Finding out you have diabetes and learning how to live with it can be a big challenge, regardless of the type of diabetes that is diagnosed. A big change is accepting responsibility for and undertaking ‘diabetes self-care’, which can be easy or difficult depending on your health, whether you believe it will help, whether you can actually perform diabetes self-care activities, and your beliefs about the risks associated with diabetes.

Although the focus is often on controlling diabetes, ‘control’ is not necessarily the main self-care goal — balance is.

Management in your hands
People with diabetes only consult health professionals occasionally; self-care therefore comprises 80–90% of overall diabetes care. Self-care is a type of delegated responsibility where health professionals expect you to undertake many of the diabetes
management tasks that were once their responsibility. It has emerged partly because of technological advances, such as blood glucose testing and insulin pumps.

Delegating diabetes self-care does not mean health professionals are no longer responsible for other aspects of care. Most people with diabetes still need regular health professional assessment and advice, at least yearly but often more frequently.
A respectful, trusting relationship where open, honest communication can occur is essential. Significantly, both health professionals and people with diabetes need to be prepared to compromise to develop a self-care plan that suits the individual.

In addition, people can only take on the responsibility for diabetes self-care if they have all the information they need. The information must be in a language and design (colour, font size, font type, layout) suitable to the individual.

What is diabetes self-care?
There are many definitions of self-care but most are technical and focus on ill health rather than health. They often neglect the emotional and spiritual aspects of self-care, or the significant and ongoing work needed to manage diabetes for a lifetime, i.e. without ‘holidays’.

People need to learn what is ‘normal’ for them so they can recognise when things are not right. Ten key diabetes self-care tasks are:

1. Setting goals for self-care and how it fits with life goals (also called ‘work–life balance’).
2. Eating a nutritious, balanced diet suitable to the person’s age, gender and health, as well as to manage blood glucose levels.
3. Undertaking regular physical activity/exercise that suits the individual.
4. Testing blood glucose (this includes most people, especially if they are on insulin and other medicines that lower blood glucose).
5. Knowing how to recognise and manage hypoglycaemia if using insulin or other medicines, and carrying glucose to treat it.
6. Managing medicines, which can get complex when prescribed several types that have to be taken several times a day with and/or without food.
7. Watching out for diabetes complications and other illnesses by taking care of their feet and attending regular assessments of blood pressure, eye and kidney function,
   and blood tests to check blood glucose (HbA1c) and blood fats.
8. Having regular health assessments beside diabetes check-ups, e.g. vaccinations, mammograms, prostate and dental checks.
9. Knowing how to manage illnesses and developing an effective working relationship with health professionals, including knowing who and how to ask for advice.
10. Knowing how to keep safe e.g. when driving, operating machinery and other motorised vehicles, such as wheelchairs and GoFors.

A lot of self-care behaviour and attitudes are acquired during childhood and may need to be revised when diabetes is diagnosed. Some of these behaviours are influenced by gender, culture and age.

Some obstacles to self-care are:

• Not having the relevant information needed to undertake self-care or solve problems
• Having relevant information but not being able to understand it
• Physical problems (e.g. arthritis, weakening vision) that affect exercise and can make BG testing difficult
• Psychological problems such as stress and depression
• Lacking support from family, friends or work
• Financial problems and difficulty accessing health professionals and services.

Including self-care in daily life
Positive thinking is important to good mental and physical health: self-care is essential to avoid admissions to hospital.

• Learn which self-care tasks you need to undertake and then reflect on your lifestyle and ability to decide how to fit self-care in your life.
• Discussing self-care with family and close friends may help. Discussing issues with other people with diabetes helps many.
• Explore your feelings about having diabetes and about self-care.
• Find health professionals you can trust to listen to you and with whom you feel comfortable.
• Experiment to find which routine will work for you. Different routines may work best for different days.

Professor Trisha Dunning AM, RN, PhD, MEd, FRCNA, is the Chair of Nursing at Deakin University and Barwon Health, and Vice-President of the International Diabetes Federation.

This article was originally published by Conquest magazine, published by Health Publishing Australia