Chapter 9

Maintaining Long-Term Control

Now that you are well underway in your action plan for diabetes, we will discuss ways of maintaining your success. You have set short-term goals that have been linked together to meet your main goal of glucose control through an active and healthy lifestyle. Your challenge now is to reeducate yourself about diabetes as new knowledge is gained in this field and to keep up with new technology. With this newly gained knowledge and technology, you must remotivate yourself to make the necessary changes to your action plan and promise yourself that you will keep on moving forward.

In chapter 7 we discussed ways to monitor your progress and how to respond to change. The same principles carry over into the maintenance phase of your action plan. It will be important for you to meet with your health care team at least once a year during the maintenance phase and more frequently (every three months) in the earlier phases to ensure that you are on track. New information may become available that your physician will be aware of and can pass on to you. But more important, your health care team will be available for you as challenges present themselves. They can help you make the correct changes in response to these problems and to avoid potential frustrations.

You must understand what the common complications are and how to avoid them. It is even more important to understand what to do if you are faced with them. As we discussed in chapter 3, just as the lead planner of the project to send a spaceship to Mars and back to Earth has to be prepared for all situations, you have to be prepared to deal with potential problems and have a rescue plan in place. The best way to create your rescue plan is to identify the things that may interrupt your exercise plans or interfere with your healthy eating habits. For instance, say you find yourself skipping exercise sessions to watch television. Or say that you find yourself going out with friends and indulging in high-calorie foods several times a week. The best preventive measure is to recognize the triggers early and have a rescue plan in place. Let’s look at some sample situations and ways of dealing with them.

Decreased Exercise

You may find yourself exercising less than you had planned. This may come about for several reasons: illness, work, school, family obligations, moving, vacations, and so on. Whatever the issue may be, you need a plan so that you can preempt a relapse into your old habits. Say you were sick for one week and were unable to exercise. The solution to this problem could be as simple as setting a realistic and reasonable restart date on the calendar, such as 10 days from the start of your illness, and having a friend, family member, or exercise partner give you a reminder. If you recover from your illness sooner than expected, then start back earlier. Remember to start at a comfortable pace until you are back on track. A reasonable time frame to be back on track after resuming your plan is around two weeks. However, if your illness lasts longer than a week or if you have had a severe illness such as influenza, which can involve significant fluid loss from diarrhea and vomiting, you should see your physician before restarting your program.

You can also set a restart date if you have special work-related circumstances, moving days, or vacations that pull you away from exercise. But most situations in life allow time for some exercise and, as discussed in chapter 4, splitting your exercise routine up into smaller, more manageable sessions is still effective. However, for those situations that do not allow for split exercise sessions, you need to recognize when your exercise decreases so that you can resume your plan as soon as possible.

Another strategy is to enlist the help of another person. For example, have a friend keep an envelope of your money. Your friend is not to return your money until you restart your program. You can even notify your health care team that you are unable to exercise for a short time, and then ask them if they could call you with a reminder to restart your program.

No matter what method you use to prevent the relapse into an unhealthy lifestyle, your main focus should be to keep on track with your program. Whether splitting up your exercise routines into smaller, more manageable sessions for a short time or stopping exercise for a week with a planned restart date, you must not allow yourself to fall back into an unhealthy lifestyle. The longer you are away from exercise, the more likely you are to slip back into your old habits and the more difficult it will be to regain the success you have achieved. From my own experience, you will find it easier to get back into your program if you do not miss more than three consecutive days of exercise.

Sample Rescue Plans for Decreased Exercise

• Set a realistic and reasonable restart date as soon as you stop exercising, and have friends, family members, or exercise partners call to remind you.

• Temporarily split up your exercise sessions into shorter ones to make them more manageable during difficult times.

• Place some money in an envelope and give it to a friend; ask your friend to return the money to you only when you resume your program.

Increased Caloric Consumption

Relapsing into old eating habits may be one of the most difficult problems to overcome in the first year of an action plan for diabetes. In thinking about this, recognize what situations may trigger you to overeat. Eating for most people is a social event. Most of us have lunch dates with colleagues or friends on a weekly or even daily basis. At this point you have likely made changes to your eating habits that are more conducive to your goal of glucose control. But it is important to be aware that falling into old habits may be easier than you anticipate. For instance, you may have made changes in your diet and have been eating healthier foods, but one day you decide to meet friends at a restaurant that is known for serving mostly deep-fried foods. You may decide not to be the “odd guy out,” and you have your share of high-calorie food—not to mention that this kind of food tastes unbelievably good! Doing so does not qualify as a relapse. But making this a regular part of your life certainly does.

So where should you draw the line? The best way to do this is to calculate your caloric intake versus your calories burned with exercise, and then balance this out, as discussed in chapter 5. For example, if you decide to eat a not-so-healthy meal, estimate the number of calories you’ve eaten over your planned calories, and increase your exercise to burn off those calories over a one- to four-day period. So if you ate an estimated 1,000 extra calories in a day, you should burn an extra 1,000 calories over that week. Split up the extra exercise into three or four days to burn an extra 333 calories each day for three days, or 250 calories each day for four days. But be aware that doing this even as infrequently as once per week can lead to regression toward your old lifestyle. Calories have a way of adding up faster than you might think! Having an occasional higher-calorie meal followed by a planned increase in exercise will allow you to have some balance in your life, but I would recommend this only once your plan has been stabilized and no more frequently than twice per month. Even so, I would not encourage you to plan these types of meals in your diet on a regular basis.

Sample Rescue Plan for Increased Caloric Consumption

• Estimate the amount of calories over your planned calories and increase your exercise to burn off those calories over a three- to four-day period.

• Be aware that doing this even as infrequently as once per week can lead to regression toward your old lifestyle.

Contracts

If you find yourself falling into the trap of relapse, devising a contract with your health care team may help. The contract is an agreement between you and your health care team that is designed to help you keep on track. The details of this contract will depend on what you can anticipate as being problems for you, and your contract must be realistic in order to work. For instance, you may have a contract with your health care team that says that you will lose three to four pounds per month until you reach your goal (see sample contract in figure 9.1). Or you may have a contract that states that you progress at a certain rate in your exercise program until you reach your goal. You can incorporate many things into a contract, but you must understand that you’re doing this for your own benefit. The only person who will suffer from a breach of contract will be you. Your health care team will be flexible, understanding that your needs and desires may change; they will respond to that in kind, ensuring that you meet your goals.

Figure 9.1 Sample contract.

The keys to maintaining your success are largely dependent on your understanding of your personal health goals. In this book I have defined the types of diabetes and explained how diabetes can affect you as well as how exercise affects diabetes. I’ve discussed nutritional components crucial to good health and how to develop a healthy lifestyle. You have put these together to create a personalized plan that supports the primary goal of glucose control. I wish you the best success. Remember that you must reeducate, remotivate, and keep moving!

Action Plan:

Maintaining Long-Term Control

• Anticipate the problems that could occur that would pull you off track with your action plan.

• Illness or injury

• Travel

• Events that disturb your usual schedule

• Increase in caloric intake

• Make a contingency plan for all of these situations so that if they happen, you can minimize the disturbance to your plan.

• Find friends who will help you stay committed through encouragement and motivation.