The Resolution Revolution

posted from: https://www.diabetesdaily.com/blog/the-resolution-revolution-352909/

By Gary Scheiner MS, CDE

Every year, it’s the same thing.  During the month of January, the YMCA where I work out year-round is stuffed to the hilt with new bodies.  The basketball courts are packed, the classes fill up early, and there’s often a wait to use the cardio equipment and weight machines.

By the end of the month, the crowd starts to thin a bit (literally and figuratively).  And by February, I can pretty much pick & choose my workout without the slightest inconvenience.   The reason for this cyclical bump in the fitness business is simple:  New Year’s Resolutions don’t work.

That’s not to say we shouldn’t try to improve our lives.  Even though the holiday season can be a busy and stressful time, it is also an ideal time to think about aspects of our diabetes that we want to work on in the upcoming year.  Maybe you truly want to exercise more regularly.  Perhaps you want to get your A1c down, lose weight, or change some aspect of the way you manage your blood sugar on a day-to-day basis.

The difference between pie-in-the-sky New Year’s resolutions and SMART goal-setting is about ten minutes of actual planning.  In the SMART system, goals are designed to be Specific, Measurable, Achievable, Relevant and Time-limited.  Below is a description of how to use the SMART goal setting system for diabetes self-management
Specific:
Your goals should be clearly defined.  Stating that you want better blood sugars is not specific enough.  Instead, focus on one or two elements of your diabetes management – such as your post-meal peaks or your fasting (wake-up) glucose readings.  If you aren’t sure what to focus on, it may be helpful to talk it over with your diabetes care team.  Here are a few other examples:

“General” GoalsSPECIFIC Goals

I want to eat better.I will limit my nighttime snacks.

I need to get in shape.I will improve my cardiovascular fitness.

I should pay more attention to my diabetes.I will start to check my blood sugar more.

Measurable:
It is absolutely necessary that you set goals that are quantifiable.  You have to be able to look back at some point and be able to say, definitively, whether or not the goal has been met.  For instance, rather than vowing to have better blood sugar control, you might set your sights on having at least 75% of your readings within your target range.  Of course, it will be necessary to track your data somehow.  If you’re not into keeping detailed written logs, there are many software programs, web-based tools and smartphone apps that can help you to organize and quantify your data.  Here are a few examples of how to take your specific goals turn them into measureable ones:

Specific GoalsSpecific, MEASURABLE Goals

I will limit my nighttime snacks.I will only have one snack each night.

I will improve my cardiovascular fitness.I will walk for 30 minutes after dinner every night.

I will start to check my blood sugar more.I will check my blood sugar at least four times every day.

Achievable:
Your goal should be something that you can realistically achieve.  Perfect blood sugars all the time would be nice, but when you have diabetes, it’s generally not realistic.  If, say, 40% of your readings are currently in-range, achieving at least 60% in-range is within reason.  If your A1c is currently above 10%, a goal in the 8s is more realistic than setting your sights on 6.  Continuing from our previous examples:

Specific, Measurable GoalsSpecific, Measurable, ACHIEVABLE Goals

I will only have one snack each night.I will only have one snack each night on weeknights.

I will walk for 30 minutes after dinner every night.I will walk for 30 minutes before breakfast or after dinner at least 3 times a week.

I will check my blood sugar at least four times every day.I will check my blood sugar morning and night every day, and before lunch, dinner and exercise on days off.

Relevant:
Your diabetes management goals should be relevant to your life as a whole.

For example, improved blood sugar control is not just about numbers and lab results.  It positively impacts work productivity (which could lead to a raise or promotion), athletic/physical performance (which could enhance your self-esteem and sense of accomplishment), moods (which can boost your social stature) and sleep (enough said!).  Adding relevance to the goals in our previous examples:

Specific, Measurable, Achievable GoalsSpecific, Measurable, Achievable, RELEVANT Goals

I will only have one snack each night on weeknights.I will only have one snack each night on weeknights, which will help me control my nighttime blood sugar and sleep better.

I will walk for 30 minutes before breakfast or after dinner at least 3 times a week.I will walk for 30 minutes before breakfast or after dinner at least 3 times a week so that I can start to lose weight and lower my risk for heart disease.

I will check my blood sugar morning and night every day, and before lunch, dinner and exercise on days off.In order to ward off serious hypoglycemia, I will check my blood sugar morning and night every day, and before lunch, dinner and exercise on days off.

Time-Limited:
Goals should be tangible and concrete, and the action that you take to achieve these goals should also be tangible and concrete.  Do not set a goal without including a time element for achieving that goal.  Efforts to achieve more in-range blood sugars can start right away, but there needs to be a stated time for evaluation, adjustment, and reaching the stated goal.

Specific, Measurable, Achievable, Relevant GoalsSpecific, Measurable, Achievable, Relevant, TIME-LIMITED Goals

I will only have one snack each night on weeknights, which will help me control my nighttime blood sugar and sleep better.For the entire month of January, I will only have one snack each night on weeknights, which will help me control my nighttime blood sugar and sleep better.

I will walk for 30 minutes before breakfast or after dinner at least 3 times a week so that I can start to lose weight and reduce my risk for heart disease.Starting the first of the year, I will walk for 30 minutes before breakfast or after dinner at least 3 times a week so that I can start to lose weight and reduce my risk for heart disease. By March 31, I will have walked at least 40 times.

In order to ward off serious hypoglycemia, I will check my blood sugar morning and night every day, and before lunch, dinner and exercise on days off.Starting immediately, in order to ward off serious hypoglycemia, I will check my blood sugar morning and night every day, and before lunch, dinner and exercise on days off. I check my meter memory every Sunday night to measure my progress.

Now What?
Someone much smarter than me once said, “Nobody plans to fail.  They just fail to plan.”

To increase your chances for success, creative strategies are needed.  Consider what will motivate you and ease the path toward goal attainment, and consider obstacles that might get in the way.  A decision to increase the number of times you check your blood sugar might be easier if you have more than one meter at your disposal, and if your insurance will cover the test strips.

If your goal involves walking more often, your chance of success might increase if you have a partner to walk with, and an indoor option in case the weather turns nasty.  Cutting out the night snacks is much easier if you have a filling dinner, stay busy at night and don’t bring junk food into the house.  Your diabetes clinician/educator should be able to help you develop some effective strategies for meeting your specific goals.

So, there you have it – the SMART goal setting system for diabetes self-management.  Hopefully, the wheels are already turning and some ideas are popping into your head.  By all means, jot them down!  Then set out to make them specific, measurable, achievable, relevant, and tangible.

Editor’s note: Gary Scheiner is owner and clinical director of Integrated Diabetes Services (www.integrateddiabetes.com; 610-642-6055), a private practice specializing in advanced training and management of children and adults on intensive insulin therapy.  His team of CDEs (all of whom have Type-1 diabetes) provides consultations worldwide via phone and the internet.  Gary is author of several books including “Think Like A Pancreas” and was named 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators.  Feel free to submit questions and comments to gary@integrateddiabetes.com

Photo Credit: David Mark (Pixabay)

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