Increasing Independence

It is important for the carer to provide support and assistance to the person with diabetes. It is also important for the person to take some responsibility for managing their diabetes themselves.
Their ability to manage themselves will depend on their ability to understand, and their competence and capacity to carry out the tasks.
Support should be provided when the blood glucose levels are outside the ideal range.
There is a lot to learn about diabetes and many skills to acquire to successfully manage it.
Carers are often the people who provide the initial and on-going education to the person with disability.

It is much easier to explain and assist the person to look after their diabetes themselves if you are able to:

Know who the key people are that need to be involved - family, staff, health professionals

Some people need to see the 'big picture' first whilst others need to learn the little bits that make up the big picture.

Some people learn by listening whilst other people learn by pictures, diagrams, or by being shown

Involving the person in their menu planning and writing of the shopping list
Showing how to cook healthy meals
Talking about their blood glucose test result and what may have caused it if it is out of the expected range
Encouraging exercise and discussing how it impacts on their diabetes
Leading by example - 'Let's go together'
Negotiating changes to increase activity like removing the remote control of the television

"I can't eat lollies or sweet food."
"I like walking; it reduces the sugar and I lose weight."
"I can't eat greasy stuff or salt and I can't eat Chinese all the time or pizza."
"I change the needle on the pen."
"I manage my diabetes with a needle and diet stuff and tablets."
"I can't eat anything with sugar."
"I can drink light beer."

"She writes it all in her book."
"She can prick her finger and put the stick into the machine."
"He chooses which finger to prick for the glucose test."
"She takes her own blood sugar levels; she doesn't't draw up but gives her own injection."
"She pulls her shirt up and shows me where she wants me to put the injection."

Activity

Identify each of the following actions the person can do for himself or herself

Print these tables and show them to all key carers.

Action	Person can do for themselves	Assistance Required
Eat meals same time every day
Eat low fat meals
Select healthy foods
Exercise regularly
Check feet daily
Take medication if required
Take insulin if required
Visit doctor or diabetes health team as per scheduled visit

Action	Person can do for themselves	Assistance Required
Get blood glucose testing kit
Wash and dry hands
Turn blood glucose meter on and insert strip
Dispose of the lancet in the sharps container
Prick side of finger with lancet
Press finger to squeeze out a drop of blood
Put blood on the strip
The next step depends on the Glucometer being used. Some strips can't be removed from the meter. Some strips actually pipette up the blood, with the strip in the meter.
Wait for results
Write the blood glucose level in the diary
Understand the result and take appropriate action
Think about what the result means. If it is high, why can it be high? If low, why is it low? Document blood glucose level, time, symptoms, food and drink consumed and activity prior to the reading, and action taken after the reading.

Action	Person can do for themselves	Assistance Required
Get insulin
Dial up insulin dosage
Self inject correctly or gives consent for approved person to administer insulin
Show preferred site for insulin injection
Dispose of needle themselves into a 'sharps' container
Write dosage up in diabetes diary

Action	Person can do for themselves	Assistance Required
Understand what causes a 'hypo' - Hypoglycemia
Identify their symptoms
Treatment - Stop what they are doing
TELL someone they feel sick
Ask for assistance to test blood glucose level
Eat something sugary like a jelly bean or 1/2 glass lemonade
Wait 10 - 15 min. If not better, repeat blood test and eat something sugary
If feeling better, eat piece fruit or sandwich or have milk drink.
Try and test blood glucose levels again.
If feeling better person can go back to what they were doing.
If not feeling better ambulance may need to be called.

Action	Person can do for themselves	Assistance Required
Understand cause of Hyperglycemia
Understand symptoms
STOP what they are doing
Tell somebody they don't feel well
Ask for assistance to test blood glucose level
May need to have a drink and check diabetes medication has been taken
If not getting better ambulance may be called

"This has taken months but it has been worth it."
"In the beginning I used to dial it up myself and give it to her and encourage her to do it."
"Joining the dots on the blood glucose graph to show her how her BSL is going up and down before and after meals."
"Took a lot of time and perseverance on both sides (to assist her to become independent)."
"Need time to show her."
"She does not like change at all, it has to be done very slowly."
"Modeling was the best way."
"I don't use the word sugar as she thinks of it as grains."
"I tell him if its OK or too high; but if I said a number I don't think he would understand what that means."
"We just muddle along and we will try something and if it doesn't't work we don't do it again."
"He tends to forget so we have lent him a tape recorder and we encourage him to use it."
"Assure her that we will try very hard with the medication and the diet and exercise to control it but it is all up to her."

"What is stopping her from doing the right things? - Probably because she just doesn't want to do it"
"Their communication may be verbal but the difficulty is with the ideas and the language and the concept so you have to make it more concrete"
"We will explain it to her but she will forget"