www.journeyforcontrol.com

One of the more recent tools I came across on the net was a wonderful all-in-one package for diabetic patient education and guidance - Diabetes new day.

It is based in the US and while references to glucoses are in mg/dl rather than mmol/l, I do not believe this should necessarily be a major negative feature.

More reference and emphasis is appropriately made to HbA1c measurements (fortunately an internationally consistent parameter) which is excellent and helps us to guide our patients confidently in the right direction.

With the advent of Dr Sandy Dawson's excellent "Diabetes Get Checked" programme several years ago, there has been a major upsizing of the diabetes "playing field" and now most New Zealand practice nurses are tackling - and enjoying - the ongoing challenge of getting our diabetics trimmer, healthier and less insulin resistant.

So, a high quality accessible tool such as this website-based programme, could be invaluable and would certainly help our nurses to focus more on the specifics of patient-based management rather than the time-consuming and somewhat repetitive "lifestyle monitoring".

The programme includes useful tools for recording glucoses and a daily exercise log.

While the net has been seen in previous years as somewhat inaccessible/unavailable or "too hard" to the middle-aged and more especially the elderly, this is certainly changing fast - and maybe having diabetes is a very good reason to ensure our patients become web enabled.

There is an excellent and substantial front section on What is Diabetes? which goes into some detail and gives the main A to G "Diabetes and Me" guide, eg: A HbA1c Tests and Blood Sugar Monitoring B Blood Pressure C Cholesterol D Diet: Planning for Healthy Eating E Exercise: Choosing Your Activity F Family, Friends, and Feelings G Good Days With Diabetes.

The motivational tools are very good and perhaps the main positive feature for the site is the "30 ways to reach 30 minutes" exercise guide which can complement our own local green prescription initiatives.

For the diabetic retinopath the home page also offers three easy text size options - and of course changing these will not affect other website browsing as it is not modified through the browser.

There is a "Simple Guide for Diabetes", which tries to be not-too-clinical - the "Five Things to help keep your approach to diabetes in perspective" - referring specifically to principles such as: 1. Sugar in itself isn't the enemy 2. Your body gets sugar from two sources 3. Insulin is the key to balance 4. Living out of balance feels bad - and can be dangerous 5. You can take control.

There is a good section explaining the significance of organ dysfunction and failure with poorly controlled diabetes, emphasising in modest detail the effects on eyes, kidneys, nerves, feet, heart and teeth.

There is a subsection devoted to the risks of the fast food culture (topical with the recent release of the movie Fast Food Nation in Auckland cinemas) and simple calorie/fat/sodium guidance on how to rationalise the sometimes unavoidable.

There is also a good, albeit succinct, recipe section and presumably this puts up new recipes from time to time. One can also sign up for more information and this may possibly offer a larger range of diabetic food recipes.

There is also an Ask the Expert section, which did not appear to be especially interactive at first view. However, there is also a good Just In section which gives the latest news on current approaches to general NIDDM management.

Overall, I felt the website's approach to NIDDM was well based, consistent with my own approach and was focused largely on weight and exercise management (ie, insulin resistance) more so than on the "sugar in the diet" approach.

And, as we ourselves know, patients can indulge in some sweeteners if they are at the same time successfully managing their BMI and fitness, and the markers of HbA1c, weight reduction and improving (reducing) fasting insulin tests are certainly powerful positive behaviour modifiers.

I have put this site on my toolbar so I can refer to it quickly to show patients and then simply print out the web address for them to explore it for themselves.