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What is the Best Motivator?

I've heard that fear is a pretty good motivator.  Over my two plus decades with diabetes, I've heard the "fear tactic" from many medical professionals.  Actual statements:  "Make sure you test or your eyes will become diseased and you'll go blind." And "If you don't take care of yourself, you'll lose a leg when you're older."  And of course, "If you eat that, you'll end up with complications and then you'll have to live with that."  (see also:  ugh)

Fear has never been a good motivator for me.  When I'm scared, I have a tendency to hole up and hide.  When I think about the future of my diabetes, I know there is a good chance I will have some kind of complication. I have sat in the endocrinologist's office far too many times to tune out the threat of "what might happen."  I know what could be brewing.  Like it or not, I understand the effects of unmanaged diabetes.  I work hard to manage diabetes.  But I'm not so hot with managing the fear.

And if, for even a second, I forgot what diabetes complications may be waiting in the wings, I have many things to remind me.  Like the pamphlets at doctor's offices.  And the commercials on TV.  And videos about how diabetes can cost you a leg.  

That video makes me so frustrated because if I had seen it before the diabetes online community had bloomed, I would have been so distressed.  The images in that video would have haunted me, but not in a way that would impact my diabetes favorably.  That kind of video makes me want to stick my head in the sand and pretend it's not happening, instead of taking charge and control of my own disease and realizing I have the ability to impact my future health TODAY.

Give me hope any day.

I think it's more important to remember that there is a good chance I WON'T have some kind of diabetes-related complication. That some combination of good care and good support and good luck (yes, I think some of it is just plain luck) will usher me into my later years without a scary complication. Fear is not the best motivator for me - hope is far more effective.  I hope to be healthy for a long time.  And it's hope that keeps me testing my blood sugar every morning, working with my doctor to best-manage diabetes, and monitoring this monster closely. I don't want images of amputation flashing in front of my eyes every time I go to grab my meter.  I'd rather think about blowing out the candles on my 75th birthday party, a strong and healthy old bird.

Fear?  No thanks.  Give me hope any day.


This about sums up my feelings about the video. I couldn't believe this is the one they chose instead of something hopeful, something to show that life can be good in spite of diabetes.

I'd never seen that video. I'm extremely disappointed World Diabetes Day produced that. I have so much to say but let me just share that I can see a glimpse of where you're coming from, and I choose hope with you.

Well Said! :)

Thanks for this post - I try to always take the positive angle on living with diabetes. Yes, fear is a big motivator; hence it's used by news, govt, and corporations. But, other motivators can include the desire to improve your personal health. I have multiple family members who have had a leg amputation; this video frustrates me because it doesn't take a positive spin at all. They could at least say that "it doesn't have to happen with good BG control. Learn more about how to live with diabetes." The D-O-C really adds value to these types of dialogue, thanks for sharing this post.

i am so with you, babe. fear is deadly. right now i'm listening to a pema chodron talk on fear, and one of the things she talks about is "going to the places that scare you" - you can't do that if you're paralyzed with fear. but you CAN do that if you have hope and joy in your heart! good for you for spreading the word. xo

i was just thanking science the other day while i was driving and listening to my 5 year old daughter (dx'd @ 11 months old) singing along to gwen stefanni. my faith in science and my belief in what the future holds for diabetes is what helps kick fears arse out of my mind. i look at the strides that have been made just since her diagnosis over 5 years ago and look ahead to what awaits us all. even if it is not a cure it will be something better than today and that makes me thankful for science. oh and about the video... i did not click the link, i can't.

I have not even watched the video yet and I am upset. When I got it in my e-mail, I saw the title and thought "what in the world are they thinking?!" If you want more people to find out if they have diabetes and treat it appropriately, scare tactics are not the way!!

Agree with you. I think sometimes the doctors are taught to teach fear when it comes to diabetes. But hope is a much better motivator. Sometimes there is a place for instilling fear in someone over the way they are caring for themselves, but it's RARE. And if doctors used it RARELY, patients would probably listen more.

Fear is a motivator for me, but the video disappoints me too. Are they trying to goad people into getting screened, be more "compliant" or make a statement about the D's impact?

Personally I would have done a shot of looooong queues of people in cities around the world. Maybe even show a time lapse of a kid standing in line their whole life and still waiting. But then, that wouldn't be quite so dramatic...

What does the screenwriter think? ;)

When I worry about complications, I always think about "A Christmas Carol." I've seen friends and family decline and die of diabetes complications, and I call them the "ghost of Christmas future." As Scrooge says, "Are these the shadows of the things that Will be, or are they shadows of things that May be, only?" I know that the unholy trio of blindness, amputation and heart disease only May be, and it is up to me to keep them in that category.

Did not watch the video...not sure if I want to.
And yes, I totally believe that Luck is part of the equation. As we all know, sometimes (a LOT of times) there is just no rhyme or reason to this!
When I was at one of my worst a1C's...with in the same month, my dentist and retinal specialist both said, "Wow! I can tell you have tight control and a great a1C based on what I'm seeing in your gums/eyes". I was embarassed to tell them my a1C at that point!
Thanks for always posting great things!

Oh I SO agree Kerri! I, myself, have never been motivated out of fear to do anything in life. It is in the promise that the motivation lies for me. It is the hope for something better. And the same goes for my T1 kiddo I believe. That we do al the things that keep her #s in control, we go see the doctor, we do things we don't want to do, because there is hope that she will go to college, marry, have kids if she chooses, become a grandmother and an old woman, who happens to have T1. How we get there is the on the road of hope and promise and positiveness, not the road of fear.

I spent much of my adolescence avoiding my diabetes because fear caused to to feel hopeless and like a lost cause. It wasn't really until I found the DOC and found hope that I really managed to get control of this beast. I think this is an important message to pass along to the medical community: preach hope instead of fear and maybe your patients will take better care of themselves...

I wish more doctors understood this... Fear drove my T1 management for the past 11 years and didn't help much. As soon as I became hopeful (the possibility of a healthy pregnancy/healthy baby - thank you Kerri and BSparling) my A1c's dropped into the 6's for the first time EVER. For certain, it's been more testing, more diligence, more communications with my CDE and thank God for my CGM - but HOPE played an equal part in that victorious A1C. Heading to my Endo now - to celebrate! (yes, it's a sick world we D's live in... ) :-)

I let fear drive me for the longest time after being diagnosed in '83 - mainly because the "offline" nature of my exposure to those with T1. Mostly older T1's with complications - and one in particular - well you would have to redo the video with NO footprints and just wheelchair marks.

A potent mix of hope, frustration and not wanting those kids I meet through JDRF to have to go through the same things I did before I had hope - that is what motivates me now. That distant light at the end of the tunnel is finally getting closer!!

Fear most certainly did not get me where I am now...it actually drove me in the opposite direction. I'm like you; I hid when I'm afraid. Hope is what got me to dust myself off, shake the cobwebs and get myself movin' toward better control. The DOC played a major role in that. So yeah. I'm siding with Hope all the way.

Fear doesn't work. I have yet to meet a diabetic who is motivated to good control because of fear. Sure, maybe when you're first diagnosed, but it doesn't last long.

Ugh! So true, thank you! Until just a few years ago I honestly thought I was doomed. No one should go through teenage years feeling hopeless but I did. I'll be right next to you spreading the word about how hope crushes fear any day! Thanks for reminding us.

I agree with a comment left on the video site-Changing the tagline to "untreated" or "uncontrolled" diabetes can cost you a leg is a lot more accurate, and I think it gives hope too.

I'm with you, give me hope and encouragement and it will go along way with me!

Thanks for sharing this with a large audience. I really disagree with the IDF's choice to use this video; but since Kerrita left the organization, it's anyone's guess what goes into the organization's thought process, but consulting with patients isn't on the list, that's abundantly clear. With that in mind, I am seriously reconsidering whether to throw support behind World Diabetes Day. There are so many other initiatives to support, and with ads like this, I am inclined to put my efforts behind Insulin for Life instead.

Dude... Dude.

I ... Ugh. Dude.

Really? For serious?

I was so disappointed. We're never going to make any progress by trying to scare people.

Like Rachel said, I've never met anyone who was motivated for the long haul by fear.

uggh. I am so at my limit with how WDD is being portrayed this year that this has just sent me over the edge. I swear to God, if my son sees that on TV someone's head will roll, somehow.

Anyway, fear no. Truth is a motivator for me though. Anything with emotions attached don't help me, but truth, knowing that my child is so many times less likely to have XYZ if we keep his a1c in a good range. I need the facts. Just the facts. Call me joe friday.

I have mixed feelings about the ad, and appear to be in a small minority of people who don't feel especially offended by it. I don't feel like the ad is targeted at me (or you, or t1's), so maybe that's why I kind of shrugged at it. My take is that it's targeted at t2's and people who either have undiagnosed t2 or are at risk. In my personal experience, and this is purely anecdotal, it seems that there are a fair number of t2's who seem to grossly underestimate the consequences of undiagnosed or mismanaged diabetes, and really, the same can be said of too many people in the general public who think diabetes isn't a big deal. So I do think there's a place for informing people about complications in awareness campaigns, I just don't know what the right way to do that is. As has been mentioned, if the ad qualified diabetes as mismanaged or undiagnosed, would that have been satisfying to people?

Another problem I see is that it's hard to identify what's going to motivate people to get tested if they aren't having symptoms that are noticeable enough to be concerning or distressing. Those are the people who let it go undiagnosed for so long that by the time they get diagnosed, they either have complications or they're darn close. It's not like a t1 whose diagnosis is caught long before they have to worry about complications.

I think the ad highlights the challenges of educating the general public about how diabetes is a serious disease (i.e. you can't just have "a touch of sugar"). It also highlights that motivating people to get tested despite the fact that they're either not symptomatic or aren't symptomatic enough to seek medical intervention is a real public health issue. I just don't think this ad is *that* bad, and I think it shows that creating effective ad campaigns and educating people isn't such a black and white issue.

Disappointing indeed! I work hard every day to get future docs to NOT use fear like this. Diabetes Educators, myself included, understand that fear is mostly ineffective. Most people do not respond positively to negative reinforcement or threats. Emphasizing overall well-being, not just related to diabetes/glycemic control, is the way to go and is supported in the research literature.


Thanks for inspiring us to keep hoping for the best that this journey can be :)

This is a great post. Though I don't have diabetes, as a cancer survivor I found the message universal: Fear Paralyzes, Hope Inspires.

Though I can see Lee Ann's point about the ad being a means to raise people's awareness of the issue, it is disappointing that people somewhere find these fear inducing methods worth-while.

Biggest motivators? Self-respect (taking care of myself) so I can take care of others (my husband and daughter). If you respect yourself, you'll take care of yourself as best you can.

you said it! That's exactly why I named my blog Don't Fear Diabetes. Fear doesn't get you very far. I think you do a great job of showing how full of life you can be with diabetes, and how normal it is to have a complicated relationship with it. I swear, if people don't change the way they portray this disease, and start sending more positive, encouraging, hopeful messages, I'm going to cut their legs off!

Thank you all for your comments. Just to reiterate, this video is NOT targeted at those with type 1 or type 2 diabetes. It's aimed at the millions and millions of people around the world who are at high risk of diabetes but don't get tested because they don't think diabetes is serious. Type 1 diabetes is auto-immune and not preventable, but 85% to 95% of diabetes cases worldwide are type 2 which CAN be prevented through a healthy lifestyle and early interventions. This particular video is a wake-up call to those at risk of or predisposed to type 2 diabetes.

We also reach out to policy-makers and governments the world over who need strong messages, scientific evidence and proof of impact to public health and the economy to convince them to fund diabetes and integrate diabetes care into healthcare systems. Sugar-coated messages are lost on them because they deal with conflicting priorities. Right now, diseases like HIV/AIDS get disproportionate amounts of funding because of their strong grassroots/political campaign with hard-hitting messages. All chronic diseases (TB, cancer, heart disease and diabetes) cause 60% of global deaths but get 0.9% of total health funding.

What this means is if you have diabetes in developed countries like the US, UK or Canada, health systems are better-equipped to take care of you and you can live a (relatively) normal life. But if you have the misfortune of getting diabetes in Africa, it’s virtually a death sentence. Your family abandons you because they simply cannot support the cost of your treatment. I invite you to see this short about Sam who is 19 and struggles with his type 1 diabetes in the slums of Kenya. http://vimeo.com/9461078

Let’s also keep in mind that 4 out of every 5 people with diabetes now come from low-and-middle income countries. It’s plunging families and entire communities into poverty and is very much a development issue. So I hope we can appreciate there is a bigger picture here. The World Diabetes Day campaign is not only about this particular video and goes beyond the type 1 community alone.

Of course, there is a human element to this. And at IDF, we think that people with diabetes, especially those with type 1, are nothing less than unsung heroes, who do amazing things to live with a condition that is no fault of theirs. Not just them, but also parents who care for children with type 1, their friends, family and loved ones deserve credit for being part of the support structure needed to deal with diabetes. As we mentioned, we’ve planned campaign videos to depicting just that, saluting those living/shining/excelling with diabetes.

Apologies for the long comment, but we want to let you know that your feedback is important to us. World Diabetes Day is a people’s campaign and needs your support and understanding to be successful. Thanks again.

Hey, at 75 you will not be an old bird, remember it is only 57 in reverse, you will be a healthy young bird.

WDD, The video is aimed at low to middle income countries? I doubt those people will be watching YouTube. This video was sent to diabetes bloggers obviously because I've seen it mentioned on a lot of these D-OC sites, so tell us again who it is aimed at? I think you guys were taking a low blow and the D-OC has called you out for doing it.

I especially hate the fear argument because taking good care of yourself doesn't guarantee that you WON'T have complications. Fear is a great motivator in the short term, but you can't live every moment in fear.

I can't help but shake my head at some of these negative comments and bad reaction to the video. When I watched it, my first reaction wasn't one of anger, nor did I think it was a scare tactic video. In fact, it spares us what some might find uncomfortable imagery like actual amputated limbs. Instead I see a clear, simple message done in under 1 minute that makes me want to pay greater attention to my health.

Perhaps if Jane Knight(see article below) had seen a video like this, she wouldn't now have to wear THREE prosthetic limbs.


I agree our doctors and medical assocations have used the "stick" of complications to make people realize the dangers to uncontrolled glucose levels with good intentions.But for those of us who have lived with diabetes for years, the stick gets old. We are just not in the same place as those who can avoid being diagnoised or treated. Those of us who need insulin and/or pills have a greater understanding of our condition by necesity.
Years ago, I became annoyed by the pre categorized assumptions of diabetics and having diabetes.I also felt the focus of my life had more to do with avoiding complications and death, than living life to its fullest.
Something that gave me food for thought was a talk by Dr. Jessica Bernstein in Berkely CA. Throught her talk and excerpts of her film, I had a chance to look at the programing we all hear about health and chronic illness from outside the box. I was surprized by how the most obvious of references to health effected my perception of my diagnosis and how those messages at times gave me excuses for not having hope and caring for myself. Changing the "stick" to a sentence.
Dr. Bernstein's website is http://www.bloodandhoney.org/talks.html .This link is a description of her message and film. Maybe this will help some of you.

I can remember being in the hospital when I was 6 months pregnant. I have been diabetic since I was 12 and this was my first pregnancy so I was trying really hard to toe the line. My dr. had completely changed my insulin types and dosages so it was no surprise to me that my sugar would be high as we tried to figure out what to do dosage wise. He wanted me to call him with any highs and told me to go to the hospital immediately. When I got there he actually yelled at me and told me that I needed to pay more attention and he wouldn't be surprised if my child died and it would be from my carelessness! I cried so hard and it took several nurses to calm me down so we could correct my sugar. I completely agree that scare tactics don't work!!

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