The information in this booklet is of a general nature only and should not be substituted for medical advice or used to alter therapy. It does not replace consultation with qualified healthcare professionals to meet your individual medical needs.
Contents
5 8 12 16 20 24 28 32 35
Introduction My interest in Diabetes developed after working, since 1994, in a medical practice and seeing the condition of diabetes become more and more prevalent. I became more involved in the care of people living with diabetes within the medical practice and in 2011 I completed a post graduate degree in Diabetes Education. I became a Credentialled Diabetes Educator in 2013, ongoing annual re-credentialing is required to maintain this qualification. Helping people to understand the condition of diabetes and to make decisions about how they manage it to prevent the long term complications is my passion. Education and knowledge empower you to make informed decisions. I believe the education needs to be patient focused and in terms tailored to the individual. This workbook is in simple everyday terms that
will provide you with a basic understanding of diabetes that will compliment additional professional education sessions. This information is directed towards people living with Type 2 diabetes. I’d like to thank the team at “That’s Easy Learning” for their work and support in putting this workbook together. I met the CEO of “That’s Easy Learning”, Jeff Muir, a few years ago, not only has he supported me in growing my business, he has taught me many life lessons of which I am eternally grateful for and I can say without hesitation ………….. “Jeff, your training has not been wasted.” Finally, thank you to my life partner Greg, who has encouraged me to keep going when I felt it got too hard, supporting me, motivating me and providing me with articles of interest, and just being there as my rock.
Merle Taylor
Glucose enters the blood via the gut.
Diabetes and Your Body Diabetes is a condition where there is too much sugar or glucose in the blood. This occurs because the pancreas can’t make any insulin or it can only make a small amount and the insulin it makes cannot work properly. Glucose is one of our body’s fuels, like petrol is to the car. This fuel comes from the food we eat, not all food but the food we call carbohydrates. Carbohydrate foods are healthy starchy foods like bread, rice, pasta, cereals and potatoes or sugary healthy foods like fruit, milk and yoghurt and the not so healthy choices like chocolate, ice cream, takeaways, cakes, biscuits, cool drinks and lollies. When we eat these foods and they go into our stomach, it gets broken down and moves into the gut or intestines.
The sugar that comes from food is called Glucose The sugar that comes from these foods is called glucose. This glucose is absorbed from our gut into the bloodstream and travels around our body where it’s used for energy by the body’s cells. It is stored in the muscles for energy, in the liver and what’s left over is stored in the fat cells, around the organs and ultimately increases the waist circumference. Our body makes insulin in an organ called the pancreas and insulin works like the key to your front door. The cells of the body are like little houses or rooms with lots of doors. Insulin is needed to open these
What is Diabetes? 5
doors just like a key is used to open a locked door and then the glucose goes into these rooms to be used for energy.
Type 1 Diabetes is an auto immune condition In Type 1 diabetes the pancreas cannot make any insulin at all, this is known as an autoimmune condition and is quite different to Type 2 diabetes. When the pancreas can’t make enough insulin keys or the insulin it’s making doesn’t work properly because the locks are rusty or clogged, the sugar stays in the blood and the levels rise too high: this is known as Type 2 diabetes. Several things can cause these rusty locks, age, being overweight or obese especially around your waist, being inactive, your family history or ethnic background, sometimes certain medications and other diseases can cause problems too.
By the time there are symptoms, the glucose level is high The rusty locks are often referred to as insulin resistance. These high levels of glucose can lead to complications like blindness, kidney disease, heart attack, stroke and amputation in both Type 1 and Type 2 diabetes. The symptoms of high blood glucose are thirst, peeing alot, visual changes and feeling tired and lethargic. In many instances people can have had diabetes for a long time and not have any symptoms, that’s why regular blood tests with your Doctor are important as you get older or if you have any of the risk factors that cause diabetes. 6 What is Diabetes?
Measuring glucose in the blood is done with a machine called a glucometer. The nondiabetic range is from 4-8 mmol fasting levels. In people living with diabetes there are target ranges for, fasting and 2 hours after eating a meal. Fasting is when you first wake up in the morning and this target is between 6-8 mmol/ L and 2 hours after food should be taken from the time of the first mouthful, the target is <10 mmol/L. Keeping blood glucose levels in the healthy range will reduce the risk of complications in the future.
Questions Diabetes & Your Body
Q1. Type 1 diabetes is… a. An autoimmune condition and requires insulin from diagnosis b. Caused by eating too much sugar c. Just the same as Type 2 diabetes Q2. Type 2 diabetes is… a. Caused by eating too much sugar b. Caused because there are rusty locks on the cells or insulin resistance and not enough insulin c. Nothing to worry about d. Just the same as Type 1 diabetes Q3. The complications of diabetes… a. Can affect people living with Type 1 and Type 2 diabetes b. Only affect people living with Type 1 diabetes c. Only affect people living with Type 2 diabetes
See answer on page 40
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 7
There are carbohydrates in all food groups.
Carbohydrate Foods and the Glycaemic Index These are the foods that the body breaks down into glucose or sugar. Eating too much of these types of foods can cause the blood sugar to rise too high if you have diabetes.
You can still enjoy carbohydrate foods Carbohydrate foods can be broken down into starchy foods and sugary foods. These starchy foods are foods like bread, rice, noodles, pasta, potatoes and corn, crackers and cereals like porridge. The sugary foods are foods like fruit, milk and yoghurt, cakes, cool drinks, ice-cream, chocolate, honey and of course sugar. Now you might be thinking that you can’t eat
8 What is Diabetes?
these foods any more if you have diabetes. That’s not so. There are healthy choices to make when deciding to have these foods and that’s what people living with diabetes need to know. You may have heard of the glycemic index or GI. This is a measure of how quickly the body absorbs the sugar from these carbohydrate foods.
Quantity is as important as quality When a High Glycaemic Index food is eaten the blood glucose levels spikes really quickly and the body has to work really hard producing insulin to get the level down, this
can be a problem if the body is unable to do this and causes the levels to stay high. If you are concerned about your blood glucose level, then choosing Low Glycaemic foods is the best choice. Low Glycaemic foods break down much more slowly and keep the glucose levels in the blood much more even and the body doesn’t have to work so hard to remove the glucose from the blood. Although eating low to medium glycaemic foods is the best way to manage blood glucose levels, it still comes down to how much of that carbohydrate food you
All fruit is carbohydrate and the recommendations are 2 serves daily, 1 small to medium sized piece or 2 small pieces equal a serve of fresh fruit or a half a cup is a serve of tinned fruit. Grains and cereals like bread, rice, pasta, porridge, breakfast cereals are all carbohydrate and staying with the recommended serving size is important. Protein foods that contain carbohydrate are legumes, like baked beans and chickpeas. Then there’s the dairy group, many people are surprised to know that milk and yoghurt are carbohydrate foods.
Low
GI less than 55.
Medium GI between 55 and 70. High GI greater than 70.
actually eat. Even too much Low Glycaemic carbohydrate will push the blood glucose level up so the amount of carbohydrate food is very important. Mixing a High Glycaemic food with a Low Glycaemic food will make the food medium glycaemic so you can see you don’t have to miss out on some of those special foods, just take care with amount you eat. Carbohydrates can be found in all the food groups, potato, sweet potato and corn in the vegetable group and the recommended daily intake is 5 serves of vegetables. A cup of raw vegetables or half a cup of cooked vegetables is a serve.
All food groups contain carbohydrates How could you tell if you have eaten too much carbohydrate in your meal if you have diabetes? I would recommend you monitor your blood glucose using your glucometer before you eat and then 2 hours from when you started the meal. Then you can compare the readings, the blood sugar should be less than 10 millimoles per litre. If the gap in the reading is more than 3 millimoles, even if it is less than 10 millimoles per litre, then that may indicate that the serve of carbohydrate is too large. Reducing the serve next time may show a better response and this will What is Diabetes? 9
help you identify how your body is managing the glucose from your food and what is the best type of carbohydrate for you and itâ&#x20AC;&#x2122;s serving size. If the reading is higher than 10 millimoles per litre it probably means that the serve of carbohydrate was too much, so reducing the amount next time should reduce the reading. It could also mean that the condition of diabetes has progressed and the amount of insulin being produced in the body has decreased and therefore the sugar has remained in the blood.
Stress can also be a cause of raised blood glucose levels Stress, infection, illness and pain can also cause blood glucose levels to be elevated so considering how you are feeling is important when levels are higher than expected. You may need to see your Medical Practitioner or Diabetes Educator for advice on how to manage the levels if they remain high.
Questions
Carbohydrate Foods and the Glycaemic Index
Q1. Carbohydrate foods can be healthy and unhealthy foods... a. False b. True Q2. Low GI carbohydrate foods are the best choice because... a. They break down much more slowly and keep the glucose levels in the blood much more even b. They taste the best c. They make the blood sugar rise really quickly Q3. Carbohydrate foods can be found in all the food groups (vegetables, grains, fruit, protein, dairy)... a. False b. True c. All except protein d. All except dairy See answer on page 40
14 Using a test strip and glucometer, you can measure your blood glucose levels. 10 What is Diabetes?
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 11
Monitoring blood levels can help you gain control.
Monitoring Your Blood Glucose Level Blood glucose monitoring is how you can tell if your diabetes is changing. It can also tell you how the food youâ&#x20AC;&#x2122;re eating is affecting you, the exercise youâ&#x20AC;&#x2122;re doing is benefiting you and how your medications are working for you.
Use your lancet device to draw some blood from your finger, using the side or fleshy area of your fingers rather than the tip.
Apply the blood Wash your hands To make sure your reading is accurate always wash your hands before performing the test. If you have been preparing a meal or eating a snack you may have food or juice on your fingertips and your result will be inaccurate. Prepare your meter with a test strip checking that the strip has not expired and your meter is clean. 12 What is Diabetes?
Apply the blood to the strip, most strips will draw the blood into themselves making application of the blood easy. Record the reading and the time you took the test in your record book. Record any medications taken at the same time. What the reading tells you depends on the timing of the test, whether you have eaten something, had something to drink or not had anything to eat at all, and perhaps even how you have been feeling.
Fasting is when you have not eaten or drunk for four hours or more Doing a reading when you first wake up is known as the ‘fasting’ sample and the target range for this is between 6-8 millimoles per litre. This is also the target range before you eat your meals. The fasting reading should be lower than the reading the night before, doing levels in pairs can show you how your body is working.
should be less than 10 millimoles per litre. The difference between the pre-meal and the post meal reading should be about 2-3mmol/L. If the reading is greater than this then looking back at the meal to identify which foods may have caused the rise is recommended. There may have been too bigger serve of carbohydrate food and reducing this may have a better result next time. If the serve of carbohydrate was according to the recommendations and the rise was greater than 2-3mmol/L then assessing how you feel is important as not just food can
Keeping a record can help you GP or Diabetes Educator see how you are going.
When diabetes progresses, the fasting reading can be higher than before you go to bed Overnight is generally the longest time you are not eating, this can be the time where the liver will make its own sugar and cause the blood glucose levels to rise. Checking your levels before bed and then on waking can identify if this is occurring to you. These two readings are the overnight “pair”. If you have had something to eat or drink and you are checking two hours later, from the time of your first bite the target range
increase blood glucose levels. Suffering from pain, infection or stress can also contribute to high blood glucose levels. If you cannot find a reason then it may be that the condition has progressed and you will need to consult your Medical Practitioner or Diabetes Educator to discuss this. These readings are known as your day to day readings and they can help you to see how your diabetes is going from day to day. Regular readings can tell you how your medication is working. It can help you to see the impact of certain foods that you eat, drinks that you consume or how exercise affects your readings. What is Diabetes? 13
See your Diabetes Educator for help When you visit your Credentialled Diabetes Educator they too will be able to see how your diabetes is going and discuss any questions you have about your readings.
that day. To know how the team has been performing over the season we need to look at where they are placed on the league ladder. The HbA1c is the league ladder.
Red: “over 8%” Orange: “7-8%”
There are times when you may be unwell, have an infection or be feeling really stressed. These situations can increase your readings so checking more often at these times can help you make decisions about whether you need to visit the doctor or your educator or go directly to hospital.
HbA1c or Glycated Haemoglobin is another measure of glucose control Another test can be done to check the blood and see what the blood sugar levels have been over the previous three-month period, this is known as the HbA1c or glycated haemoglobin. This measures the amount of sugar or glucose that has stuck to the red blood cells in your blood stream. The result comes back to your Doctor and Diabetes Educator as the average reading over the previous three months. It is reported as a percentage and also as an international measure called mmol/mol. The target level for this reading is to have it less than 7% or 53 mmol/mol in the blood. The analogy of the football scores can be used to see the difference between the day to day testing and the HbA1c. Doing a finger prick test is a one-off result, like winning a weekly game of football during the season. It tells you how the team is performing on 14 What is Diabetes?
Green: “6-7%”
Questions Blood Glucose Monitoring
Q1. Blood glucose monitoring is... a. unnecessary b. useful to see how food affects blood glucose levels c. the same as doing the HbA1c Q2. Checking blood glucose on waking or fasting... a. and doing one the night before is a “pair” b. is unnecessary c. can tell you whether you ate too much carbohydrate at dinner Q3. When you check before and after the meal the levels should be no more than... a. 2-3 mmol/L difference b. 4-5 mmol/L difference c. 6mmol
See answer on page 40
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 15
Stress And Its Impact On Your Body When You Have Diabetes Most of us experience stress in some form on a day to day basis. It might be at work, it could be at home or when that car stops suddenly in front of you and you have to brake quickly.
The flight and fight response is a reflex action by the body in a stressful situation. It’s designed to allow your body to react quickly when you’re in a threatening situation, just like when that car stops suddenly in front of you and you need to brake quickly to preventing an accident.
Good Stress/ Bad Stress Stress can be both good and bad for us, it depends on the situation. Reacting to stress is a personal experience, what stresses some might have no impact on another. Living with a chronic condition such as diabetes can cause major stress and it’s important to recognise how it might be affecting you.
16 What is Diabetes?
There are many physical changes with stress There are physical changes when we’re stressed or the body goes into fight and flight mode. • Heart rate rises • Blood Pressure rises
• Breathing becomes quicker • Blood glucose levels rise • Blood moves from the gut to the big muscles of the arms and legs so they can get you out of the situation • The brain becomes more alert • Blood prepares to clot just in case you might start to bleed.
Recognising stress is the most important thing so that you can decide what you can do to manage it. Here are some steps that could help you;
These things all happening without you even knowing. In people with diabetes the main problem is the rise in blood glucose levels because they are unable to produce enough insulin to manage that rise and the blood levels then remain high. Being aware of the stress in your life and keeping it managed as best you can is important.
• Think positive: Having a positive outlook is a choice, thinking positive thoughts can lift your mood and make those difficult situations less of a problem. • Seek help: finding a confidante and reaching out to a health professional who can help you determine what’s causing the symptoms and help you develop a plan. • Keep active: There is good evidence that regular physical activity may generate biological changes that may help in reducing depression.
Handling stress is a personal thing Everyone handles stress in their own personal way. Some people are open and honest and some people shut down and bottle it up inside. Poorly managed stress can affect your diabetes so learning to manage it in healthy way is vital.
• Eat well: Follow the healthy food guidelines. Have a variety of foods from all the food groups, watching the quantity that you eat. Incorporate lots of vegetables and water, eating low GI carbohydrate spread evenly throughout the day. • Spend time having fun: moving the focus onto enjoyable events, taking up a hobby can help to build positive thoughts. • Monitor your blood glucose levels (BGL) regularly: you will able to identify the effects of stress on your blood glucose levels and seek help if required. • Talk to your GP. What is Diabetes? 17
Questions Stress and its impact on your body
Q1. Stress can increase blood glucose levels... a. Not likely b. False c. True Q2. Stress can be avoided... a. All the time b. False c. True
When you are ill your Blood Glucose Levels can rise and the strategies I have listed above may not help in that case. If you’re sick and your blood glucose levels are above your target range, then see your GP or Diabetes Educator for advice. Diabetes itself can be a source of stress. If that’s the case for you then talk to your Medical Practitioner or Diabetes Educator. Stress that’s not managed can progress to much more serious conditions such as anxiety and depression. Make sure you talk to someone about how you’re feeling, stress unfortunately is part of this world, and so learning to manage it can change your life.
18 What is Diabetes?
Q3. Stress can cause diabetes to progress... a. Not likely b. False c. True See answer on page 40
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 19
Hypoglycaemia (Low Blood Glucose Levels) Low blood glucose levels are the numbers on your meter less than 4mmol/L. This low level can be dangerous if not treated as the levels can continue to drop and this can lead to coma and death.
• Shaky • Headache • Collapse and coma
The causes of low blood glucose levels are: • Too much diabetes medication • Not enough carbohydrate food at the last meal • Too long between meals • Unplanned activity There are signs that your blood glucose levels are dropping low, here are some of those signs: • Feeling hungry • Being irritable and cranky • Sweaty 20 What is Diabetes?
Checking your blood glucose level at the time you feel any of the signs listed will tell you if it is because your blood sugar is low and that is why you are feeling this way. Treating low levels of blood glucose correctly will help you recover in the quickest most effective way.
The essential steps to follow There are 2 steps. Step 1: YOU NEED SUGAR! Eating or drinking 15-20 grams of sugar is recommended and can be found in these foods: • 6-8 glucose jelly beans OR • Half a glass of sweetened fruit juice • Half a glass of sweetened cool drink (NOT DIET) • 6 Glucose tablets Once you have taken ONE of these options check your level in 10 to 15 minutes to see if the level has risen. If the blood glucose level is still under 4 then repeat step one.
not then have a meal making sure it contains some healthy starchy food or sugary food such as potato, rice or fruit yoghurt. Now it’s time to look back and try to work out what caused your level to drop below 4. Go back to the causes and see which one you think it may have been that caused this event. You may need to discuss this with your medical practitioner or diabetes educator so you can prevent it from happening in the future.
“5 to drive” Always check your blood level before you drive if you have ever suffered from a hypo event of if you are on medication that causes your blood levels to drop low. Your blood glucose level must be 5 or over before you drive any vehicle. Preventing hypo events can be possible most of the time by: • Taking your medications at the correct time • Eating low glycaemic carbohydrates spread evenly throughout the day • Making sure you carry a hypo kit with you especially when you are exercising or driving the car
Step 2: If the blood glucose level has risen to above 4 then it’s time to eat some more complex carbohydrate food like a banana OR a slice of bread OR a tub of yoghurt. This will help the blood glucose level remain safe until the next meal.
A hypo kit contains the items you need to treat a hypo event
You will need to do step 2 if your next meal is more than 20 minutes away. If it’s What is Diabetes? 21
A small snap lock bag works well containing your sugary food such as the jelly beans and then a more complex carbohydrate food such an individually wrapped crackers or a small muesli bar. Itâ&#x20AC;&#x2122;s wise to make sure your family, friends and work colleagues know what the symptoms are so they can be aware and prompt you to check your blood levels and that they also know how to treat a low blood glucose level.
Wear or have identification. Wearing a bracelet or neck chain with a tag that identifies you as having diabetes is recommended, especially if you are on medication that may cause your blood glucose levels to drop. There are many available in a range of designs; I have even seen people who have a tattoo that says they have diabetes.
Identification Bracelet saves lives. You will know that a person who has collapsed in the street has diabetes because they are wearing identification of some type. It will mean that you or others can treat them more effectively. You may purchase these kind of bracelets in this store: https://australia.universalmedicalid.com/
22 What is Diabetes?
Questions Hypoglycaemia (Low blood glucose levels)
Q1. The causes of low blood glucose levels are... a. Too much diabetes medication b. Not enough carbohydrate food at the last meal c. Too long between meals d. Unplanned activity e. All of the above Q2. The symptoms of low blood glucose levels are... a. Feeling hungry b. Being irritable and cranky c. Sweaty d. Shaky e. Headache f. Collapse and coma g. All of the above Q3. The first line of treatment is to eat or drink something sugary... a. True b. False c. This will only make it worse Q4. What should your blood glucose level be before you drive? a. a. 4mmol/L b. b. 10mmol/L c. c. 5mmol/L See answer on page 40
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 23
All injectable diabetes medication is given into fatty tissue.
Insulin: A Treatment For Diabetes You may have been told by the Doctor or your Diabetes Educator that they think insulin would be a good treatment for you.
One goal of good diabetes management is to have good blood glucose control
Some of the things you might be thinking are:
Over time the condition of diabetes can and is likely to progress. This may occur despite a person’s best efforts with lifestyle changes and medication, and especially if the person has been diagnosed at a young age.
• How long do I need to stay on insulin? • OMG I hate needles; however, am I going to be able to inject myself? • How many times a day will I need to inject myself? • I have heard that insulin is the last resort, my GP threatened me with insulin if I didn’t look after myself when I was first diagnosed. • People die after they start insulin! Let me see if I can allay some of these fears and explain more about how insulin can save your life and you can live a happy and healthy life with diabetes.
24 What is Diabetes?
Medication is required at this time to bring the blood glucose levels into the target ranges, insulin is just another medication used to control blood glucose levels and it works really well.
There are several different types of insulin Some are long acting and given once a day, others are rapid acting and given with meals, some are a combination of the two. It can be used in combination with oral medications or on its own and this would be determined by your Medical Practitioner or Diabetes Educator reviewing your blood glucose levels. Insulin is given to mimic the bodyâ&#x20AC;&#x2122;s own production of insulin once the pancreas has got exhausted and is unable to produce enough insulin to keep blood glucose levels in the target ranges. I have known people to commence insulin and then been able to reduce the amount they use, however like many medications once you start using insulin you would continue to use it.
Needles can be scary Needles are scary mostly because people imagine them to be the ones used for taking blood or like the flu needle or an injection
Disposable Pen
Pen with Cartridge
given when you go overseas. Insulin needles are nothing like that, they are fine needles and the shortest needle is 4 millimetres long and this is the length anyone can use. Many people say that doing their finger prick test is more painful than giving their insulin. Insulin comes in both disposable pen devices and cartridges and they are easy to carry, store and use. Your Diabetes Educator will teach you how to inject, store and manage your insulin and the doses that you require so making an appointment with them is the best thing to do when starting insulin. Many years ago, when there were very limited insulins available it was used when oral treatments were no longer effective and this was often towards the end of the personâ&#x20AC;&#x2122;s life and they died. This is why for many people it was associated with that personâ&#x20AC;&#x2122;s death.
What is Diabetes? 25
Insulin is used much earlier in the management of diabetes these days Insulin is no longer used as the last resort when treating diabetes. Insulin now offers a good way to manage blood glucose levels earlier in addition to oral medication. The types of insulins available now give more flexibility to treatment and result in better control of blood glucose levels and helps people to live longer and with less risk of complications occurring. No one should ever use insulin as a threat to someone living with diabetes and hopefully these days this occurs less frequently than it did in the past. Like some oral diabetes medication insulin can put you more at risk of having low blood glucose levels so understanding hypoglycaemia, what causes it and how to prevent and treat it is essential.
Questions Insulin...
Q1. Diabetes progresses over time... a. False b. Don’t know c. True Q2. Insulin is just one of the medications used to treat diabetes... a. All the time b. False c. True d. Don’t know Q3. Insulin is given to... a. mimic the body’s own production of insulin once the pancreas has got exhausted and is unable to produce enough insulin to keep blood glucose levels b. increase the blood glucose levels c. you as a punishment See answer on page 40
26 What is Diabetes?
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 27
Knowing The Risks and Reducing The Risks Of Having Diabetes Diabetes is when the blood sugar level is outside the normal range of 4-8mmol/L. Having high blood sugar levels over an extended period of time is known to damage the bodyâ&#x20AC;&#x2122;s blood vessels which in turn damages the bodyâ&#x20AC;&#x2122;s organs like the heart, kidneys, eyes and brain and can lead to amputations of limbs.
High levels of glucose damages the circulation The damage occurs in the arteries, the big arteries are called macrovascular blood vessels and the small ones are known as microvascular blood vessels.
28 What is Diabetes?
When the damage happens to the large blood vessels of the body it can result in heart attack, stroke and amputation. When damage occurs in the small blood vessels it can do damage to the eyes, known as retinopathy, nerves, known as neuropathy, and kidneys, known as nephropathy.. When the blood glucose levels are high it causes the inside layer of the blood vessel to become inflamed narrowing the vessel.
So what happens to these blood vessels? So, what happens to these blood vessels? Many people with diabetes also have raised cholesterol levels which results in plaques forming on the blood vessel wall causing further narrowing of the vessel. If the sugar levels remain high for an extended period of time a permanent layer can be left on the blood vessel wall resulting in a layer which hardens the vessel making it more difficult for the blood to move through. This layer is called AGE’s (advanced glycation end products) and once it has been laid down remains permanent. If the blood is sticky with sugar then it is much more difficult to move through the vessels and this can then cause the blood to clot. If this clot is in the blood vessels in the heart, it will result in a heart attack and if this occurs in the brain the result is a stroke. Blood vessels and nerves are all throughout your body so other parts of the body can be affected: • The digestive track where your food is broken down and absorbed. • The skin can become dry and cracked especially on your feet. • Your immune system is affected and this means you become more susceptible to catching the flu and other infections.
Be active
Be active most days of the week for at least 30 mins, activity uses energy or sugar; it strengthens the heart and helps you feel good. You may need to visit the Exercise Physiologist if you find activity difficult or have a physical problem that limits your ability to be active. Eat a healthy diet, low in carbohydrate foods, as this helps you control your weight, blood sugar levels and waist measurement. A healthy low carbohydrate diet will help to control your cholesterol level and blood pressure. Seeing a Dietitician may help you understand the foods that you are eating may be impacting on your blood glucose, cholesterol levels and waist circumference.
Look after your feet Look after your feet checking them daily. Wearing shoes that fit well and protect your feet. You may need to see the Podiatrist.
Reduce the risk of this type of damage by keeping your blood sugar levels in your recommended target ranges. The fasting levels should be between 6-8 mmol/L and two hours after food the blood glucose should be less than 10 mmol/L. What is Diabetes? 29
Drink responsibly
Questions
Knowing and reducing the risks of diabetes
Q1. Blood glucose levels above the target ranges can damage... a. Arteries b. Your blood glucose meter c. Fat cells Q2. Small arteries are called microvascular arteries and when damage occurs here it can be seen in... a. Eyes b. Nerves c. Kidneys d. All of the above Q3. Damage to the macrovascular or large arteries can cause... a. Heart attack b. Stroke c. Amputation d. All of the above If you drink alcohol, drink in moderation. No more than 2 standard drinks per day, this can help reduce cholesterol, blood pressure and nerve damage. Don’t smoke! as this causes the blood vessels to spasm and narrow reducing the flow of the blood and it increases the plaque caused by cholesterol. You could see your Doctor or join a ‘quit’ program to help you stop smoking. The complications from having high blood sugar levels don’t have to happen; learn about your diabetes so you can put into place the actions to stop this from occurring. Have a team of professionals that can educate you, monitor you and support you in your management.
30 What is Diabetes?
Q4. Complications from diabetes are inevitable... a. True b. False See answer on page 41
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
What is Diabetes? 31
Your Diabetes Team For Good Health Managing diabetes can be challenging. It throws up all sorts of problems and feelings. Having a team of professionals around you can help you.
Start with your General Practitioner He or she, will provide regular reviews of your blood pressure, cholesterol, kidney checks, medication reviews and prescribe treatment. The GP can also do referral for you other team members, many GPâ&#x20AC;&#x2122;s use a GP Management Plan and Team Care Arrangement (GPMP and TCA) to refer you to other health professionals. Under this plan Medicare will subsidise up to 5 visits to allied health professionals such as the Diabetes Educator.
32 What is Diabetes?
See a Credentialled Diabetes Educator The Diabetes Educator is the go to person to help educate you so that you understand the condition and provide support for you and guide you in your management decisions. Most diabetes educators will work with you to achieve the goals that you have for your health.
Visit a Dietitian The dietitian will provide in depth advice on how diet impacts on health and wellbeing and your blood glucose levels. They can work with you to identify areas where your current eating patterns may be contributing to increased blood glucose levels or cholesterol or any other health issues.
Exercise is vital
Look after your feet
Exercise is a key to managing diabetes. If you donâ&#x20AC;&#x2122;t have a regular exercise program or you have any physical limitations around exercise then seeing a physio or exercise physiologist can help get on the road to being more active. The recommendations for exercise are 150 to 300 minutes per week of moderate intensity exercise and strength exercise at least twice per week. Being physically active every day is essential, this amounts to covering 10,000 steps daily.
It is important to learn how to look after your feet protecting the skin from damage, cutting toenails correctly and wearing wellfitting shoes. The Podiatrist is the person to guide you in good foot care and provide advice on preventing damage to your feet. The Podiatrist is going to check your sensation, circulation, nails and skin, having a diabetic foot assessment is recommended every 6 months.
Walking for 30 mins per day over at least five days per week will get to the minimum recommendations. This can be done in increments of three 10 minute sessions or two 15 minute sessions if you are unable to manage 30 minutes in one go.
Have your eyes checked The Eye Specialist or the Optometrist is essential to monitor the health of your eyes and this should be done at least every 2 years. The damage to the eyes over the long term is to the retina which is at the back of the eye. Blood vessels can burst and then the area which they feed with healthy blood is damaged and will not allow the vision to be clear, if this continues blindness will occur.
Look after your mental health Carbohydrate is not the only causes of high blood glucose levels: stress, both physical and mental can have the same effect. Staying mentally well may require the expertise of a Counsellor or Psychologist as part of your team.
If there are problems with your feet they will recommend footwear and educate you on preventing further foot damage which could lead to amputation.
Visit the Dentist People living with diabetes are much more susceptible to gum disease so visiting the dentist at least twice each year to check your gums is recommended. Specialist doctors in diabetes and other hormone conditions are called Endocrinologists. Your Medical Practitioner may refer to an Endocrinologist for specialist care and advice.
You may need a specialist in diabetes The person living with diabetes is always the central person in the team, ultimately making the decisions about their own management. The team is there to assist in diabetes management to prevent or manage complications that may arise from uncontrolled blood glucose levels.
What is Diabetes? 33
Questions Your Diabetes Team
Q1. Having a team of people to help with diabetes management... a. Is a real nuisance b. Is completely unnecessary c. Can assist in educating the person living with diabetes to prevent complications Q2. The Diabetes Educator... a. Will tell you what to do b. Will work with you to achieve your goals c. is the center of the team Q3. The Endocrinologist is... a. a specialist doctor dealing with hormone conditions b. someone every person with diabetes need to see c. expert in checking your eyes See answer on page 41
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
34 What is Diabetes?
Medications And Diabetes There are many medications that can be used to control blood glucose levels, they can be oral medications or injectable medications. Some medications come as combinations which can decrease the amount of tablets needed to be taken.
Type 2 diabetes progresses over time
medications that target all of these organs. Letâ&#x20AC;&#x2122;s look at some of the oral medications to begin with. Your Medical Practitioner will probably prescribe Metformin (Diabex, Diaformin) when you are first diagnosed determined by your blood results. These medications are from a class called Biguanides.
Metformin is an insulin sensitiser
Because diabetes is a progressive condition it is common that you may require additional medication over the course of your life, and diabetes journey, to control blood glucose levels in addition to lifestyle and physical activity.
Metforminâ&#x20AC;&#x2122;s job is to make your body more sensitive to the remaining insulin you are making; it also slows the liver from making its own sugar and putting it back into your bloodstream.
There are many organs involved in the metabolism of glucose and there are now
Metformin can have some side effects; these tend to be gastrointestinal disturbances
What is Diabetes? 35
like diarrhoea. This is not uncommon so Metformin is usually started with a small dose and is increased gradually as this helps to reduce the side effects. Metformin also comes as a slow release medication and this can assist in preventing some of those gastrointestinal side effects.
cause weight gain, which for a person living with diabetes is not recommended. If you are overweight your Medical Practitioner may bypass this medication and prescribe an alternative.
If the dose you are taking is causing side effects for you speak to your Medical Practitioner to see if it can be reduced or change to the slow release medication. Taking even a small dose of Metformin can be beneficial.
There are 2 classes of medication that work via the gut
Metformin takes about 2 weeks to reach therapeutic levels therefore it may take this long for you to see a change in your blood glucose levels.
Sulphonylureas stimulate the pancreas to make insulin.
Another of the oral medications can be from the class called DPP-4 inhibitors, (Januvia, Onglyza, Galvus) are some of the brand names.This medication works in the gut, by increasing the amount of two incretin hormones found in the body, called Glucagon-like Peptide-1 (GLP-1) and Glucose-dependent Insulinotropic Peptide (GIP). The body produces these hormones naturally in response to food intake and helps to control blood glucose levels. Sitagliptin (Januvia) works by binding to the DPP-4 enzyme and preventing it from breaking down the GLP-1 and GIP. This increases the levels of these hormones in the body and so increases their effect on controlling blood sugar. It has four main actions:
The next class of medication are called Sulphonylureas( Diamicron,Glyade) are two brand names. This medication is designed to stimulate your pancreas to produce more insulin. It does this all the time so it can put you at risk of blood glucose levels going low, that is below 4 mmol/L. You will need education regarding hypoglycaemia and how to prevent, treat and manage it if you are taking this medication.These types of medication can 36 What is Diabetes?
1. Stimulating the pancreas to produce insulin when the levels of glucose are increasing. 2. Reduces the production of glucagon, glucagon stimulates the liver to make its own sugar. 3. It also reduces the rate that the food passes through from the stomach to the intestines, this helps to slow theabsorption of glucose from the gut. 4. It also acts on the brain to give a feeling of fullness that can further reduce the food intake.
Be sure to report any side effects to your GP or Diabetes Educator Like all medications it can have side effects, some but not all are as follows: disturbances of the gut such as nausea and vomiting, constipation, diarrhoea, abdominal pain, excess gas in the stomach and intestines (flatulence), loss of appetite. Similar to the DPP-4 inhibitors the Incretin Mimetics (Byetta and Bydureon) also work on the gut increasing the gut hormones GLP-1 and GIP resulting in the same main actions as the DPP-4 inhibitors however they are given via an injection either twice daily or once per week. You will need education to help you learn how to use the medications and will likely be referred to the Practice Nurse or the Diabetes Educator.
seen are genital infections such as thrush, urinary tract infections,hypoglycaemia and weight loss. Weight loss effect can be useful for people living with diabetes reducing waist circumference and insulin resistance.
Insulin is used in Type 1 and Type 2 diabetes Insulin is commonly used to manage diabetes and people diagnosed with Type 1 diabetes require it from diagnosis. There are several types of insulin, some are long acting, some are short acting and some are combined short and long acting. What you require will be determined by what your blood glucose levels are doing and your Medical Practitioner will determine this. Insulin can be associated with weight gain (but does not have to be) and also increases the risks of hypoglycaemia or low blood glucose levels less than 4 mmol/ L, you will require education about how to prevent, treatment and manage this. Your Diabetes Educator can assist you in understanding hypoglycaemia and you can read the chapter in this workbook.
The kidney is a filter system and under normal circumstances filters and then reabsorbs nutrients before getting rid of those excess into the urine. A relatively new class of medications called SGLT2 inhibitors (Sodium-Glucose CoTransporter-2 inhibitors) works by preventing the kidneys from reabsorbing glucose back into the blood in the kidney which results in an excretion of glucose into the urine. The side effects most commonly
There are some other medications such Glitazones (Actos and Avandia) and AlphaGlucosidase Inhibitors (Acarbose) however these are used much less today. Always take your medications as prescribed, talk to your Pharmacist or Medical Practitioner if you are suffering any side effects.
What is Diabetes? 37
Questions Medication
Q1. Metformin is the first medication used to treat Type 2 diabetes in most cases... a. True b. Fasle c. donâ&#x20AC;&#x2122;t know Q2. There are many medications and they work on all the different organs associated with glucose metabolism... a. False b. True Q3. Insulin is used to treat people with Type 1 and Type 2 diabetes... a. True b. False See answer on page 41
Notes 1. What is one message you have taken from this chapter?
2. How does this message relate to you?
38 What is Diabetes?
What is Diabetes? 39
Correct answers TO THE QUESTIONS
DIABETES AND YOUR BODY (p5) Q1. Type 1 diabetes is... a. An autoimmune condition and requires insulin from diagnosis Q2. Type 2 diabetes is… b. Caused because there are rusty locks on the cells or insulin resistance and not enough insulin Q3. The complications of diabetes… a. Can affect people living with Type 1 and Type 2 diabetes CARBOHYDRATES FOODS (p8) Q1. Carbohydrate foods can be healthy and unhealthy foods... b.True Q2. Low GI carbohydrate foods are the best choice because... a. They break down much more slowly and keep the glucose levels in the blood much more even Q3. Carbohydrate foods can be found in all the food groups (vegetables, grains,fruit,protein,dairy)... b.True MONITORING (p12) Q1. Blood glucose monitoring is... a. Useful to see how food affects blood glucose levels Q2. Checking blood glucose on waking or fasting... a. and doing one the night before is a “pair”
40 What is Diabetes?
Q3. When you check before and after the meal the levels should be no more than... a. 2-3 mmol/L difference STRESS (p15) Q1.Stress can increase bloodglucose levels... b. True Q2. Stress can be avoided... c. False Q3. Stress can cause diabetes to progress... d. True HYPOGLYCAEMIA (p20) Q1. The causes of low Blood glucose levels are... e. All of the above Q2. The symptoms of low blood glucose levels are... g. All of the above Q3. The first line of treatment is to eat or drink something sugary... a. True Q4. What should your blood glucose level be before you drive? c. 5mmol/l INSULIN (p24) Q1. Diabetes progresses over time... c. True Q2. Insulin is just one of the medications used to treat diabetes... b. True
Q3. Insulin is given to... a. to mimic the bodyâ&#x20AC;&#x2122;s own production of insulin once the pancreas has got exhausted and is unable to produce enough insulin to keep blood glucose levels
DIABETES AND MEDICATION (p35) Q1. Metformin is the first medication used to treat Type 2 diabetes in most cases... a. True
KNOWING THE RISKS AND REDUCING THE RISK (p28)
Q2. There are many medications and they work on all the different organs associated with glucose metabolism... a. True
Q1.Blood glucose levels above the target ranges can damage... a. Arteries
Q3. Insulin is used to treat people with Type 1 and Type 2 diabetes... a. True
Q2. Small arteries are called microvascular arteries and when damage occurs here it can be seen in... d. All of the above Q3. Damage to the macrovascular or large arteries can cause... d. All of the above Q4. Complications from diabetes are inevitable... b. False YOUR DIABETES TEAM FOR GOOD HEALTH (p32) Q1. Having a team of people to help with diabetes management... c. Can assist in educating the person living with diabetes to prevent complications Q2. The diabetes educator... c. Will work with you to achieve your goals Q3. The Endocrinologist is... d. a specialist doctor dealing with hormone condition What is Diabetes? 41
Glossary of Terms Amputation: the action of surgically cutting off a limb Blood Pressure: The pressure in the arteries during the contraction of the heart muscle and when the heart is between beats. Carbohydrate: a large group of compounds occurring in foods including sugars, starch and cellulose. Cholesterol: a substance containing a lot of fat that is found in the body tissue and blood of all animals. Credentialled: the process by which the eligibility of a Diabetes Educator is established by determining if the educator has the specified qualification and has fulfilled the defined requirements. Glucose: a simple sugar, the component of many carbohydrates Glucometer: a machine used to test the blood for glucose Heart attack: is the death of, or damage to, part of the heart muscle because the supply of blood to the heart muscle is severely reduced or stopped. Heart Rate: the speed of which the heart beats Millimole / mmol/L: is the unit uses to measure blood glucose levels Medical practitioner: doctor, general practitioner Pancreas: a large gland / organ that produces insulin and other digestive enzymes Stroke: the sudden death of brain cells in a localised area due to inadequate blood flow. Waist circumference: is a measurement taken around the abdomen at the levels of the umbilicus or belly button.
42 What is Diabetes?