Diabetes Mellitus is a chronic disease that affects how your body turns food into energy. when someone is diabetic the body doesn’t or can’t use the Insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in the bloodstream.

1. Adaptation to Diabetes Mellitus
Department of Psychology
Professor:
Reza Pourhosein, Ph.D.
By:
Negin Dorri
May 2020

2. Part One: Introduction
• The Homan Body
• The Endocrine System
• The Pancreas
• Pancreatic Endocrine Hormones

3. The Human Body
The human body is the structure of a human being. It is composed of many different types of
cells that together create tissues and subsequently organ systems. The main systems of the
human body are:
• Circulatory System • Digestive System • Immune System
• Lymphatic System • Muscular System • Nervous System
• Reproductive System • Respiratory System • Urinary System
• Endocrine System• Integumentary System

4. The Endocrine System
The endocrine system is a network of glands and organs located throughout the body. It’s similar to
the nervous system in that it plays a vital role in controlling and regulating many of the body’s
functions.

5. The Pancreas
The pancreas has 2 main functions. The exocrine function and the endocrine function
The Exocrine Function makes enzymes, which help digest proteins, fats, and
carbohydrates before they can be absorbed in the intestine. When food enters the
stomach, these pancreatic juices are released into a system of ducts that culminate in
the main pancreatic duct.
The Endocrine Function makes hormones, the most important of which is insulin,
which control how the body uses and stores sugar glucose, its main source of energy.

6. The human body wants blood Glucose maintained in a very narrow range.
Insulin and Glucagon are the hormones which make this happen. Both insulin and
glucagon are secreted from the Pancreas, and thus are referred to as
Pancreatic Endocrine Hormones.
Pancreatic Endocrine Hormones

7. Part Two: Diabetes Mellitus
• Diabetes Mellitus
• The History of Diabetes
• The Global Prevalence of Diabetes
• Types of Diabetes
• Gestational Diabetes Mellitus
• Infographics of Diabetes Types
• Causes and Risk Factors of Diabetes
• Impaired Fetal Nutrition
• Symptoms of Diabetes
• Diagnoses of Diabetes
• Possible Physical Effects of Diabetes

8. Diabetes Mellitus
Diabetes Mellitus is a chronic disease that affects how your body turns food into energy.
when someone is diabetic the body doesn’t or can’t use the
Insulin it makes as well as it should. When there isn’t enough
insulin or cells stop responding to insulin, too much blood sugar
stays in the bloodstream.
Insulin

9. Insulin
The History of Diabetes
Scientists and physicians have been documenting the condition now known as diabetes for thousands of years.
• The first known mention of diabetes symptoms was in 1552 B.C., by Hesy-Ra, an
Egyptian physician.
• In 150 AD, the Greek physician Arateus described what we now call diabetes as
"the melting down of flesh and limbs into urine.“
• Centuries later, people known as "water tasters" diagnosed diabetes by tasting the
urine of people suspected to have it.

10. The Global Prevalence of Diabetes
Estimates and projections of the global prevalence of
diabetes in the 20–79 year age group
Millions
Estimates
One in two adults with diabetes are undiagnosed
232 million people.
One in eleven adults from 20 to 79 years old have diabetes
463 million people.

11. Types of Diabetes
Insulin
• Type 1 Diabetes
Type 2 diabetes results from the body’s ineffective use of insulin. Type 2 diabetes comprises
the majority of people with diabetes around the world, and is largely the result of excess
body weight and physical inactivity.
• Type 2 Diabetes
Type 1 diabetes is characterized by deficient insulin production and requires daily
administration of insulin. The cause of type 1 diabetes is not known and it is not preventable
with current knowledge.

12. Gestational Diabetes Mellitus
• Gestational diabetes mellitus is defined as carbohydrate intolerance resulting in
hyperglycemia of variable severity with onset or first recognition during
pregnancy.
• Gestational diabetes affects 3–10% of pregnancies, depending on the population
studied.
• Some causes and Risk Factors of Gestational Diabetes Mellitus include:
Obesity, Family History, Increasing Maternal Age, Multiple Pregnancy and
Previous Gestational Diabetes Mellitus.
Doi:10.1016/j.ogrm.2014.05.005

13. Insulin
Gestational Diabeteswith Type 1 Diabetes:
The Body
doesn’t produce
Insulin
Infographics of Diabetes Types
with Type 2 Diabetes:
The Body
produce Insulin
but is not used
efficiently
← Can be prevented →

14. Causes and Risk Factors of Diabetes
Insulin
• Type 1 Diabetes possible Causes:
Genetics
Viral or bacterial infection
Chemical toxins within food
Unidentified component causing autoimmune reaction
• Type 2 Diabetes Causes:
Obesity
Living a sedentary lifestyle
Increasing age
Bad diet
Other type 2 diabetes causes such as pregnancy or illness can be type 2 diabetes risk factor.

15. Impaired Fetal Nutrition
• Low-birthweight babies, are more prone than those of normal weight to a range of clinical and
metabolic abnormalities including :
• A poor diet during pregnancy may increase the risk of a woman’s children and
grandchildren developing type 2 diabetes in later life.
Obesity
Hypertension
Dyslipidemia
Insulin Resistance
Doi:10.1002/14651858.CD006674.pub3
• Mothers who eat unhealthily could “programme” susceptibility into the cells of their
unborn baby. This genetic vulnerability could then be passed down to future
generations.

16. Insulin
Symptoms of Diabetes
Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence.
Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.
Some of the signs and symptoms of type 1 and type 2 diabetes are:
Extreme Hunger Fatigue
Frequent Urination Irritability
Slow-healing Sores Blurred vision
Unexplained Weight Loss Increased Thirst

17. Insulin
Diagnoses of Diabetes
There are several ways to diagnose diabetes:
• The A1C test measures your average blood sugar for the past 2 to 3 months. The
advantages of being diagnosed this way are that you don't have to fast or drink
anything.
• The Fasting Plasma Glucose test checks the fasting blood sugar levels. Fasting
means after not having anything to eat or drink for at least 8 hours before the
test.
• The Oral Glucose Tolerance Test is a two-hour test that checks your blood sugar
levels before and 2 hours after you drink a special sweet drink.

18. Insulin
Possible Physical Effects of Diabetes
Damage to the large blood vessels of the heart, brain
and legs. Damage to the small blood vessels, causing
problems in the eyes, kidneys, feet and nerves. Other
parts of the body can also be affected by diabetes,
including the digestive system, the skin, sexual organs,
teeth and gums, and the immune system. The risk of most diabetes-related complications can be
reduced by keeping blood pressure, blood glucose and
cholesterol levels within recommended range. Also,
being a healthy weight, eating healthily, and not
smoking will help reduce your risk.

19. Part Three: Psychological Aspects of Diabetes Mellitus
• Diabetes and Mental Health
• Facing Life with Diabetes
• Dealing with Diagnosis
• Diabetes Distress
• Diabetes-related Distress
• Depression and Diabetes
• Fear of Hypoglycemia
• Psychological Barriers to Insulin Use
• Identifying Patients

20. Diabetes and Mental Health
Chronic illness usually leads to more symptoms. Many people assume that the symptoms they are
experiencing are due to only one cause: the disease. While the disease can certainly cause certain
symptoms., it is not the only cause.
Symptoms
Tense Muscles
Disease
Fatigue
Pain
Depression Stress
Difficult Emotions
Vicious Cycle
The Vicious Symptom Cycle
In no particular order
ISBN-13: 978-1-933503-01-1

21. Insulin
Facing Life with Diabetes
“I was just shocked, thinking, because I’m so healthy. And I thought, “oh my God,
it’s like the end of me”, kind of, you know, that shock.”
(Person with Type 2 diabetes)
“I was jumping around from shock to denial to grief to tears to… I certainly went
through that… the reactions might go up and down for quite some time… for my
first 12 months I went through lots of reactions.”
(Person with Type 1 diabetes)
“I don’t think it’s all that devastating. There
are far worse incurable sorts of things.”
(Person with diabetes)

22. Dealing with Diagnosis
The diagnosis of diabetes is a life event that has been likened to the experience of grief.
The diagnosis of diabetes can trigger a grieving for one’s “Lost Health”.
Not everyone with diabetes will necessarily experience all of these emotional reactions,
or in this particular order.
The stages of grief:
• Stage 1: Denial
• Stage 2: Anger
• Stage 3: Bargaining
• Stage 4: Depression
• Stage 5: Acceptance “I can take Control and Manage this”.

23. Insulin
Diabetes Distress
1 in 4 people with Type 1 and 1 in 5 people with Type 2 diabetes have high levels of
diabetes distress that is likely to be negatively effecting how they manage their diabetes
Living with diabetes is challenging. ‘worrying about the future and the possibility of serious
complications’ and ‘experiencing feelings of guilt and anxiety when diabetes management goes off track’.

24. Insulin
• Diabetes-related distress is defined as a patient's concern about
disease management, support, emotional burden and access to care.
Diabetes‐related Distress
The relationship between diabetes-related distress and glycaemia control does not assume the direct
involvement of any physiological process, but instead, emphasizes the ongoing negative subjective experience
of emotional distress around the management of diabetes that has implications for ongoing disease‐related
behaviors, motivation, self‐efficacy, problem solving and even depressive symptoms.
Doi: 10.1002/14651858.CD011469.pub2

25. Insulin
Depression and Diabetes
People with diabetes are more likely than the general population to be effected by symptoms of depression.
Diabetes-specific contributors may include the chronic nature of the condition and complex management
regimens. In people with diabetes, depression or depressive symptoms are associated with adverse
medical and psychological outcomes.
1 in 5 people with Type 1 and 1 in 3 people with Type 2 diabetes using insulin and 1 in 4 people with
Type 2 diabetes not depending on inulin a have high levels of depression.

26. Insulin
Depression and Diabetes
• Sub-optimal self-management such as:
In people with diabetes, depression or depressive symptoms are associated with adverse medical and psychological
outcomes, including:
Reduced Physical Activity
Less Healthy Eating
Smoking
• Elevated HbA1c, Hypoglycaemia and Hyperglycaemia.
• Increased prevalence, and earlier onset, of complications and disability.
• Increased risk of diabetes distress and elevated anxiety symptoms.
• Impaired quality of life, and social role/ functioning.
• Increased burden/costs to the individual and the healthcare system.

27. Insulin
Fear of Hypoglycaemia
Fear of hypos is a specific and intense feeling brought on by the risk and/or experiences of having low blood glucose. It
is common to worry about:
• Losing consciousness
• Being judged by others
• Relying on others for help
• Having a hypo while asleep
• Having an accident or injuring yourself

28. Insulin
Fear of Hypoglycaemia
is a common challenge for people managing their diabetes with insulin or other
glucose-lowering medications. People with diabetes often worry or become fearful
about hypos.
“There’s nothing worse than having that fear at the back of your head that you’re going
to be in a meeting or something and pass out from not treating a hypo quick enough—
it’s never happened, touch wood.” Melissa, 31, person with diabetes.
Hypoglycaemia

29. Insulin
Psychological Barriers to Insulin Use
1. Painful Injection
2. Apprehension about self-injection.
3. Needle Phobia
4. Social Embarrassment
Abu Hassan et al. BMC Family Practice 2013
In a qualitative exploration study of factors influencing insulin acceptance, Many participants had
negative concerns related to insulin use. The main concerns vented by them were about injection of
insulin:
People with diabetes often have negative thoughts or feelings about starting, using,
or intensifying insulin. This is also known as ‘Psychological Insulin Resistance’ or
‘Negative Appraisals of Insulin’.

30. Insulin
Other Impacts of Using Insulin
Inconvenience and Impractical
“I see my daughter half an hour before dinner, she has to inject, so
troublesome, very inconvenient”
Lifestyle Restriction
“When you are on insulin, it is more difficult to go out or eat out. You are more
restricted. You have to plan your exercise as well”
Social Stigma
“Our society is quite ignorant of insulin therapy and they might
associate insulin injection with drug addicts”

31. Insulin
Identifying Patients
Emotional problems are associated with poorer self-care behavior. Thus, addressing emotional
problems is a key health care intervention even if diabetes self-care is adequate, and all clinicians
should be able to:
1. Identify patients suffering from distress and depression.
2. Identify patients who are suffering from any other psychiatric disorders.
3. Apply effective treatments to relieve these issues.
4. Refer patients for specialized mental health care when appropriate.

32. Part Four: Social Aspects of Diabetes Mellitus
• Social Aspects – Daily Life
• Students with Diabetes
• Employment and Diabetes Mellitus
• Driving and Diabetes Mellitus
• Diabetes and Social Support

33. Social Aspects – Daily Life
Diabetes influences many aspects of daily life, principally through the effects of treatment and its
potential side effects, particularly hypoglycemia.
• Students with Diabetes
• Employment
• Driving
The development of diabetic complications, such as neuropathy
and retinopathy, can also affect everyday activities, particularly
when these are severe with clinical manifestations, or require
time-consuming treatment such as dialysis for chronic renal
failure. Diabetes could effect ones daily routine such as:

34. Students with Diabetes
There is a natural desire for students with diabetes not to appear different from their peers and
this may lead them to assign a lower priority to diabetes management than they would
normally and to undertake potentially high-risk activities.
Some short and long terms problems can include high or low blood glucose levels that
significantly effect the student's ability to concentrate and learn, and can cause serious
immediate consequences such as brain damage or death if not treated.
ISBN-13: 978-1118912027
ISBN-10: 9781118912027
Every Child with Diabetes May Experience Different Symptoms of Low Blood Sugar.

35. Employment and Diabetes Mellitus
Diabetes is not a bar to most occupations, and people with diabetes are protected in many
countries by legislation against discrimination on the grounds of disability. However People
with insulin-treated diabetes are barred from certain occupations because of the risk of
Hypoglycemia. These include:
• The Armed Forces
• Commercial Pilots
• Emergency Services
• Prison and Security Services
• Jobs in Potentially Dangerous Areas

36. Insulin
Driving and Diabetes Mellitus
• Newly diagnosed people with diabetes, especially insulin-treated, should not drive until
glycemic control and vision are stable
• Potential hazards facing the driver with diabetes might include hypoglycemia, visual
impairment and some other difficulties.
• Hypoglycemia can severely disrupt driving skills by causing cognitive dysfunction and
Mood Changes.
• Motor skills and judgment can become impaired when blood glucose falls below 3.8
mmol/L, often without inducing hypoglycemic symptoms

37. Diabetes and Social Support
Social support helps with diabetes control and provides support for the necessary
physical and dietary changes.
Social support is an important explanatory variable with prognostic significance for
health outcomes and it plays a pivotal role in patients with diabetes and can contribute
to the successful management of the disease.

38. Decision Support for Improving Adaptation and Self-management
Emotional Support Information Support Tangible Support
Healthy
Food
Physical
Activity
Medical
Insurance
Financial
Support
Engorgement
Support
Express
Respect
Empathetic
Understanding
Listening
Support
Analysis of the
Condition
Feedback
Check
Guidance
“An integrated model to evaluate the impact of social support on improving self-management of type 2 diabetes mellitus”

39. Social Support
Doi:10.1186/s12911-019-0914-9
Emotional support included providing empathy, care, love and trust. This
kind of support could enhance the sense of self-worth and affirmation, and
the coping efforts of patients with diabetes.
Informational support referred to providing guidance, advice, and counseling
to those under stress. Such support might help individuals benefit from
advice on how to best respond to the challenges of diabetes
Tangible support referred to offering material aid or behavioral assistance.
Tangible support could be measured by Healthy Food, Physical Activity,
Medicine and Medical Instruments, and Financial Support.

40. Insulin
The mentioned study surveyed more than 1000 articles related to social support and diabetes in which the appearance
of “Emotional Support” ,“Information Support” and “Tangible Support” accounted for 90, 88, and 83%, respectively,
much higher than other social support dimensions.

41. Part Four: Adaptation and Self-Management
• Adapting and Coping with Change
• The Stages of Change
• Self-Care in Adaptation and Management of Diabetes
• Self-care Behaviors

42. Adopting and Coping with Change
• A diabetes diagnosis can turn the patients life upside down and force them to re-examine how
they live if they want to stay healthy and properly manage their diabetes. Sudden lifestyle
changes are not without their challenges.
• Change is defined as sustainable modification to a behavior or habit. Whatever needs to be
modified, change generally follows the same route. Understanding the key stages can help the
patients achieve their goals.

43. The Stages of Change
• Precontemplation:
At this stage, you are quite resistant to change. You don’t understand why you need to
change and have no intention of doing so. This is the time to take responsibility and
gradually consider the change.
The more informed you are about the consequences of the disease and your current
lifestyle, the more you will be prepared to make changes.
• Contemplation:
At this stage, you are less resistant to change. You embrace the idea of change over the
medium term, but see more disadvantages than benefits in adopting new behaviors. For
example,
“If I take my blood glucose readings before bed, my husband will be less worried, but it
hurts, it’s expensive and I won’t be able to sleep after I get the result.”

44. The Stages of Change
At this stage, you are getting ready to take some concrete action. You buy your
blood glucose meter, you register for an exercise program or you cut down to 3
cigarettes per day. You intend to adopt a new behavior in the near future 30 days.
You adopt the desired attitude but you sometimes revert to old habits. For
example, you take your blood glucose readings four times per day, but stop after a
month and start again three weeks later. At this stage, encouragement and praise
from your family and friends are very important. This is also the time to reward
yourself for your successes.
• Action:
• Preparation:

45. The Stages of Change
You have reached the maintenance stage when you have stuck to the desired
behavior for at least 6 consecutive months. At this point, reverting to an earlier
stage is less likely or of shorter duration. This can also be the time to contemplate
making another change.
• Maintenance:

46. Self-Care in Adaptation and Management of Diabetes
• The World Health Organization defines self-care as: The ability of individuals, families
and communities to promote health, prevent disease, maintain health, and to cope with
illness and disability with or without the support of a healthcare provider.
• There are many essential self-care behaviors in people with diabetes which predict good
outcomes and helps them to adopt better with their diagnoses.
DOI: 10.1186/2251-6581-12-14

47. Self-Care Behaviors
The AADE Self-Care Behaviors are a series of seven skills determined by the American
Association of Diabetes Educators to be essential to effective diabetes self-management and
adaptation. The skills include:
Healthy
Eating
Being
Active
Blood-
Sugar
Monitoring
Problem
Solving
Taking
Medication
Healthy
Coping
Reducing
Risks
Aim for Diabetes Control

48. Nutrition and Diabetes Mellitus
Nutrition is an important parts of a healthy lifestyle when someone has diabetes.
Following a Healthy Meal Plan can help the patients keep their blood glucose level, in
the targeted range. Eating well most days of the week can help:
 Keep blood glucose level
 Lose weight or stay at a Healthy weight*
 Prevent or delay diabetes problem
Healthy Weight often based on having a body mass index that falls in the normal, or healthy
range. A healthy body weight may lower the chances of developing health problems such as type
2 diabetes and heart disease.

49. The Food Groups
The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts
that the patients meal plan outlines.
Vegetables Broccoli, Carrots, Greens, Peppers, and Tomatoes
Fruits Oranges, Melon, Berries, Apples, Bananas, and Grapes
Grains At least half of the grains for the day should be whole grains
• Includes wheat, Rice, Oats, Cornmeal, Barley, and Quinoa
• Examples: Bread, Pasta, Cereal
Protein Chicken or Turkey without the skin, Fish, Egg, Nuts, Lean Meat
Dairy Non-fat or low fat Milk, Yogurt, Cheese

50. The Balanced Plate Model
The Balanced Plate Model is a simple tool designed to help patients prepare meals. It can help to
allocate the carbohydrate intake, so that people feel full and nourished until the next meal or snack.
Image from: Meal Planning for People with Diabetes at a Glance, © Government du Québec, 2014

51. Being Active
Being active helps condition the heart, lungs, and muscles, and even
improves weight-control, and energy. For people with diabetes,
exercise may improve blood sugar levels by helping the body to
better use insulin and food.
Being physically active looks different for each person, depending on:
• Age
• Interests
• Physical Ability

52. The Importance of Exercise in Treating Diabetes
• Increased insulin sensitivity (insulin works better)
• Lower blood sugar levels
• Increased energy and endurance throughout the day
• Weight loss with increased muscle tone
• A healthier heart and lower blood pressure
• Better sleep at night
• Stronger bones and a lower risk of osteoporosis
• Better resistance to illness
• Improved cholesterol, heart rate, and blood pressure levels
• Lower stress, anxiety, boredom, frustration and depression
The effects of regular exercise:

53. Stop Exercising When
Lightheadedness or dizziness
Rapid heart beat
Chest discomfort
Jaw, arm, or upper back discomfort
Nausea
Unusual shortness of breath
Sudden weakness
Severe or unusual fatigue or sleepiness
Severe discomfort of any kind

54. Home-based Exercise During COVID-19
In response to the current COVID-19 pandemic, governments in many countries have restricted the
movement of their citizens confining them to the home environment. Below are a series of daily exercises
that can be performed at home, provided by The Italian National Association of Athletes with Diabetes. The
exercise intensity of each activity is comparable to one hour of brisk walking, resulting in an energy
expenditure of 150-200 Kcal.
 Treadmill
 Stationary bicycle
 Bodyweight exercises
 joint mobility and stretching exercises, such as yoga and Pilates

55. Home-based Exercise During COVID-19
 Two series of 20 Jumping Jacks
 Two series of 15 crunches
 Two series of 15 forward flexes
 Two series of 10 rowing exercises
 Two series of 8 push-ups
 Two series of 8 sitting/standing
 Three series x 15 squats
 20 minutes treadmill training
 Final stretching and relaxation

56. Blood-Sugar Monitoring
• Blood sugar monitoring involves using a device to regularly check blood sugar levels,
which can help keep track of blood sugar level fluctuations throughout the day and
inform if action needs to be taken to maintain levels as close to normal-70- 120 mg/dl-
as possible.
• Recording blood sugar levels gives insight into how medicines, physical activity, stress,
and other activities affect blood sugar daily.

57. Problem Solving
Obstacles in diabetes self-management and adoptation are encountered every day, so it is very
important to know how to find solutions for unexpected problems. Daily problems or stressors
can put the body under stress and result in dramatic fluctuations in blood sugar levels. Problem
solving involves 3 steps:
• Step 1 Identify the Problem
• Step 2 Find Solutions
• Step 3 Take Action

58. Problem Solving
• Take Action
• Identify the Problem
While on vacation, you don’t have easy access
to a gym or time for exercise. How will you
handle this?
• Find Solutions
You get the flu and notice your blood glucose
levels are higher than normal. What do you do?
You have a hard time finding healthy food
choices within your family’s cultural or taste
preferences. What steps can you take?

59. Taking Medication
• People with type 2 diabetes may need to take pills or insulin to lower blood glucose levels
and manage their diabetes. Diabetes medication works best when used regularly and in
combination with healthy eating and physical activity.
• With technology ever-evolving in the fight against diabetes, the quality of apps that assist
in diabetes management and adopting to it is also improving.
• Depending on whether you want your diabetes app to log blood glucose readings or
monitor food intake, the options are increasing for those with single or multiple
requirements.

60. Reducing Risks
People with diabetes are at higher risk to develop some complications, such as circulatory
problems and infections. Many activities can help reduce that risk, such as quitting smoking,
controlling blood pressure and foot care.
Poorly managed diabetes can lead to short term problems
and long term complications. Reducing risks can help
improve quality and quantity of life for people with diabetes.

61. Healthy Adaptation
Living with diabetes can be emotionally challenging, so dealing positively with emotions can help
overcome daily diabetes adaptation and management challenges. Healthy and positive coping with the
emotions associated with diabetes can contribute to better control over one’s diabetes. Some of the skills
that reflect healthy adaptation include:
Doi: 10.1089/pop.2009.0065
• Expressing emotions
• Having an adaptive coping style
• Fulfilling health care obligations
• Demonstrating basic problem-solving skills
• Incorporating physical activity into one's life

62. Part Six: Conclusion

63. Setting Goals for Adapting to a Healthier Life
To initiate lifestyle changes and measure the progress, it can be useful to set specific goals. the
S.M.A.R.T Method can help diabetes to set their goals. People with diabetes have to make sure their
goals have the following five characteristics:
 Specific
 Measurable
 Achievable
 Realistic
 Time-based

64. The S.M.A.R.T Method
Specific:
The goal must be precise to be motivating and incorporated into your life.
Measurable:
You must be able to quantify and measure your progress, by specifying the
frequency and duration, for example.
Achievable:
For a goal to be motivating, it must be attainable through concrete measures
that match your abilities and tastes.

65. The S.M.A.R.T Method
Realistic:
Your goal must be consistent with your reality, your schedule and your limitations.
You must feel able to achieve it in your current situation.
A goal will not be effective or measurable if it is not defined by time.
Set a precise time limit. You can even set the date you will be ready to begin.
Timely:

66. Key Words
May 2020
0 50000 100000 150000 200000 250000 300000 350000 400000
Diabetes Mellitus
Nutrition
Exercise
Self-management
Depression
Mental Health
Type 2
Anxiety
Adaptation
Distress
Driving
Students
Emotional Support
Gestational Diabetes
Hypoglycaemia
Travelling
Coping
Type 1
Stigma
Neadle Fear

67. The Blue Circle is the Universal Symbol for Diabetes.
November 14th is “World Diabetes Day.”
“You Can be Both, a Masterpiece and a Work in Progress, at the Same Time”
Thank You