Diabetes Forecast

Help Yourself Form Healthy Habits

By Linda A. DiMeglio, MD, MPH, Associate Editor ,

As you well know, effective diabetes management is a constant juggling act, requiring careful balancing of medication dosing, eating, activity, and unexpected variables, such as a sick day. Add the daily stresses of life, school, and work, and the motivation to take the best possible care of yourself can quickly and understandably wane. As a pediatric endocrinologist, I feel that much of the time I spend with children and families in the clinic is aimed at kindling and then resparking this motivation.

Yet, there are ways to encourage the necessary habits for good diabetes care. One of them is to harness existing habits. Evidence suggests that a good way to establish new habits is to attach desired behaviors to routines we already have in place. In his book, The Power of Habit, author Charles Duhigg shows that up to 45 percent of our daily activities are controlled by the basal ganglia, a part of the brain that is important for emotions, developing memory, and recognizing patterns. This area is quite unlike the prefrontal cortex, which regulates decision making. The basal ganglia allow us to do complex tasks (such as driving a car) while carrying on a conversation or singing along to the radio.

Duhigg suggests that when looking to change habits, it is key to put concrete "cues" in place to trigger habit initiation and then to link the desired habits to rewards. An example: Encourage morning exercise by putting your tennis shoes next to the bed before going to sleep. After exercise, treat yourself to a healthy reward such as a nice long shower or logging your miles to track progress. Once the habit is routine, the reward will become less important.

Recognizing less positive habits can also reduce unhealthy behaviors. Changing what you do or where you do it can decrease temptations. For instance, you can substitute a routine you associate with unhealthy snacking, such as sitting on the couch late at night while watching TV, with a new routine, such as reading a book in bed. Focusing on a specific, longer-term reward—maybe it's fitting into a favorite pair of jeans or having a great A1C at your next doctor's visit—can also help create good cravings that crowd out the desire for negative behaviors. Breaking bad habits is sometimes best accomplished when we are out of our usual routines. It might be when we're on vacation or after a life transition, such as the birth of a child.

I have started using these strategies in my clinical practice. When adolescents are having a hard time remembering to check their blood sugars before bed, I ask them if they can remember to brush their teeth every night. When they laugh and say yes, then I ask them to link the two habits—and to help make it happen by keeping an extra meter near the bathroom.

Transforming habits can take work but, as Duhigg says, "Habits are not destiny." Becoming aware of your habits is a first step to making healthy changes.



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