ABSTRACT
For the person with diabetes, the problem relates to the dominance of the orderly framework so that the view of diabetes and of him/herself was, and still is for many, fundamentally mechanical. For the patient, it is all a matter of taking the right drug doses, structuring lifestyle as rigidly as possible and hoping for an eventual cure for the disease. Carers and patients are being taught excellent diabetes self-management strategies, but fitting them all together on a day-to-day basis remains a challenge for many. Without a framework to guide this, there will be a natural tendency to drift back towards a more teacher-child type of relationship. This regressive tendency is strengthened by the growing command and control ‘accountancy culture’ that has emerged in the National Health Service (NHS) in the last decade.
