Articles

Interview With A Newly Diagnosed Diabetic

Author: Brian Ayers, CSCS
Released: 01/25/2009

Leo C. is a 66 year old ex-Hartford police officer who now works as a private investigator. He is formerly my boss as well as a long-time family friend. Over the years, Leo has struggled to keep his weight down. He has tried a variety of diet and exercise strategies and has had some short term success with some of them. Unfortunately, he would inevitably revert to his poor eating habits and regain the weight he had lost. Both of his parents had developed diabetes in their later years and his doctor had regularly cautioned him that he was heading in that direction. This looming threat of developing the disease was certainly a factor in his decision to begin these diet programs but it would ultimately fail to keep him motivated through the obstacles and temptations that would arise.

I had the opportunity to sit down and talk with Leo after not seeing him for several months. During our conversation he brought up that he had been officially diagnosed with type 2 diabetes two weeks prior. His doctor had given him specific nutritional directions as well as a blood glucose meter and instructions to keep a log of his blood sugar levels numerous times throughout the day. As our conversation continued Leo went on to recite, from memory, the specifics of the eating regiment that his doctor had prescribed to him. He acknowledged that he was familiar with these changes, having attempted similar programs in the past. I inquired as to how it was going this time around and he proudly described his now strict adherence to a program that he had struggled with in the past.

I couldn’t help but notice a shift in his attitude regarding the changes he was now making. In the past, we had often discussed nutritional changes and his mind-set had always seemed a bit sarcastic and dismissive. I could tell he was listening to the information I was giving him however, I could also tell that he wasn’t taking the prospect of making the changes very seriously. In contrast, he was now very matter-of-fact about what he had to do and seemed to be accepting responsibility for it. I confronted him with the fact that he had always been aware that he was at high risk for developing diabetes but it never seemed to strongly motivate him to change. I inquired as to what specifically about getting the diagnosis had brought about this change in attitude. His response was one word, “fear”. In his most recent appointment with the doctor he had been told that he would need to begin injecting himself with insulin if the disease progressed further. Leo explained to me that he did not like needles and that being confronted with the reality that those needles were in his very near future was the driving force behind his new outlook regarding these changes that he had once viewed as inconvenient. What was even more interesting to me was that from our conversation I could tell that, beyond merely complying with the program, Leo seemed to be actually embracing these changes. He was much less resistant to suggestions and was actively developing his own strategies to implement the changes in a way that would work for him.

The fact that the threat of a consequence was not enough to motivate Leo to change but being faced with the inevitability of that consequence was, illustrates a key distinction between intrinsic and extrinsic motivators. It is widely acknowledged that intrinsic motivators, or a motivator that comes from within, are much stronger catalysts for change than extrinsic motivators, motivators that come from outside one’s self. Most people would categorize one’s health or wellbeing as an intrinsic motivator. However, I would argue that for many people this does not hold true until the risk of a detrimental behavior reaches the person on an emotional level. If the individual is merely intellectualizing the danger based on what other people (i.e. friends, family, doctors, etc.) are telling the person could happen, then it has still not reached the level of an intrinsic motivator. Even if the person is telling his/herself that they need to do something it can still be classified as an external motivator until the danger of that particular behavior is truly internalized. Once the individual realizes that the negative consequences of that behavior are a certainty, he or she begins acting on the emotional aspects of fear and self preservation. Thus, the motivation to change becomes intrinsic. For some, the mere possibility that a behavior can have negative consequences is enough for them to access that deeper emotional response and embrace change. However, for many others it takes a more clear and present danger to elicit the same response.

The analogy I’ve come up with to illustrate this principle involves a person being mugged. In the first scenario, a man comes up to you with his hand in his pocket and tells you he has a gun and he wants your money. For many people that threat alone is enough to get them to comply however, some people may stop and think “How do I know that this person really has a gun?” That type of person can be compared to someone whose doctor has told them that they need to change their ways or they will develop a certain disease. The person’s beliefs and expectations regarding this warning will determine his or her perceived level of danger and will ultimately influence the decision of whether or not to make a change.

In the second scenario, the same man comes up to you, takes a gun out of his pocket, puts it to the side of your head, and demands your money. Now there is no mistaking the danger and the overwhelming majority of people will quickly comply without hesitation. Not a lot has changed between the two scenarios. The person making the demand hasn’t changed. The demand itself hasn’t changed. The only difference between the first and second scenarios is the level of perceived danger increases once the gun is actually put to your head. This is what made Leo able to flawlessly adopt the nutritional and behavioral changes that he was unable to in the past. However, even in the second scenario I’m sure that there are a few people that would still stop to wonder if the gun is loaded or if the person is bluffing.

I think that we can all agree that fear can be a powerful motivator, but that begs the question: How close do you have to get to danger for self-preservation to kick in? The answer is different for everyone. Some people are more cautious. They take the preventative approach to health and adopt a lifestyle and try to steer clear of being in a position of risk. Others prefer to throw caution to the wind. I asked Leo; now that he has developed diabetes does he regret not having been more cautious in the past? His answer was no. He explained that he enjoyed his previous lifestyle and that if he had the opportunity to go back with the knowledge of the outcome, he would not have changed his behaviors. Before you judge his attitude as reckless, it’s important to understand that his decisions have been based on his individual priorities. He realizes that health was not so high on his list of priorities in the past. Now that it is more important to him, he is accepts responsibility for the changes he must make.

Life moves so fast that it’s easy to get caught up in the rushing current and not take the time to asses what is important to us or to be mindful of our behaviors and their possible consequences. At some point, it is necessary for each one of us to decide where our health falls on our list of priorities. If we find that it is high, then it is important that our actions reflect that now before we find ourselves in the wrong neighborhood with the gun to our head. For those who prefer to “live on the edge”, that’s fine as well as long as you are aware of and accept the fact that it may catch up with you eventually. As for Leo, it’s now been about 2 months since he was diagnosed with diabetes. I spoke with him again and I am happy to report that he has continued to follow the nutritional regiment that his doctor had prescribed him. He has also fine tuned several strategies that are allowing him to do so with much less effort than he had originally perceived. Leo has lost close to 10lbs. since he began making positive changes and while he is still on medication to manage his diabetes, he has not had to progress to insulin shots.

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