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.

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.

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

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

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

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."

Next: 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.

Daily Management of Diabetes

Blood Glucose Test

Insulin Injection

Hypoglycemia - Low Blood Glucose

Hyperglycemia - High Blood Glucose

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"