be avoided.

One suggestion for the isolated person is to join a group either face to face or an online forum like this one. reporting back your successes and venting when you are really frustrated really help a person to move on.

For the person who does not eat enough in the morning. You can sit with him/her and make a breakfast plan for a whole week that seems doable based on the time and motivation they can muster in the morning and considering other constraints they might be facing that make them skip breakfast.

The biggest impediment for my husband to eat well is he hates to think about what to eat when he wakes up in the morning. The whole process at that time feels more like I can't eat this I can't eat that, I dont want to/can't put in effort in that other thing and I dont have ingredients for that other breakfast idea. But if the breakfast schedule is decided in advance and there is no thinking to be done in the morning things seem to work better.

The gentle approach is all fine, but sometimes people also need to hear dooms day scenarios. That works with my husband sometimes and he snaps out of his self distructive ways.
Some other times I convert the same things into positive scenarios. For example, there was some talk about how high blood sugar affects brain etc. We were talking about it and I said, see if your sugars are better then you would have a sharper mind and work better on your disseration because your brain will get better blood supply.

rewards (and threats) to motivate need to be in line with the immediate concerns of a person. The rewards can be given by an outsider, a family member or friend or you can show how the patients can reward themselves by addressing an issue or motivator in their own life.

Anyways, enough about my random talk. Hope this might give you some ideas to help these two. Glad you are putting an effort to help them.

Dr Gary
Dr GaryCA 2010-09-30 10:19:35 -0500 Report

Hi Dev,

Thank you very much for your thoughtful response! Some great ideas here.

One thing that struck me is that cultural differences sometimes arise between healthcare professionals and patients, including eating habits. This can cause some frustration for patients. We would hope that professionals would take the time to gain understanding of cultural differences, starting with putting their own expectations and misperceptions aside, but that does not always work. Professionals need to educate pateints but sometiimes patients have to educate us first!

Planning for breakfast is a great idea. If your husband isn't in the mood to go through the decision tree first thing in the morning, then catching him when he is more open to thinking about the options, and making decisions, is a great idea. That way, as you suggested, it's a done deal, part of a routine.

I also agree that sometimes the positive approach needs to be grounded in hard facts of reality. Focusing on the rewards of self-care, e.g. being able to finish an important project, is a great starting place. But maybe keeping the 'bad cop' around, who can step in and offer a reminder of the consequences of not watching the diet, and otherwise being non-compliant, can also be effective.

Sounds like your husband has a lot of great support! He is fortunate to have you!

Tracy J
Tracy J 2010-09-25 20:36:57 -0500 Report

Hello Dr Gray…I am in total agreement with you that diet and exercise are very important in conquering this disease. I am a living testimony that with a strong will and determination to live, yes, we can conquer the disease and our lives. By the GRACE of GOD, I have been able to fight this on going battle for some time now. I was once 323lbs and without the support of caring doctors, I would probably be dead. YES, dead. My life was at stake and I surely did something about. I prayed t be shown GOD'S WISDOM, KNOWLEDGE, and UNDERSTANDING afterall, He created us. Then, I began my quest of what was revealed to me that I had to get off the pity pot and fight for my life. Surely, it took me by surprise and surely it was going to take me to make that first move. Once I got going and began to see the results, I became even more motivated to take my life back from this frightening disease. It took me to change my eating habits and patterns. I had to come up with a rouitin that would not totally deprive me or result in a feeling of starvation. My life of fastfood joints, too much sugar intake and eating what I felt like eating had to stop and a new attitude set in. Yes, I had to become true to myself that I was not fooling anybody but me I said I was trying and truly I wasn't. When the doctor told me that the weight I was carrying around would kill me or my A1C that was through roof would bet the weight first to take me totally away from here. I become so motivated and determined to whip the disease before it whippped me to death. Day in and day out I prayed for my miracle and was delivered not only from the insulin; from 100lbs of weight as well. I did what was revealed to me via medical journals, doctors, diabetics just like us but GOD first and foremost. I came from wearing a 26W to a size 14(LADIES) and feeling good about myself. All of this came from a determination to live life on lifes terms. I did not think twice about what needed to be done for my life, just changing my eating habits and exercising has allowed me to be delivered from all whole lot of diabetic medication to just about none at all. I must say that it is still a battle that will remain in my life just like everyone else, but I can surely say that YES we can whip this disease and maintain s well. I encourage us all to always be cautious of what we eat and do not delay in exerting ourselves. In ending my reply, drinking lots of water was a must too. Let us fight together for improving our health. TO GOD BE THE GLORY!!!

conniespurling70@yahoo.com
conniespurling70@yahoo.com 2010-09-26 18:05:59 -0500 Report

Thank you for your story. I just joined the sight. I too am over 300 lbs and need to change my eating habits but im not sure what has fiber , and carbs, ect. I hope to find out whats good to eat for a diabetic. I grew up on meat and potatoes kinda meals. And Thank you for including God. Im also learning to rely on him,

Dr Gary
Dr GaryCA 2010-09-26 09:20:10 -0500 Report

Hi Tracy,

Thanks so much for your honest and inspiring post. You reallly are a role model for people challenged by diabetes -- a true Fighter!

Some really important themes jumped out at me when I was reading through your post. For one thing, it sounds like did some hard work to get informed and to create a diet and exercise routine that you could live with, that was tailored to your lifestyle so that, as you said, you didn't feel depriived. Knowledge is power. So often, I find that clients don't take the time to work with their own unique make-ups and, instead, assume that they have to turn their whole lives upside down and adopt a lifestyle that has no connection with who they are. That is a recipe for failure. It seems that what you did was work with your own uniqueness.

I was also impressed by your determination to beat diabetes before it beat you. Obviously, that took a lot of hard work and motivation, along with a lot of self-discipline, working with yourself and with your doctor. I really liked whan you said that as you began to see results you became even more motivated. I encourage clients to take baby steps. Each little success leads to the desire for more success.

And what amazing success you have had!

It sounds like had a lot of support during this time from your healthcare professionals. And it certainly doesn't hurt to have spiritual connection as well. That is quite a powerful support team you pulled together.

Thanks again for telling your story. I am honored that you took the time took the time to reply.

All my best wishes for continuing success!!!

Gina rico
Gina rico 2010-09-25 14:20:36 -0500 Report

Hi Dr. Gary, I guess I can give my point of view on what doesn't motivate me at this time. I got diagnosed with Diabetes type II two years ago after having a severe headache and going to the urgent care. My BP was very high (stroke worthy) and my B.S was 268. After that incident everyone thought that would motivate me well i went into depression and the sad part is that I do know what to do! Like many people say the worse patients are docs and nurses. Yup we are! I go see my doc and he tells me "all kidding aside you know where you are you need to take your meds" That didn't motivate me! He then sent me on my way with another RX (that didn't help me! I ended up in the urgent care once again and scared the PA because I was spilling ketones and sugar was high I convinced them to treat me in the urgent care and send me home after being hydrated and some insulin (no hospitalization) I went home. Saw my doc who said "I need to know what's going on I trained you and I know it's tough but you know the consequences" that didn't motivate me! I then spoke of my personal situation with my family and he then understood but reinforced that I needed to take the meds. I told him that i take them in the morning but always skip my evening dose because I don't know where I will be or my hrs of work are long and i fall asleep wherever I am. He then placed me on an antidepressant and referred me to counseling. THe counselor heard my story and was overwhelmed and said "I can see why you priority is not taking care of your health but you know the consequences" that did not motivate me! Dr. Gary, I guess what I am trying to say is that if you have someone who is not motivated find out what the underlining problem is or send them to someone who work with this type of clientele. Being overworked, overstressed, over pressured by family obligations and work obligations can cause someone to be non-compliant. Trying to figure out how to time manage is a big issue and if it's lifestyle changes support groups meeting people like on this website helps although this is my first post! I would love to become more fit but I hate doing it alone if there was a local group I would join and meet someone who would like to do some physical activity with me but I won't do it alone due to a traumatic past history. I was once in the military went to the persian gulf fit as can be. I know what it means to have the "right mental attitude" but I cannot find it right now. People think it's easy to prepare a meal before you go to work "not if you go to bed at 1am and wake at 4am and have to be at the hospital at 5. I grab a banana now and a slice of wheat bread with a tsp of peanut butter and a diet coke to eat while I'm driving. It is better than nothing! I then do not eat until I get home sometimes 11pm when I start my homework (PhD-program) my boyfriend gets upset because he says I look so tired so he make me a meal (I call it my binging meal) thank God I don't purge! Maybe I should? I am just kidding sorry! He is now moving in with me to see if he can help me with meal preparations I plan on taking him to a dietician with me so he understands what has to happen. Throughout the day if I get shaky I grab a miniature snicker or 2 or 3 or 4 and a diet coke my nutrition is horrible and I KNOW THIS! I am still not motivated. I am hoping by seeing this page diabetic connection and taking the time to see what is available is the first step to accepting that I am diabetic. Like I tell my students the first thing in treating an alcoholic is that they have to admit that they are and then the work can be started! I hope this long story helps! Sorry for the length!

Dr Gary
Dr GaryCA 2010-09-26 10:03:07 -0500 Report

Hi Gina!

I totally appreciate your honest and heartfelt post. I know it took a lot of courage to describe what is really going on with you.

Being honest and realistic is the first step to making positive change. You clearly don't have any delusions about what it takes to get your diabetes under control.

I would recommend a couple of things. First, I would recommend working closely with your doctor and nutritionist to create a diet that works for YOU -- your food preferences, your cooking skills, and your schedule. Figure out what you can do to build healthy eating into your demanding life. With diets, and other lifestyle changes, one size definitely does not fit all.

The fear factor can be a big motivator. Nobody wants the consequences of untreated diabetes. But it doesn't work for everybody. The fear factor can't always stand up to denial!

Fear is about what you don't want. Motivation is about what you DO want. Want do you want in your life? Do you want to feel better, be more alert and active, more vital? Focus on a positive vision for your future -- getting more and not just avoiding consequences. Create a realistic vision for the future and then see what you can do to make it happen!

Support is a key factor in fighting diabetes. I am happy to see that you have a strong support though your boyfriend, who seems to want to partner with you in facing the challenge of diabetes. You are very fortunate. I would recommend taking him up on his offer to help you improve your diet. I would suggest that the two of you sit down with your dietican, and work out a realistic plan for building better nutrition into your life. See where he can help you and make an agreement to work together. Sounds like he is really there vor you. Don't you want to be there for him?

At the end of your post, you described admitting to being a diabetic as similar to admitting that one has a drinking problem. So, I will again introduce the denial word. You know what's going on here. Ultimately, the only person who can really motivate you to take care of your health is you!

Thanks again for replying to my post. You sound like a person with a lot to offer the world. Stay connnected with your friends on Diabetic Connect and let us help you to get powered up!

starmom4
starmom4 2010-09-25 17:15:55 -0500 Report

Boy do I relate!! Life just keeps pushing us along faster than we want to go and there's no time to stop, evaluate and PLAN! And just when I have PLANNED, my husband or kids step in and rearrange everything! I'm having trouble planning breakfast. I got to thinking I can't afford Jenny Craig or those plans that deliver the food to the door, so I'm thinking of Weight Watchers frozen meals and having dinner for breakfast because if I have to eat another egg I'll start growing feathers!! Yeah, I get "you can't have just one" too. I'm an emotional overeater AND I have family who are more than willing to accommodate my suggestion of ice cream! Some support they are, but maybe I'm depending too much on outside help and not realizing it's going to take me all by myself to achieve this seemingly impossible achievement.

richardchaven
richardchaven 2010-09-27 13:29:54 -0500 Report

One day, my levels were high and they would not come down no matter how many 60-unit hits of Humalog I took. That scared me. Perhaps it was some stresses in my marriage and having to look at the rest of my life, but I started a very strict diet with HMR. No cheese, no hummus, no nuts. 1200 calories of their shakes and (small) pre-packed entrees and all the fruits and vegetables I want. I do 60 minutes of aerobic exercise and some simple weight training six days a week.

It is _hard_. One interest I share with my wife is food and cooking, and I really can't do either (I allow myself one (1) dinner "out of the box" per month). I will not go to her birthday BBQ because it's too hard for me to be around all that food. Maybe in 90 days I will stop thinking about pancakes and bacon and Dim Sum and cheese …

But.

I have lost about 12 pounds in three weeks. I am using NO insulin anymore, and my sugar levels are as good as before with insulin (and no exercise). I knew that I used to eat for comfort and distraction and a feeling of control (ha!), but now I can see them for what they are every time they happen because I can never indulge them. That's control that I never experienced before.

I will take a break from the diet around Thanksgiving (but not go crazy) and do more three-month sets to try and lose 80 pounds total. The cost of the food for me is less than half of what we were spending on groceries for two (we are foodies), and I'm saving money on insulin. Maybe I'll start saving money on Actos and my cholesterol medications too.

So far, it's worth it.

Dr Gary
Dr GaryCA 2010-09-26 10:10:05 -0500 Report

Thanks for your honest response, starmom. I know it is very hard to be the only diabetic in the house. As you suggested, it all starts with you. I would really recommend finding a suppport group or working with a mental health professional to develop some new coping skills to help get you through those times when you are looking for a food fix for your emotions. Sounds like you could you use some help in 'changing your relationship with food.' What's good here is that you see the connection. That is first step in creating change. Also, do you have access to a dietician who might be able to help you to develop some alternatives to the less healthy food in your life? Sounds like developing some new coping and eating strategies could help you make some healthy lifestyle changes. Keep us posted!

melosweety
melosweety 2010-09-25 10:52:32 -0500 Report

Greetings Dr Gray
God is all there is, know that you are God's Child once you know the truth you can not go back. Love, pray all the time, prayer does change you. I am a God Woman , we are all children of the creator and all is well.
God Bless you.

annesmith
annesmith 2011-11-14 00:50:44 -0600 Report

YES…I too pray really hard to God…especially at night, but am working on my relationship with Him more in the daytime..I keep telling myself, God has always helped me all my life, so DON'T stray from His path. I tell myself, it is not God's fault I have had really bad luck with doctors for 4 years, etc…pray all the time is such a good reminder—-thank you…sincerely, ANNE

Pynetree
Pynetree 2010-09-21 13:05:55 -0500 Report

If "the right words" to motivate are out there no one knows them yet..words that click for some will, turn off others. Everyone has a trigger, but usually not out in the open. Depression masks the "starter" , even from the person. Living for grandchild not such a draw if you feel down and useless…the "they'd be better off without me" is louder than "I want to be around for." All someone can do is to keep trying…say the things everyday…you never know when it will click! And how long the "WILL" will live…so you have to keep trying to motivate.

Dr Gary
Dr GaryCA 2010-09-21 17:30:33 -0500 Report

Hey Pynetree, I appreciate your straightforward advice. You make a good point -- there are no 'right words' out there, one size does not fit all. It is a matter of helping each person to recognize that one thing that might motivate them to take more control over their health and take better care of themselves. And it does take some trial and error... and patience. Thanks a lot for sharing this with me!

CaliKo
CaliKo 2010-09-20 11:56:07 -0500 Report

Greetings, You remind me of my college roommate that threatened to switch to pediatrics because the children listened to her the best…
I think motivation is one of the most difficult aspects to diabetes care. Being a life-long condition, I'm sure most of us go through highly motivated periods and tired-of-it-all periods. I was highly motivated at first because I had been diagnosed with MS a few months earlier, and as you know you are pretty much helpless against that disease, except to take your shots properly. The diabetes diagnosis kind of made me mad at myself, and there's a lot to dig in and do to make oneself healthier, so I did. I like keeping a journal, seeing the numbers improve is good motivation. I think we also need to have reasons to want to be healthy, odd as that may sound. I want to see my teenager grow up, and to be able to work through his college years. I want to be healthy for my husband, and our life together. I want this disease to have the least impact on my life as possible. I'm not scared of dying, but I do not want to suffer the complications which everyone here already knows about so I won't talk about them.
I find exercise addictive, so that takes the place of motivation sometimes, but the motivation could be that I get to eat a little more because of the exercise.
I know you said you didn't want to be the tough guy, and my doctor wasn't either, but he did send me to CDE classes where I met the "tough guy." The usual CDE was all smiles and helpful, very informative and nice. The last day of class, though, her child was sick and they sent over the in-house CDE from the hospital to substitute, and she took one look at the class and said "You all look good!" and proceeded to tell us about her patients at the hospital who didn't look so good, and were all willing to listen to her now that they had complications that couldn't be reversed. You could have heard a pin drop in that room while she was talking.
Anyway. My two cents and I hope there was something in there helpful for you or your patients.

Dr Gary
Dr GaryCA 2010-09-20 21:36:12 -0500 Report

HI CaliKo, I totally appreciate your generous response to my question. It sounds like you are a natural fighter in that you mobilized your resources and got busy in taking care of your health. It also sounds like you got informed about what you need to do. As you suggested, having an additional diagnosis may also have provided you with additional motivation. And you had the greatest motivation of all, a child that you wanted to see grow up. So you faced your fear down and got busy. You are really a success story.

I like the idea of getting involved in something that is 'addictive' like exercise. In a way, the process itself, and being able to eat more, become self-rewarding and therefore motivating. I am thinking that pushing clients toward activities that they enjoy, and that would also benefit them in some way, would be a good idea.

The story about the CDE was excellent. A classic example of good cop, bad cop. I have learned the same thing in working with clients who were trying to stop smoking. They finally took the plunge to quit based on two motivations -- they wanted to be around for their children or they didn't want to go through the cancer experience. The first motivation was suggested by a good cop, the second by a bad cop. It is the end result -- taking charge -- that counts.

Thanks again for taking the time to respond to my question. I hope we run into each other again!

Gemm
Gemm 2010-09-20 11:32:56 -0500 Report

Wish I knew of a way to get someone else motivated. My husband was diagnosed with T2 several years ago, not long after his father died as a direct result of his diabetes that he did not take care off - infection in his toe that ended up with 2 amputations from septicemia - the 2nd because the stump from the 1st didn't heal properly. During the 2nd surgery he had both a stroke and heart attack on the OR table and spent the last couple of months in a nursing home not knowing anyone or what was going on (basically the stroke erased most of his memory and all his ability to speak or let anyone know what/if he needed anything). That didn't motivate him at all for more than a few days to make any changes. About 5 years ago my husband had a heart attack and started a few changes (diet - he is considered obese at almost 300lbs and 5'5" -before starting to lose some this year, tried to stop smoking etc) that lasted only until his heart doctor told him all his tests came back clear (about 4 - 5 months), then it was right back to not watching his diet, smoking 1 1/2 - 2 packs a day, little to no exercise outside of work (he walks a lot there though not brisk walking) etc.

Most recently, he had a stroke this past April. Again he has begun some of the same changes but this time I do see a more positive approach. Rather than making them all at once he is slowly adopting actual life-style changes rather than just "cosmetic" ones he has done before. I have been trying to get him to make them for years but to no avail. Shortly after my husband had his stroke I was also diagnosed as diabetic - had been hypoglycemic for years and had made some of the life-style changes slowly over time though my weight is still way to much, I am slowly losing a few pounds a month (3 - 5).

So far, my husband has been doing much better than he ever has in the past as far as these changes go. I think the stroke scared him enough (hopefully anyway) and then the resulting heart surgery soon after to fix the hole in his heart that the docs attributed to part of the cause (actually about 20 - 25% of us have that hole left over from our prenatal time when it was our way of getting O2 and nutrients from our mother - it doesn't close properly for about that many of us though most of us don't have a problem with it - found this out when we went to the heart doc that did his surgery). He has actually begun to lose some weight (about 5 - 10 lbs a month) since his stroke and has really been watching his diet a lot better. He has stopped buying all the sugary snacks he usually had with him at all times and has gone to some of the healthier snack bars to keep with him along with his glucose tablets for when he does have a hypoglycemic episode. He has talked to his employer about making sure he takes breaks as needed for his snack times and meal times on a regular basis rather than just whenever he or they got around to it. He tests his sugar regularly and has even volunteered for a study group for a new insulin (not real sure of those details though it's supposed to be one that somehow levels out the highs and lows???)

We also have a dear friend who is diabetic who doesn't take care of herself either. She does look at how much total sugars are listed in foods but won't listen or accept that there is a difference in what kind of things go into making the total sugars (carbs, etc) and figures that if the total sugars are the same then she can eat whatever she wants and gorges on sugary cereals, candy etc. I truly believe she is a sugar addict (I've read other posts here that mention that) as I also believe my husband and step-son to be. Our friend is also considered grossly obese - she is a dwarf and at 4'4" +/- a couple inches she weighs almost as much as my husband - close to 300. Currently she is wheelchair bound and cannot manage to do basic household chores such as dishes, cleaning floors etc. I go over 1 - 2 xs a week and do all that for her as well as most of her shopping and bill paying (what she can't do by checks and mail). I have noticed as well that her vision seems to be getting worse as she has to sit a lot closer to her TV to see it (her words as well) but refuses to go see a doc about it. In my husband's defense though I do have to say he is doing a lot better the last few months.

I've really been concerned also about my step-son as his mother was a "brittle diabetic" (still not sure exactly what that means) and died from complications of her diabetes (also not well taken care of) at 42 or 43 a little over a year ago. She would often "use" her diabetes to get attention by eating things to spike her sugars high and have to go to the ER or not eat and have them drop to levels where she needed the ER &/or hospitalization. We watched her the last 6 - 7 years of her life on kidney dialysis from failing kidneys docs said was a direct result of her unchecked diabetes (docs also said she was rare to live that long on it??? I don't know for sure if that's really true or not just what her docs said). She had a major heart attack about 5 years ago, again attributed to her diabetes, that her doctor said afterwards that there was no medical reason why she was still alive, and said that the only thing in her favor was that she was a fighter even though she wouldn't take care of herself over the long term. That heart attack left her with residual affects to her general health, her mental state, etc. We also watched her vision decrease to the point before she died of being almost totally blind. Her sons (2 by different fathers), her family and friends all tried to help get her motivated to take better care of herself. She would for a few days to a few weeks then went right back to her old ways. By the last couple of years she stopped even making them at all.

She and my husband were 2 of the main motivators for me to learn how to make things sugar-free (baking, jams, jellies etc) even before I got to the point about 8 years ago when I took all processed sugars out of my diet because of my "critical hypoglycemia" (they literally would cause my blood-sugar to drop to dangerous levels - even as low as the teens a few times - that the doctors told me I was lucky to have survived. I was left with neuropathy from that which has gotten a lot worse the last year and was 1 of the major factors in my doctor repeating the glucose testing on me this past Spring that showed I had gone from hypoglycemia to diabetes.

How to motivate someone else? If we could find a reliable way that would work on most people we could get rich lol All I've seen tells me that the only person I can truly motivate is myself and try to be an example to others that they will want to emulate.

Sorry for the long rant. lol

Hugs to y'all
Gemm

Dr Gary
Dr GaryCA 2010-09-20 22:02:15 -0500 Report

Hi Gemm, I really appreciate your respone to my quesion. You gave me a lot to think about. What I was especially impressed with was just how difficult it is to motivate people to take better care of themselves. As you discussed, sometimes people have to experience decline and diagnoses that could possibly have been prevented if they had only taken better care of themselves. It's really sad how self-destructive people can be.

But I also understand that we all have freedom of choice. And I understand that it is not easy to change. For someone who has always eaten certian foods and learned to enjoy them, having to give some or all of what they enjoy seems like an impossible task. What are they going to replace it with? The same thing with lifestyle changes like adding exercise. I am sure that it all just seems to hard at times, and not rewarding.

It sounds like you have learned to motivate yourself. As you said, I guess watching so many people around you letting their health decline probably had an impact on you. Sometimes the worst examples are also the best examples.

I'm glad you are taking care of yourself! Congratulations!

And thanks so much for responding to my post. Your honesty and concern for others was inspiring. Have a great week!

bicker68
bicker68 2010-09-20 01:41:16 -0500 Report

Hi Dr. Gary,
My husband was recently diagnosed with type 2 and is slightly over weight, and I just asked him instead of what he normally eats to cut it in half. He has lost 2 pounds thats a start and I can see him losing more for I know he is worried about his health and wants to live to be here with me and our children and Grandchildren. He can't exercise because of the RSD and other health problems he has, but he keeps moving for he says if he don't he won't get back up.
Good Luck with helping to convince your patients to help themselves, they have to decide that LIFE is worth Living.
Take care and God Bless.

bicker68

Dr Gary
Dr GaryCA 2010-09-20 22:05:48 -0500 Report

Hi, a great idea here. I think sometimes people with conditions like diabetes think that they have to make major changes overnight. By doing this, they set themselves up for failure. Instead, taking a reasonable approach, and cutting back slowly, can be the key to real success. And I suspect having someone like you who is an encouraging partner and coach also makes a big difference. He is lucky to have you.

Thanks again and God bless you too!

bennycat
bennycat 2010-09-19 16:33:27 -0500 Report

I would just like to say that if you care about youself then turn your thoughts to I want to live life everyday because I don't want to die .We have so much in life to look forward to .We just need to accept that we have gotten here and need to go on each and every day. For Who you ask MMMMEEEE! I am #1. I want to see my grandchildren when they grow older , my friends , my family.Life is so good even with all the problems we all have.Put God in your life .Pray each and every day all you like it will help.Try it you will like it.Get yourself going I know its hard I have health problems that keep me from walking like I should. But I must keep going so I can be able to move . I have Pain all over and I must keep going to be able to move .WE can keep Us up by trying every day .God helps me all the time. I want to LIVE.

Dr Gary
Dr GaryCA 2010-09-19 21:01:51 -0500 Report

Sometimes it really does come to deciding to take care of ourselves by taking action. Personal responsibility! One of my clients is a mother and I know she wants to be here to see how her daughter's future unfold, that alone should be incentive to get involved in her own self-care. Sounds like you have applied some tough love to your own life, and are motivating yourself to keep moving. Thanks a lot for taking the time to respond to me. Best wishes to you!!!

Diane987
Diane987 2010-09-19 16:13:23 -0500 Report

I think motivating someone to make changes in their lives that they know are necessary is much like trying to force a horse to drink the water you have led him to. There comes a point in time when it is up to the individual to make the necessary changes. If you don't want to try pissing them off to get them going perhaps a contest for all of your unmotivated diabetics. It could be based on a point system for any activity that contributes to their overall health improvement. You can also take away points for days of inactivity toward their individual goals. Obviously the honor system will have to be used to report activity. Make sure the contest is long enough for them to form a habit of healthy activity. You can keep the prize simple like a free dinner with you at a local healthy restaurant. Good luck!!

Dr Gary
Dr GaryCA 2010-09-19 21:06:07 -0500 Report

Hi Diane. The leading the horse to water image certainly works well in this situation. Sometimes my suggestions and gentle prodding work, at least temporarily, and sometimes they don't. Getting people motivated - whatever the goal - is a struggle. I guess human beings don't like change, even if it would benefit them. I like the point system. I hadn't thought of that before. Clients could collaborate with me on choosing their own goals and rewards -- hopefully, if they choose rather than think I am pushing it down their throats, they will actually want to participate. I will give this a try! Thanks a lot for your time! Hope all is well with you!

Harlen
Harlen 2010-09-18 23:08:18 -0500 Report

I dont think you realy can it's up to the one that has it to take care of it
Wishing to keep your feet where they are, keep your eyes working well
It's up the diabetic to do it or not.There is so much that will go rong if you dont take care of it.
Best wishes and good luck with that
Harlen

Dr Gary
Dr GaryCA 2010-09-19 21:07:42 -0500 Report

Hey Harlen, you got a good point here. Like Diane said, you can lead a horse to water, but the horse had to decide what to do from there. I will keep up with the gentle pushing, but maybe with a little more tough love and pushing toward goal setting. Hope you are doing well!

msann
msann 2010-09-18 22:39:31 -0500 Report

hi, dr.gary both sounds like they have depression going on, one not doing all that needs to be done to feel better, other closing himself off, maybe each need some couseling one on one, just some suggestions, take care

Dr Gary
Dr GaryCA 2010-09-19 21:12:26 -0500 Report

Good point here. Clients are often depressed and feeling defeated, and helping them to get to the other side of their funk probably has to come first. Usually, that's where we start. But it's hard not to worry about how they are managing their diabetes when I see that they don't feel well and clearly aren't taking care of themselves. I sometimes wish I could bring in their physician so that I could play good cop while the physician played bad cop. Between the two of us, we might be able encourage them to get motivated. Thanks a lot for offering me your insight.