I don’t think I’ve ever met a person with diabetes who has said that they don’t want to live a long, healthy life. However I meet people all the time who are having a hard time managing their diabetes well. On the surface, this seems confusing. These people are saying they want to be healthy and then not following through with what they said they want. Does this mean that these people don’t want to live long, healthy lives, or is there more to the story?

People with diabetes’ behavior, like all humans’ behavior, is shaped by reinforcement and rewards. Simply put, this means that we do things that give us pleasure and we avoid doing things where the cost is more than the perceived benefit. The more obvious and meaningful the benefit, the more motivated we are to behave in a certain way. Think back to when you were a kid and your mom told you that if you do your chores, then she’d give you a treat. Most kids will (try to) do their chores because they know that if they do, they will get something out of it.

So what does this have to do with diabetes? Managing diabetes well means doing a lot of things. If you have diabetes, take a minute and think about all the things you do every day to manage your diabetes. What motivates you do these things? What causes you not to? Some diabetes management behaviors have an immediate reward. For folks with T1D, if your blood sugar is high and you feel awful, taking insulin will make you feel better. This one is simple because there is an obvious and tangible reward. But other for other diabetes behaviors the ‘reward’ for doing the right thing can be really abstract and too far off in the future to help someone make the choice to behave in a certain way.

Most people with diabetes have a hard time motivating themselves to make good choices all the time, however motivation can be especially tough for people with type 2 diabetes (T2D). Often people with T2D don’t have any symptoms, or if they do have symptoms, they are mild and they don’t even notice them. The only reason they know they have diabetes is because their doctor told them they do – it is an abstract concept. Then, in order to manage their diabetes, they’re told they have to make some pretty big changes to their lifestyle. If the person felt sick, and they knew that making these changes would make them feel better soon, then making these might be a bit easier. But since a lot of times the person doesn’t feel any different than they always have, finding the motivation to change can be a bit more challenging. This is not to say that there is no benefit to making these changes, but the benefit is not something that necessarily offers immediate reinforcement. A lot of times it is a choice between something you want now and avoiding the possibility that something bad will happen in the distant future. A lot of prefer an immediate payoff because the future just seems to abstract. If someone offers you $100 today or $500 a year from now, a lot of people will choose the $100 today because they have a hard time thinking a year ahead, and they can have $100 that they can spend right now – a concept known as hyperbolic discounting.

This presents a big challenge for people with diabetes. Diabetes is a serious condition, whether a person has symptoms or not, and making lifestyle changes and taking medication can help manage diabetes. But people with diabetes continue to have a hard time making these changes. This doesn’t mean that these folks don’t want to live long, healthy lives, it means they are human. As a diabetes community, our challenge is to help people to find the motivation to make these changes, even when there is no immediate and tangible benefit for doing so and to find ways to build rewards into the change process.

Do you have any thoughts or ideas on how to do this? Leave a comment below!