Saturday, August 14, 2010

Diabetics Are Athletes Too: Knocking Out Old School Stereotypes

Image: Gary Hall
Diabetics are Athletes Too: Knocking Out Old School Stereotypes

November is National Diabetes Awaresness Month.The New York Times Best Seller "Diabetes Rising" lets us know we're not out of the woods yet...
Diabetes and an athletic lifestyle are not mutually exclusive. Diabetics are tired of walking out of podiatrists office with a prescription for shoes that look like Herman Munster's. They want a normal lifestyle. "Old school" doctors need to recognize that there are new and more appealing options for our patients. We must also take on the role of a coach for our patients that are athletes and those that need to become more like athletes.

Diabetic advocate and Olympic swimmer Gary Hall Jr. provides a first hand account of the problem:
"For all the efforts of removing the stigma attached to living with diabetes, the unfortunate mark of diabetes remains apparent in prescribed footwear. I dedicated my life to proving that diabetes didn't have to stop an individual from accomplishing their dreams, whatever that dream was. For me it was swimming in the Olympics. When I won gold I was able to help tear down that barrier (often viewed as liability) that separated people with diabetes from the rest of the pack. The important message was that while additional requirements were necessary in properly managing diabetes a person living with diabetes was equal. Somehow that message hasn’t come through in shoe design. If you have diabetes you are asked to wear, let’s face it, ugly shoes.

It’s hard enough to get diabetes patients to comply with the call to exercise. Asking someone to slap on ugly shoes and exercise exacerbates that challenge. With a diabetes diagnosis we are bombarded with the mantra, “diet and exercise”. Regular exercise helps increase insulin sensitivity and lower blood glucose levels but competitions have a dramatically different effect.
The stress associated with competitions sends blood sugars soaring. Throw in endorphins and adrenaline and levels can reach dangerous and dizzying highs. My targeted blood sugar level before a major competition (last glucose test taken five to ten minutes prior) was around 140 to 150. I competed in the 50 meter freestyle, it typically took me 21 second to swim. I would test my blood sugar immediately after a competition and my levels were never less than the high 300’s. This dramatic hike associated with Game Day is common for athletes young and old, fast and not so fast and is in stark contrast to the blood glucose effects of Practice Days.
I enjoy sharing with people that as a swimmer about 60% of my training was done out of the pool. For any athlete living with diabetes, at any level, it is imperative to have a good pair of “trainers”. Is it too much to ask that a good pair of diabetes friendly sneakers be good looking too?"

Fortunately, vendors that deal with diabetic are starting to get it. They are developing lines that incorporate style and function. Flying Virgin Air on the way back from Seattle it struck me that even the in coach class on a red eye style and attitude can dramatically affect the experience. They payed attention to lighting, eliminate the stock airline stewardess 2 finger point to the nearest exit in favor of a more friendly graphic presentation on the multi-use movie screen in front of your seat and convey a relaxed fun attitude.
Fear has it's place as a wake up call in certain cases but the unfamiliar will not help them comply when it comes to equipment. How much of what we dispense is actually worn at home? It turns out prescriptive shoes are only worn about 15% of the time in the home according to research by David Armstrong DPM . Appliances are only used about 25 % of the time.

In an uncertain fast changing world People are more comfortable with things that they are familiar to them. In Martin Lindstrom's New York Times bestseller, Buy-Ology he attributes this phenomona to the ritualistic behavior that becomes attached to branding. It explains why people engage in tribal behaviors as well.
It's a lot more reassuring to trudging through the morning commute to be part of the "Apple Community" with an army of I-Phone users. The natural conclusion is that positive peer pressure and coming up with ritualistic hooks may be the key for less motivated diabetic would be athletes. The World Fit program is an example of positive peer pressure in action. At it's outset it was targeting middle school kids with a monitored walking program to combat obesity. Olympic athletes are involved as positive role models and Gary Hall Sr., also a former Olympic swimmer is one of the principal organizers. The unexpected benefit was that adults started participating in the program as well because of their kids. What happened here?
In one sense a subculture was created. If we look at how strong that subculture can reinforce branding (think about a loyal legion of Harley Davidson riders) it may help us understand how we can create a subculture of diabetics as athletes instead of passive patients.

A Clockwork Orange and Compliance
The brutal movie, "A Clockwork Orange" explored how we are wired to do certain things like clockwork
without consciously thinking about them and the limits to which behaviors can be conditioned. Conditioning and association can be so powerful it can even affect our memory. There was a study done where people were able to remember a series of playing cards that had normal colors and symbols better than a a deck that had a reversed color scheme; red spades, black hearts etc. This helps explains why it can be so difficult to change behaviors to new ones when they are completely unfamiliar.
Our routines are also somewhat wired. Consider the data on stopping and starting on ulcer formation t just presented in Seattle. Apparently. takeoff shearing is the most destructive factor. If the routine is to get up and change the channel on the TV because the remote has a dead battery a series of such routines can profoundly affect an outcome. To that end, solutions that deal with that takeoff shearing would be something vendors could focus on in addition to our patients' lifestyle change.

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