The other bit I wanted to share from my day at the Behavioral Diabetes Institute was our discussion of what gets in the way, i.e. why do many patients so consistently neglect their diabetes? That is, the first hour of my time at the BDI was spent in a "provider" session sharing concerns with a group of people including CDEs, psychologists, nutritionists, and reps from BDI sponsor Roche Diagnostics.
The topic du jour was what to do about the many, many patients that seem to "fall off the map" by not coming in to see their doctor or diabetes educator for months or even years at a time. Most of these are Type 2 patients, out in areas of the country where a doctor's office is much more than just a 15-minute jaunt to the nearest office park. Yet the providers puzzle over why these people don't seem to understand or care about the state of their own health? One woman sitting behind me kept using the "NC" word, i.e. "non-compliant," which made my skin crawl.
Why aren't these people motivated to achieve a long and healthy life, you ask? They are, of course. Everyone wants to live well. The trouble is many-fold. As I discuss in my newest dLife column, most patients are on the "do-what-your-doctor-says" or "try-to-do-everything-at-once" diabetes treatment plan, which both tend to lead to inertia, because: 1) diabetes requires dynamic day-to-day management, rather than minimal check-ins with your doctor just 3-4 times a year; and 2) trying to make drastic lifestyle changes can be incredibly overwhelming and frustrating. Agree?
On top of that, Dr. Polonsky identifies three things that prevent people from actively caring for themselves:
* diabetes invulnerability -- the old "I feel fine, so I must be fine" approach
* diabetes vulnerability -- the flipside, as in "I'm doomed anyway, so it doesn't matter what I do"
* life gets in the way -- there's so much I'm supposed to do, "I don't have time for all this"
Even though my Type 1 diabetes DEMANDS my attention, I see a little of myself in each one of these statements. They also help explain why my own father did so little for his diabetes for so many years.
I wish to God I could send out a free copy of our new book to every single person in America caught up in these excuses. But then again, they'd have to be motivated enough to read the thing and then actually do something about what they read. Longshot, ay? So the best we can do, I suppose, is some sort of buddy approach in which very one of us who's plugged in to caring for our diabetes -- no matter how much we might be struggling -- should try to grab one other person who's doing little or nothing and help shake them up a bit. Because if they're not part of the solution, they're part of the problem: on the direct path to the diabetic complications whether they realize it now or not.
I'm on my soap box, I know. But diabetes is a do-it-yourself (DIY) proposition for sure.