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Diabetes Centre

Type 1 Diabetes

Adjusting to being told you have diabetes will take time and the first few weeks after the news, life will be full of questions. This information is for people with Type 1 (insulin dependent) Diabetes and aims to give you and your family information to help answer some of these questions and to be used as a guide now and in the future.

Although fitting diabetes into your life can be daunting, with help from family, friends and your ‘diabetes team’, you can learn how to deal with it, take control and get on with your life.

If you would like this information in a booklet format then please contact our Diabetes Centre via our Switchboard on 0191 233 6161 where a member of our staff will be happy to help.

Contents


What is Diabetes Mellitus?Show [+]Hide [-]

Diabetes is becoming more common. There are around 1.3 million people in the UK with diabetes.  About 15% - 20% of these people will have Type 1 diabetes and it most frequently occurs in children, young people and young adults.

Diabetes occurs when the body does not produce enough INSULIN.  Insulin is a hormone made in the pancreas and then released into the blood stream when you eat food.  We all need food to give our body energy.  Some of our food, specifically sweet and starchy food (carbohydrates) will be digested and turned into glucose (sugar).  When the glucose in our blood rises we need insulin to allow the glucose to enter the body’s cells to provide us with this energy.  The glucose and insulin levels will then fall until the next time it is needed, such as the next mealtime or snack.  If we do not make enough insulin when we eat carbohydrate foods, the level of glucose will rise too high (called hyperglycaemia) and you will feel unwell.  You may recognise some of the symptoms of hyperglycaemia:

  • Extreme tiredness
  • Increased thirst
  • Passing large amounts of urine
  • Blurred vision
  • Weight loss

High blood glucose (hyperglycaemia) can cause damage to your health over the years.  This effect is particularly noticeable in the eyes, heart, kidneys and feet.  The key to preventing these problems is to keep your blood glucose as near as normal as possible.

Types of DiabetesShow [+]Hide [-]

There is more than one type of diabetes.  If the pancreas continues to produce some (but not enough) insulin, this is called Type 2 Diabetes.  Type 2 diabetes is treated by maintaining a healthy lifestyle that incorporates a healthy diet and exercise.  However, tablets or even insulin may also be needed at some stage.

You have Type 1 diabetes.  This is when the pancreas is unable to produce insulin because the body's immune system attacks the cells within the pancreas that make insulin.  You therefore need to replace this lack of insulin and this has to be given by injecting insulin.  Insulin cannot be taken (as a tablet) by mouth as it would be destroyed before it had any effect.

Due to this lack of insulin, energy from your food can get into the body's cells.  You start to burn up your own stores of fat as an alternative source of energy.  This causes weight loss and a substance called ketones to appear in the blood and the urine.  Ketones are dangerous as they are poisonous acids.  Treatment with insulin injections will help lower the blood glucose and the ketones will quickly disappear.

Balancing Blood Glucose with Insulin

A person’s need for energy and therefore food can vary so it follows that each person will need different amounts of insulin.  To find out how much insulin you need, you have to test your blood glucose levels using a blood glucose meter.  This shows your blood glucose level at that moment in time.  We can then decide on the right amount of insulin you need to balance with the food you eat.

Another important guide to the insulin you need is a test performed at your clinic visits called Glycosulated Haemoglobin, also known as HbA1c.  This measures the amount of glucose that has been ‘attached’ to the red cells in your blood stream.  It is used as a guide to how your daily blood sugars have been over a period of 2-3 months.  The HbA1c does not replace blood glucose test you do and it can only give an overall picture.  It is important to understand the targets for both your blood glucose and HbA1c.

What Is The Best Level For Blood Glucose and HbA1c?

The figures for blood glucose and HbA1c can look similar.  However, they are different.  The target for a persons’ HbA1c and blood glucose may vary.  Discuss yours with the diabetes team.  The following diagram may help:

   Blood Glucose Mmols HbA1c 
 Normal 4-7  < 6.1% 
 Good Control 4-9 < 7.5%
 Poor Control Often more than 10 

7.5-8.5%

 Very Poor Control Frequently more than 10 8.5% and over 

Once you have started on insulin it will need to be adjusted accordingly to your lifestyle to properly control your diabetes.  With the combination of healthy eating and blood glucose testing, we can identify the right type and amount of insulin that you need.

Insulin treatmentShow [+]Hide [-]

Why Do We Need Insulin?

In Type 1 Diabetes, (your type of diabetes), the pancreas stops producing insulin altogether.  This is because the body's immune system attacks the cells in the pancreas that make insulin.  You therefore need to inject insulin, to replace the insulin the body is not supplying.  The reason that insulin has to be injected and not taken in tablet form is because, being a protein, it would be digested in the stomach before if had any effect.

How Long Will I Need To Take Insulin?

You will need to take insulin for the rest of your life.

Some people during the first year may need to inject only very little insulin.   This is called a ‘honeymoon period’.  It is thought the injected insulin rests the pancreas, which helps it make a small amount of its own insulin.  When the pancreas stops making insulin altogether, then the dose of injected insulin needs to be increased.   For this reason, regular monitoring of blood glucose levels is very important.

How Is Insulin Made?

Insulin is a type of protein.  In humans and animals it is made by the pancreas.  The insulin that the person with diabetes injects comes from two sources:

  1. Human insulin. Scientists have discovered a way to engineer types of yeast and bacteria to produce insulin that is identical to human insulin.
  2. Analogue insulin. This is a new range of insulin, which is nearer in action to our own insulin.

Types Of Insulin

There are many different insulins available, along with several types of injection devices.  The main types of insulin we use are listed in the chart below.

 Type of Insulin  Peak Action  Time of Injection  Other Comments
 Rapid acting analogue
(looks clear)
Works between 1-5 hours Give just before a meal or up to 15 minutes after Used with a medium or long acting insulin. Up to 4/5 injections a day. Convenient
Short acting insulin
Or also called soluble
(looks clear)
Works between 2-6 hours Give 15-30 minutes before a meal Can be used twice a day with a medium acting insulin or in combination up to 4 injections a day
Medium acting insulin
Or also called Isophane
(looks cloudy)
Works between 2-12 hours Give 15-30 minutes before breakfast and evening meal Can be given twice a day or in combination with a short or analogue insulin
Mixtures
Short and medium acting insulin premixed
(looks cloudy)
Works between 2-12 hours Give 15-20 minutes before breakfast and evening meal Can be given twice a day
Long acting analogue
(looks clear)
Works between 2-24 hours Can be given at breakfast, lunch, evening meal or at bedtime Often used in combination with a Rapid acting analogue, up to 4 injections a day

Equipment

Depending on the type of insulin you need and your preference, your insulin may come in either:

  • A syringe and needle, which is filled from a bottle of insulin
  • A refillable pen device and needle that is changed when the cartridge is empty
  • A pre-filled pen device and needle that is disposed of when empty
  • An insulin pump/syringe driver

It is important to know how to use your chosen equipment and inject your insulin correctly.  Your Diabetes Specialist Nurse will show you how this done.

Injection Sites

There are 3 main areas where it is best to inject your insulin: abdomen, buttocks and thighs. 

You are advised to use a large area of the body for injecting and to rotate/change the sites, to avoid developing fatty lumps or swellings.

Insulin is absorbed faster from the abdomen and more slowly from the thighs and buttocks.  You can inject into the abdomen in the morning and thighs or buttocks in the evening.

Injection Technique: check list

Do:

  • Give insulin at correct time, around meals, as advised by your Diabetes Specialist Nurse
  • Gently shake pen device or insulin bottle before injection
  • Perform test shot
  • Dial/draw up correct dose
  • Pinch skin (unless otherwise advised)
  • Inject insulin and hold needle in for a count of 6-10 seconds before removing needle
  • Change needle/syringe for every injection

Don’t:

  • If possible inject cold insulin from the fridge
  • Use your insulin if it looks lumpy or a strange colour
  • Use expired insulin
  • Use another persons insulin

There are several things that can speed up the action of insulin after it has been injected.  This can cause a hypo or low blood sugar, so you need to be aware of this and check your blood sugar level more often.  These include:

  • Heat: sunbathing, sunbeds or taking a hot bath or sauna
  • Physical activity or exercise: exercising an area of your body into which you have just injected insulin, can cause the insulin to work faster, eg. injecting into your leg and then jogging
  • Massage: massaging the area where you have injected

Storage

  • Keep spare insulin in the fridge.
  • Keep a check on the expiry date.
  • Do not let your insulin freeze.
  • Keep your insulin away from direct sunlight or sources of heat eg, above a radiator, on a windowsill, in a hot car glove compartment.

Disposal

When using needles/syringes for insulin injections and lancets for blood testing, it is very important that they are disposed of safely.  Needles are a risk to people in your household and the community.

Sharps boxes are available on prescription, but this will need to be arranged individually with your GP Practice and it will be your responsibility to return the full box to either the Practice or Pharmacist for disposal.

If a sharps box is not used, a suitable container should be identified.  It should be sealed when no more than two thirds full and wrapped in paper, before going into the bin.  Otherwise a device called a Safe Clip can be used to remove the needle end before disposal.

ComplicationsShow [+]Hide [-]

Diabetes if not carefully managed, can cause long-term problems with your general health, known as complications.  Controlling your blood glucose levels and avoiding other risk factors can reduce the risk of developing these complications.

These include problems with your:

  • Eyes
  • Kidneys
  • Feet
  • Circulation
  • Heart

The treatment of Diabetes aims to keep blood glucose levels as near to normal as possible and therefore preventing or reducing the risks of developing long-term complications.

There are other factors however that can increase the risk of developing complications, these include:

  • Smoking
  • High blood pressure
  • Raised blood fats or cholesterol levels
  • Not having a balanced diet
  • Being inactive and not exercising
  • Excessive alcohol intake

Complications – a close up

Head: Eye damage:  Diabetes can cause damage to the retina which is the layer at the back of the eye.  It is important to have your eyes examined and retinal photography once every year

Stroke:  The risk of stroke is increased in people with diabetes

Body: 

  • Heart: Heart disease is also more common
  • Kidney damage:  This is caused by the blood vessels that supply the kidney becoming damaged and in many cases can be successfully treated
  • Erection problems:  Some men with diabetes can develop difficulty in having an erection
  • Foot problems: Can occur due to damage to either the blood supply or the nerve supply to the feet and risk can be greatly reduced by daily foot care

Preventing Complications

Research has shown that keeping blood glucose levels within target ranges can reduce the risk of developing complications.  You will be given advice as to your own target levels and can discuss these with your diabetes care team. 

In addition, targets are importantly set for your blood pressure and blood fats (cholesterol). These levels will be monitored closely and treatment commenced if necessary.  You should also expect that at your annual review appointment, your eyes and feet will be examined.

However, there are also some actions and lifestyle changes you can personally make to further reduce your risk of developing the complications of diabetes:

  • Eating a healthy balance diet is very important
  • Maintaining your weight or perhaps losing weight if you are overweight
  • Doing regular exercise or activities such as walking, swimming and cycling
  • Not smoking/stopping smoking – smoking is particularly harmful for people with diabetes
  • Attend your appointments and check-ups.  This can detect and potential problem early on and it can then be appropriately treated
  • Stick to recommended guidelines for alcohol intake: 21 units per week for men and 14 units per week for women

Food and insulinShow [+]Hide [-]

To achieve good blood glucose control, you need to be knowledgeable about both.

Here is a common picture of the 5 food groups:

[Picture]

The most important thing for you to be aware of is foods which contain carbohydrate (scientific term), in everyday terms foods that contain sugar and starches e.g. sweets, chocolate, potatoes, breakfast cereal, in fact all the ones that are highlighted.  The importance of carbohydrate foods are that they have the most immediate impact on your blood glucose, so how much; when and which Insulin(s) you are on is very important.  This will vary with individuals, however the basis guidelines are:

  • Eat carbohydrate at breakfast,  midday and evening meal
  • Snacks; you need these at bedtime and mid-morning

Will I be eating all day? NO.  You may need to introduce food in the morning – a bowl of cereal or 2 slices of toast is enough.  You do not need a full English breakfast!

Mid-day: Most of us have a sandwich with crisps or similar again.

Evening meal: This, generally for most of us is our biggest carbohydrate meal, e.g., chicken and chips, pasta, rice and sauce etc., so probably little difference to your normal meal.

Snacking: You do not need to snack all the time.  The majority of people with Type 1 diabetes, (if they have an early breakfast) may need a piece of fruit or a biscuit mid-morning.

Bedtime snacks: These are important. This is ensure that your blood glucose does not dip too low during the night.  It does not need to be a large snack, e.g., a couple of slices of toast or a bowl of cereal.

REMEMBER: The eating plan is NOT sugar free, just low sugar.  Sugar in large amounts (greater than a total of 10g) frequently will make it difficult to control your blood glucose, try using artificial sweeteners and diet ‘pop’.

Carbohydrate counting: If you are on multiple injections, it will help give you more flexibility, while still maintaining good control.  If appropriate, as a dietician / nurse for further information.

Can I have alcohol? YES.  This should be in moderation as with everything else.  The guidelines are :-

 Women - no more than 2 units per day = 14 units per week
 Men -  no more than 3 units per day = 21 units per week

What is a unit?  A unit is:

  • ½ pint (300ml) 3.5% Lager/Beer or Cider
  • 1 single pub measure of spirit (Gin, Vodka, Rum)
  • 1 small (100ml) glass of wine.

Remember, many Ciders, Special Brews, Beers and Lager’s and Alco-pops are much higher in alcohol 5-7% volume, which means 300ml is equivalent to 2 units.

KEY POINTS:

Alcohol and the Liver:

  • Your liver is an important part of your body with many functions.
  • One of these is to store glucose and then release it into your bloodstream when your blood glucose level falls.
  • Your liver is unable to release glucose into your bloodstream if you have drunk too much alcohol.

Alcohol and Hypos:

  • Drinking alcohol may cause your blood sugar levels to fall further and you may experience a low blood glucose reaction (a hypo).
  • Remember your judgement may be affected when you drink.  You may not recognise that your blood glucose levels are low.  Make sure that your friends know about hypos.
  • Hypoglycaemia and drunken behaviour can be confused with each other. Always wear or carry diabetes information (a bracelet, necklace or ID card).
  • Keep to sensible drinking levels. 
  • You could alternate alcoholic drink with a low calorie mixer.
  • Do Not drink on an empty stomach.  Enjoy a meal before or with your drink.
  • You may need to eat a bigger, starchier meal and adjust your Insulin before you drink.
  • Do Not skip meals or substitute alcohol for meals.
  • Eat little and often if you are drinking.
  • Always carry glucose tablets or sweets with you.
  • Remember hypos can happen some hours after a drinking session.  Check your blood glucose levels and always have a snack before you go to sleep.
  • Check your blood glucose level in the morning and during the rest of the next day.

Blood glucose monitoringShow [+]Hide [-]

As you will already be starting to realise, the key to managing your diabetes is controlling your blood glucose (sugar) level, and understanding how your insulin, food and activity levels affect your blood glucose.

When you are first diagnosed with diabetes your blood glucose levels will be high.  With the help of your Diabetes Specialist Nurse, your Insulin Doses will be adjusted until your blood glucose levels gradually return to within the normal range.

The normal range for blood glucose is 4-7mmol/l (millimoles of glucose present per Litre of blood).  Maintaining your blood glucose levels as near to normal as possible, helps you to feel and stay well and reduces the risk of you developing problems associated with your Diabetes.  As blood glucose levels can be so changeable it is not always possible to determine just by how you are feeling so testing is important to detect when levels are high (hyperglycaemia) and low (hypoglycaemia).

How to measure your Blood Glucose Levels

A blood glucose measurement can be easily carried out using a small drop of blood from the finger, using a finger pricking device designed to be virtually painless.

  1. Hands should be washed and dried thoroughly.
  2. Milk the blood towards the end of the finger.
  3. Prick the side of your finger (as this is less painful) and try to swap fingers each time to avoid getting sore.
  4. Squeeze the finger gently until you have a good drop of blood.
  5. Apply the blood to the testing strip as you have been shown or as the instructions indicate.
  6. The blood glucose meter will not give you the result.

When to test your blood glucose

Initially you will be asked to test your blood before meals.  Testing is especially important when starting on Insulin therapy and your diabetes nurse will be helping you adjust Insulin doses, and will help you manage your diabetes.

Also in times of illness or during pregnancy for example, testing will need to be more frequent (2-4 hourly).

Usual times for testing may include:

  • Before each meal and at bedtime
  • Before and after exercise
  • If you think you may be going hypo
  • If you suspect blood glucose is high
  • With some of the rapid-acting Insulin’s you may be asked to test 2 hours after a meal
  • During changes of treatment.

Using the meter

There are many different meters available.  The meter reads the test strip digitally and will provide a result in 5 – 30 seconds depending on the meter chosen.  Special features of the meter such as being able to test on alternative sites e.g., forearm may be appropriate for you and your Diabetes Specialist Nurse will be able to advise you.  However, when doing so remember to update your prescription information at your GP practice to ensure you obtain the correct strips for the new meter.

It is advisable to carry your blood glucose monitoring equipment with you.  When you measure your levels, record them in a diary which will help you to see patterns in your day to day blood glucose levels. Some meters have the facility to download results into your computer.  This diary/printout will also be helpful when you attend appointments, so that your Diabetes care team can advise you of any necessary adjustments to your treatment, aiming to improve your overall control.

Blood glucose levels can swing up and down for lots of different reasons.  Don’t worry if you get the occasional high result (that happens to everybody) and is most often diet related.  However, if blood glucose levels are consistently high or low, it would be advisable to discuss this at your clinic appointment or with your Diabetes Nurse, as it may require adjustment to your insulin.

Insulin dose adjustmentShow [+]Hide [-]

Learning how to safely and effectively adjust your insulin is a key aspect to self-managing your diabetes and can help you achieve flexibility in your lifestyle and control over your blood glucose levels.

However, adjusting your insulin takes knowledge, experience and confidence and here we will explore some basic rules:

Basic Rules:

  • Understand how your insulin works
  • Monitor your blood glucose levels
  • If using rapid/short acting insulin, learn how to count carbohydrates in your food
  • Look for consistent trends in your blood glucose levels before considering altering your insulin
  • In general, alter insulin doses by 2 units (expect when ill)
  • Only self-adjust if you know what you are doing – seek advice if unsure.

Knowing how your insulin works, understanding how carbohydrate foods affect your blood glucose and testing your own blood glucose levels are all essential for effective dose adjustment.

Alteration on Twice Daily Insulin Regimes

This may include a medium acting insulin such as Insulatard or Humulin Isophane given twice daily (before breakfast and evening meal) or a twice daily injection of pre-mixed combination of short acting and medium acting insulin eg., Mixtard 30, Humulin M3.

Each blood glucose test will reflect the action of an individual insulin dose and therefore when adjustments are needed.

Insulin Affects Blood Test 
Morning
Medium Acting
 Before evening meal
Evening
Medium Acting
 Before breakfast

 Insulin  Affects Blood Test
Morning
Pre-Mixed
Before lunch and evening meal
Evening
Pre-Mixed
Before bed and before breakfast

Thus a consistently high blood glucose before breakfast requires an increase to the evening dose of insulin.

Alteration on Basal / Bolus Regime

This regime allows more flexible timing of meals and size of meal.  Short or rapid acting insulin is taken with each meal (usually 3 times daily).  In addition, a medium or long acting insulin is also given to maintain a background amount of insulin.  The rules for adjusting insulin on these insulin are as follows:-

Advice for Insulin Dose Adjustment

The following charts are a basic guide to help you understand how to change your insulin dose, to achieve your target blood glucose levels.

Your Diabetes Specialist Nurse will be able to give you more detailed advice on your current insulin, injection routine and monitoring.

Targets for Blood Glucose

 Time of Blood Test Target Blood Glucose Levels 
 Before breakfast  5.0 – 6.5 mmol/l
 2 hours after meal  Less than (<) 8.0mmol/l
 Before meals  5.0 – 7.0 mmol/l
 Before bed  5.0 – 7.0 mmol/l

Advice for Changing Insulin Doses

Time of Blood Test  Blood Glucose Reading  Action
Before breakfast
5.0 – 6.5
> 6.5 on 2 days in a row
< 5.0 on 2 days in a row
 Relates to dose at Bedtime or Teatime
- Continue with some dose.
- Increase insulin by 2 units
- Decrease insulin by 2 units
2 hours after breakfast
or before lunch
5.0 – 8.0
> 8.0 on 2 days in a row
< 5.0 on 2 days in a row
 Relates to Breakfast Dose
- Continue with same insulin
- Increase insulin by 2 units
- Decrease insulin by 2 units
2 hours after lunch or
before evening meal
5.0 – 8.0
> 8.0 on 2 days in a row
< 5.0 on 2 days in a row
 Relates to Breakfast or Lunchtime Dose
- Continue with same insulin dose
- Increase insulin by 2 units
- Decrease insulin by 2 units
 2 hours after
evening meal or
before bed time
5.0 – 8.0
> 8.0 on 2 days in a row
< 5.0 on 2 days in a row
 Relates to Teatime Dose
- Continue with same insulin dose
- Increase insulin by 2 units
- Decrease insulin by 2 units

For Example:

If you take 2 injections a day and your blood glucose is too high before tea, you would increase your breakfast dose of Insulin.

or,

If you take 4 injections a day and your blood glucose is too low before tea, you would decrease your lunchtime dose of Insulin.

If you are ill or unsure, please contact your Diabetes Specialist Nurse.

HypoglycaemiaShow [+]Hide [-]

What is a hypo?

It is a medical term for low blood glucose level.  A low reading is classed as 4mmol/l or below.

What can cause a hypo?

There are a number of causes:

  • Delaying or missing a meal
  • Not eating enough
  • Too much insulin or diabetes medication
  • Exercising more than usual: Sport, Spring cleaning, Gardening, Dancing
  • Alcohol in excess, or if taken without food
  • Stress
  • Increase in temperature which can include saunas, sunbeds or warm weather

Symptoms of a hypo

The beginning of a hypo will feel different to each individual, and they even can differ from one to the other

You may feel:

  • Shaky
  • Sweaty
  • Slightly confused
  • Hungry
  • Bad tempered

You will soon learn to recognise your own warning signs and how to act on them.

Treating a hypo

Mild Hypoglycaemia (If blood glucose is below 4mmol/l)

Treating a mild hypo is quite simple: you need to take some fast acting energy foods to bring your blood glucose levels up.  Take:

  • 2/3 Dextrose tablets
  • Sugar (2 tsp) in tea/coffee
  • Lucozade (100mls)
  • Any sugary pop

When you feel better, follow this with either your meal if it is due, or a good snack.

Moderate Hypoglycaemia

If you do not respond quickly enough to the symptoms of mild hypoglycaemia the hypo event may then proceed to moderate.  Normal thought processes start to leave you, and other people nay start notice your symptoms and you may not.  You can behave oddly or appear drunk so it is wise to tell family or friends about this, so they can recognise any of these symptoms and help you if necessary.

They should not take any notice if you try to refuse their help, and need to take immediate action.  Initial treatment is the same as above if you are still able to swallow liquid.  Also jam or honey can be put in the side of your mouth and rubbed from the outside.  You can also use HypoStop Gel which can be bought at chemists.  However swallowing reflux must be ensured to use these treatments.

If you were to pass out (become unconscious), your friends or family should follow the guide on severe hypoglycaemia.

Severe Hypoglycaemia

Rarely, you may not respond to the warning signs of a hypo and become unconscious.  If this happens it is important that family, friends and work colleagues know what to do.  They will need to:-

  • Call 999 immediately for an ambulance.
  • Inject you with Glucagon (Glucogen HypoKit), if it has been prescribed for you and they have been instructed how to use it.
  • Not give you anything by mouth as this may cause you to choke.

When sugar levels rise you will regain consciousness.  Once you are awake have a sugary drink.  Continue to have small amounts of sugary drinks until you feel well enough to eat in order to prevent another hypo.

If you have recurring hypos speak to your diabetes care team.

Useful tips to help with hypos:

  • Always carry carbohydrate
  • Carry or wear diabetes identification
  • Tell family, friends and people at work about hypos and how they can help
  • Avoid driving if blood glucose is low
  • If someone tells you that you need to have some glucose, take it and argue later
  • Try not to skip or delay meals
  • Always take your insulin
  • Test you blood glucose levels regularly
  • Try and find out what caused your hypo and you may be able to prevent that happening again.

Coping when you are illShow [+]Hide [-]

Illness and infections tend to raise blood glucose levels.  This will happen even if you are not eating very much as usual or are being sick.  It is important at these times not to stop taking your insulin injections.  If you do your blood glucose levels will keep rising.  Blood glucose levels will return to your usual range once you are better.

Illnesses and infections that can upset your diabetes control:

  • Colds, bronchitis, flu, sore throat
  • Vomiting and diarrhoea, stomach upsets
  • Urinary infections, cystitis
  • Skin infections, boils, skin ulcers, inflamed cuts, abscesses

Sick Day Rules

Guidelines to follow:

  • DO NOT STOP YOUR INSULIN INJECTIONS
  • If you are unwell, act immediately and seek prompt treatment for infections.
  • Try to eat a normal diet.  If you can not manage this, replace with fluids such as milk or juice.
  • Drink plenty of water: 1 – 2 litres/day (5-7 pints).  Sipped throughout the day.
  • Keep testing your blood, at least 4 times a day.  Or every 2-4 hours if necessary.  Keep a record of results.
  • Test urine for Ketones 4 times a day.
  • Rest, as exercise can make Ketoacidosis worse.

Consult your GP or Diabetes Specialist Nurse if:

  • You have Ketones
  • You are vomiting and unable to keep anything down. 
  • You do not improve quickly.
  • Your blood glucose levels remain high.
  • Your blood glucose level is low.
  • You are worried.

Newcastle Diabetes Centre, Diabetes Specialist Nurses, Telephone contact:
(with answer machine).

Tel:  0191 256 3003  9.00 am – 4.30 pm Monday - Friday

What are Ketones?

Ketones are acid substances produced when the body is short of insulin and can start appearing in the urine during periods of stress and illness.  More insulin is often needed to bring the blood glucose level down and to clear the ketones.  (This process can happen even if you are not eating).  Ketone urine test strips are available on prescription; always keep a supply, just in case.  Your Diabetes Specialist Nurse will show you how use them.

Developing Ketones is a potentially life threatening situation, seek advice early from your GP or Diabetes Specialist Nurse during office hours and out of hours contact your emergency GP or attend your nearest Casualty Department.

If flushed, persistent vomiting, deep rapid breathing and drowsiness become noticeable then Hospital treatment is needed quickly.   Dial 999.

Seeking advice at an early stage can prevent a more serious situation developing. 

Insulin Adjustment

NEVER STOP YOUR INSULIN

During illness you may need to increase your insulin dose, depending on your blood glucose results.  If Ketones are present in your urine, then more insulin is needed, even if your blood glucose results are improving.  If you are happy to adjust your insulin dose, then follow these basic guidelines.

 If Blood Glucose Level:  Insulin Dose:
(Unable if unable to eat)
 Less than 13mmol/l  Continue with your normal insulin dose
 Between 13-22mmol/l  Take 4 units extra with each injection
 More than 22mmol/l  Take 6 units extra with each injections

This is a basic guide only, for more advice on your individual requirements, then discuss with your Diabetes Specialist Nurse.

Easy to eat carbohydrates

Here are some foods that may be useful alternatives to solid food when you are feeling unwell:

  • Milky drinks
  • Soup
  • Fruit juice
  • Squash or fizzy drinks, Lemonade, Coke
  • Ice Cream
  • Yoghurts
  • Drinking chocolate, Horlicks, Ovaltine
  • Complan, Build Up

Planning a pregnancyShow [+]Hide [-]

Many women who have diabetes have healthy pregnancies, however it requires much more thought and careful planning.

During the very early weeks of a pregnancy, until at least 12 weeks, your developing baby is very sensitive to high blood glucose levels.  This increases the risk of some abnormalities or malformations in babies such as spina bifida (incomplete closing of the spinal column), heart and kidney problems.  The risk of malformation is four to ten times greater in babies of women with diabetes.  However the chances of any of these problems occurring are much lower if you can keep your blood glucose tightly controlled – less than 7.5mmol/l after meals.

Taking folic acid 5mg tablets daily for 12 weeks before and into the pregnancy has been shown to also reduce the spinal problems that can occur in the baby.

Once you have decided to plan a pregnancy and, before you have stopped using contraception, talk to your diabetes team.  A special women’s health clinic is available to give you support and advice.  The following checklist of things you can do to get your pregnancy off to a healthy start:

  • Tell your GP/Diabetes team is you are planning a pregnancy.  Ask for an appointment at a specialist clinic.
  • Continue using contraception until you have been seen at the specialist clinic.
  • Discuss your medications with your GP.  Some medicines including those to treat high blood pressure should not be taken any may need to be changed.
  • Try to stop smoking.  Smoking can harm your baby.
  • Begin to take folic acid 5mg tablets – on prescription from your GP.
  • Choose healthy food – arrange to see a Dietician.
  • Good blood glucose control is a key factor and is important before and during your pregnancy.  Discuss your individual targets with your diabetes team.  Ensure you know how to manage hypoglycaemia.

Planning a pregnancy will take a bit of working out but will give you a good chance of having a healthy baby.  Once you find you are pregnant inform your diabetes team straight away and arrangements will be made for you to be seen at a specialist Obstetric Diabetic Clinic.

Sports and exerciseShow [+]Hide [-]

Regular exercise is good for your general health as well as for your diabetes.  It improves your muscle tone and strength.  Exercise helps you manage stress which help you feel better about yourself.

It helps to reduce your risk of developing heart disease by lowering the level of triglycerides (harmful fats) and raising the level of HDL or ‘good cholesterol’ in your blood.  Exercise can also help to lower blood pressure.  High blood pressure contributes to many of the long term complications that can occur with diabetes.

Exercise helps you lose weight or maintain your weight by burning calories.  By following a healthy diet and exercising regularly, you can lose weight and maintain it at a desirable level.  Exercise over time will increase the amount of muscle and decrease the amount of fat stored in your body.  Muscle cells use more sugar and improve your blood sugar levels.

During exercise your body uses more sugar than when your body is at rest.  This can result in a rapid lowering of your blood sugar if you are taking insulin.  You may have hypoglycaemia (low blood sugar) during or after exercise.  It is important that you keep your blood sugar in a safe range while you exercise.  In order to do this, there must be a balance between the sugar used for energy while you exercise, the sugar available from food, and the insulin you are on to lower your blood sugar.  Testing you blood sugar is the best way to check this balance. 
 
Exercise, Glucose and Insulin

Depending on the type of exercise you do, you may need to lower your insulin dose and/or increase the food you eat to avoid low blood sugars (hypos).

  • Gentle activity may not affect your blood sugar levels
  • For short strenuous exercise (e.g. squash), you may need more food beforehand and extra food afterwards at your next snack or main meal
  • For prolonged exercise (e.g. a long cycle ride, football to rugby match), you may need to take extra food before, during and after your activity
  • After exercise:  your muscles will take at least 1 -2 hours to refuel.  During this time your blood sugar may still drop so it is important to check your blood sugar levels some hours after exercise to prevent delayed hypos, which may occur in the night.

Remember that everyone is different and there will be some trial and error involved in working out how to balance your diabetes with your exercise.

NB.  If your blood glucose is raised e.g., over 13mmol/l, prior to exercise, the exercise will probably not reduce the blood glucose level.  You may find that your blood glucose level will rise.  This is because you probably do not have enough insulin on board.  You must consider taking an extra dose of quick-acting insulin to help reduce the level prior to exercising – AND always check for KETONES.
 
Self-care for Exercise

In Type 1 diabetes, you may need less insulin or more food or both when you are exercising.  Trial and error over time will help you determine what insulin or food changes your body will need for safe blood sugar levels during exercise.  Blood sugar testing before and after exercise helps you know if the changes you make in your insulin or your food intake or both were right for you.  If you are starting a new exercise, and especially if the exercise is done for a long time, you will need to also do blood sugars during exercise.   Keeping careful records will help you establish the pattern of your blood sugar response to exercise.

Planned Exercise                                                                      Unplanned Exercise

 Aim to lose weight Weight not an issue   
 Focus on reducing Insulin Focus on increasing CHO or reducing Insulin  Only option is to increase CHO

Reducing Insulin

 Type of Exercise Example  Guidelines 
 Short - gentle Walk - 20 mins  Do nothing, carry glucose 
 Medium - gentle Bike ride 30 - 45 mins  10 - 20 grams CHO 
 Prolonged / intense - upto 4 hours Aerobic class 1 hour Cycling 4 hours  30-50% reduction in insulin and snacks 
 Prolonged exercise > 4 hours A day hiking or decorating  50% reduction of Insulin and CHO snacks - pre and post exercise 

Exercise Snack Guide

LIGHT ACTIVITY
(Strolling, leisurely bike ride for <30 minutes)

 

 If blood sugar is:

mmol/l

 

 <4.4

4.4-10 

10-15 

 Eat 10-15 grams carbohydrate / hour of exercise Eat 10-15 grams carbohydrate  No snack required 

MODERATE ACTIVITY
(Cycling, golfing, doubles tennis, jogging, bowling, yoga)

 

 If blood sugar is:

mmol/l

 

  <4.4

 4.4-10

 10-15

 Eat 25-35 grams carbohydrate before exercise then 10-15 grams per 30min of exercise
 Eat 10-15 grams Carbohydrate per 30mins of exercise
 No snack needed
Test for ketones
Before and after
Exercise if blood sugar > 15mmol/l

STRENUOUS ACTIVITY
(Squash, intense bike ride, swimming, running, hockey match)

 

  If blood sugar is:

mmol/l

 

   <4.4

  4.4-10

  10-15

Eat 50 grams Carbohydrate before exercise then 10-15 grams per 30 mins of exercise Eat 25-50 grams Carbohydrate before exercise then 10-15 grams per 30 mins of exercise No snack needed
Test for ketones before and after exercise

Exercise Snack Guide

10 – 15 grams
Carbohydrate
Equals

25 – 50 grams
Carbohydrate
Equals

 50 grams
Carbohydrate
Equals

 ½ cup apple juice

or

½ cup orange juice

or

½ 1 banana
or 1 fruit

or

1 slice of bread
or 2 rich tea biscuits

or

1 packet crisps

or

3-4 dextrose tablets

1 slice of bread + 1 cup of skimmed milk

or

1 cup apple/orange juice + 1 whole medium banana

or

1 cereal bar

or

2 slices of bread

or

small-medium
scone

or

chocolate bar

1 chocolate bar + 1 glass milk

or

1 cereal bar + 1 glass milk

or

1 scone + 1 glass fruit juice

or

1 banana + 2 chocolate biscuits

or

2 slices bread + glass fruit juice

or

½ bottle Lucozade


Weight Loss

You may prefer to adjust your insulin for exercise.  This would be the best action to take if you are trying to lose weight and are doing planned exercise.  Reduction in the amount of rapid or short acting insulin prior to exercise will reduce the amount of extra food you might have to eat to prevent or treat hypoglycaemia.  If you have certain days of the week when you are active and other days when you get very little exercise, your insulin regimen may be adjusted to match these changes in your exercise pattern. If you notice a pattern of decreased blood sugar levels after you begin exercising, your intermediate or long acting insulin doses may need to be decreased.

Factors to consider when exercising

Often you will need to eat extra food before you exercise.  Whether you will need extra food before exercise and how much food you will need depends on several factors:

  1. When is your insulin peaking?
  2. When you last ate a meal or snack?
  3. Duration and intensity of your exercise?
  4. Blood sugar levels prior to exercise?
  5. Always treat any hypo symptoms before exercising.
  6. Always carry glucose when exercising.

Water

Drinking too little water and losing too much fluid through sweating can:

  • Cause you to become extremely fatigued during exercise
  • Inhibit your ability to get the most out of your exercise
  • Worsen your diabetes control

In your body, it does the following things:

  1. Carries glucose, oxygen and fats to working muscles and removes wastes like carbon dioxide and lactic acid.
  2. Helps absorb your body’s heat and gets rid of it through sweating.
  3. Eliminates wastes through the urine.
  4. Helps digest food as part of your saliva and gastric secretions.
  5. Lubricates joints and cushions tissues and organs.

Foot careShow [+]Hide [-]

Diabetes can affect both the nerves and the circulation to your feet.  If this happens your feet are at risk due to poor sensation and poor circulation; however you can help to prevent these problems if you take extra care of your feet.

Prevention is better than cure

Dos

  • Wash feet daily always ensuring water is at the correct temperature.
  • Dry feet well especially between the toes.
  • Apply moisturiser to keep the skin supple and prevent cracking, however, not between the toes as the skin can get too moist and soggy.
  • Look at your feet daily and pick up any problems such as cuts, redness, swelling, discharge or pus.
  • Cut and file nails straight across.  Any breaks in the skin should be covered with a clean dry dressing.  Do not burst blisters and seek advice if concerned.  Contact a Podiatrist if you have any problems.
  • Buy well fitting shoes and remember shoes should fit your feet not vice versa.
  • Check inside your shoes for any objects that should not be there. 
  • Give up smoking.
  • Take regular exercise.
  • Keep your blood glucose well controlled.

Do Nots

  • Never use sharp instruments on your feet.  Also corn plasters contain acids, so do not use. If any problems seek advice from a Podiatrist.
  • Avoid direct heat and hot water bottles.  If your sensation is at all dulled these can be dangerous.
  • Never walk barefoot. It is not recommended to use foot spas.

Remember diabetes can affect how quickly breaks in the skin heal so this may take a little longer than expected. It is also very important to control your blood glucose levels to as near normal as possible to promote healing and reduce the risk of infection.
A thorough assessment of both the blood supply and the nerve supply to your feet will be carried out at each annual review appointment and any changes will be discussed with you.

Diabetes, if not very well controlled, can damage the nerves in your feet and legs.  This is called neuropathy, this can cause numbness, burning, tingling or pain. This loss of feeling means that you may not be aware of discomfort, such as a blister developing or you may not notice your shoes rubbing or that the bath water is hot.

Diabetes can also affect the circulation in your feet, which means that any cuts or sores may not heal up very well. You can help stop problems developing by taking extra care of your feet.

Holidays and travelShow [+]Hide [-]

Planning ahead will make sure that holidays and travelling are stress free.  The following points will help you enjoy your holiday.

  1. Prepare and plan well in advance.  Your  Diabetes Specialist Nurse or GP can help with more detailed advice, but you will need to contact them at least two weeks before you go away.
  2. Make sure you take a good supply (and spares) of tablets or insulin, pen devices, needle clipper, test strips, monitoring equipment, etc., in your hand luggage.  (Flying at high altitude can cause freezing in the baggage hold, so do not pack your insulin in your suitcase).  Your particular equipment may not be available in some countries and some insulins have a different name.
  3. It is important that you carry or wear some form of diabetes identification, to prevent confusion or in case you are ill abroad.  Although you do not need to declare your diabetes equipment when passing through Customs, it is a good idea to take a letter from your Clinic or GP explaining that you  have diabetes and need to carry insulin, pen devices and monitoring equipment.
  4. Ensure that you take out appropriate medical insurance.  Some policies do not cover diabetes or diabetes emergencies.  Check your policy includes all of  this, make sure the insurance company knows that you have diabetes.  In E.U. countries, free or reduced cost emergency treatment is available, but an E111 card must be produced, (application form available from Post Offices), but does not cover all medical services and equipment.
  5. Prepare for the journey.  In case of delays or hypos, take extra food/snacks with you that include quick acting carbohydrates, such as biscuits or glucose tablets.
  6. Vaccinations are recommended when travelling to certain countries.  Check with your travel agent or GP/Practice Nurse at least 3 months in advance.  Some vaccinations can cause a mild upset in general health, so do not have then just before you go.
  7. If you suffer from travel sickness, make sure you get some effective tablets from your GP/Pharmacist before leaving.  If you do become ill on holiday, such as sickness and diarrhoea, you can substitute food with fluids containing carbohydrates, such as sweetened drinks.  NEVER STOP YOUR TABLETS OR INSULIN EVEN IF YOU CANNOT TOLERATE SOLID FOODS.  You should monitor your blood sugar levels frequently and adjust your insulin as needed.   If the illness or sickness and diarrhoea persist or you are worried SEEK MEDICAL HELP.
  8. Insulin can be safely kept at room temperature for up to 28 days, (below 25 C / 80 F).  In a hot country insulin can be kept reasonably cool in your hotel room, if a fridge is not available.  Keep your insulin out of direct sunlight.  Cool bags/boxes are useful if you are travelling by car, camping or backpacking.  There are some specially designed travel kits, ask your Diabetes Specialist Nurse for details.  Any supplies left after the holiday that cannot be used in 28 days should be thrown out.
  9. Going on a long journey does need more thought and can be discussed with your Diabetes Specialist Nurse or GP well in advance.  If flying across time zones your usual routine, tablets and insulin doses will need to be adapted.  Going East to West the day is longer and you will need an extra meal and extra insulin.  Going West to East, the day is shorter and your insulin may need to be reduced.
  10. Food, alcohol and activity are often different on holiday.  Remember all these things can affect your blood glucose, you will need to test to check for high and low blood sugars.
  11. Things to think about in a hot climate:
    • Watch for hypos, insulin can be absorbed faster so monitor regularly. 
    • Some meters or testing strips may not perform well in very hot weather or if there is sun cream on the skin.
    • Sun safety, use a high factor sun cream and do not sun bathe too long to prevent sunburn.
    • Avoid walking barefoot on the beach.
    • Drink plenty sugar free fluids to prevent heatstroke.
  12. Things to think about in a cold climate: 
    • Insulin should not be allowed to freeze and should be thrown out if it does.
    • Some meters or testing strips may not perform well in very cold weather.
    • Wear warm socks and sensible shoes to avoid injury to feet.

SmokingShow [+]Hide [-]

As we all know, smoking is dangerous (and expensive).  It is linked to cancer, chest problems, heart attacks and strokes.

It is especially important for people with diabetes NOT to smoke, as the risk of heart attacks, angina, strokes and circulatory problems are already higher.

If you want to stop smoking, there is help available through your Practice Nurse at your GP Surgery.  There is also a specialist Smoking Cessation Service in Newcastle and North Tyneside.  They both provide advice, support, education and when appropriate recommend Nicotine Replacement Therapy.  (Speak to your Diabetes/Practice Nurse).

Drugs and diabetesShow [+]Hide [-]

Drugs both legal and illegal can lead to problems with your health.  The best way to avoid problems is to avoid taking them, particularly the more addictive ones (including tobacco).

Drugs can be divided into three main groups:

Downers
Also known as depressants, these are drugs like alcohol, heroin, tranquillisers and painkillers.  They slow the body down, including thought processes, heart rate and breathing.

Uppers
Also called stimulants and include drugs such as speed, ecstasy and cocaine.  They speed the body up including speech, thoughts and heart rate and decrease the appetite.

Hallucinogenic
Include drugs such as cannabis, acid and magic mushrooms and alter the way people hear, see and feel things.  (Avoid mixing cannabis with alcohol).

Drugs can affect people in different ways depending on the type, amount and purity of the drug and on the person.  Drugs may affect individuals with diabetes and make their blood glucose difficult to control.

Speed, ecstasy, cocaine often taken whilst out clubbing, may give rise to particular dangers such as:

Dehydration – which means your insulin does not work fully.
Suppressed appetite – when combined with dancing may cause a hypo.

Additional advice:

  • Eat a substantial meal (with potatoes, rice or pasta) before going out.
  • Monitor blood glucose throughout the evening and carry glucose.
  • Have a snack before bed.
  • Let friends know about the risk of hypos and what to do.

Drugs are unpredictable and the affect on your diabetes will be unpredictable.  Take care and stay safe.

DrivingShow [+]Hide [-]

Having diabetes does not stop you from driving a car, but if you are treated with diabetes tablets or insulin, you must by law, inform the Driver and Vehicle Licensing Agency (DVLA) as soon as possible after diagnosis. If your diabetes is treated by diet alone, you do not need to inform them, but you must let them know if your treatment changes, for example, from diet alone to diet and tablets. You must also inform them if you have had your diabetes for some time but are applying for a licence for the first time.

The address is:

Driver and Vehicle Licensing Agency (DVLA)
Drivers Medical Branch
Swansea
SA99 1TU

www.dvla.gov.uk/welcome.htm

When you apply for a licence, on the application form, answer yes to the question about diabetes and give details whether your diabetes is treated by tablets, insulin or by diet alone.

A Diabetic 1 form must be filled in, if you are treated with insulin.  This does not mean that you will be refused a driving licence, you will be issued with a licence for one, two or three years. If you are treated with tablets or diet alone you may be issued with a “til 70”  licence.

The DVLA needs to be sure that every driver is safe on the road and you must inform them if you develop any problems or diabetes complications which may affect your ability to drive safely.

If you take insulin you cannot hold a licence for a:

  • Large Goods Vehicle (LGV)
  • Passenger carrying vehicle (PCV).

If you currently have such a licence and start using insulin, you must inform the DVLA and stop driving that vehicle.
The only exception is for a small number of people who had insulin treated diabetes and were given a licence before April 1991, when the law changed.

If you feel hypo when driving:

  •  Stop the car as soon as it is safe to do so.
  • Immediately take some glucose tablets or glucose drinks or biscuits or some other form of carbohydrate.
  • Remove the ignition key and move into a passenger seat.  (This is to prevent any suggestion that you are in charge of the car whilst under the influence of any drugs, which includes insulin).
  • Only continue your journey when you are fully recovered.


You should not drive if you:

  • Have a lot of hypos or have difficulty in recognising the early warning signs of hypo.
  • Have problems with your eyesight (that is not corrected with glasses).
  • Have weakness and numbness in your arms or legs.

If you are worried, discuss this with your Diabetes Team.

You must also tell your Insurance company of your diabetes, for your policy to be valid.  If your Insurance company wants to charge you a higher premium, get quotes from other companies.

Prescription exemptionsShow [+]Hide [-]

You do not have to pay prescription charges, if you have diabetes that is treated with diabetes tablets or insulin. You are allowed to apply for a prescription exemption certificate, which is shown to the Pharmacist when you pick up your prescriptions. You can get an application form (P11) from Post Offices, Social Security Office and GP Surgery or some Chemists.  This form must be signed by your GP.

This means that all your diabetes tablets, insulin, needles, lancets, test strips and all other non-diabetic medication that is prescribed for you is free of charge.

InsuranceShow [+]Hide [-]

Having diabetes can affect both your existing insurance policies and many new policies that you might choose.

Although diabetes can be treated, people with diabetes are more likely to develop medical complications and because of this risk, insurance companies take this into consideration when deciding on premiums and cover.
The Disability Discrimination Act 1996 has reduced the problem of insurers loading premiums

You should tell insurance companies about your diabetes, even if they do not ask about your health, to prevent your policy being invalidated.

It may be a good idea to get a few quotes from different insurance companies, for more realistic quotes and advice on all aspects of insurance cover and financial planning, such as motor, travel, house insurance, critical illness, life insurance and mortgages.

EmploymentShow [+]Hide [-]

The vast majority of jobs are open to people with diabetes if you are treated by diet alone or diet and tablets, providing you do not have diabetic complications. There are some exceptions, if you are treated with insulin, because an unexpected hypo at work could put your life or others in danger, eg.

  • The Police Service
  • The Fire and Ambulance Service
  • The Armed Forces and Merchant Navy
  • The Prison Service
  • Train Driving
  • Airline Pilot, air traffic control and cabin crew
  • Driving large goods vehicle or buses
  • Working offshore
  • Coal face work

If you are already employed when you develop diabetes, it is sometimes possible to continue.

Shift work is made easier if you have flexible insulin regime and do regular blood tests and your diet and insulin doses can be rearranged.  Your  Diabetes Specialist Nurse or Doctor can help with an individual plan.

Diabetes is covered by the Disability Discrimination Act (1996) protecting you from being refused work or dismissed because of your diabetes.  Also changes in European Union Law in October 2004 are expected to remove employment bans.  Any problems experienced at the work place can be discussed with your Diabetes Team.

Care to expectShow [+]Hide [-]

Effective diabetes care is achieved by teamwork, between you and your diabetes care team.  The most important person in the team is you.

Members in your Diabetes Team

  • Yourself
  • Hospital Diabetologist
  • Diabetes Specialist Nurse
  • Clinic Nurse
  • Medical Secretaries
  • Administration Staff
  • Practice Nurse
  • Dietician
  • Retinal screener/Ophthalmologists/Optometrist
  • Podiatrist/Chiropodist
  • Pharmacist
  • Psychologist
  • GP

Your diabetes care team will:

  • Inform you about your diabetes, blood sugar control and how to monitor.
  • Give you information on the benefits of a healthy diet and exercise.
  • Provide you with regular information and opportunities for education.
  • Support you on how to manage your diabetes when you are ill or when your blood sugar is low and how to adjust your nsulin correctly.
  • Provide formal medical clinic reviews and keep a check on your HbA1c, weight, blood pressure, eyesight, feet, kidneys, cholesterol levels and watch for any developing complications.
  • Discuss the effects of diabetes and your lifestyle, e.g. Work, driving, holidays, diet, exercise, insurance.
  • Help you make informed decisions about your treatment and care.

It is your responsibility to:

  • Attend your appointment.
  • Take as much control of your diabetes as you can and learn how to manage your diabetes.
  • Talk to your diabetes care team and ask questions about your control.
  • Learn how to look after yourself when you are ill or when you are hypos and how to look after your feet.
  • Follow a healthy lifestyle.
  • Know how to contact your diabetes care team, know who to contact in an emergency and how to use your clinic appointments effectively.

Looking after your diabetes is hard work.  You will not always get it right, none of us does, but your diabetes care team are there to support you.

“Life for me with diabetes” by Kelly MurrayShow [+]Hide [-]

Before I was diagnosed with diabetes I was constantly tired and very thirsty.  I would wake up during the night and drink four and five glasses of water and still feel thirsty, the thirst never went away.  I would get hot and bothered just sitting in the chair.  After a few weeks of feeling worse each day, I went to the doctors.

The doctor did a urine check in the surgery and told me there and then I had diabetes.  I hade never heard of diabetes so I did not know what to think, he told me to go to the hospital that day and they would help me and show me how to look after myself.

When I was first diagnosed with diabetes, I went through many different emotions, in the first few weeks I was in denial, I went through the motions, checking bloods, doing the injections, I couldn’t make sense of what had happened to me.  I was fit and healthy, so why me, but it was me.

As the weeks went on the Specialist Nurse would help me with the amounts of insulin I needed.  I felt out of control and frightened to do anything for myself.  I was worried about everyday life i.e., going for walks, out for meals, going to the gym, how would this affect me.  4 – 5 weeks later I suddenly realised that this was for life, forever.

I spent 2 days in bed sobbing, my friends and family were very supportive.  Non one in my family has or had diabetes so we were all very shocked.  The specialist nurse was at the end of phone day and night to help me with any worries and concerns I may have had.

You are told you can live a normal life, but what is normal about checking bloods and sticking needles in yourself.

I was very angry for a while.  I would not listen to anyone telling me I would be fine, how would they know, this went on for a few months until I gradually gained confidence and understanding in what was happening to me.

I didn’t like talking about diabetes, or telling anyone I have it.  That has never changed.  As the months went on I began to rely less on the diabetic nurse, thinking more for myself.  However, you then start to worry about the ‘hypos’.

Hypos are very frightening at first.  As time passes I became more in control of my diabetes, the hypos became less.  My hypos make me feel hungry, sick and very shaky.  After a hypo I am left tired and with a headache.  Hypos are something that are always at the back of my mind, but then every day gives you more confidence.  I began to live a normal life with diabetes.

After about 10 months, I started going out for drinks and meals this is something I found hard at first.  I worried that I might have a hypo when out or have too much to drink, after a while it gets easier.  I think it is harder for my friends and family they would always be asking what they have to do if I have a hypo.  Even now they ask ‘should we eat now or later, have you had your insulin’.

2 years later my husband and I decided we would like to start a family.  This was one the most frightening decisions I had to make.  The diabetic team then advised me of the importance of good blood control before and during the pregnancy.  The nurse and doctors explained about the complications that can happen during pregnancy and birth.  I would have to have good control throughout the pregnancy, and be monitored closely.

There is nothing that can prepare you for the emotions you go through.  When I became pregnant, I was thrilled and excited, but at the same time I was terrified, worrying about everything.  I checked my blood levels constantly and phoned by diabetic nurse everyday, who was patient and understanding.

Every time I went for a scan, I was worried that something would be wrong, I worried that the baby was growing too big but I was constantly reassured that everything was fine, which it was.  I went into hospital for an induced labour, everything went well and I gave birth to a beautiful boy, he was quite big, 10lb 2oz, but he was gorgeous.

After giving birth all the diabetic team were there to help me with my insulin, which had doubled while pregnant, this was frightening.  I had many hypos and struggled to get my blood levels under control for weeks after the birth.  The diabetic team continued to help me, after a few months, the blood levels settled down as I got used to being a mother.  Everything went well and so 3 years later I did it all again.  I wouldn’t say it was easier, but at least you know what to expect.

I eventually gave birth to a 9lb 12oz health girl.  This time it took a lot longer to get my diabetes under control.

To gain better control I have had to change my insulin, and increase my injections daily.  This helped me gain control of my blood levels again.

Diabetes had not stopped me doing anything I want to do.  I go on long flights and short breaks away, I drive anywhere I want.  I think the best way to do all of this is to be prepared and organised with snacks and rest times and keep a close check on your blood levels.  It helps me when I can ring the diabetes nurse when I am planning to go on holiday or long drive.

I have a busy life with 2 young children.  I often feel tired and sometimes can’t be bothered to check my blood.  I look at my children, who inspire me to want to keep fit and well.  I look at my friends and family and I know I’m normal and live a normal life.  I just have diabetes, it’s a way of life for my family and me.  You learn to live with it.  I control my diabetes it doesn’t control me.

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