Controlling Your Diabetes

 Controlling Your Diabetes

There’s good news for people with diabetes. Studies show that keeping your blood glucose (also called
blood sugar) close to normal helps prevent or delay some diabetes problems.
Through careful control, many problems such as eye disease, kidney disease, heart disease, nerve
damage, and serious foot problems can be prevented or slowed. People who have type 1 diabetes, as
well as people who have type 2 diabetes can also benefit by keeping their blood glucose levels closer to
normal.

 

Keeping a Balance
As the turtle makes steady progress, so too must those with diabetes continue to maintain healthy
lifestyles and stick to daily routines that involve regular exercise, good nutrition, glucose monitoring,
and regular visits to health care providers.
To keep your glucose at a healthy level, you need to keep a balance between three important things:

- What you eat and drink.
-  How much physical activity you do.
-  What diabetes medicine you take (if your doctor has prescribed diabetes pills or insulin).

This book gives you only some of the facts you need. Your health care team can give you more.
A Few Things about Food
Here are some tips for making healthy eating choices:

- Eat regular meals. Ask your health care team to help you choose a meal plan. Your dietitian
may suggest you eat three meals and a snack or two every day at about the same times. Eating
every 4 to 5 hours can help control blood sugar.

- Eat a variety of foods. Choose a variety of foods to eat so that your body gets the nutrition it
needs.

- Eat less fat. Avoid fried foods. Foods that are baked, broiled, grilled, boiled, or steamed are
more healthy to eat. Eat meats that have little fat. When you eat dairy products (cheese, milk,
yogurt, and others), choose those that have little or no fat or cream.

- Eat less sugar. You may find that eating less sugar helps you control your blood glucose level.
Here are some things you can do to eat less sugar:
o Eat more high-fiber foods, like vegetables, dried beans, fruit, and whole grain breads
and cereals.
o Drink water and other drinks that have no added sugar.
o Eat fewer foods that have extra sugar, such as cookies, cakes, pastries, candy, brownies,
and sugared breakfast cereals.
o Talk with your health care team about ways to sweeten food and drinks without using
sugar.

- Eat less salt. Eating less salt may help control your blood pressure. Here are some ways to eat
less salt:
o Use less salt when you prepare foods.
o Cut down on processed foods, such as foods you buy in cans and jars, pickled foods,
lunch meats (“cold cuts”), and snack foods, such as chips.
o Taste your food first before adding salt. You may not need to add any.
o Use herbs and spices instead of salt to flavor your food.

-  A word about drinking alcohol: Alcohol can cause health problems, especially for people with
diabetes. It adds calories and doesn’t give your body any nutrition. Drinking alcohol may cause
dangerous reactions with medicines you take. Your blood glucose can go down too low if you
drink beer, wine, or liquor on an empty stomach. If you want to include a drink in your food
plan once in a while, ask your health care team how to do so safely.

 

Few Things about Physical Activity

-  It's important to be active. Physical activity has many benefits. It can help you control your
blood glucose and your weight. Physical activity can help prevent heart and blood flow
problems. Many people say they feel better when they get regular exercise.

- Start with a little. If you haven’t been doing any physical activity, talk to your health care team
before you begin. Walking, working in the yard, and dancing are good ways to start. As you
become stronger, you can add a few extra minutes to your physical activity. If you feel pain,
slow down or stop and wait until it goes away. If the pain comes back, talk with your health
care team right away.

- Do some physical activity every day. It’s better to walk 10 or 20 minutes each day than one hour
once a week.

- Choose an activity you enjoy. Do an activity you really like. The more fun it is, the more likely
you will do it each day. It’s also good to exercise with a family member or friend.

 

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What is gestational diabetes?

 

What is gestational diabetes?

 

Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. Diabetes means that your blood sugar (also called blood glucose) is too high. Your body uses glucose for energy. But too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby.

Often, women with gestational diabetes have no symptoms. However, gestational diabetes may increase your risk of:

• high blood pressure during pregnancy


• having a large baby and needing a cesarean section at delivery

To learn more about managing gestational diabetes during pregnancy, including how gestational diabetes can affect you and your baby

What Should a Woman Who Had Gestational Diabetes Do After Her Baby Is Born?

If you had gestational diabetes, you should be tested for diabetes 6 to 12 weeks after your baby is born. If test results show that your blood glucose is higher than normal, but not high enough to be considered diabetes, you should be tested for diabetes every year. If the test is normal, you should get tested for diabetes again in 3 years.

What many women don’t realize is that having a history of gestational diabetes increases their chances of getting diabetes – mostly type 2 -- in the future.

Additionally, the child born from a pregnancy affected by gestational diabetes may have a greater chance of being obese and developing type 2 diabetes. Be sure to tell your child’s pediatrician that you had gestational diabetes so the child’s growth and other factors can be monitored accordingly.

 

 

 

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Prediabetes: Am I at risk?

Prediabetes: Am I at risk?

 

The Centers for Disease Control and Prevention (CDC) estimates that 1 of every 3 US adults had prediabetes in 2010. That is 79 million Americans aged 20 years or older. The vast majority of people living with prediabetes do not know they have it. A person with prediabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes.

Prediabetes is a serious health condition that increases the risk of developing type 2 diabetes, heart disease, and stroke.

• 79 million Americans—35% of adults aged 20 years and older—have prediabetes.


• Half of all Americans aged 65 years and older have prediabetes.


• Without lifestyle changes to improve their health, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years.

 

 

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How can type 2 diabetes be prevented?

How can type 2 diabetes be prevented?

 

Research shows that modest weight loss and regular physical activity can help prevent or delay type 2 diabetes by up to 58% in people with prediabetes. Modest weight loss means 5% to 7% of body weight, which is 10 to 14 pounds for a 200-pound person. Getting at least 150 minutes each week of physical activity, such as brisk walking, also is important.

The lifestyle change program offered through the National Diabetes Prevention Program—led by CDC—can help participants adopt the healthy habits needed to prevent type 2 diabetes. Trained lifestyle coaches lead classes to help participants improve their food choices, increase physical activity, and learn coping skills to maintain weight loss and healthy lifestyle changes.

Many factors increase your risk for prediabetes and type 2 diabetes. To find out more about your risk, see which characteristics in this list apply to you.

• I am 45 years of age or older.


• I am overweight.


• I have a parent with diabetes.


• I have a sister or brother with diabetes.


• My family background is African-American, Hispanic/Latino, American-Indian, Asian-American, or Pacific-Islander.


• I had diabetes while I was pregnant (gestational diabetes), or I gave birth to a baby weighing 9 pounds or more.


• I am physically active less than three times a week.

It is important to find out early if you have prediabetes or type 2 diabetes, because early treatment can prevent serious problems that diabetes can cause, such as loss of eyesight or kidney damage.

Find out if you could have prediabetes by taking the online quiz on this page. If the quiz shows you could have prediabetes, talk to a health care provider as soon as possible. You also can download and print a copy at Prediabetes Screening Test  [PDF-758 KB] or Cuestionario para la detección de la prediabetes  [PDF-455 KB].

If you are 45 years of age or older, you should consider getting a blood test from a health care provider for prediabetes and diabetes, especially if you are overweight.

 

 

 

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Insulin Injection

Who needs insulin injection?

Type 1 diabetics are dependant on insulin as their body is unable to produce insulin.

In Type 2 diabetes, there may be periods (eg. during illness, surgery or pregnancy) when insulin is required. In addition, some Type 2 diabetics do better on insulin injections, especially when tablets are no longer effective.

Types of Insulin

Fast Acting

This is a clear solution. It has a quick onset and short duration of action.

Intermediate Acting

This is obtained by adding a substance which delays the absorption of insulin. This results in formation of tiny insulin crystals which give the insulin a cloudy appearance.

Premixed

This is a ready-made mixture of fast-acting and intermediate-acting insulin. They come in different portions of fast-acting and intermediate-acting insulins, e.g. 30% of one and 70% of the other.

Long Acting

There are also long-acting insulins that have a duration of action of more than 24 hours.

Very-fast acting

This form is the latest to come on the market. It acts even faster than the fast-acting insulin but its duration of action is shorter.

Insulin treatment must be individualised for each patient according to needs. Your doctor will choose the type or types of insulin that will best suit you.

How to Store Insulin?

Unopened insulin vials should be stored in a refrigerator between 2 and 8 degrees centigrade. The vials can be kept at the door or the lower compartment, away from the freezer. Frozen insulins should never be used.
The current vial in use canbe keptr in the coolest possible place for up to 6 weeks. Avoid extreme temperatures and direct sunlight.

Long exposure to direct sunlight will give the insulin a yellow-brown colour. Do not use the insulin if this happens.

Cloudy insulin can form clumps when not properly stored or when subjected to excessive shaking. They should be thrown away.

Types of Insuin Delivery Devices

Syringes and Needles

The best syringes are plastic disposable ones.

Insulin Pens

An injection pen is convenient to use and carry about. It loads a large quantity of insulin of any kind. The amount of insulin to be injected can be easily dialed up and delivered.

Insulin Pumps

Pumps have been developed to supply basal insulin continuously. Boluses of insulin can be activated and delivered before meals. The pump is attached via a tube and needle to the user. The control that can be achieved is comparable to a carefully monitored multiple injection regime.

Disposal Insulin Pens

These are the latest form of insulin-delivery device. The pens are preload with insulin, and thrown away after each injection.

How to Inject Insulin (Syringe Needle)

Getting ready

• Get ready a syringe and needle.


• Wash your hands with soap and water.


• Clean the rubber stopper on the insulin bottle with an alcohol swab.


• Roll the insulin bottle gently between your hands to suspend the insulin and warm it up.

Filling the Syringe

• Pull back the syringe plunger until the tip reaches the marker for the correct number of insulin units you will need.


• Put needle through stopper of insulin vial. Push plunger down putting air into the vial.


• Turn vial and syringe upside down and pull plunger down to just beyond the unit marker for the correct dose of insulin. (slightly more than the correct dose)


• Flick any air bubbles to the top of the syringe and push plunger up to unit marker for your dose.


• Take needle out of vial.

For a mixed insulin injection, do the above procedure for the clear insulin first and the cloudy insulin second.

Giving the Injection

• Clean injection area and firmly pinch up skin. Holding the syringe like a pencil, quickly push the needle all the way into pinched up area. The usual injection angle is between 45 and 90 degrees.


• Push plunger all the way to inject insulin beneath pinched-up skin.


• Remove syringe. Gently press hand over the area for a few seconds if bleeding occurs. Do not rub the injection area.


• Dispose of your syringe and needle safely.


• Record insulin dose in your diary.

 

 

 

 

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About Diabetes

About Diabetes

Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose (sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream. The pancreas then releases insulin to move the glucose from the bloodstream into the body cells for use or storage. People with diabetes are unable to fully use the glucose in their bloodstream due to:

• lack of insulin in the body


• insulin is ineffective

There are three major types of diabetes:

• 
  

  Type 1 Diabetes

  
  
  
  
  • no insulin is produced due to damaged pancreatic cells
  
  
  • usually diagnosed in children or young adults although it can occur at any age
  
  
  • insulin is needed for treatment
  
  
  • complications are sudden and life-threatening
  
  
  
  


• 
  

  Type 2 Diabetes

  
  
  
  
  • insulin produced is not enough or not effective (insulin resistance)
  
  
  • occurs more frequently in people over 40 years old, particularly those who are overweight and physically inactive
  
  
  • more younger adults and children are developing Type 2 Diabetes
  
  
  • can be controlled with proper diet and exercise but most diabetics also need oral medication
  
  
  
  


• 
  

  Gestational Diabetes Mellitus (GDM)

  
  
  
  
  • Occurs in about 2-5% of all pregnancies. Women who were not diagnosed to have diabetes previously show high blood glucose levels during pregnancy.
  
  
  • needs specialised obstetric care to reduce serious complications to the unborn baby
  
  
  
  

Signs & symptoms

The common symptoms of diabetes are:

• frequent thirst despite drinking lots of water


• constant hunger


• constant tiredness


• itchy skin especially around the genital area


• passing excessive urine during day and night


• weight loss despite good appetite


• poor healing of cuts and wounds

Complications

Uncontrolled diabetes can lead to high blood glucose (hyperglycaemia) and low blood glucose (hypoglycaemia).Both situations can cause a diabetic to become very sick very quickly and even go into a coma.

The long-term complications of diabetes include:

• coronary heart disease such as angina, heart attack


• stroke


• eye disease


• kidney disease


• foot disease such as numbness, ulcers and even gangrene


• nerve disease which can lead to problems such as impotence and diarrhoea

Screening & diagnosis

Diabetes can be detected through a blood glucose test.

You have diabetes mellitus if your

• Random Blood Glucose is 11.1 mmol/L or higher


• Fasting Blood Glucose is 7.0 mmol/L or higher

TEST (mmol/L)	Normal	Diabetic
Random blood glucose (check anytime of the day)	< 7.8	≥ 11.1
Fasting blood glucose (tested in the morning after 8 hours of overnight fast)	≤ 6.0	≥ 7.0

Treatment

Diabetes is a life-long disease. It can be controlled if you do the following:

Your diabetes may be controlled through diet or a combination of diet and medication. Follow your doctor's instructions on diet and/or medication.

Oral medication

All medicines must be taken regularly at the correct dosages at the given times as advised by your doctor

• Sulphonylureas (SUs)


• Non-SU Secretagogues


• Biguanides


• Alpha-Glucosidase Inhibitors


• Thiazolidinediones

As in all medicines, sometimes side effects such as skin rashes, eye swelling, vomiting, diarrhoea may occur and these have to be reported to your doctor at once.

Insulin

There are different types of insulin. Some are short-acting and others are long-acting, while still others are a mixture of both. Your doctor will prescribe the exact amount of the specific types of insulin you would need.

• Follow instructions carefully and do not make any changes without consulting your doctor


• Always keep all insulin bottles plus an extra spare bottle in the refrigerator when not in use


• Short acting insulins by themselves or as part of a mixture need to be injected about 30 minutes before a meal

Self-care

A diabetic person has to take extra care of his body to maintain good health.

Foot care

As a diabetic, you have a higher risk of foot problems. In serious cases, it can lead to amputations. Taking care of your feet is very important:



Wash your feet daily with soap and water.






After washing, dry them fully, especially in between the toes.






Keep your toe nails short, trimming them straight across to avoid ingrown toenails.






Moisturise your feet daily to prevent dryness and cracking of the skin.






Examine your feet daily for scratches, cuts, blisters and corns. Use a mirror to check the sole of your feet.






Use shoes that fit well and wear clean cotton socks which have loose fitting elastic tops.






See your family doctor for screening of your feet every year.






If you have any corns or any wounds that are not healing well, seek help from your doctor as soon as possible.

Eye care

Diabetes can cause severe eye problems where the small blood vessels in the eyes become damaged (diabetic retinopathy) and can lead to blindness.

It is important to have regular eye check-ups at least once a year.

You can get your retinae (inside surfaces of your eyes) photographed by a procedure called retinal photography to detect any damage to small blood vessels. The doctor might also perform laser photocoagulapathy, a form of highpowered light and heat energy, to prevent further damage.

Skincare

Avoid skin injury as diabetes makes the skin more prone to many problems such as rashes, infections and colour changes.

• Wash every part of the body while bathing using mild soap and warm water.


• Dry all parts of the body using a clean towel.


• Pay attention when washing and drying skin folds in areas such as under the breasts, abdominal folds and groin area.


• Apply moisturising cream to keep skin moist and soft.


• Treat all cuts and scratches at once, wash with soap and water and then apply mild antiseptic lotion.


• See a doctor if the skin injury does not heal in 2-3 days.

Dental care

Dental care is important as many infections start in the mouth.

• Brush your teeth twice a day – after breakfast and before bedtime.


• Use a soft toothbrush to prevent gum injury.


• Rinse your mouth after every meal or snack.


• Floss your teeth gently after meals to remove food particles between your teeth.


• Dental check-ups: Inform your dentist that you have diabetes and visit him at least once a year.

Prevention

Lead a healthy lifestyle

• 
  

  Have a proper diet

  
  Besides insulin and medicines, eating a healthy diet helps you keep your blood glucose under control. It also helps to maintain your weight at a healthy level. Use the Healthy Diet Pyramid.


• 
  

  Engage in regular physical activity

  
  Regular physical activity is an important part of your diabetes control. It helps to prevent the onset of complications. Exercise also helps to control your weight and keeps your heart healthy. Consult your family doctor before starting any exercise programme.


• 
  

  Do not smoke

  
  Smoking worsens the narrowing of blood vessels already caused by diabetes. It reduces blood flow to many organs and leads to many serious complications.


• 
  

  Limit your alcohol intake

  
  Alcohol interferes with your meal plan and blood glucose control, especially if you are taking insulin or medicines for your diabetes.

 

 

 

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Treating type 1 diabetes

 

Treating type 1 diabetes

There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life.

If you've been diagnosed with diabetes, you'll be referred for specialist treatment from a diabetes care team. They'll be able to explain your condition in detail and help you understand your treatment. They'll also closely monitor your condition to identify any health problems that may occur.

Insulin treatment

Type 1 diabetes occurs because your body can't produce enough insulin. This means you'll need regular insulin treatment to keep your glucose levels normal.

Insulin comes in several different preparations, each of which works slightly differently. For example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). Your treatment is likely to include a combination of these different insulin preparations.

Insulin injections

If you have type 1 diabetes, you'll probably need insulin injections. Insulin must be injected, because if it were taken as a tablet, it would be broken down in your stomach – like food – and would be unable to enter your bloodstream.

When you're first diagnosed, your diabetes care team will help you with your insulin injections, before showing you how and when to do it yourself. They'll also show you how to store your insulin and dispose of your needles properly.

Insulin injections are usually given by an injection pen, which is also known as an insulin pen or auto-injector. However, injections are sometimes given using a syringe. Most people need two to four injections a day.

Your GP or diabetes nurse may also teach one of your close friends or relatives how to inject the insulin properly.

Insulin pump therapy

Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device that holds insulin and is about the size of a pack of playing cards.

The pump is attached to you by a long, thin piece of tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms.

The pump allows insulin to continuously flow into your bloodstream at a rate you can control. This means you no longer need to give yourself injections, although you'll need to monitor your blood glucose levels very closely to ensure you're receiving the right amount of insulin.

Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 1 diabetes. However, it may not be suitable for everyone. Your diabetes care team may suggest pump therapy if you have frequent episodes of low blood glucose (hypoglycaemia).

 

 

 

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Diabetes Introduction

Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high.

The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood.

There are two main types of diabetes:

• Type 1 – where the pancreas doesn't produce any insulin


• Type 2 – where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin

This topic is about type 1 diabetes. Read more about type 2 diabetes.

Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear following birth.

It's very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated.

You should therefore visit your GP if you have symptoms, which include feeling thirsty, passing urine more often than usual and feeling tired all the time (see the list below for more diabetes symptoms).

Type 1 and type 2 diabetes

Type 1 diabetes can develop at any age, but usually appears before the age of 40, particularly in childhood. Around 10% of all diabetes is type 1, but it's the most common type of childhood diabetes. This is why it's sometimes called juvenile diabetes or early-onset diabetes.

In type 1 diabetes, the pancreas (a small gland behind the stomach) doesn't produce any insulin – the hormone that regulates blood glucose levels. This is why it's also sometimes called insulin-dependent diabetes.

If the amount of glucose in the blood is too high, it can, over time, seriously damage the body's organs.

In type 2 diabetes, the body either doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. Around 90% of adults with diabetes have type 2, and it tends to develop later in life than type 1.

Diabetes symptoms

The symptoms of diabetes occur because the lack of insulin means that glucose stays in the blood and isn’t used as fuel for energy.

Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine.

Typical symptoms include:

• feeling very thirsty


• passing urine more often than usual, particularly at night


• feeling very tired


• weight loss and loss of muscle bulk

The symptoms of type 1 diabetes usually develop very quickly in young people (over a few days or weeks). In adults, the symptoms often take longer to develop (a few months).

Read more about the symptoms of type 1 diabetes.

Causes of type 1 diabetes

Type 1 diabetes occurs as a result of the body being unable to produce insulin, which moves glucose out of the blood and into your cells to be used for energy.

Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis, where the bloodstream becomes acidic and you develop dangerous levels of dehydration.

Type 1 diabetes is an autoimmune condition, where the immune system (the body's natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them.

Read more about the causes of type 1 diabetes.

Treating type 1 diabetes

It's important that diabetes is diagnosed as early as possible, so that treatment can be started.

Diabetes can't be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life.

If you're diagnosed with diabetes, you'll be referred to a diabetes care team for specialist treatment and monitoring.

As your body can't produce insulin, you'll need regular insulin injections to keep your glucose levels normal. You'll be taught how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do.

Insulin injections come in several different forms, with each working slightly differently. Some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). You'll most likely need a combination of different insulin preparations.

There are alternatives to insulin injections, but they're only suitable for a small number of patients. They are:

• insulin pump therapy – where a small device constantly pumps insulin (at a rate you control) into your bloodstream through a needle that's inserted under the skin


• islet cell transplantation – where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes (read about the criteria for having an islet transplant)


• a complete pancreas transplant

Read more about diagnosing diabetes and treating type 1 diabetes.

Complications

If diabetes is left untreated, it can cause a number of different health problems. Large amounts of glucose can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term.

Read more about the complications of type 1 diabetes.

Living with diabetes

If you have type 1 diabetes, you'll need to look after your health very carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications.

For example, eating a healthy, balanced diet and exercising regularly will lower your blood glucose level. Stopping smoking (if you smoke) will also reduce your risk of developing cardiovascular disease.

Read more about living with diabetes.

 

 

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