Most people with diabetes work with their healthcare provider and use their own knowledge to develop a diabetes management plan. But how well do you stick to your plan? During this week’s community discussion, we discussed forming a plan and adhering to it. We were joined by Gabrielle Kemble, RD, CDE, and clinical manager for Fit4D, as our guest and Chris “Clem” Clement, T1D and Diabetic Connect social media guru, who moderated the conversation.
Q1. Why should your diabetes management plan be customized for you?
A. Gabrielle: Everyone finds motivation in different places; different techniques and routines work differently for people. Every person with diabetes is different. The way food, exercise, and medications affect people is completely individual.
• Because everyone and everyone’s diabetes is different.
• Variables that affect blood glucose will affect each person differently.
• No two humans are the same. I’m awesome in my own way!
Q2. The difference between “compliance” and “adherence” is subtle, but important. What do these terms mean to you?
A. Gabrielle: Adherence is more of following a plan that a person with diabetes (PWD) helps develop, and stays involved in the decisions they get to make. This brings out positive emotions. To me, adherence is a lot friendlier and less judgey. I will complain about compliance being used to describe me as good or bad. Non-compliance means failure. The word brings out negative emotions. Compliance is more of a clinical label. If a PWD does not do everything perfectly, a medical team will label them “non-compliant.”
• The word “non-compliant” drives me nuts, as if you can force diabetes to do what it’s supposed to do all the time.
• They both mean (to me) that I’m being told what to do instead of being guided.
• To me, compliance is willingness to make changes and discuss them honestly, and adherence is being able to stick to those changes.
Q. How adherent are you to your personal diabetes management plan?
A. Gabrielle: Are you doing blood glucose checks, taking medication as prescribed, counting carbohydrates, making healthy food choices, and staying active?
• It depends on the day, what’s for dinner, if my workout was good or not so good, if there are donuts in the mail room, etc.
• I’ve been trying my hardest to follow my plan that I made for myself, and I think I’m adhering quite well.
• We actively ensure my son gets the best support by empowering him and ensuring that we get the basics right.
Q. What do you feel is your biggest barrier to adherence?
A. Gabrielle: Remembering everything. Burnout. Finding enough time for meal prep. Exercise. Motivation.
• Human factors. And my diabetes often has a mind of her own, despite me playing by the so-called rules.
• Biggest problem is myself and periods when I don’t care about anything, diabetes included. Life burnout!
• I’ll wake up some days just not wanting to diabetes.
Q. What tools and actions would fit into your custom pathway to better health?
A. Gabrielle: Continuous glucose monitoring, pumps, insulin pens, Certified Diabetes Educator (CDE) visits, and phone calls, texts, or emails from a CDE between office visits. Support is so important!
• Talking about it helps a lot. Social media is one of my biggest tools because it keeps me focused on what’s important.
• It would be nice if insurance helped cover more advanced therapy! I feel I use older devices. I’d like to ease the process.
• Better communication from my diabetes clinic.
• Becoming empowered with knowledge and having access to healthy food and technology. My current focus is improving mindfulness.
Q. What is your best tool for sticking to your personal food and exercise goals?
A. Gabrielle: Family support, healthcare provider support, remembering why you want to stay healthy, and wanting to feel your best.
• I love my FitBit, teaming up with my friend to get me off the couch, and food journaling.
• MyFitnessPal is helpful for tracking macros, water, and exercise.
• Best motivation is the results of healthy eating and exercise! Normal blood glucose levels allow you to focus on life and not on diabetes.
Q. How do you bridge the gaps between appointments to help you maintain adherence?
A. Gabrielle: Watch blood glucose levels, track medication use, exercise regularly, make healthy food choices. Appointments can be intimidating, and they aren’t meant to be!
• I see my appointments as little pep talks. After three or four months, I need another one.
• I stopped focusing on appointments as big deals, and now I focus on the day to day.
Q. If out-of-pocket cost didn’t matter, what focus of professional diabetes education would be most helpful to you?
A. Gabrielle: Better medications and technology, longer healthcare provider visits, calls, texts, and emails from CDEs, support groups, and more education for family and friends.
• Diet. I want to know more about food. I spent about five minutes talking diet with my doctors. I’d like a lot more.
• I want my educator to educate me where I am, not preach to me. I want a partnership, not a student/teacher relationship.
• Advanced pumping, learning how different macronutrients affect blood sugar, and being shown how to give up the reins as a child gets older.
Thank you, Gabrielle Kemble and members of the diabetes online community (#doc), for joining our chat.