Increasing Independence

Everybody's support requirements are individual.
  • 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.


Before You Begin

Get to know the person you are carer for.

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

  •     Communicate using their preferred style of communication

  •     Identify what the person can naturally do for themselves

  •     Identify how the person learns

  •     Discuss with the person as to what they would like to take responsibility for

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


How People Learn

Everybody learns differently.

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


Learning Can Occur By:
  •      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


When Explaining Diabetes Try To:

  •     Speak directly to the person

  •     Use simple words

  •     Listen to what the person says or indicates

  •     Demonstrate what needs to be done

  •     Go through instructions step by step

  •     Check the person understands by observing and using open ended questions

  •     Give feedback immediately


Comments from People with Intellectual Disability about their Diabetes

  •      "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."


From the Carer

  •     "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."



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

Print these tables and show them to all key carers.


Daily Management of Diabetes



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

Blood Glucose Test


Person can do for


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.

Insulin Injection


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


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.






Hyperglycemia - High Blood Glucose


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

Comments from carers on supporting a person to managing their diabetes themselves

  • "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."


Comments on what makes it difficult for a person with intellectual disability to understand diabetes

  • "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"