The Lean Anthology

107

Chapter 10

Using Process

Behavior Charts

TRACY SCOTT MANAGES

HIS BLOOD SUGAR

As you eat and drink, glucose enters your

bloodstream. Then your pancreas secretes

a hormone that allows your body’s cells

to convert the glucose to energy—unless

your pancreas doesn’t. If that hormone

doesn’t materialize, the glucose will just

sit there, and then you’ll be in trouble.

Tracy Scott’s pancreas didn’t secrete that

hormone. So several times a day, he had to

determine his glucose level and whether

he needed to inject the hormone—

insulin—directly into his bloodstream

with a needle. Such is the life of a person

with type I diabetes. And food wasn’t the

only thing to consider: exercise, stress,

health, environmental factors, and other

While enjoying lunch with his friend

Daniel, Tracy, a diabetic, describes

his plan to control his blood sugar

levels. He distinguishes between

routine variability and special, or

assignable, causes (i.e., travel), which

might require him to eat unfamil-

iar or nonoptimal foods. His close,

systematic observation of the factors

that might increase his blood sugar

swings and his efforts to eliminate

them have had the effect of estab-

lishing a continuous process for

improving his self- care.

As you read Tracy’s story, think

about what he might do next on

his path of continually improving

his health.

108 THE LEAN ANTHOLOGY

medications could all affect glucose level. When it was high, Tracy

added insulin, but when it was low, all he could do was ingest some

carbohydrates as soon as possible, much as a blood donor is quickly

offered juice and crackers.

By planning his intake of carbohydrates at each meal, measuring his

blood glucose level several times a day, and adjusting his insulin level

by injection as needed, Tracy could avoid cardiovascular disease, kidney

failure, nerve damage, blindness, and amputation, among other health

risks. But keeping track of all this could be quite a complex process. Tracy

had made a game of it—something he not only had to do but also was

interested in doing. He used a spreadsheet to keep track of everything,

for example, which gave him another excuse to carry around his tablet.

While out to lunch with a colleague, Daniel Stagnaro, Tracy recorded

the hamburger and fries he ordered, piquing Daniel’s curiosity.

USING PROCESS BEHAVIOR CHARTS 109

Daniel: What are you doing?

Tracy: I have diabetes. I use this spreadsheet to keep track of things

that affect my blood sugar.

Daniel: Are you supposed to eat hamburgers?

Tracy: It’s hard to know what to eat sometimes. There are so many

factors that can affect your blood sugar when your body can’t

regulate it for you. Hamburgers are actually fine for my blood

sugar; it’s the fries I need to worry about.

Daniel: Really? Hamburgers?

Tracy: Hamburgers aren’t the greatest in terms of fat content, but from

a carb perspective, they’re okay.

Daniel: I have to take cholesterol- lowering medication. I know the feel-

ing. I don’t like the idea that I need to take medication to stay

healthy. Especially when the medication has other side effects.

110 THE LEAN ANTHOLOGY

Tracy: I have to take statins, too. On that front, the hamburger

might not have been such a good idea. As a matter of fact,

I take four medications related to the diabetes and choles-

terol problem.

Daniel: I feel your pain.

Tracy: Well, we all get dealt a different hand of cards, right? I’ve got

great children, an amazing wife, I love my job—not many

people can say all that. Diabetes management is a pain, but

it can be done. I use this spreadsheet to make a game of it.

Daniel: A game? How do you win?

Tracy: Every time I improve my process for managing the blood sugar

variations and lowering the average level.

Daniel: What do you mean?

Tracy: It’s just like any complex system with multiple, interacting

inputs and one resulting measured output. In this case, the

inputs to my spreadsheet are diet, exercise, medication, and

special causes. Special causes are usually something environ-

mental that’s either outside of my control or a change from

the normal routine. For instance, I usually bring my lunch.

Today is different because I ordered off a menu. The output

is my blood sugar, which I measure with this meter [takes it

out of his briefcase] and these test strips.

Daniel: Hmm, I’m still not seeing the “game” here. It’s great that you’ve got

a system down, but I don’t understand how you can improve.