Management of Diabetes

Successful treatment and management of diabetes very much depend upon the motivation and positive engagement of the affected person. There is a considerable element of self-management involved and so the person with diabetes needs to acquire knowledge about the condition and to understand why he or she is advised to follow a certain course of action. It is a very good idea for the person's family to be involved as well, and education about all aspects of the condition is a very important part of the work of the diabetes clinical care team. Usually, the diabetic person will be asked to attend the first examination/ interview in the company of a close family member so that the process of education can begin straight away. There are very many aspects to this but the most important is that it should be tailored to the individual needs of the person concerned. It is an ongoing process and the requirements may change over time. Many clinics offer group sessions after the initial interview, covering everyday aspects of living with diabetes and allowing plenty of time for discussion. These can be very helpful, allowing new friendships to be made and experiences to be shared in an informal and enjoyable way. There are a variety of educational materials available dealing with different aspects of diabetes, including leaflets, books and videos, which are a helpful source of information that can be referred to at home.

During the initial interview, general educational aims will include:

• Establishing a good relationship or partnership with the person and listening to his or her views
• Exploring the person's current beliefs about diabetes and other health issues with a view to correcting any that are inaccurate
• Attempting to get to know the whole person by talking about family, work responsibilities, cultural and religious beliefs etc., all of which may affect his or her ability to manage diabetes
• Explaining clearly the nature of diabetes and the reasons behind a proposed programme of treatment which is likely to include some of the following: diet and weight control, lifestyle changes, exercise, and drug or insulin treatment
• Setting realistic goals, worked out in partnership, which the person feels able to achieve
• Explaining and demonstrating all aspects of management and treatment, probably including home blood glucose monitoring, home urine testing, when to take tablets and the effects that they will have, when and how to self-inject insulin and the type and nature of the insulin being used. All this will be worked out so that it can fit in with the person's usual daily routine.
• Ensuring that the person understands the importance of attending subsequent appointments and how to get in touch quickly with the diabetes care team, should the need arise
• Asking the person how he or she feels about the diagnosis of diabetes in order to assess the person's state of mind and giving reassurance, when necessary.

Psychological factors have a major impact on the treatment and management of diabetes. The person may be in a state of shock on receiving the diagnosis and may be finding it hard to absorb the information that is being given. It is very important that this should be recognized and that the person is dealt with sensitively and feels supported by the clinical team. Plenty of time may be needed to discuss the person's fears and to endeavour to build his or her self-confidence and belief in the ability to cope. Hence the amount of information (education) given in the first instance may need to be limited to that which is strictly necessary and the person may possibly be referred for further counselling or psychological care.