THE GLUCOSE GETAWAY Diabetes Technology Meets the Psychology of Real Life William H. Polonsky, PhD, CDE Behavioral Diabetes Institute June 24, 2011
Behavioral Diabetes Institute• Old products• New products• New online services• Visit our first-ever ADA booth!www.behavioraldiabetes.org
The Promise of New Diabetes Technologies• Insulin pumps, bolus advisors, CGM, software, apps, social media• So much more is coming, which should make diabetes management easier, more convenient and less isolating• And all of this is needed!
Percentage of Patients Achieving ADA Treatment Targets 100% reaching ADA target 90 80 70 60 50 40 30 13.2% 20 10 0 A1c BP Chol All three Ong et al. Ann Epidemiol. 2008;18; 222-229
Diabetes Tech is Cool, BUT…• Many people, even those using pumps and CGM, are doing poorly.• Many people have no interest in trying an insulin pump or CGM. In fact, many even avoid blood glucose monitoring.
So What’s the Problem?• Having cool technology is not enough.• The obvious missing ingredient: is that technology being used? • Recent JDRF-sponsored CGM study • STeP study• But WHY isn’t technology being used effectively (if used at all)?
So What’s the Problem?• Everyone is struggling with one major, often invisible issue: • How do you balance taking good care of diabetes vs. having a spontaneous fun-filled life? • How can you ever take time off from diabetes?
Why a Diabetes Break is Needed• The “24/7” Problem
Why a Diabetes Break is Needed• The “24/7” Problem• Frustrating results
Frustrating Results• I did everything I was supposed to, and myblood sugars are still all over the place !• I finally get my A1C down and now I mhaving all these problems with lows.• So now I m doing insulin like I m supposedto, and I ve gained 10 lbs. This sucks!
The Glucose Getaway“And you know, you can never take a vacation oreven the afternoon off from diabetes. Like a lot ofdiseases, it is a 24/7 job. I wouldn’t mind a littlebreak here and there. To go for a hike or even justa long walk and not have to worry about my bloodsugar…that would be pretty awesome.” -- Ginger Vieira
The Glucose Getaway• Pssst! Don t tell anyone, but…. everyone does it!• Often it is done unconsciously
Diabetes Care: Too Much To Do • Eat more fruits and vegetables • Limit sweets and saturated fat • Eat 3 meals a day • Cut your portion sizes • Be more physically active • Check blood glucose • Take your medications on time, every day • Have an eye exam at least yearly • Check your feet every day • Quit smoking • Make sure you glucose doesn t get too high, or low • Lose some weight, but not too much…..
You Can t Do it Perfectly• Good diabetes care is a compromise: • Have best blood sugars possible • Have no distressing hypoglycemia • AND have a spontaneous, fun-filled life
The Glucose Getaway• Pssst! Don t tell anyone, but…. Everyone does it!• Often it is done unconsciously• But there are two types: • Unsafe getaways • Safe getaways
The Unsafe (or Not Very Smart) Getaway• Leads to bad outcomes• Leads to guilt, emotional discomfort and more
The Unsafe (or Not Very Smart) Getaway1. Decide to completely ignore one’s diabetes for several decades2. Avoid blood glucose monitoring
The Unsafe (or Not Very Smart) Getaway3. A pound of chocolate candies every night
The Unsafe (or Not Very Smart) Getaway4. Skipping doctor appointments for a year5. “Winging it”6. The seesaw syndrome
The Safe Glucose Getaway• BG’s may not be perfect, but long-term outcomes are good.• Like any good getaway, it is mostly guilt-free, enjoyable and restorative. It enables you to return back to the “job” of diabetes
The Safe Glucose Getaway1. “On Sundays, my mom pokes my finger for me, then suggests what I need to do. For this brief period, I don’t have to worry about it.”2. “Every month, my spouse and I go out for a ferocious pig out. I dose up ahead of time (as best as I can), but for that one evening, I don’t think about diabetes.”
The Safe Glucose Getaway3. “I love my pump, but I get so sick of being attached sometimes. So every month or so, I just disconnect for a few days.”4. “CGM is awesome, but it does get old. Every couple of weeks is perfect for me.”
Everyone Deserves a Getaway• Plan ahead. Taking a break shouldn’t mean that your long-term BG’s have to suffer.• Identify a single change. Don’t take a break from everything!• Be reasonable. Don’t make it so long that it wrecks your long-term BG’s, but do it frequently enough to give you something to look forward to.• Dont do it alone. When you involve a loved one, you are more likely to be successful.
So What about You?• Tell us about some spectacularly BAD glucose getaways• Tell us about some safe and satisfying glucose getaways that work for you• Help us to inspire others!