Bang for Your Self-Management Buck

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You can’t learn all the steps required to manage diabetes at once. Whether you’re experienced or a newbie, what do you focus on now and what do you get to later? One way to decide is to ask, “What activity will give me the most bang for the buck?”

“Bang for the buck” means comparing. How much benefit will you get out of something versus how much it will cost you? With self-management, the benefits can include feeling better, being healthier, and having lower glucose and blood pressure numbers. The costs can be financial (like paying for strips and drugs), effort (like learning to prepare new foods), time (like that spent exercising), and discomfort.

William Polonsky, PhD, CDE, author of Diabetes Burnout, says it’s best to make these decisions consciously. Most of us just fall toward the behavior that is easiest, or one that sounds attractive, without analyzing how much good the behavior actually does.

Polonsky told us about a client named Roberto who wanted to improve his self-management. Given a choice about where to start, Roberto wanted to cut down on his tortilla intake. He was eating four to six tortillas with each meal. He thought he could try to cut them out completely, or at least reduce the amount to one to two with each meal.

Now that sounds like a sensible idea. Six tortillas will raise your blood sugar, as Roberto had verified with blood glucose monitoring. So cutting them out would probably lower his A1C (a measure of glucose control over the previous 2–3 months) slightly.

And this was a change he wanted to make. Diabetes educators are often taught to let clients decide where to start. Polonsky often advocates that himself. “Where do you want to start” should be your first question.

Still, Roberto’s plan might not be best. There is not enough bang for the buck. We might ask, “How hard will it be for you to give up tortillas? Can you really stick with this plan, or will you backslide? How much will it reduce your pleasure in eating? What will you substitute?” This plan has a high cost in emotional and behavioral bucks.

And how much benefit will he get from giving up a favorite food? His postprandial (after eating) sugars were about 15 points lower when he didn’t eat tortillas. That’s a benefit, but not that much of one.

Now, if Roberto was doing everything else right and just looking for a way to tweak his program to make it even better, the tortilla plan might be worth the effort. But he wasn’t. His A1C was over 9.0%. So it was best for him to consider an approach that gave more bang for his buck.

In this case, it turned out that the client wasn’t taking his medications properly. He frequently forgot them. When he did take them, it was often not at the best times. The doses may have been too low.

So there were other things Roberto could improve. He came up with a strategy for taking his medicines regularly. He asked his doctor about his prescriptions and the doctor made a few changes. His A1C came down to about 7.5%. Then he started building up his physical activity.

It wasn’t discussed at Polonsky’s lecture, but other activities include trying out alternative treatments such as vinegar with meals. There is a cost for that (effort and getting used to it), and a potential benefit (lower blood sugar levels after meals and fasting). To see if the bang is worth the buck, you would have to monitor your glucose.

Does this make sense to you?
Do you sometimes wonder if the self-management activities you do are worth the effort? Many people wonder that about monitoring; others about their diets or their medicines. The behaviors seem like a lot of trouble, and they aren’t making you feel any better. In that situation, perhaps other self-management activities might be easier and more helpful.

If you feel that way, it’s good to check with your doctor or diabetes educator. Tell him what you are doing to self-manage and ask what he thinks. Are you getting bang for your buck? You can also talk with a support group or a friend with diabetes for some feedback.

Checking your blood sugar levels can also help. You’ll see how much your foods raise your after-meal sugars and how much exercise lowers them. You can see if an herbal treatment like bitter melon tea reduces your fasting blood sugar or not.

Finally, you can do your own research online to find out more about the relative values of different self-management activities.

You don’t want diabetes to take over your life. Most self-management behaviors are helpful, but some are more helpful than others, and some are more time-consuming. You might want to focus on the ones that give the most bang for the buck.

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