Seasons, Reasons & Celebrations

May 29, 2018
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We know treating and living with diabetes and excess weight or obesity takes a village, a multidisciplinary village, not only related to the patient and health care providers but truly the whole village or world. It also helps to remember the seasons and reasons why we do the things we do. We sometimes forget about how changes in weather, our personal cultures, living environment, even friends and loved ones who seemingly mean well can “sabotage” the greatest intentions.

Early and ongoing education and intervention is important in almost every patient encounter for ongoing management, whether the patient seems to be doing well at the time of the encounter or having difficulty. Some patients, when doing well, will leave our encounter and reward themselves with the very foods or habits that got them in trouble to begin with, only to have difficulty getting back on track. Or, once the weather seems comfortable out, they become more active. Or, the many holidays, celebrations, and spending time with loved ones result in them succumbing to temptations.

No matter “where” the patient is on the continuum, at every visit, discuss barriers and ways to get over the barriers. The barriers are what get people off track.

Some examples:

Know the why. Most important, discuss the reason the person wants to be healthier by managing their weight and/or diabetes.
Celebrations, parties, holidays. We usually teach that it’s okay to “celebrate” once in a while. Discuss what it means to the patient to “celebrate” by eating more or eating the foods that cause their glucose or weight to increase. Discuss how often they think they can do this and manage their condition. Set goals.
Track without judgment. Some patients see checking their glucose or their weight as a judgment of the kind of person they are. Remind them this is not true, it is just information to help make decisions. For example, checking glucose once a day doesn’t give them the information needed to know how their food intake, activity, or medications are balanced or if they need to make changes. A good choice is teaching them about wearing a CGM to get the whole picture. As for weight, research has shown us that people who lose weight and keep it off weigh themselves at least weekly.
Don’t use the weather as an excuse. Some say, “When the weather is better, I’ll get out and be more active.” And, it’s true, they do, but what about when it rains, snows, is exceedingly hot or cold? Make a plan with the patient that the patient can and will do between this visit and the next.
Discuss the toxic environment we live in. Some areas are not safe to go out; some aren’t walkable; and temptations from media and even family and friends who may mean well, cause some patients to get off track. This helps people realize it’s not just them, they are not alone, and it’s not their fault. They are battling a big battle, one they can win.
Make a list. Teach patients to make a list of excuses that could get them off track and what they think they can do to fight the excuse.
Just say no. Teach your patients the importance of saying, “No, thank you!”
Ditch perfection. Teach your patients you don’t expect perfection. What is it anyway? And if they get off track, discuss how to learn from it, and say, “Live and learn.”

Arming your patients with this information during your encounters can be helpful when faced with challenges. If anyone has any examples of how they have helped their patients to conquer such challenges, please let us know! Let’s learn from each other how to help our patients reach and stick with their goals!

Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl.com

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Joy Pape, FNP-C, CDE
Medical Editor
Diabetes In Control

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