Diabetes management: Viewpoint of the patient

Several topics of interest to the diabetic patient will be covered. The structure of the diabetic clinic, and how it might be reorganised to fulfill more clearly defined objectives. The aims and objectives of the medical consultation, and how it shduld have greater emphasis on health and successful coping skills. The difficulty of assessing glycaemic control, a problem both for clinical research into diabetes, as well as for everyday management. Lastly, the effects of insulin upon feeling states and behaviour, and how alterations in feeling state could be used as a self‐monitored index of glucose level. The traditional diabetic clinic can be divided into three groups: physicians, patients, and nurses, with each group in a state of stress. The physician is stressed through excessive work load and unclear aims/objectives. The patient is stressed through inactivity, boredom, and uncertainty over the usefulness of the consultation. The nurse is stressed by doing unskilled menial tasks. Any solution to this state of inefficiency must involve a workload reduction for the physician. This could occur through the greater use of trained nursing specialists. However in order for this restructuring to be undertaken, the aims and objectives of the medical consultation need to be considered. Current consultations seem to be medical/ motivational, concerned with urging tighter glycaemic control over the illness ‘diabetes’. A more useful consultation for the patient would be medicall educational, concerned primarily with being ‘diabetic’. It would need to become more positively orientated, concerned with life skills, and strategies to deal with the problems typically faced by diabetics. The central aim of the consultation should be to aid the diabetic to develop a more successful lifestyle.