Diabetes Self-Management Shruti Bajaj Ann Hsieh Hane Kim

1. Francesca is attending an “Introduction to Diabetes” class at Palo Alto Medical Foundation. She is newly diagnosed, and has been advised to take this course by her physician. The class is composed of 6 people who have also been newly diagnosed. During the class, the members exchange their background information and discuss the problems they have encountered with their disease.

2. The instructor, Sasha, begins by giving them diabetes-specific information, such as blood glucose range, complications, healthy diet, and proper nutrition. She also shows them how to measure their blood glucose.

3. Next, Sasha shows the class how to design goals and develop action plans to manage their diabetes. Francesca chooses one goal: “Bring down blood glucose from 250 to 160 in one month”. Her action plan consists of: 1) walk one mile 3x/week; 2) eat salad 3x/week; 3) eat fruits 3x/week; and 4) monitor blood sugar 5x/week.

4. Lastly, Sasha distributes MON devices, which are portable handheld tools with wireless connectivity. She gives them a tutorial of the features and shows them how to input their action plans. The MON will allow Francesca to manage her action plan as well as function as a blood glucose monitor. She will also be able to remotely communicate with her classmates.

5. Sasha bids the class farewell and instructs them to begin their plans on the following Monday. They will reconvene in one month.

6. On Monday morning Francesca turns on her device to setup her weekly plan. She needs to decide on what days and what times she will enact her action plan. This task takes her about 10 minutes. For today, she needs to exercise at lunch and eat fruits for her mid-day snack. After making her family breakfast and packing her lunch, she heads off to work.

7. At lunch time, the MON device beeps, reminding her to head to the gym. When she returns, she highlights the exercise icon and marks it as DONE, causing it to gray out. Later in the day, her group celebrates a co-workers birthday and Francesca cannot resist a piece of chocolate cake. She figures she can eat her fruit tomorrow. When the MON beeps her, she highlights the fruit icon and MOVES it to Tuesday.

8. At the end of the week Francesca looks at her log. She sees that she met her 100% of the exercise goals and salad goals. However, she only met 30% of her fruit goal, and 60% of her monitoring goal. She has an overall success rate of 72%.

9. She feels a bit discouraged and decides to see how her five classmates have managed in their first week. She looks at George’s record. She sees that his success rate is 70% also. She leaves him a voice message, asking him how his week went and shares some of her frustrations. He returns a message to offer some encouragement and to invite her to join him at the farmer’s market this weekend, so that they can both pick up fruit they enjoy!

10. She next views her blood glucose graph. She looks at her progress over the week and is pleased to see that she has gotten her sugar down to 220. She looks forward to the projections of Week 4 and sees that in order to meet her goal, she will need to reduce her blood sugar by 30 units each week.

11. She looks at the rewards page. The end goal is illustrated as an island far away, with intermediate islands to reach in between. She has reached the first island, but her boat is slightly sunken since she was at a 70% success rate. She receives 7 point for her efforts. A message on the screen encourages her to keep her chin up!

12. She finishes off the week by going back to her action plan. How could she achieve 80% success rate next week? She decides that she would check her blood glucose in the mornings, since her evenings were always so hectic. She also decides to bring more fun fruit to work so that she’ll actually want to eat it.