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One and done?

"Doc, I (we) tried that once before and it didn't work"

For me, that's one of those "if I had a nickel for every time I heard that... I'd be rich" sayings.

When working with patients and parents of children with diabetes, I'm constantly attempting to explain, teach, or suggest the adoption of new ideas, devices, or strategies based on my interpretation of what I'm told by them or what I deduce during the encounter.

But the "push back" I sometimes hear (or see posted on line in many instances) revolves around the belief that because that suggested change, device, or care strategy didn't work once before, then it won't ever work at all, or is not worth continuing to work on until success is achieved.

Such a firmly held belief can be very self-limiting, since most of the time the suggestion could have worked if the person had simply spent more time trying to make it work and worked out the bugs along the way (on their own or with the help of their diabetes team).

Before you flame me with dozens of personal examples of failed suggestions, please don't misinterpret my meaning here. Some care suggestions, devices or strategies just may not be desirable to the person or parent. I certainly respect that. But if that's the reasoning then please say so. I'm the first to say that diabetes care is a series of choices. I respect that.

But diabetes care is also a practicable skill. Approach it that way and it will serve you much better in the long term. Barriers to good diabetes self-care are often located more in the mind than anywhere else.

For example, I've worn a CGM device for years now. But not only did it take about 6 months for me to become comfortable with what the device was telling me about my sugar levels, but I continue to improve my Sugar Surfing skills the longer I wear it and the more I use it to associate "BG results" with "BG causes".

Here's another example. Insulin shots can be uncomfortable if done with a poor technique. My mom's injection technique was a slow penetration of the skin with the needle (ouch!) as opposed to my dad, who darted it in swiftly with minimal discomfort. She wasn't trying to hurt me. Just the opposite: she thought slow was better. I was not old enough to do anything but grimace, which made her go even slower.

Advanced features on an insulin pump are routinely used by only 15-20% of users. By advanced I mean frequent use of combination and extended boluses, temporary basal rates and alternate basal rate profiles. Why? In part due to inadequate education, but even when these skills are properly taught, if they don't show a positive result quickly they are more likely to be abandoned and labeled by the person as dead end strategies and ineffective. And maybe they are, but not because the concept is flawed, rather due to the implementation. Good ideas can be doomed by poor execution.

Persons with diabetes usually get a "boot camp"-like introduction to their disease at onset. Sadly that might be all they ever get in regards to quality self-management education. Some folks may be able to push forward and learn more, then hone their abilities through hard work, self-study and practice.

Others may have doctors who like to teach or have diabetes educators readily available. But the path to success in each instance is paved with a personal investment to reflect or self-analyze, prioritize what's important and seek out the skills and knowledge needed to excel.

I would also say there is an element of sacrifice. It certainly takes an investment of time and patience to tame the diabetes beast. I personally know what it takes and respect those who work hard to tame theirs. Plus I'm supportive of those who might not yet be ready or are oblivious to the need for changing anything. I've found delivering good diabetes care to be as much about negotiation, encouragement and patience than anything else.

I'm always impressed by professional athletes who carefully review game films, photo images of their opponent's defensive formations immediately after a series of downs, or watch their next challenger during another match to gain insight on how to best prepare. Professionals do their homework and they don't punch a clock. Those of us with diabetes are "professionals" of our condition whether we realize it or not. Perhaps embracing a professional-like work ethic is what we should all strive for. Aim to combine the heart of a champion with the mind of a professional. What an incredible combination indeed.

Knowing when to move on from a failed strategy is equally important. Many of us cling to the "comfortable and familiar" even when these are not improving our control in any measurable way or may even be dragging us down.

So...start collecting and PRACTICING new self-care "tools", new self-care procedures and situational strategies. Not just "stuff" or things (devices and technology), but rather "how diabetes stuff and things really work". This has been one of my driving goals of diabetes education over the years. Once you understand how your diabetes works inside your body, it tends to dilute the fear and loathing it holds over you.

Practice, patience and perseverance are the "three P's" of purposeful diabetes self-care. Don't give up too quickly on new things. After all, diabetes care has always been a marathon, not a sprint. Be willing to retry failed methods or strategies and don't be so quick to dismiss them out of hand when they don't work the first time you try them.

Feel free to share this post freely with others you feel might benefit. Thank you.

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