How Missing This Cardinal Rule of Behavior Change Messed Up My Blood Sugars
You'll never guess what it was...
A couple of weeks ago, I decided to change up my diabetes management. I had been running a “green streak” (blood sugars over 70% time in range, so that my Clarity goal page was all green) for weeks, and I decided it was time to challenge myself and bring my blood sugars into an even tighter range. I lowered my high glucose threshold on my CGM and I narrowed my target glucose range on Clarity.
Almost immediately after doing that, my blood sugars actually got worse.
Now, part of that was definitely from some hormonal changes creating added insulin resistance, but I also noticed something shift in my mindset. I didn’t even really realize what was going on. But while I was reading the book Atomic Habits by James Clear, something clicked.
The reason why all of my diabetes management behaviors suddenly felt like a drag (even though nothing had really changed) was because the act of tightening my range on Clarity meant that my green streak vanished. I knew that was going to happen, but I didn’t realize what kind of impact that would have until I experienced it first-hand.
James Clear states the 4th law of behavior change is to “Make It Satisfying” and that the cardinal rule of behavior change is “What is immediately rewarded is repeated. What is immediately punished is avoided.”
What I was getting on a daily basis from my green streak was essentially a near-immediate reward of keeping up the streak. It felt good to see that streak go on and on. And sure I felt physically better too, I had fewer roller coasters and overall less intrusions in my day.
But it was the green streak that I had attached meaning as positive feedback about my behaviors. I had done gamification with my diabetes management and I was winning! And it felt great! And now without that positive feedback and reward - and in fact, I was now almost guaranteed to fail because my target goal was much more challenging - suddenly all my diabetes management habits and behaviors had sort of… lost their luster.
I knew the long-term reasons to keep doing them (as we all do!) but being stuck in what James calls a “delayed-return environment” just didn’t do anything for me. I needed something immediate to keep my spirits up in the midst of the work.
So did I revert back to where I started?
I realized two things:
I needed to have some kind of immediate positive feedback to reinforce my behaviors by making them feel satisfying. Seeing the green streak helped me feel satisfied with what I was doing in a way that the cognitive knowledge of “doing the right thing” failed to make me feel.
I did need to make some modifications in my behavior or I wouldn’t see any progress.
So what I ended up doing was moving my goal target range back to its original parameters, but I kept my high threshold where it was. That means I’m still notified earlier about rising blood sugars so I can take action (if necessary), and thereby helping me reach my goals of a lower A1C and even a tighter time in range, despite the fact that the time-in-range goal on Clarity hasn’t actually changed. Being alerted on my CGM earlier will do that for me just fine. I also haven’t made my goal such a challenging reach that I have stopped getting positive reinforcement altogether. This makes my diabetes behaviors feeling rewarding in the immediate, not just the future.
And that I think is my main takeaway from this experience. Shifting things environmentally to make improvements (in my case, the high threshold alarm) is a good thing, but we still need ways to feel like we are getting that immediate positive feedback. If our expectations suddenly become too challenging, we may inadvertently lose the motivation we were trying to gain.
We need some way of feeling a sense of satisfaction earlier in the process in order to encourage and maintain the behavior. Yes, eventually I will feel satisfied by a lower A1C, but it could take weeks or months to get that kind of feedback. We need short-term methods of reward because the long-term methods of good health and well-being are, frankly, too long-term.
As James writes, “A habit needs to be enjoyable for it to last. Simple bits of reinforcement … can offer the immediate pleasure you need to enjoy a habit. And change is easy when it is enjoyable.”
So what do you think of this behavior change law? Leave your thoughts in the comments!
Honestly having it spelled out like that, it makes a lot of sense. It's the same thing I deal with re: exercise. I know all these long term benefits from getting outside and walking a bit, but it has been so hard to establish the habit. Right now, the only way I've found to be consistent is by using an app that tracks my walk and then sharing that with my friends. They've been cheering me on every time I share a photo of the app screen, so I keep going out to get that pat on the back lol. It just seems to work!