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Mastering Motivation with Diabetes

By Adam Brown

Twitter summary: Master motivation by asking great questions, identifying key barriers, and using proven tactics for diabetes, diet, exercise, and more

Have you ever heard a “motivator” like this...?

“Try harder! Don’t you want to avoid diabetes complications and live a longer life?”

I find statements like this frustrating for several reasons:

  • They are vague, and it’s not clear what specific actions should follow;

  • They make change sound unrealistically easy, ignoring the unhealthy environment we live in;

  • The reason to act is a benefit far off into the future: short-term sacrifice for no immediate gain.

I think about motivation all the time. When it’s high, I’m like a car equipped with GPS, snow tires, and four-wheel drive – I can overcome the harshest weather conditions and perilous roads. When my motivation is low, I’m the same car stuck in a ditch on the side of the road without gas. And my phone is out of battery!

The hardest part about motivation is that everyone needs something different, and motivators can change over time. But for most of us with diabetes, motivation needs to be more tangible than “avoid long-term complications” or “live a longer, healthier life.”

That’s where this article comes in. I’ve tried to write a motivation how-to-guide based on my experience, my conversations with diaTribe advisors, and many books. It starts with key questions to ask yourself, shares proven tactics for building and sustaining motivation, and identifies key motivation mistakes. I also share my personal motivators, in case they are useful.

Please let me know what you think via Twitter or email – hearing from readers makes my day!

I. Ask the Big Questions

1. What is my purpose? Why is managing my blood sugar, eating healthier, or exercising important to me now? We all need a compelling reason to build motivation – otherwise, all the hard work won’t seem worth it. The ideal answer to this question is specific and short-term! For instance, does diabetes affect my mood, relationships with others, ability to do things that make me happy, or other areas of my life that are important?

  • I am motivated to _____ now because ________.

  • How would life be different if I ________.

  • Review this statement often: a post-it on the bathroom mirror, the background on a computer screen or phone, etc. It’s a great pick-me-up when motivation wanes.

2. On days when I am incredibly motivated to manage my diabetes, eat well, or exercise, what are the biggest factors driving that? Challenges, barriers, and setbacks can obscure my vision, but the good days are even more important – that way I can replicate them!

  • What big or small things do I do on “super motivation” days? What do I avoid on those days? How can I have more of them? _________

3. What are my biggest barriers? Here are two ways to identify them:

  • Imagine that in the middle of the night, while sleeping, a miracle happens, and all my troubles are resolved. When I wake up in the morning, how will I know? (Credit: Switch)

  • Have a partner or friend ask you the following questions. Fill in the blanks with your own responses. The answer to the last question is often the key barrier that needs to be addressed. (Credit: Dan Pink at SXSW)

    • Partner: On a scale of 1 to 10, how ready are you to ______ (insert your desired goal, like start exercising 30 minutes each day)

    • Me: I’m a __ out of 10 [insert number out of 10, with 10 being ‘very ready’ and 1 ‘not at all ready’. For example, “I’m a 6”]

    • Partner: What would need to happen for you to go from a ___ [current number] to ____ [higher number]? (For example, “to go from a 6 to a 7”)

    • Me: I would need to _____. (For example, “find someone to walk with me after work”).

4. Is my environment crushing my motivation? What can I change to make the desired behavior easier? Surroundings have a massive impact on behavior, often overshadowing the most fervent motivation. The challenge is recognizing what is holding things back – sometimes it’s big and obvious (weather), while sometimes it’s small and barely noticeable (storing food on the counter vs. in a cabinet).

  • Evaluate: What is my goal and what are the key barriers? See questions above.

  • Experiment: What changes can I make to my environment to make the desired behavior easier? For example, stop buying certain foods so they are not in the house; use smaller plates or eat with chopsticks; obtain duplicate glucose meters so there is always one nearby to test; get exercise clothes ready the night before; don't eat food directly out of containers, etc. The important thing is to try lots of different experiments – everyone’s environment is different!

II. Try These Motivation Tactics

I’ve seen different people use the following tactics effectively, but there is a lot of variance – not all of these may work for you.

1. What is the absolute smallest step I can take right now to improve things? Think tiny and specific – what can be done in the next five minutes? When I consider the magnitude of a big goal, the thought process can be truly de-motivating. Focusing on the immediate next step – even when it is small – is often enough to boost my motivation, and from there, it can snowball! A journey of a thousand miles begins with a single step. Just. One. Step.

  • Examples: Eat one extra vegetable at my upcoming meal; go for a walk around the block right now; test my blood sugar one extra time today; floss one tooth today; make an appointment with my doctor.

2. Do I feel a sense of progress? Am I improving? Drive author Dan Pink calls this “mastery,” and boy is it motivating! Conversely, feeling like I’m trying hard and making zero progress is the absolute least motivating thing in the world. Here's what helps me during times of zero progress:

  • Make the goal easier or more near-term. If a goal is too lofty, it can be hard for me to even start, or the payoff for hard work can feel too far away.

  • Measure! Sometimes, it’s hard to see progress when I’m not objectively monitoring it. I may be making inches of progress each day, but if the goal is 10 miles, it’s going to be hard to see. Monitoring can take the form of a device, an app, handwritten data, or even the watchful eye of a partner or a friend.

  • Choose actions that can really make a difference. It might be that a selected action is doable (e.g., drinking more water every day), but won’t really have the desired impact (e.g., better blood sugars). Ask, "Are my actions serving the larger goal?"

  • Try a different approach. Zero progress could mean I’m simply going about things the wrong way. There are many ways to achieve a goal; what else can I try? Sometimes it’s adding something (an extra walk after work), or taking something away (one less restaurant meal each week), learning something new (how to sleep better), or reaching out for help.

3. Where can support from others help?A little help from my friends’ can be a huge motivator; the critical part is figuring out where and how. I find support is most helpful around eating – it’s such a social activity that the people around me can make a truly meaningful difference. Here are ways to find more support:

  • What can someone start or stop doing to help you, even in small ways? What does a loved one say that is super motivating and helpful? What is harmful or de-motivating? Those around me cannot read my mind – I must give clear and honest feedback!

  • Can a friend or loved one help me eat more or less of certain foods? – e.g., when I see my best blood sugars (ideally 80-140 mg/dl) 90 minutes after a meal, what did I eat? When I see higher blood sugars (over 200 mg/dl), can someone help me eat less of those things?

  • Can I find an exercise partner, try an exercise class or team, or experiment with a social exercise app? (e.g., Fitbit for activity tracking, Strava for running and biking, Fitocracy for workouts)

4. What kind of goals get me fired up? A well-phrased goal can add turbo boosters to my engine, while the wrong one can clog it up.

  • Be SMART: Behavior experts talk about setting SMART goals that are Specific, Measurable, Achievable, Results-focused, and Time-bound. See this helpful guide from the University of Virginia on setting SMART goals.

  • Process goals: I’m also a big fan of process goals, which focus on the interim step of doing something rather than the outcome. For example, checking blood sugar before and after every meal or riding my bike three times every week. Focusing on the process can ensure the larger goal is served (e.g., better blood sugars), but with less pressure to hit an outcome.

  • Moderation vs. abstinence goals: One alcoholic drink per week on Saturdays (moderation) vs. no more alcohol (abstinence). Some people do better when they have a little wiggle room, while others excel with strict avoidance. Abstinence works best for me when it comes to food, though I know many who are the opposite!

5. Have I built in rewards? We all need sticker charts! The right rewards can be powerful motivators, and it’s okay to celebrate small gains. Just make sure the rewards don’t conflict with the larger goal – e.g., a buffet meal when the goal is weight loss. What kind of reward would fire me up and pull motivation through on the toughest days? I’m a big fan of experiences as rewards – a place I’ve been wanting to visit, a dinner with loved ones, etc.

6. Am I motivated by frequent data on my performance? It’s hard to argue with data, but I have some friends who respond really well to it, and others that don’t. Here are some ways to get constant feedback and use it as a motivational tool:

  • Check your blood sugar more often or wear CGM (Dexcom, Medtronic); if you’re in the EU, you can also use FreeStyle Libre.

  • Answer the first two questions in my diet commandments column from March (what foods keep your blood sugar in range, and what foods throw it out of whack?).

  • Try wearing an activity tracker or using an exercise app (I’m a huge fan of Fitbit and Strava because they are easy to use, give frequent data, allow easy goal setting, and let you know when you’ve achieved a personal best).

  • Try a Wifi-enabled scale (Aria, Withings).

III. What Motivates Me?

The key with motivation is to find what works for you, and it will take some experimentation. Give some of the tactics above a try, think of your own, or ask your healthcare team to help you brainstorm!

As for me, teenage Adam was definitely the car on the side of the road without gas and a dead phone (Nokia brick!) – my diabetes motivation was miles from where it is today. Why?

Those pesky, vague, long-term motivators didn’t help. It wasn’t until college that things clicked – I connected the rewards from hard work to near-term benefits, I got on CGM when I began working at diaTribe, and I learned more about nutrition and diabetes.

In case you’re wondering, here’s what motivates me now:

Diabetes

  • When my blood sugar is in range, I’m a nicer, more patient person; I have more energy to do things that make me happy; I smile more and am less stressed; I sleep better; and I can think more clearly (and thus, help more people through better quality work at diaTribe and Close Concerns).

  • Reminding myself that blood sugar values are neutral information and not judgments on my performance. What can I do right now to improve this number? (Instead of, “How could I be so lame and eat that!”). Admittedly, this one can be hard to do in the heat of the moment!

  • Remembering that diabetes is still effectively a death sentence in many places in the world. I’m incredibly lucky to have access to diabetes tools and resources; failing to take advantage of them would be disrespectful to those who don’t have access.

Food

  • Wearing CGM – seeing the real-time glucose data after a meal has dramatically changed my food choices.

  • Thinking about how a food is going to make me feel (positive or negative) after I eat it.

  • Asking myself, “Am I really hungry?”

  • Clarifying my personal diet commandments and the foods that work for me.

Exercise

  • Remembering how much happier and less stressed I will feel when I’m done.

  • Using Fitbit and Strava, and having friends that also use them.

  • Signing up for a long-distance cycling events that feel like reach goals, especially to raise money for diabetes (JDRF, ADA)

  • Living in San Francisco, which is walkable, bikeable, and has year-round good weather. (I don’t take this for granted for a second! Though even growing up in suburban New Jersey, I found ways to be active given environmental constraints).

IV. Motivation Mistakes: Going Beyond the Obvious

1. Go beyond fear or financial rewards. These carrot-and-stick approaches (as author Dan Pink calls them in his brilliant book Drive) narrow the brain’s scope and focus. They are effective when the task is super clear, like leaving a burning building or stacking boxes. But fear and cash rewards typically work poorly as a motivational mechanism when people need to have a wider focus (e.g., coming up with new ideas). Managing diabetes, eating well, and exercising often require exactly that kind of expansive view, which makes these strategies ill suited for motivation. See Dan Pink’s compelling TED talk to learn even more from him!

2. Education and knowledge are terrific, but they won’t solve everything. Getting smarter about a topic is an effective motivator in many cases, but it’s not the only factor needed. Even the best learner may struggle to exercise or eat well if the environment is not right, or if the steps to take are too vague or daunting.

  • Example: 42 million Americans (18%) still smoke cigarettes despite widespread educational efforts that smoking is bad for health (and 50 years of Surgeon General warnings!). Education and public awareness are clearly important – in 1965, 42% of the population smoked, compared to 18% today – but they are not the only factor that matters.

3. Assuming what works for me will automatically work for someone else. In my experience with activity tracking devices and apps, some friends love them, while others try them for a day and never use them again. Why?

It comes back to this article’s central thesis – each of us must do our own motivation experiments!

What motivates you? Please let me know!

V. More Resources

Switch by Chip and Dan Heath – A compelling read on hitting the three necessary factors to change any behavior: intellect, emotion, and environment.

Drive by Dan Pink – Drive is business-focused, and makes a compelling case that intrinsic motivation is what matters (autonomy, mastery, and purpose).

The Power of Habit by Charles Duhigg – A story-filled exploration of how habits work: cue, routine, reward. It’s great on audiobook!

Nudge by Richard Thaler and Cass Sunstein – How small changes in the environment can make a big difference.

Mistakes Were Made (But Not By Me) by Carol Tavris and Elliot Aronson – This was a profoundly valuable book for me about self-rationalization and cognitive dissonance (the stress of holding two opposing ideas in your head at the same time). In the words of physicist Richard Feynman, “The first principle is that you must not fool yourself, and you are the easiest person to fool.”

Postscript: A special thanks to experts Dr. Korey Hood, Dr. Bill Polonsky, Ms. Virginia Valentine, Ms. Hope Warshaw, Dr. Jill Weissberg-Benchell, and Ms. Gloria Yee, who gave me guidance on the first draft of this piece. We’re so lucky at diaTribe to have an outstanding Advisory Board and I benefited from so many of them this month! 

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