Plan to Succeed

Five ways to make sure your plan succeeds

By Richard R. Rubin, Ph.D., C.D.E.

Managing your diabetes takes work—a lot of work, every day. It's impossible to manage your diabetes perfectly, and very few people even come close. But most people could do more to stay healthy. Could you?

A good plan is the first step to healthier living. Whether you want to change the way you eat, be more active, take your medication more faithfully, or find a way to cut stress in your life, success depends on that essential first step—good planning.

Reasons for change: a case history

Let's take a look at a patient, Mary, who was referred to me by her endocrinologist, and how you might benefit from her example. He was worried about Mary's high A1c levels, and it turned out Mary was, too. In fact, she immediately said, "They keep telling me I'll get complications and die if I don't change my ways, and I know they are right." Mary clearly recognized the potential risks if her diabetes continued out of control, but those consequences were years away. In her view, corrective measures looked like a lot of hard work for little immediate benefit. Like many people, Mary needed motivation to take action now.

The reasons for change should be immediate, positive and personal. I asked Mary what brought her pleasure in life, and she responded right away, "my garden and my new granddaughter." Mary's garden had been the pride of the neighborhood for almost 20 years, and Mary's first grandchild had been born in London the month before. Mary's first chance to see the baby was in six months, when Mary's daughter was planning to come for a visit.

As much as she loved her garden, Mary had been spending less time there the past few years because she just didn't have the energy. She also wasn't sleeping well, had to get up frequently to urinate, and she had put on weight. Mary was worried about getting the garden together this year and her ability to keep up with her granddaughter when she came to visit.

Mary didn't realize it, but her loss of energy and her sleeping problems were likely the result of high blood glucose levels. If she got her diabetes under control, she would probably be able to keep her garden in tip-top shape and have energy for her granddaughter when she came crawling next summer. Studies show that when blood glucose levels rise, energy levels can drop, and mood could, too. When blood glucose levels are closer to normal, people may feel happier and more relaxed. So Mary might be able to do more of the things she loved and have more fun doing them once she established better blood glucose control.

Does that sound like a good thing to you? Can you think of an immediate, positive, personal reason to make some healthy changes in your life?

Setting goals

Mary was motivated and ready to set goals. How much weight should she try to lose? What would she have to do to lose that much? She knew she was at least 25 pounds overweight but did not see how she could possibly lose that much.

Losing as little as 10 pounds would make a big difference in Mary's health. It would help lower her blood sugar, blood pressure and cholesterol levels, and help improve her mood, her energy level and her ability to keep up with her granddaughter. Those are hefty benefits for losing just 10 pounds and keeping them off.

So Mary decided to lose 10 pounds in six months before her daughter's visit. I did some calculations and found that Mary could reach her goal if she cut her calories or increased her activity by 200 calories a day. Mary liked this simple way of thinking about her goal, and she started planning ways to eliminate or burn 200 calories per day. She followed my advice and looked for the easiest way. Mary decided to join her husband three days a week on his daily 30-minute walks, which represented 200 calories a day. On the other four days Mary would meet her calorie goal by eating healthier lunches at work. For example, diet soda and low-fat yogurt instead of regular soda and yogurt would save 255 calories; an orange instead of Danish pastry for dessert would save 250 calories; and a turkey sandwich with mustard instead of a meatball sub with cheese would cut 315 calories.

The rate of Mary's weight loss—about 1½ to 2 pounds a month—is considered healthy. What would be the easiest way for you to lose 200 calories a day? Look for the activities and food substitutions you will find the easiest to live with.

Focus on your successes

Mary left my office ready, willing and able to live healthier. When she called me two weeks later she said she was doing great with the walking but not quite as well with her lunches. She had no trouble substituting lower-calorie sandwiches for higher-calorie ones, and she had almost completely switched to diet soda. But on several days she had not been able to resist calorie-rich sweet desserts.

Mary sometimes succeeded in choosing a healthy dessert; in fact, she made that choice happily when a nice ripe piece of one of her favorite fruits was available. She got into trouble only when none of the fruit was appealing. Focusing on her successes told Mary what she needed to do, so she started taking a nice ripe piece of fruit to work with her every day.

Mary planned to succeed. First she found an immediate, positive, personal reason for getting her diabetes under control. Then she set good goals. Finally, she focused on her successes as she pursued her goals.

Richard Rubin, Ph.D., C.D.E., associate professor of medicine and pediatrics at Johns Hopkins, is the co-author of "Psyching Out Diabetes: A Positive Approach to Your Negative Emotions," "Sweet Kids," and "The Johns Hopkins Guide to Diabetes." He also has written extensively on the effects of diabetes education, psychological problems associated with diabetes and techniques for counseling people with diabetes.

Last updated: February 2008