Breaking Down Barriers to Diabetes Self-Care

Inclusion Criteria: For Patients With Type 1 Diabetes * Aged 18-65 * Presence of type 1 diabetes mellitus. * 2-25 year duration. For Patients With Type 2 Diabetes * Aged 25-65 years * presence of type 2 diabetes mellitus. * 2 years since initial diagnosis. Exclusion Criteria: * Renal disease, microalbumin \>300 ug/mg) * Severe peripheral diabetic neuropathy and/or severe peripheral vascular disease * Symptomatic severe autonomic neuropathy who may be at risk when increasing activity levels. * Women who are currently pregnant * proliferative diabetic retinopathy based on dilated eye examination within one year of study entry. Patients whose eye disease is successfully treated will be included. * HbA1c levels less than 7.0% (normal range 4.0 - 6.0%). * HbA1c levels greater than 14.0% * patients who underwent intensive insulin treatment within one year * a history of severe, unstable myocardial infarction, congestive heart failure or other severe cardiac disease, severe hypertension (systolic more than 160 mmHg or diastolic 90 mmHg) who may be at risk when mildly increasing physical activity * a DSMIV diagnosis of eating disorders including anorexia nervosa, bulimia, and severe weight-related insulin omission. * Patients with recent diagnosis (past 6 months) of bipolar disorder, schizophrenia, mental retardation, organic mental disorder, and alcohol or drug abuse * Patients whose diabetes diagnosed cannot be clearly classified as type 1 or type 2.