© IDF (Europe) 1998

A Desktop Guide to

Type 1 (Insulin-dependent) Diabetes

Sections 5-8: Effective self-care

5 Patient empowerment
6 Patient education
7 Self-monitoring of blood glucose
8 Life-style issues - living with diabetes

TYPE 1 DIABETES - 5 - PATIENT EMPOWERMENT

( Top of page ) ( Guidelines contents list ) ( Guidelines index )

5 PATIENT EMPOWERMENT

A salient goal for diabetes care is to enable each person with diabetes to lead
the health-care team involved in the management of their diabetes

5.1 Assessment of empowerment

Assess whether the person with diabetes :

has the knowledge, behavioural skills, and sense of awareness necessary for optimum self-care
makes early and effective responses to everyday problems
has the confidence to obtain the best input from the diabetes health-care team

5.2 Achieving empowerment

Ensure that empowerment is :

a primary objective of your consultations and patient education programme
supported by availability of diabetes publications and other information sources
the active policy of your diabetes service

Provide

positive encouraging responses to requests for information and understanding
a copy of the European Patients' Charter or a similar national or local statement of rights and roles
a copy of the person's diabetes health-care record
information on the results and meaning of all investigations

It is the right of each person with diabetes to become empowered to derive the
maximum benefit from the health-care system

It is the responsibility of the diabetes team to ensure that the person with diabetes
can follow the life-style of their educated choice, based on the three elements
of empowerment: knowledge, behavioural skills, and self-responsibility

( Top of 'Patient empowerment' )

TYPE 1 DIABETES - 5 - PATIENT EMPOWERMENT

TYPE 1 DIABETES - 6 - PATIENT EDUCATION

( Top of page ) ( Guidelines contents list ) ( Guidelines index )

6 PATIENT EDUCATION

6.1 Assessment of patient education ( needs and achievements )

Use :

review of diabetes skills
( self-monitoring, injections, hypoglycaemia management, food identification )
biomedical measures ( changes in body weight, glycated haemoglobin ( Targets )
evidence of appropriate behaviours ( footwear, use of injection sites, membership of diabetes associations )
assessment of life-style, emotional adjustment, and perceptions of barriers to life-style activities and self-care
perceptions of desired short-term goals ( glucose control, weight ), and long-term vulnerability ( to late tissue damage )
knowledge ( as a basic measure )
diabetes-specific well-being and health profile assessments (as global measures)

Perform :

as part of routine care visits, by direct enquiry
as part of Annual Review, or first contact, more formally

The aims of education and training are to provide information in an acceptable form,
in order that people with diabetes develop the knowledge to self-manage their diabetes
and empower them to make informed choices in their life

6.2 Patient education targets

Aim to optimize :

knowledge of diabetes, and the aims of its management
motivation
attitudes to self-care
behaviours which interact with diabetes management
empowerment in handling health-care and other professionals

Aim to provide skills:

to ensure optimal and appropriate use of insulin therapy
to deal with the social and life-style consequences of insulin therapy
to be able to detect and manage hypoglycaemia and other complications of therapy
to be able to monitor the results of therapy and act appropriately on the results
to manage effectively nutrition and exercise
to enable appropriate self-management during intercurrent illness
to be able to formulate and agree health-care targets and strategies for meeting them
to use the professional members of the diabetes care team effectively
to understand and cope appropriately with the late tissue damage of diabetes
to make appropriate responses to unpredicted and new problems in diabetes care
to avoid self-destructive behaviours and deal adequately with stress

6.3 Provision of education

Integrate into regular clinical care by providing your own curriculum and programme

Ensure your diabetes team has adequately trained personnel

Assess special needs of each individual ( see above )

Be aware of needs of special groups ( young people, pregnant women, the elderly )

Perform education within three time frames :

At and shortly after diagnosis :

the minimum skills to obtain control over the new situation
supportive information on the nature and outcomes of diabetes
basic information on self-injection, self-monitoring, hypoglycaemia, dietary carbohydrate distribution

In the months following diagnosis ( on a one-to-one basis ) :

a comprehensive coverage
topics covered previously, plus
coping with illness, targets of insulin therapy, healthy eating
complications of diabetes, associated risk factors, foot care
employment or schooling, insurance, driving and travel ( Lifestyle issues )
pregnancy, genetic counselling, contraception

In the long term :

reinforcement periodically after annual evaluation ( see above )

Include family members and significant others as appropriate

Use group education to uncover problems and provide solutions and behavioural change through peer example

The tools of diabetes care can only be used effectively and optimally
when combined with the process of patient education and
with continuing evaluation of the outcomes of care

( Top of 'Patient education' )

TYPE 1 DIABETES - 6 - PATIENT EDUCATION

TYPE 1 DIABETES - 7 - SELF-MONITORING

( Top of page ) ( Guidelines contents list ) ( Guidelines index )

7 SELF-MONITORING OF BLOOD GLUCOSE

7.1 Use and assessment of self-monitoring

Advise use of self-monitoring for :

insulin dose self-adjustment
education on effects of life-style on blood glucose
coping with illness and new situations
hypoglycaemia management and avoidance

Assess ability to use self-monitored information as part of routine care

Assess skills yearly or if self-monitoring problems

Check meters yearly or if self-monitoring problems

Evaluate reliability of self-test results ( if indicated ) by :

assessment of self-test technique
comparison with acute results obtained at consultation
consistency with the results of glycated haemoglobin estimation ( Targets )
review of the quality of self-test record diaries

Unreliable records suggest a failure of patient education
by the diabetes health-care team

7.2 Achieving effective self-monitoring

Use

for all people with Type 1 diabetes
reagent strips with or without meters, or electrode strips

Provide appropriate training and regular review of technique

Recommend :

results are recorded ( with date and time, insulin dose, hypoglycaemia ) to provide a cumulative record as a basis for day-to-day changes in therapy

different patterns of testing according to need :

four or more times a day during illness, life-style changes, pre-conception, in pregnancy, with hypoglycaemia unawareness
at night ( 0200-0400 h ) if unrecognized night-time hypoglycaemia is suspected
one or two multi-point profiles a week ( on different types of day )
once daily testing is the minimal acceptable frequency ( different times of day )

day-time tests preprandially and 1-2 h after meals
regular bed-time tests in people prone to nocturnal hypoglycaemia
testing to cope with variations in eating or activity
special equipment for those with visual impairment
urinalysis for glucose where blood glucose monitoring is not possible or the patient does not wish to continue with it
urinalysis for ketones when hyperglycaemia, illness, or vomiting is present