The Association of Diabetes Care and Education Specialists (ADCES) have found 7 Self-Care Behaviors essential for successful diabetes management that also support general well-being. While information sharing is a basic part of health education, positive behavior change is the goal. Only behavior change leads to clinical improvements supporting a higher health status. This is true for all chronic illnesses.
The ADCES 7 Self-Care Behaviors include:
Healthy coping
Step 1 is finding barriers, if any, that might interfere with your ability to learn and practice self-care behaviors. How do you feel about living with diabetes? Are there times you feel overwhelmed with the daily activities of self-care? Do the activities of self-care for wellness isolate you from family or friends? Do you have little interest or pleasure in daily activities? If living with a chronic illness is stressful, problem solving and management becomes difficult. Your healthcare provider can help connect you to resources to help in removing these barriers.
Healthy eating
If you are what you eat, the building blocks of good health begin with your mouth. Healthy eating supports wellness and better health. Foods that are high in vitamins, minerals, and fiber are preferred to foods high in carbohydrates, sodium, or saturated fat. Tips for eating healthy include:
- Avoid adding salt to food.
- Choose healthy fats (canola, olive, avocado, peanut, sunflower and soybean oils) and avoid saturated and trans-fats.
- Eat more non-starchy vegetables.
- Avoid adding sugar to food.
- Raise your awareness of foods that produce an exaggerated blood glucose rise and/or foods that don’t raise blood glucose much.
- Consider using a smart device app to help track food intake, e.g., MyFitnessPal, MyPlate, or Calorie King. NOTE: People who track their food intake are more successful reaching their goals than people who do not track their food intake.
- Request a referral to a registered dietitian for more nutrition support and resources.
Being active
Whether structured physical movement like an exercise class or yoga, or an unstructured activity that decreases the time spent sitting, just move. Physical movement that increases breathing and heart rate supports more positive health outcomes. Physical activity includes:
- Intermittent walking, short activity breaks during the day, and/or chair exercises can boost the metabolism during normal daily activities. The more metabolic boosts, the more energized you feel.
- It takes time. Rome wasn’t built in a day and being active isn’t going to happen overnight. Begin by increasing daily activities a little bit every few days or week. If a physical activity group fits your style, then do it. If not, consider things you can honestly commit to on your own, e.g., walking at lunch.
- It’s okay to be resourceful and/or creative. If the dog is meeting you at the end of the day with the leash or Frisbee, grab your shoes and go play. No one said physical activity had to be “work”.
- Partner with a friend or family member(s) to keep each other accountable and/or use a fitness app to guide and/or track (and compete?) your physical activity, e.g., MyFitnessPal or Stridekick. Remember to keep it fun and it’ll be easier to hang in there over time. Remember, this isn’t a race . . . it really is a marathon. Enjoy!
- Again, your healthcare team can refer you to additional resources if desired.
Taking medication(s)
The longer we live, the more likely things are going to begin losing their ability to keep us in healthy target ranges. When this happens, there’s usually a medication for that. Medication tips include:
- Understand the goal of medication and other things that might affect success. Taking the right medication, at the right time, at the right dose is all important to reach the health goal. It’s your right as a patient to know the game plan.
- Even the simple aspirin has side effects — know potential medication side effects. If you only see a healthcare provider once every 3 months, are you really going to continue to take something you believe is causing a side effect that is a problem for you? Probably not. Ask the best way to communicate with the healthcare provider if you have concerns between visits. Don’t wait 90-days for the provider to realize you haven’t been taking the medication because of a side effect. Remember: medication doesn’t work if you don’t take it.
- Keep an updated medication list available. If you go to a new healthcare provider for a different issue (dentist), that provider will want to know about medications and changes.
- In this world where we receive some things at the pharmacy and some things via mail, someone needs to review everything you’re taking — prescription meds and over-the-counter meds — to check for drug-to-drug interactions or drug-to-food interactions. I have always recommended doing this with a Registered Pharmacist at your regular drug store.
- Taking medication at the “right time” could mean medications one to four times a day and/or on certain days of the week. Reminders can be helpful in this situation. Cell phone alarms or reminders, and visual reminders can increase medication adherence. Remember: the right medication, at the right time, at the right dose.
- If remembering medications is still a challenge, discuss this with your healthcare provider for local resources that might assist you.
Monitoring
Up till now we’ve been talking about behaviors that support wellness and positive health outcomes. It is well accepted that words talk, but numbers scream. When you talk about goals, you ultimately start talking about numbers; do you know your numbers?
- Know your numbers: Knowing blood glucose numbers, blood pressure targets, weight losses and gains, kidney function, and more support positive self-care. You can’t change a problem you don’t know exists, and you can’t hit a target you don’t know.
- Discuss with your healthcare team what numbers you should focus on. Don’t obsess about health indicators that are good; have a plan to address health indicators that can be improved or supported.
- Numbers can be overwhelming. Realizing the target may not be an exact number but a range can help. Sometimes the numbers may be a little higher than desired and at other times the numbers may be a little lower than desired. Overall, what’s your time in range?
- Your healthcare team can share what numbers you should be targeting.
Reducing risks
Anything you do to increase the likelihood of positive outcomes is reducing risks. This includes safety behaviors like wearing a seat belt or following posted speed limits. It’s no different in healthcare. Positive lifestyle choices tend to produce positive health outcomes. Tips to reduce risks include:
- Talk to your healthcare provider about appropriate health screenings and preventive actions that would possibly benefit
- Talk to your healthcare provider about recommended vaccines for you.
- Realize some medications may actually be to reduce the risk of future complications.
- Participate in regular health visits to assess wellness not just health issues. It’s easy to forget a check-up when everything seems to be going well. Put a reminder on your calendar to check-in if it’s been a while since the last check-up. Ultimately, your healthcare team knows the best way to reduce your risk of future complications.
Problem solving
Find a problem, fix the problem, and check the fix. While “find it, fix it, check it” sounds simple, it obscures the toughest issue: what exactly is the problem? We’ve been discussing self-behaviors. What if the problem isn’t a self-behavior problem but something else? Consider these tips:
- What’s the problem? What does the problem look like and how does it represent a change? Is it really a problem or is it more a discovery? Additionally, realize some “problems” aren’t problems as much as changes over time. Your healthcare team can help with this.
- What’s the fix? Is there history where this problem has been addressed before, and did it work or just sort of kicked the can down the road? Is it a fix that’s truly doable or is it more than you’re willing to commit to? Honesty with the healthcare team can avoid misunderstandings and continue to support positive outcomes.
- Check the fix: Make a plan and check the plan. Problem solved? Did it create a new problem? Are you having difficulty sticking with the plan? Is there another option?
- Your healthcare provider can often shed insight into problems that arise. Confirm a problem is a problem with the healthcare team before launching into changes that might not be necessary.
When the ADCES 7 Self-Care Behaviors were originally developed, researchers were looking for a self-management framework for diabetes. It was soon discovered that these behaviors were applicable to so much more. With the 7 Self-Care Behaviors as a guide, start to change your health status for the better.