Six Impossible Things Before Breakfast: Examining Diabetes Self-Care

Abstract

“I dare say you haven’t much practice,” said the Queen. “When I was younger, I always did it for half an hour per day. Why sometimes I’ve believed as many as six impossible things before breakfast.” —Lewis Carroll, Through the Looking Glass Judging from the quote above, Lewis Carroll’s White Queen from Through the Looking Glass is clearly a very smart lady who knows something about diabetes, because the advice she gives to Alice could also apply to diabetes. When it comes to diabetes, though, we not only ask people to believe impossible things, we actually ask them to do impossible things. We know that diabetes is associated with serious complications. It has complicated treatment prescriptions and demanding lifestyle requirements. Furthermore, daily care for diabetes is done by people with diabetes and their family members. It is not surprising that diabetes self-care can affect family relationships. And, unfortunately, a person’s lifestyle and life priorities may conflict with the treatment prescription, putting that person in a very difficult position. Our broad goal for diabetes care is to maximize the health and quality of life of people with diabetes, while preventing complications and minimizing costs. Once complications occur, the Diabetes Control and Complications Trial (1) showed us that their progression can be slowed; thus, we can focus on maximizing our patients’ health while striving to maintain their quality of life. Diabetes education and the people who provide it play an important role by helping people with diabetes and their families find information about diabetes and, importantly, helping them learn how to use that information. The education process also supports people as they learn the skills necessary to understand their treatment, integrate diabetes self-care into their lives, and adapt to the unexpected events and changes that life may bring. We learned from meta-analyses …