Monday, June 24, 2024

The Four Pillars of Diabetes Self-Management

Imagine yourself waking up from a nightmare at 3 a.m. with sweats from an episode of low blood glucose (sugar). Your day progresses with the lack of sleep. Although food provides you with comfort, you need to consider the importance of portion control. You remind yourself you will need to check your blood glucose levels prior to eating and 2 hours after your meals. Not to mention being mindful of the numerous scheduled appointments with the physician, the diabetes team, the endocrinologist, and the nephrologist; and the routine check-ups for your eyes, feet, and dental health.

The essence of diabetes self-management encompasses more than just numbers discussed in the physician’s office.

It also includes the day-to-day management of this chronic condition and the collaboration of various key players: physicians, nurses, dieticians, and family members.

Unfortunately, when you finally feel comfortable that you have gained control, the inevitable progressive nature of diabetes will challenge you to change with it.

As a diabetes nurse educator at a community health center, I often work with clients that require assistance with basic needs in housing and social support.

Ultimately, these aspects obscure their ability to self-care.

But what drives their motivation to stay healthy with diabetes, despite these challenges?

Here are some ways that can help you build the backbone for self-management:

  1. Explore your feelings and find the key to unlocking your motivation from within1-3. What does it mean for you to have diabetes and stay healthy? Take ownership of your health.
  2. Set simple and realistic goals so they can be achieved while increasing your confidence and ability for self-care1.
  3. Explore the significance of your personal experiences. Use this wisdom to build strength and create pathways for finding and defining achievement. Through channels of individual or group environment, sharing of experiences is a powerful way to boost your confidence for believing in your capabilities4-5.
  4. Define your support system, whether it is your family, friends, or healthcare team. They walk with you in the flow of care as the course of diabetes management changes with life’s milestones4-5.

Diabetes Education Centres embrace the above pillars of self-management.

Although the complexity of diabetes care increases with the duration of the disease, the way of living healthy with diabetes is no different than living a healthy life without diabetes.

As evidenced in my practice, applying the four pillars as guidance in your daily life will help build a strong structure for decision-making and problem-solving.

This can lead to a successful and sustainable lifestyle without future complications.

Aside from all the missing pieces and setbacks – let’s take a moment to appreciate and acknowledge your efforts in living with chronic conditions!

Jessica Chan, BScN, RN is a registered nurse and Queen’s University Alumnus. She completed the Diabetes Educators Graduate Certificate Program and is a candidate for the Certified Diabetes Educator (CDE) designation. Jessica provides diabetes education in various settings including acute care hospitals,  and the diabetes education centre in Unison Health and Community Services in Toronto. Jessica has also completed an Advanced Clinical/Practical Fellowship from the Registered Nurses Association of Ontario (RNAO) on promoting and enhancing interdisciplinary care in diabetes management.


1) Belton A, Simpson N. The how to of patient education. 2nd ed. Canada: Anne Belton & Nancy Simpson; 2010.

2) Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. JCCP, 2007; 75(2); 336-343.

3) Sandén-Eriksson B. Coping with type-2 diabetes: the role of sense of coherence compared with active management. JAN. 2000; 31(6); 1393-1397.

4) Canadian Diabetes Association. Clinical practice guidelines for self-management education. Can J Diab Canada; 2008; S25-S28.

5) Funnell MM, Anderson RM. Empowerment and self-management of diabetes. Clin Diabetes. 2004; 22; 123-127.



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