Table 3 Terms used in ”The Logic of Care” and the application to T1DM

Patientism

Establishing living with a disease, rather than normality as the standard. The patient has to be aware of what is happening in the body and to respond and adapt to what is happening. Patientism means that the professionals motivate the patients to recognize their body’s signals for wellbeing and malaise. The professionals are admitted into every individual patient’s lifestyle and values and are aware of the sick body’s reactions i.e. the professionals and patients jointly explore ways to achieve a good life despite a fragile body.

Doctoring

The professionals interact with the patient but it is the patient who must control the teaching of diabetes and how the treatment will be implemented. What happens in the body when the body is affected by diabetes is something that the patient must understand as well as how diabetes is generally treated. For example, diabetes patients have to be able to inject their own insulin, measure their own blood glucose level, and count the carbohydrates they eat as well as calibrate their exercise. The professionals show the patient a great commitment by paying attention to the patient’s emotional reactions. This requires endurance and understanding of the difficulties that the patients may feel that they have in daily life with diabetes. Doctoring means that the teaching is fully adapted to the patient’s needs.

Shared doctoring

The professionals adapt their knowledge to the patient’s life and both parts are open and honest in the communication. All persons involved in the care must respect each other's experience of the disease, while being committed and creative as well as careful in their explorations. That requires that all those concerned i.e. members of the diabetes team and the patient, are taking each other's contributions seriously, and they simultaneously adapt to what the body, blood glucose measurements, diet and other relevant information shows.

Activity

This characterizes the patient involvement in the care. The body and the patient are active, i.e. the body is active in that the patient may be thinking that he/she is thirsty and drinks a lot. The doctor asks how much and the patient may respond four litres a day and the doctor interprets it as the symptoms of diabetes. The patient is active by giving blood and urine to be tested. The patient cooperates with the diabetes team (if he/she is not in a diabetes coma) by observing what is done, by asking, listening and performing the care.

Sensitivity

The patients must train their own body and sensitivity so they can actively balance the energy they need with the amount of insulin they inject. Such intro-sensing is an intriguing skill that may be trained. The sensitivity is about making the patient aware of, and helping her/him understand, how she/he can appreciate the blood glucose value by learning how the body works at low blood glucose such as with dizziness or irritation. It also about finding out how to measure so that technologies, habits, etc. are adjusted to the patient’s life.

Individuation

A person with diabetes must learn to become a special person. In the logic of care this is about being an ordinary person yet having the personal courage to be different in this new situation. The PDSN has an important role in supporting the diabetic person, and encourages and praises when the person stands up for her/his own life and the dietician may be the one who gives support to give up a diet that is not necessary. In time the patients gradually gets used to their new situation by taking the insulin without hiding, by abstaining from desserts with a good feeling etc. It is about choosing to participate in social life despite the disease.