On the Neuroscience of Engagement

Last week I had the privilege of attending Dr. Larry Chu’s (of Medicine X) Engage and Empower Me course, serving as the moderator of the Tweetchat portion of the class. The topic was the “Neuroscience of Engagement”, featuring guest lecturer David Eagleman. I encourage you to watch the entire presentation if you have time, but I want to focus on the specific action items David mentions when talking about ways to improve our own engagement with our health.

  1. Minimize Temptation
  2. Risk Money
  3. Recruit Social Pressure
  4. Leverage Emotion
  5. Establish Habits

Proper diabetes management unfortunately has the potential to frequently brush up against diabetes burnout if I’m not careful. The harder I try to keep things “normal”, the more frustrated I become when I don’t see results. That frustration leads to more aggressive efforts to control my diabetes, which in turn leads to less control and more frustration. Eventually I have to take a step back and refocus my efforts, but not without taking a “break” from my typical on-the-nose diabetes care that I need to implement on a regular basis if I want to be as healthy as possible.

David’s presentation discusses some ways to help with taking control of our health and, in my case, ways to minimize the potential for diabetes burnout. These tips start around the 30 minute mark of the video above, if you’re curious. Of course this is all easier said than done, but the core concepts are enough to get me thinking about better ways to approach my own diabetes management.

1. Minimize Temptation. “If you’re in AA, what’s the first thing you do? Get rid of all the alcohol in your house.” For my diabetes management, this means eliminating foods that have the biggest glucoaster potential. There’s nothing wrong with having ice cream or a cookie from time to time, but the key for me is moderation. My dinner plate needs to be balanced with a protein and a vegetable serving along with a low-impact carbohydrate. It’s okay if I venture off and have a cheeseburger from time to time, but that should be a reward for following a proper meal plan, not a regular occurrence.

2. Risk Money. “Having money on the line gets people present to the financial cost of not doing what they are supposed to do, what they know they should do.” This is exactly why I had a gym membership in Virginia. This is exactly why I need to sign up with a gym here in San Francisco. Even with a cheap rate, having a recurring investment in my personal health is a reminder that there’s more on the line than just my health.

3. Recruit Social Pressure. “Social media is a really crucial part of patient engagement.” Which is why we’re all here, right? This is one of the reasons why I share my Dexcom graphs, even when they disgust me, because I don’t want to hide behind any illusions that managing my diabetes is something that I can do alone. I rely on that feedback loop of sharing and interacting with my health data. Posting these kinds of pictures keeps me accountable for my actions in case I need any additional motivation to improve my care. Or, in the case of encouraging results, if I need a reminder that doing the right thing has genuine benefits, I can look back on no-hitters and see what taking care of my diabetes can result in.

4. Involve Emotion. “A lot of the brain, a lot of our decision making is steered around by emotion.” It’s easy to get frustrated by diabetes. Even when I do everything “right”, it’s still possible to get less than desirable results. Sometimes knowing when to involve emotion is just as important as knowing when not to involve emotion. Controlling my emotions when making diabetes-based decisions is particularly difficult when I’m looking at my meter showing off a 365 mg/dL for no good reason. Understanding that the science of insulin takes time to work, and that taking another 10 units of Humalog may not be the safest or smartest approach at the moment is difficult. I just want to get back in range as soon as possible, and my emotions are frequently the strongest motivator behind that desire. If I can control my emotions, I can control my reactions to less than ideal diabetes situations; hopefully getting back to “normal” sooner rather than later.

5. Establish Habits. “In your moments of sober reflection, what rules do you set up so you don’t do the wrong thing?” Perhaps the ultimate diabetes management tactic. Recognizing trends and determining best practices for them ahead of time (and following those practices when the time comes), is difficult with my diabetes because the same plan of action doesn’t always work the same way. But if I can minimize the variability, potentially by following the previous four steps, I can encounter more consistent diabetes scenarios and as a result, more consistent diabetes results. I know keeping to these habits will be tough, especially in moments of weakness – like a low blood glucose reading and a full fridge – but if I can set up and keep to healthy diabetes habits, I know I’ll tend to have more good days than not so good days.

I know there’s a lot of hypothetical in this post. And the biggest variable with all of these steps, at the end of the day, is me. Can I do this? Can I keep doing this?

There’s only one way to find out.

One thought on “On the Neuroscience of Engagement

  1. I am always so far behind reading blog posts and then I feel like leaving a comment is irrelevant… But this is a fascinating post. It’s really helpful to hear about your thought process as you take this new information and apply it to your diabetes. It makes so much sense. Thanks for writing about all of your MedX experiences.



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