Overcoming Barriers with Jane Abbey: Introduction

Fit4D CDE, Jane Abbey introduces her blog post series focused on overcoming barriers to successful diabetes management. 

Preventing Self-Sabotage; Can Keeping a Journal be the Answer?

Preventing Self-Sabotage; Can Keeping a Journal be the Answer?

What to do when you're falling into old, bad habits? Fit4D CDE and RDN, Erin Spitzberg recommends keeping a journal to identify and overcome hurdles and achieve optimum diabetes control!

Your Pharmacist Can Be Your Diabetes Educator

Fit4D CDE, Elise Swenson, writes about how patients can get the support they need by using their pharmacist as a diabetes educator.

Your Top 10 Nutrition Questions Answered!

Your Top 10 Nutrition Questions Answered!

Fit4D CDE and RD, Jennifer Bonczek, answers 10 common nutrition questions for Nutrition Month, with links to helpful resources such as recipes. 

A Step by Step Guide to Getting the Support You Need to Manage your Diabetes

Diabetes Support from Family, Friends, and more

There are 29 million people living with diabetes in the United States (American Diabetes Association).  That is equal to 9.3% of the population.  Yet many people with diabetes report that they often feel alone in managing their disease.  Managing diabetes often includes making changes to one's diet, increasing physical activity, taking medications, and self-monitoring blood glucose levels.  These changes can feel overwhelming when an individual doesn't have people to lean on.

Where can people with diabetes find the social support they need?  Family/social support can help to alleviate these feelings of isolation, while also positively impacting diabetes treatment adherence.  Often the people you already spend time with everyday such as family, friends, and co-workers can be invaluable in helping out. 

When building a social support network, it is important to be clear with yourself on several matters before reaching out and asking for support. 

First, what is it that you need help with?  One suggestion is an exercise partner. It is more fun to exercise with someone than to do it alone.  Also you can help to motivate each other to exercise on days when you're not "feeling it".  Another idea is to have someone help with reminders to check blood glucose or to take medications.  Some people might like their family to keep an eye on what/how much they are eating, while others don't want to deal with the "food police.” 

Second, you have to determine who can be most helpful.  It may be your spouse when it comes to grocery shopping and cooking together.  It may be a co-worker for a daily walk during your lunch break. Then figure out how they can best support you.  Is it a text in the morning asking if you've taken your medication?  Or perhaps a hug when despite your best efforts your blood sugar is too high.

Once you've thought about the type of support you are looking for, you will need to educate your friends and family about diabetes.  There are many misconceptions out there about living a healthy life with diabetes.  It may help to have loved ones come to a diabetes class with you, or send them to a website such as www.diabetes.org (The American Diabetes Association).  Also let your loved ones know exactly how they can best help you.  And of course teach them how to give the support you need.

The two key factors to effective support from close family members are: maintain realistic expectations about blood glucose levels and avoid blame.  Family members must understand that you cannot always control blood glucose levels, even if you follow your diabetes care plan.  Blaming the person with diabetes for high or low blood glucose levels does not help and can cause hurt feelings and arguments.  The key to genuine support is to focus on problem solving.  You and your healthcare team can help to convey this important message to family members.

There are other places to find support outside of your circle of family and friends.  Check with your local hospital to see if it offers diabetes classes or support groups.  The American Diabetes Association website (www.diabetes.org) has a section where you can search, by your zip code, for events that are close to you.  Check with your physician's office to see if they have any diabetes support group meetings or ask if they are interested in starting one.

Also, today in our ever-connected world, online communities can provide a different forum for support.  There are multiple groups on Facebook that people can join.  There are groups that specialize in Type 1 diabetes and also groups for Type 2 diabetes.  The American Diabetes Association website has online support with an active message board.  People with diabetes check in with each other and post their morning blood sugars, favorite healthy recipes, and tips for staying active.

No matter where you look for support, realize that you are not alone in managing diabetes.  If the burden starts to feel like too much, you can always seek the help of a professional counselor, social worker or Certified Diabetes Educator. 

Jodi Daigler, RD, CDE

Fit4D Diabetes Health Coach

The Five Stages to Successful Behavior Change

OK, so we are a few weeks into 2016, and many of us may already be wavering from our New Year’s resolutions, if not completely forgotten them.  Why is it so hard to make changes?  James Prochaska, from the University of Rhode Island, has studied this question for more than thirty years, and has applied his theory to many health behaviors, including behaviors important in diabetes management.

Prochaska has found that people who have successfully made positive change in their lives go through five specific stages: precontemplation, contemplation, preparation, action, and maintenance.

  1. "Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under-aware of their problems."  Some people call this phase "denial."  

  2.  "Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action."  Many people in this stage can be described as ambivalent.  They want to improve their blood sugar, but are not yet ready to cut back on eating sweets.  

  3. The Preparation stage can be considered the information gathering and planning stage.  The preparation stage is the most important.  Fifty percent of the people who attempt behavior change and skip this stage will relapse within 21 days, according to Prochaska in his book, Changing for Good.  

  4. "Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy."   During the action stage, one implements the plans developed and information gathered in the preparation stage.

  5. "Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action."

Most people I work with, who have diabetes, could be categorized in the contemplation stage. They are seriously thinking about life changes, but have not yet made a commitment to take action.  Therefore, I think it valuable to further explore this stage.

Within each stage, specific actions called, "processes of change," help someone mentally move through each stage successfully.  In the contemplation stage, the processes of change are “consciousness raising” and “self-reevaluation.”  

Consciousness raising is the process of actively becoming more aware, mindful or conscious of the current situation.  Some activities include, keeping a food diary to learn more about how much I am eating, monitoring blood sugar to learn how well or if my treatment plan is working, or reading food labels to learn about how much carbohydrate is in different foods.

Self-reevaluation flows naturally from consciousness raising.  Self-reevaluation means taking stock or appraisal of the behavior that needs to be changed, and reveals how your values conflict with the problem behaviors.  

An activity which will help clarify your values, or "why" you want to change is called “decisional balance”.   The decisional balance takes into consideration the pros and cons of behavior change.  Understanding pros and cons helps one acknowledge that behavior change has good consequences, but requires sacrifice.  

Take a piece of paper.  Divide the paper into two columns.  Label one "pros" and the other column "cons".  Under each column answer each question: ·        What will be the consequences of my behavior change be for me?  

  • What will the consequences of my behavior change be for others (family, friends, coworkers)?  
  • What will my reactions be to my new self?  
  • What will the reactions of others (family, friends, coworkers) be to my new self?
  • If the pros of change outweigh the cons, then one is ready to move into the preparations stage! This sets the foundation for the preparation, action and maintenance stages.    

I once heard a radio interview with James Prochaska.  He said that making a behavior change should be approached as if you were getting ready for a major surgery.  How much pre-planning would you do?  How much support would you solicit from friends and family? How much mental attention would you put towards it?  It would be your number one priority, and you would choose a time when there would be nothing else within your control that would take precedence.  You would not choose a time when you are making a marital change, job change, major vacation, getting ready to move to a new house, etc.  Healthy behavior change is that difficult, and it is that important.


By: Donna Webb, RD, LD, CDE

Fit4D Diabetes Health Coach  


Cancer Prevention Research Center. University of Rhode Island, 2016. Web. 10 Jan. 2016. <http://web.uri.edu/cprc/about-ttm/>

Prochaska, J. O. and W. F. Velicer (in press). “The transtheoretical model of health behavior change.” American Journal of Health Promotion.

Prochaska, PH.D., James O., John C. Norcross, PH.D., and Carlo C. Diclemente, PH.D. Changing For Good. New York, NY: Harperollins Publishers, 1994. Print.


New Year Resolutions - Managing Your Diabetes Effectively


It's the beginning of the New Year - the perfect time to review what you are already doing to take care of your diabetes and what changes you can make to manage it better. Most Year Year's resolutions begin with a great start, but often fail due to lack of motivation or burnout issues. Managing diabetes is not easy, especially with the many roadblocks that one may face. When trying to make a lifestyle change, one of the biggest challenges of individuals with diabetes is not knowing how to set appropriate goals. Here are some tips to help you be successful in implementing lifestyle changes: 

1) Set up a goal: As you work on setting your goals, it is important to set specific and realistic goals. A specific goal has a greater chance of being accomplished than a general goal because you know the behavior you would like to change and the estimated time-frame needed to achieve the goal. Goals such as, "I will eat three servings of vegetables at least 6 days a week," are more specific and realistic than, "I will eat more vegetables every day." Another example might be, "five days a week I will walk for 20 minutes after dinner," rather than saying "I will walk everyday."

It always helps to have the goal written down as a visual reminder. This means you could write it on a sticky-note and place it somewhere you can see it multiple times a day; or you can set reminders on your phone, tablet, or daily personal calendar.  

Once you have set a goal and have been successful in its implementation, you can advance the goal. You can now say, "I will eat four servings of vegetables everyday," or, "five days a week, I will walk for 30 minutes after dinner."

2) Have a Plan: Now that you have set goals to work on, set a time frame for implementing them. You also want to think about barriers that may prevent you from accomplishing your goals. Barriers may include something like not having the time to prepare recipes that include more vegetables. You could work around that by buying more frozen vegetables or salads and you can revamp your traditional recipes to make them easier and quicker to prepare. 

3) Implement your Plan: Have a daily log that helps you track changes you have already implemented. 

Remember that in spite of your best possible efforts, there may be days when you are not able to follow through on your goals. That's OK, as long as you don't lose sight of the bigger picture. 

Now that you have set some realistic, achievable goals and have actually implemented them, it's time to reward your accomplishments. It is important that the goal is relevant to you and that you have a reward and recognition system in place. You want to reward yourself with something that is appropriate to what you have accomplished. It needs to be affordable, available soon enough after successful implementation, and valuable and meaningful to you. 

In addition to specific goals you may want to implement, here are some general goals to help keep your diabetes under check:

  • Follow-up with your Healthcare Provider 3-4 times per year and more often if situations arise
  • Check your blood sugars daily
  • Take your medications as prescribed
  • Check your feet daily
  • Schedule an appointment with the dentist twice a year and an annual comprehensive eye exam


1) www.joslin.org (Joslin Diabetes Institute)

2) www.diabetes.org (American Diabetes Association

Vidya Sharma, MA, RD, LD, CDE