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Self-management of diabetes in a Puerto Rican population.

A convenience sample of 74 clients with type II diabetes mellitus was followed in the home by public health nurses. Participants were observed and interviewed to determine the pattern of self-management behaviors in the areas of insulin administration, urine testing, and dietary intake. One-third to one-half of the respondents could be judged as being noncompliant with one or more aspects of the treatment plan: over one-half (38) reported skipping insulin doses; 52 varied the time they administered their insulin; and 25 had stopped testing their urine. Breaks in procedures of insulin administration were also in evidence, with the most serious being cessation or taking incorrect doses by 21 respondents. Meal skipping was reported by the majority: 41 skipped their bedtime snack and 25 skipped breakfast. Quantitative dietary analysis showed close to adequate nutrient intake with the exception of calcium and iron. Traditional Puerto Rican foods such as rice and beans were present in 53 percent of the meals despite the overriding belief that these foods should be avoided by persons with diabetes mellitus. Case data revealed interference factor in the spontaneity of life imposed by the diabetic management plan. This shows the need for flexible approaches to home care of Puerto Rican diabetics and for increased knowledge of how effectively to alter the plan of care to meet the demands of daily living.