The value of a goal lies in the goal itself; and therefore the goal cannot be attained unless it is pursued for its own sake.
–Arnold J. Toynbee
Staying healthy with diabetes requires efforts on a variety of fronts. These include eating healthfully, being physically active, taking prescribed medicines at the right times in the right doses, scheduling and keeping numerous medical appointments every year, and being aware of not just blood glucose levels, but also blood pressure and blood cholesterol levels, the state of one’s feet, and the sources and level of stress in one’s life.
Most people feel more confident about their efforts in some of these areas than in others. So what do you do when the areas you feel less confident about need attending to, such as when your doctor tells you that you need to “tighten up” your control to prevent diabetes complications?
For starters, ask your doctor what action or actions on your part would be most beneficial to your health. Then talk about specific goals and the steps you would need to take to reach them. Ask yourself whether those steps sound like actions you are willing and able to take. And keep in mind that you are more likely to be willing to make the effort required to reach a goal that feels important and meaningful to you. If you don’t see the point to what your doctor or another health-care provider is recommending, ask for a more detailed explanation of how a particular change or action will improve your health.
A tool that can be helpful in determining which actions may be most effective at improving your health with diabetes is the AADE7. This trademarked list of seven self-care behaviors was developed by the American Association of Diabetes Educators (AADE) to help people with diabetes achieve optimal health. The seven behaviors are healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping. Here’s why each is important and some of the skills you may need to put each into practice:
Healthy eating. Making healthy food choices and understanding the importance of portion sizes and appropriate timing of food are key strategies for keeping blood glucose, blood cholesterol, and blood pressure in healthy ranges. Food choices also have an effect on weight, and weight control can be an important part of blood glucose, blood pressure, and blood cholesterol control. Some of the skills needed to make good food choices include learning how various nutrients in food affect blood glucose and learning to read food labels, estimate portion sizes, and use healthful meal-preparation techniques.
Being active. Regular exercise and physical activity can also help keep blood glucose, blood pressure, and blood cholesterol levels — as well as weight — at healthy levels. Identifying appropriate types and amounts of physical activity for your current fitness level is a necessary step toward becoming more active.
Monitoring. Regularly monitoring your blood glucose level provides you with the information you need to make decisions about your diabetes treatment, both in the short and the long term. It allows you (and your diabetes care team) to determine if what you are doing is working to keep your blood glucose levels in a safe, healthy range. Other types of monitoring that may be recommended include home blood pressure monitoring and checking for ketones at certain times, such as when you are sick.
To be able to do these types of monitoring, you need to have the necessary equipment and know how to use it. Your doctor or diabetes educator can help you with these tasks and also advise you on the types of records you’ll need to keep to make sense of the information you get from monitoring.
Taking medication. Along with healthy eating and being active, most people with diabetes need some type of medicine to lower their blood glucose levels (and possibly their blood pressure or blood cholesterol). People with Type 1 diabetes always need insulin as a part of their treatment plan. People with Type 2 diabetes may initially treat their diabetes without medicine, but it’s not unusual to need one or more medicines over time.
Knowing how your medicine works, what side effects it may cause, any precautions to keep in mind when taking it, how much to take and when, and what to do if you miss a dose will help you to use your medicine most effectively. You should also know how to store your medicine correctly at home as well as when you travel.
Problem solving. Lots of things can affect a person’s blood glucose level. Food, exercise, and insulin are some obvious ones, but others include stress, illness, certain prescription and over-the-counter medicines (including some taken for reasons other than diabetes control), and, for women, menstrual cycles. The effects of some of these can be predicted — at least to some degree — based on experience, but there is much that cannot be predicted, both in life and in blood glucose control.
Therefore, there will be times when your monitoring results come as a surprise, and you will have to make quick decisions about how to respond. This is an area where keeping careful records and working with a diabetes educator can be particularly helpful. An experienced educator will know what to look for and what questions to ask to figure out what caused the problem in the first place, and will also be able to advise you on how to respond to high or low blood glucose when it occurs.
Reducing risks. Taking action to reduce the risk of developing either short-term or long-term complications is an essential part of diabetes care. Short-term complications include very high blood glucose and too-low blood glucose (hypoglycemia). Long-term complications include retinopathy (eye disease), nephropathy (kidney disease), neuropathy (disease of various nerves in the body), and cardiovascular disease (which includes heart problems and stroke).
Some of the steps you can take to reduce your risks include becoming educated about how diabetes affects the body and how to keep blood glucose levels in a safe range, regularly seeking an array of preventive services such as eye and foot exams, and making any behavior changes, such as stopping smoking, that will lower your risks.
Healthy coping. Diabetes affects more than just physical health. It can cause psychological stress, affect how you feel about yourself, and affect your relationships with others. Coping with the emotional and social effects of diabetes is just as important for your health as taking care of the physical effects.
The good news is that healthy coping strategies can be learned, and goals can be set for learning them just as they can for other changes you’d like to make in your life. Some people find it helpful to learn and use a formal relaxation technique such as meditation or guided imagery. Others find that less formal approaches such as setting aside time for themselves, engaging in more physical activity, or setting aside time specifically for social activities reduces their stress level. Support groups are helpful for some. And for some issues, working with a mental health professional is what’s most effective.
Once you decide (ideally with the input of your diabetes care team) which areas of your diabetes care need work, you can set specific goals to work toward. Using the acronym SMART, which stands for specific, measurable, achievable, realistic, and timing, can help you set goals that you are likely to be able to accomplish. Here’s how SMART goal setting works:
Specific. A specific, clearly defined goal is much more likely to be met than a vague goal. To help define what your goal is, ask yourself the following questions:
Measurable. It helps to have a way to measure your progress toward meeting your goal. For example, you might count the number of times per day or week that you perform a particular activity, such as monitoring your blood glucose level or taking a walk. Measuring your progress helps you stay on track and also lets you know when you have met your goal.
Achievable. Is your goal achievable? Often, a goal needs to be broken down into small steps to be reachable. For example, if your goal is to learn to respond to your blood glucose levels and problem-solve out-of-range numbers, you may need to start by monitoring more regularly and keeping a more complete logbook that contains not just numbers but notes, as well. Once you have more numbers and notes, you can start reviewing your logbook at regular intervals and looking for patterns. And from there, you can go to analyzing patterns and looking for possible causes of high or low blood glucose levels. (Be sure to seek help from one of your diabetes care providers if you’re having trouble with any of these steps.)
If the goal you’ve picked seems overwhelming, try listing all of the steps you will need to take to get closer to meeting it. Keep breaking those steps down into smaller and smaller steps until you get to one you can easily do. Getting closer to your goal, even by a tiny bit, can empower you to keep working toward the next step.
Realistic. One way to know if your goal is realistic is to gauge how confident you feel you can reach it. Again, it helps to break the goal down into smaller steps. If taking even the smallest steps necessary to reach the larger goal seems too difficult, your goal probably isn’t realistic. On the other hand, if you’re willing to take the first steps toward meeting your goal, it may well be something you can accomplish.
Timing. A goal should have a time frame. It should be long enough to make the goal attainable, but short enough to create a sense of urgency. If your goal is to learn to count carbohydrates “someday,” you may never get started. But if you set a reasonable date by which to acquire this skill, you’ve set your unconscious mind in motion to begin taking the necessary steps toward meeting the goal.
(Click here for an example of the SMART method in action.)
As you work toward identifying a goal (or goals) and determining a SMART way of working toward it, put your thoughts into writing. When you’re done, you’ll have a written plan to help you get started and follow through. Keep in mind that it is OK to revise a goal as you go along or to set a new one if your circumstances change.
Consistently perfect self care is impossible, so if you are having trouble with one part of your diabetes self care, don’t become discouraged and let it consume you. Focus on what you are doing well, and come back to the problem areas when you are ready. Ask for help if you’re not sure what to do, how to get started, or how to maintain the healthy changes you have made. Setting realistic goals and mapping out clear steps toward reaching them can significantly improve your health without leaving you overwhelmed and frustrated. Take it one step at a time, and you’ll be amazed by what you can accomplish.
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