Diabetes Resource

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Disclaimer This asset contains general information about Type 2 diabetes and its treatments. The information is not advice, and should not be treated as such. The medical information in this asset is provided “as is” without any representations or warranties, express or implied. Bridgeable makes no representations or warranties in relation to the medical information in this asset. Bridgeable does not warrant that: • the medical information in this asset will be constantly available, or available at all; or • the medical information in this asset is complete, true, accurate, up-to-date, or nonmisleading. You must not rely on the information in this asset as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information in this asset.

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What normally happens in the body? 1 To explain what’s going on in your body, let’s use an analogy. Imagine your body as a city.

2 The cars on the roads need to get to different places in the city.

Your body

City

Blood sugar

Body part

This is like how your blood sugars in your blood vessels need to get to different body parts.

Blood vessel

3 The green traffic lights on the roads keep the cars moving.

You can all go!

This is like when your natural insulin keeps your blood sugars moving.

4 The cars can get to the right places in the city! This means the city is running well.

Natural insulin

Body part

This is like when your blood sugars get to the right body parts! Your body is happy.

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

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What happens in Type II diabetes? 1 When you have Type II diabetes, more and more of the green traffic lights in the city slowly become red lights.

Natural insulin

No insulin

This is like when your body slowly makes less and less natural insulin until there is no insulin. No insulin

2 When too many lights become red, most cars get stuck on the roads. This is like when your body makes too little or no insulin, your blood sugars get stuck in your blood vessels.

Everyone, stop! Blood sugar

No insulin

No insulin Blood vessel

3 As more cars enter the city, more cars get stuck on the roads. This is like when more blood sugars enter your body after you eat, more blood sugars get stuck in your blood vessels.

4 The cars can’t get to the right places in the city! This means the city isn’t running very well. This is like when your blood sugars can’t get to the right body parts! The high blood sugars will hurt your body over time. Body part THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

3


What can insulin do for Type II diabetes? 1 When you inject insulin into your body, this is like switching the red traffic lights to temporary green lights in the city.

Injected insulin

No insulin

2 The temporary green lights help the cars stuck on the roads move again. This is like when the injected insulin helps the blood sugars stuck in your blood vessels move again.

3 The cars can get to the right places in the city! This means the city is running well again.

You can all go for now!

Blood vessel

Injected insulin

Blood sugar

Body part

This is like when your blood sugars get to the right body parts! Your body is happy again.

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

4


How much blood sugar is too much? For your body to be healthy, you need the right range of blood sugar. This is called the “happy range”. The happy range is different for each person. It’s also different before and after eating. My happy range before eating:

mg/dL to

mg/dL

My happy range after eating:

mg/dL to

mg/dL

Hyperglycemia

Happy range

Hypoglycemia

is too much or high blood sugar

is just the right range of blood sugar

is too little or low blood sugar

This is like when traffic is very bad. The cars can’t get to the right places in the city.

This is like when traffic is normal. Most cars can get to the right places in the city.

This is like when traffic is very light. There are very few cars on the roads. The city can’t run well without enough visitors.

Blood sugar

Blood vessels

Body part

When you have Type II diabetes, your body may need injected insulin to help your blood sugars get to the right parts of your body. Your goal when injecting insulin is to keep your blood sugars within your happy range as much as possible.

You don’t have to be perfect to be in control of your diabetes! Even people without diabetes won’t always have their blood sugars in the happy range. This is normal!

We’ll help you find your happy range so you know what to aim for! Your healthcare team THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

5


I already take diabetes pills, why do I need to take insulin? Diabetes pills

Insulin

can only lower your blood sugar by a little bit.

can lower your blood sugar by much more at a time, depending on how much you take.

Taking pills is like switching the red traffic lights to temporary stop signs in the city. When traffic is light, the temporary stop sign lets the cars pass one by one. Most cars are still moving. There are no cars stuck on the roads. When traffic is very bad, the temporary stop sign can’t let the cars pass fast enough. Most cars are still stuck on the roads. This is like when you have high blood sugar, taking pills can bring your blood sugars down by a little bit. But pills may not be enough to help bring your blood sugars all the way back down to your happy range. Most of your blood sugars are still stuck in your blood vessels.

Injecting insulin is like switching the red traffic lights to temporary green lights in the city. When traffic is very bad, the temporary green lights can let many more cars go than stop signs. This is like when you have high blood sugar, injecting insulin can bring your blood sugars down by a lot. Injected insulin can help to bring your blood sugars back down to the happy range much faster than pills can.

Injected insulin

Pills One at a time!

STOP

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

Everybody, go!

6


Are there different kinds of insulin? There are 3 different types of insulin. When you inject insulin into your body, this is like switching red traffic lights to temporary green lights in the city. But each type of green light stays green for different lengths of time. When you inject one of the three types of insulin:

1

Rapid- or Shortacting insulin

makes red lights switch to

green for 2–6 hours

or

2

Intermediateacting insulin

makes red lights switch to

green for 12–18 hours

or

3

Long- acting insulin

makes red lights switch to

green for 24 hours

When you have Type II diabetes, you may need to inject long-acting insulin each day to make sure there is always some insulin in your body. This type of injection is called a basal insulin. This is like making sure that some traffic lights in the city stay green all the time to keep traffic moving. Your goal when injecting basal insulin is to keep your blood sugars as close to your happy range as possible at all times.

We’ll help you figure out which types of insulin you should be taking to get to your happy range!

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

Your healthcare team

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When should I be injecting insulin? You now know that you may need to inject basal insulin each day to make sure there is always some insulin in your body. Ask your healthcare team when you should be injecting your basal insulin. My basal insulin injection dose is:

mg/dL at

AM / PM everyday

There may be times when you have to tweak your basal insulin dose. How much you tweak your dose is based on changes in your blood sugars. Here are some things that may affect your blood sugars:

Things that may affect your blood sugars • • • • •

Eating will make your blood sugars go up Not eating will make your blood sugars go down Stress or illness may make your blood sugars go up Physical activities will make your blood sugars go down Alcohol may make your blood sugars go down

• Periods (menstruation) may make your blood sugars go up or down

Here is an example: Hi, I’m Lamar. I try to eat foods that don’t make my blood sugars go up too much, and I exercise for about 30 minutes a day. Every night before I sleep, I take my basal insulin injection. All of these things help me to control my blood sugar levels.

Being good at controlling your blood sugars is about knowing how to inject the right dose at the right time. Let’s work together to help you become as good at knowing how much insulin to inject as Lamar!

When I’m sick, I might throw up or not feel like eating. So then, I only inject half of the basal insulin that I normally do. But whenever I’m not sure about how much insulin to inject, I just ask my healthcare team. Lamar lives with Type II diabetes

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

Your healthcare team

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How do I prepare an insulin pen? 1 Gather all the supplies you need for your injection before you start.

Hard container with a lid

Why is this important? You don’t want to have to stop halfway or restart because you forgot to grab something. This will make sure you finish the injection as fast and as smoothly as possible.

Soap

Insulin pen

New pen needle

2 Wash your hands well with soap and water. Or you can use a hand sanitizer and rub your hands until they’re dry. Why is this important? Whether your hands look dirty or not, there are always germs on it. Wash your hands before you inject to make sure you don’t get the germs into your body through the injection.

Cotton swabs Alcohol swabs

Water Soap

Rub hands

3 Mix your insulin gently by rolling the pen between your hands. Or you can tilt your pen slowly back and forth. (You will only have to do this for some types of insulin.)

Why is this important? Some types of insulin separate naturally like water and oil. Mix it to make sure the insulin is even, so that you can get the right dose you need.

Tilt slowly

4 Remove the pen cap and use an alcohol swab to clean the top of the pen. Why is this important? The insulin you are injecting will touch the top of the pen when you inject. Clean the top of the pen to make sure there are no germs there that will get into the insulin by accident.

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

Wipe top of pen

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How do I prepare an insulin pen? 5 Place the new needle on the pen and twist to screw it tightly onto the pen.

New needle

Why is this important? You need to use a new needle each time to make sure the needle is clean. This will prevent you from getting sick from germs.

6 Dial to 2 units and push the plunger. Make sure that you see liquid come out of the needle.

Twist to screw in

Turn to dial

Why is this important? Sometimes air gets into the needle or insulin. This step will make sure you inject insulin instead of air into yourself. If you inject air into yourself, you will not get the right dose of insulin you need.

Press

7 Pick a soft fatty area that you have not used for injections recently. Why is this important? Fatty areas will absorb insulin better than muscley areas. It’s important to keep rotating between different areas on your body. If you inject into the same area all the time, that area will scar inside, and will not absorb insulin well.

8 Clean the injection area with an alcohol swab. (This example shows the stomach injection area.)

Alcohol swab

Why is this important? This is the same reason as washing your hands. Clean the injection area to make sure you don’t get any germs into your body through the injection.

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

10


How do I inject with an insulin pen? 1 Dial to the dose you need based on your healthcare team’s instructions.

Turn to dial

Why is this important? There may be more insulin in the pen than you need at that time. Dial to the right dose to make sure you can’t accidentally inject more than you need. If you inject too much, it can be dangerous for your body!

Small window showing dose

2 Pinch a fold of fatty flesh from your selected injection area between your thumb and index fingers. (This example

Pinch

shows the stomach injection area.)

Why is this important? Fat absorbs insulin better than muscle. Pinching will help to make sure you are injecting into fat and not muscle.

3 Push the needle straight into the fatty flesh then push the plunger slowly to inject the insulin. Do not stop pinching.

Press

Plunger

Why is this important? Pushing the plunger too fast may make the insulin leak out from the injection area. Inject slowly to make sure you get the right dose of insulin you need.

4 After you push the plunger all the way down, wait for 10 seconds before you pull the needle back out. Stop pinching after the needle is out. Why is this important? Pulling the needle out too soon may make the insulin leak out from the injection area. Give your body some time to absorb the insulin before pulling the needle out. THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

Hold for 10 secs

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How do I inject with an insulin pen? 5 If any blood leaks out from the injection area, wipe it with a cotton swab.

Cotton swab

Don’t worry if this happens! This means you’ve accidentally stuck the needle into a blood vessel. This won’t hurt your body.

6 Unscrew the needle from the pen and throw away the needle into a hard container with a lid that the needle can’t poke through. Once the container is full, ask your healthcare team where you can throw it out.

Used needle

Throw away

Twist to remove

Why is this important? It’s important to throw the needle away into a safe place so that your family, friends, or even the garbage man won’t accidentally be hurt by your needle!

Hard container

There are many different models of insulin pens. They might look different or work slightly differently. Ask us how to use your pen!

You can also watch a video of the injection steps online: https://goo.gl/gkMfoT (Source: Mayo Clinic YouTube)

Your healthcare team

Injection steps for my pen:

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

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Can’t my healthcare team just manage my diabetes for me? In your health journey, you are the driver. Your healthcare team is your passenger. Together, your goal is to keep your blood sugars under control.

GOAL

Healthcare team

You

Passenger’s to-do list

Driver’s to-do list Your responsibilities • Check your blood sugar levels everyday using a blood sugar (glucose) meter • Take the right type and right dose of insulin at the right time on schedule • Know when you may need to tweak your insulin routine based on life changes • Know that you may need to change your diet and exercise to help control your blood sugar levels • Tell your healthcare team when you need help or have difficulties

Remember – you and your passenger are a team working together to keep your blood sugars under control. Your passenger can only teach you what to do, but as the driver, you are the one who must step on the gas and take the team to the goal!

Your healthcare team’s responsibilities • Look out for what areas you need help in • Help you to plan out your insulin routine • Talk to you about when to adjust how much insulin you are taking • Teach you what to do if your blood sugars are too high or too low

We can’t do this without you! Let’s work together to make sure you have what you need to take control of your diabetes. Your healthcare team

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

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What else can I do to manage my diabetes? There are 3 key areas you can work on to manage your diabetes. To keep your blood sugars under control, try to follow the recommendations as much as you can. Use the writing space to plan out your personal goals in each of the areas.

Stay active

Eat right

This doesn’t mean you have to lift heavy weights or run long distances all the time! It will help with your diabetes if you exercise for at least 30 minutes a day, 5 days a week. This can be activities such as: • Brisk walking • Climbing stairs • Dancing or doing Zumba • Playing with your grandchildren

Having diabetes doesn’t mean you can’t have your favorite foods at all anymore. It means you’ll have to make decisions about what and when you eat: • What you eat – Are you eating lots of rice or beans that will make your blood sugars go up? What you eat may make your blood sugars go up really fast or slowly, and by a lot or just a little. • When you eat – How many meals do you eat in a day? How long do you go without food in between meals? How much you eat and when you eat will affect your blood sugars differently.

My exercise goals:

My food goals:

Keep track Sometimes you won’t feel sick even if your blood sugars are too high or too low. You will need to check your blood sugar levels often with a blood glucose (sugar) meter to really know. Work together with your healthcare team to plan when to check your blood sugars and when/what insulins to take. But remember – as your life changes, your plan will have to change with it. My tracking goals:

Let’s work together to help you plan out what you can do in each of these areas. If you are feeling overwhelmed by your diabetes, or if you are feeling depressed, please tell us. Let us help you. Your healthcare team

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

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I heard ________ about insulin, is it true? Here are some common things we hear from people with Type II diabetes: Maria

Doctors only give insulin to people if they are failures.

Dayton

Insulin doesn’t work for my diabetes.

The truth:

The truth:

Needing insulin doesn’t mean you are a failure as a patient.

Your insulin injections will work the same way as the natural insulin that you make in your body.

Type II diabetes is a progressive disease that will naturally get worse over time. This means that your body will make less and less natural insulin over time. When this happens, your body will need injected insulin to help bring your blood sugar levels back to the happy range.

Many people believe that diabetes is a problem with high blood sugars. But diabetes is actually a problem with not having enough natural insulin.

It’s normal and expected to need injected insulin if you have diabetes. Each person’s body and diabetes are different. Some people’s diabetes will get worse slower or faster than others.

Insulin injections are the best way to replace the natural insulin that your body isn’t making. Insulin injections work best if you inject the right dose at the right time.

What you can do:

What you can do:

• Be in touch with how you’re feeling day-to-day

• Use insulin correctly (right dose at the right time) by following your healthcare team’s instructions

• Follow the instructions and treatment plan that your healthcare team made with you • Talk to your healthcare team if: o you notice any changes in how you’re feeling o you’re finding it harder to control your diabetes o you are feeling overwhelmed or depressed by your diabetes or treatment THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

• Talk to your healthcare team if you have any questions or concerns about taking insulin

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I heard ________ about insulin, is it true?

Kyle

Wendy

Insulin makes people sicker!

Insulin will make me get fat!

The truth:

The truth:

Injected insulin was not made to hurt you. It was made to replace the natural insulin that your body isn’t making because of Type II diabetes.

You may gain weight if you use injected insulin, but this is normal and not necessarily a bad thing.

You may be afraid to use insulin because you’ve seen others in your life get hurt. Bad things can happen if your diabetes is left untreated, is not treated properly, or just naturally got worse over time. You may feel just fine now, but often times, the bad effects of poorly controlled diabetes might not be seen or felt until it’s too late. When you start early and take control of your injected insulin and blood sugar levels, you can prevent or delay bad things from happening. What you can do: • Tell your healthcare team about any stories that you’ve heard about insulin that make you worried, scared, or unwilling to use insulin • Talk to your healthcare team about why treatment with injected insulin is important for you now, and for your future

The insulin in your body helps to turn your blood sugar into two main things: 1) Energy for your body to use immediately, and 2) Energy that is stored as fat for your body to use later. With Type II diabetes, your body is not making much natural insulin. By injecting insulin, you are helping your body do (1) and (2) again. (2) can cause weight gain, but that is normal and expected! What you can do: • Talk to your healthcare team about what to expect, or if you’re worried about gaining weight • Ask your healthcare team about what you can do with diet and exercise to keep your body weight healthy and comfortable

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

16


I heard ________ about insulin, is it true?

Camila

I am still unsure about…

Insulin injections hurt!

The truth: For most people, insulin injections don’t hurt much at all. The needles used are very small and thin, so they don’t really sting when going in. In fact, insulin injections are often less painful than the finger prick you do when checking your blood sugars! What you can do: • Ask your healthcare team about which injection devices hurt less (syringe, insulin pen, insulin pump, jet injection, etc.) • Ask your healthcare team what parts of your body hurt less when you inject into them • Try a few areas for injection to see what hurts the least for you If you have any other questions or concerns about insulin, just ask us! Your healthcare team

THIS DOCUMENT IS FOR CONCEPT ONLY. Always seek the advice of your doctor with any questions you may have regarding a medical condition or treatment.

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