Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-15

INDIVIDUALIZING TREATMENT GOALS

In general, all individuals should be introduced to the concepts and principles of IT. The benefits and costs should be discussed with them as they apply to their specific situation. Individuals should be able to make an informed decision about intensifying their therapy. From a medical perspective, there are few contraindications to IT. A more physiologic approach to insulin replacement allows for the prevention of hypoglycemia, if adequate SME and SMS accompanies an intensive insulin regimen (16,25). Other factors, such as lack of a support network, lack of financial resources or ineffective coping strategies, will continue to make living with diabetes difficult for the person but are not necessarily deterrents to IT. Being able to meet individual goals for diabetes may enable the person to deal more effectively with other issues in their life. The major contraindication to IT remains a severe cognitive, physical or psychological impairment to adequately engage in self-management. Factors that may make IT inadvisable include a history of significant clinical depression, presence of an eating disorder or substance abuse. Individualized c glycemic goals should be established with the patient and consideration given to age, duration of diabetes, risk of hypoglycemia, presence or absence of cardiovascular disease, life expectancy, lifestyle and personal risk factors (6). Living well with diabetes is a lifelong endeavor. Individual goals will change throughout the lifespan. IT is not an “all or nothing” proposition: one can choose to perform some or all of its components. The educator’s role is to support the person with diabetes to make informed decisions.