Self-care Of People Research Articles

Facilitating Self-Care in People With Diabetes

Why is diabetes management so difficult for most people with diabetes, and what can we as health care providers do about it? These questions probably cross your mind numerous times every day. The answer to the first question is pretty clear—diabetes is a demanding disease. It is there all the time, 24 hours a day, 365 days a year (or 366 days a year on Leap Year, as an 8-year-old patient recently pointed out to me). My son once told me he has to stop what he is doing and deal with (or at least think about) his diabetes at least once every 15 minutes. The demands are not only continuous, they are often unpleasant as well, whether they be shots, finger sticks, or lifestyle changes. As if that were not enough, even doing all that hard work does not guarantee normal blood glucose levels and freedom from immediate and long-term problems. We all know that there is no way to perfectly manage all the factors that affect blood glucose levels and other risk factors. Even participants in the Diabetes Control and Complications Trial, with all their motivation and all the support they received, did not achieve normal HbA1c levels as a group. Continuous, unpleasant demands and unpredictable results—that is a recipe for what I call diabetes overwhelmus. Many people with diabetes are simply overwhelmed by the demands of diabetes management. Diabetes overwhelmus often triggers a negative cascade. Many patients tell me that when they feel overwhelmed, they take a “to hell with it” attitude toward diabetes self-care. Few people give up altogether, but many say they are less active in caring for their diabetes when they are feeling overwhelmed. Less active self-care generally leads to blood glucose levels farther from normal. That tends to increase the physical and …

Patterns of diet related self-care in diabetes

Our understanding of self-care actions can be enhanced by examining both the meanings attached to them and the context in which they take place. This article discusses patterns of diet-related self-care in a group of people with insulin-dependent diabetes. The study, based on a phenomenological perspective, consisted of 91 interviews with 34 people who discussed their everyday experience of living with diabetes. Individuals' response to the diabetes diet can be characterized on a continum that includes strict adherence to diet to no adherence. Factors influencing how individuals responded to the diabetes diet can be grouped into three categories encompassing individual, diabetes-related and contextual influences. Many individuals sought an appropriate balance between health and well-being. When the pursuit of health did not compromise well-being adherence to diet was not a problem. When the pursuit of health conflicted with well-being individuals took liberties with the diet in order to minimize its impact. Implications for promoting self-care in people with diabetes are discussed.