DiabetesSource

by David Hite PhD

Living with a chronic condition is difficult. Depression is twice as common in diabetic patients as in the general population. Every day, they face challenges that can wear them down. It’s easy for them to become discouraged or feel overwhelmed, struggling to take action, leading to Diabetes Burnout. Helping patients find and maintain their motivation is the foundation of any successful self-care action plan.

The 5M’s of Diabetes Self-Care plan introduced in my earlier blog offers a clear roadmap to follow, and the flexibility that allows the patient to focus on individual modalities as needed, and as they are ready. It’s important to emphasize to patients that they don’t have to change everything at once. Simple changes add up and pay big dividends. Encourage them not to be burdened by unrealistic expectations. They don’t have to have perfect numbers to stay healthy. A mantra from the poem Desiderata states it powerfully: “Beyond a wholesome discipline, be gentle with your self.”

However, in today’s reductionist world view, where it’s believed that everything can be understood by simply breaking it up into smaller pieces, it’s also important to help patients learn how to see the big picture - to assemble and integrate all of their pieces into a cohesive whole. We hear pronouncements - green tea is good for us; just eat more fiber; cinnamon may help stabilize blood sugars; exercise to stay healthy. Certainly these are all pieces that support a healthy lifestyle, but how do they fit each piece into their lives? This is where I apply the Motivation aspect of the 5Ms plan. It’s the tie that allows patients to bind together all of their pieces to create balanced wellness.

I often deal with patients that are fixed in their belief that they are entirely controlled by external forces, or are doomed by their genes. This is a kind of “stinking thinking,” a form of self-sabotage. We are not only a product of our genes, which we can’t change, but of our thoughts and actions, which we can. Genes load the gun, lifestyle pulls the trigger.

None of us has complete control over our lives, nor should we try to. However, with knowledge, support, and guidance our patients can exert considerable control over their health outcomes. The serenity prayer offers a wonderful outlook on life: “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

In his book Healthy Pleasures, David Sobel, MD, suggests that we should be good to ourselves in healthy ways - pleasing rather than punishing. Savor life. Be a part of life instead of being apart from life. Recognize and embrace the things that nourish you. Albert Einstein understood that “not everything that can be counted counts, and not everything that counts can be counted.”

The basis of maintaining self-motivation centers on a patient’s understanding that what they do outside the clinic to improve their health condition is as important as anything that goes on inside the clinic. The Japanese embrace a concept called “Kaizen,” which is evident throughout their society. It means, literally, “constant positive change” (change for the better). Whether at work or in their personal lives, each person takes seriously the challenge to work a little harder to improve or refine themselves each day. As the saying goes, “a journey of a thousand miles begins with a single step.” When you encourage your patients to take the first step toward good health, continuing to take small steps wherever and whenever they can, they will grow in strength and confidence as they start to see positive results from their efforts. Offer support and encouragement often. Voice your belief that they will be successful making and maintaining healthy lifestyle changes. Support their efforts to educate themselves and learn about their disease. Most importantly for us as healthcare providers, don’t forget to listen to your patients; they will tell you what their needs are. The greatest gift we can give to our patients is our full attention.

Sources:

1. The Comorbidity of Diabetes Mellitus and Depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717744/

2. Diabetes Burnout: What to do when you can’t take it anymore
http://www.dlife.com/diabetes/lifestyle/diabetes-stress/diabetes_burn_out

3. Max Ehrmann: Desiderata
http://mwkworks.com/desiderata.html

About The Author
David Hite PhD, is a lifelong educator, spending 20 years teaching biology, chemistry, and health education at the high school and community college levels, two years teaching science at Cairo American College in Egypt, and two years at Shanghai American School in China. Dr. Hite developed the patient-friendly "Take Control - Diabetes Basics," a diabetes educational DVD used by clinicians to encourage their patients to implement and maintain effective self-care strategies, and has spent the past 11 years working daily with diabetes patients as a Clinical Health Educator in the Chronic Conditions Management Department for a large non-profit healthcare provider in Sacramento, California. Dr. Hite is a member of the American Association of Diabetes Educators, and the American Diabetes Association.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of DiabetesProductSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.