The Need For Selfmanagement

Diabetes management requires a number of deliberate and largely conscious behaviours of significant complexity. In type 1 diabetes, the individual must alter food, insulin and physical activity on an hour-by-hour, day-by-day basis. In type 2 diabetes, management of medication, food consumption and physical activity are critical to good outcomes. For all people with diabetes there is a need to monitor blood glucose levels and make predictions, using bodily indications of hyperglycaemia or hypoglycaemia and external cues, such as time of day and physical activity. The person is also required to use health care services to screen for early signs of complications, and engage in preventive activities, such as foot care. This range of behaviours needs to be maintained by an individual within the context of helpful and unhelpful peer and social pressures, domestic and economic responsibilities and distracting life events.

If self-management is inadequate and blood glucose falls too low, the individual suffers problems of hypoglycaemia—disruption to activity, loss of control, embarrassment or fear, loss of driving license, hospital admission or, on rare occasions, death. However, if blood glucose is high for too long there is a risk of kidney failure, heart disease and loss of vision and limbs. The costs of poor self-management are thus enormous in terms of the impact upon quality of life, especially in the physical, emotional and social domains. Most recent studies suggest that 8-9% of NHS expenditure is spent treating the complications of diabetes alone1'2.

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