INFORMATION ABOUT DIABETES

There is three kinds of Diabetes they are Type 1 Diabetes, Type 2 Diabetes and Gestational Diabetes.

There is a few things you are expected to do when you are a diabetic. You have to check your blood sugar, give injections, watch your diet and watch for Hypoglycemia, Hyperglycemia and complications, and live by the eight Gold Guidlines for Life Style.

There are three common misconceptions about Diabetes:

Diabetes is not a contagious disease: you cannot "catch it".
Diabetes is not caused by eating too much sugar.
Although easy to treat, Type 2 diabetes is not a "mild" form of diabetes. If not properly treated, it can have serious consequences.

Checking Your Blood Sugar

Testing your own blood sugar level gives you the information you need to effectively manage your diabetes. Without regular testing, you will not know how well your diet, exercise and medication programs are working or when to make changes. Blood glucose tests are quick and easy to do. You can test almost anywhere, anytime, in two minutes or less. Blood glucose test can be done with a test strip and a small hand held meter. My personal preference is the Precision Q.I.D meter offered by Medisense. Reasons For Blood Glucose Monitoring

The main reasons for testing blood glucose are:

To monitor the effectiveness of diabetes treatment and to serve as a guide for you and the doctor in planning adjustments of medication doses.
To show the relationship between blood glucose, food, exercise and diabetes tablets/insulin.
To define unacceptable control as indicated by blood test results.
To diagnose hypoglycaemia including nocturnal hypoglycaemia.
To detect unstable or "brittle" diabetes.
To manage "sick days" at home, and when recovering from an illness.
To monitor the response to a new treatment schedule such as stabilisation on to insulin.
To provide continuity of care following admission to hospital for illness or an operation. To establish the renal threshold and the reliability of urine testing for glucose.
To achieve the ideal diabetic control during pregnancy.
To assist people with nerve damage (neuropathy) to recognise hypoglycaemia.
To achieve an acceptable blood glucose range, which may have a role in preventing or delaying the onset of diabetes related complications.

The Most Common Glucose Meters Available In Australia in 1991

METER NAME Glucometer Series (Bayer) Glucometer II with memory Glucometer M GX	REAGENT STRIP USED Glucostix Glucostix Glucostix	MEMORY OPTION Yes Stores and averages 26 values Yes Stores 338 values for computer analysis with Glucofacts software. Most commonly used by hospitals Yes, stores and averages last 10 results.	SPECIAL FEATURES Small Size Small Size	COMMENTS Short reaction time - may make use difficult in poorly co-ordinated Easy to Calibrate. Service back is good Cheaper than other meters
Glucochek series Glucochek 90 Glucochek 91 Glucochek (audio version)	Glucostix or BM Test BG Multistrip version available BM Test BG	Yes 19 values stored Yes 85 values stored. Printer option for visually impaired		Service back up may not be ideal
Hypocount series (Hypoguard) Talking hypocount "B" Hypocount MXB Hypocount MXR Hypoguard GA	BM Test BG or Ames BG BM Test BG or BM Test-Glycemie 20-800 Hypoguard GA	Yes Yes Yes 10 Values stored		For visually impaired Special strip guide available to assist accurate placement of blood on strip.
Reflolux series (Boehringer Mannheim) Reflolux II-M Reflolux S	BM Test Glycemie 20-800 BM Test Glycemie 20-800	Yes Stores and averages 30 values Interfaces with device for input of treatment details and computer analysis (Camit; For hospital use) Yes 20 memory spaces Interfaces with Camit for computer analysis		Can be difficult to calibrate Good service backup Will show "OFF" signal if unclean, "ERR" if insufficient blood. Easy to calibrate.
ExacTech Series ExacTech ExacTech Companion	ExacTech ExacTech	No No	Small Size Small Size	Needs Immediate press of button for accurate result. Simple to use and fast

Giving Injections or Taking Tablets

Currently there is no cure for diabetes. So for people to survive with diabetes they have to either give injections or take tablets. People with type 1 diabetes normally give injections to stay alive you can have upto 4 or 5 injections a day. (I am currently on 3 injections a day). People with type 2 diabetes can control their diabetes with tablets or by diet. But anyone who has diabetes has to watch what they eat because if they eat the wrong stuff they can make themselves very sick. There are a lot of different tablets but this is a summary of tablets available:

Sulphonylureas Biguanide

Chemical Name

Tolbutamide

Chlorpropamide

Gilbenclamide

Glipizide

Gliclazide

Metformin

Brand Name

Tablet Size
Daily Dose range
Approx. Duration
Frequency
Administration

Potency

Rastinon 0.5 & 1.0gm 0.5 - 3.0gm 8-12 Hours 2-3 Times Day With Meals Weak

Diabinese 250mg 125 - 500mg 36Hrs Once Daily With Meals Strong

Daonil Euglucon Glimel 5mg 2.5 - 20mg 18-24Hrs 1-2 Times Day With Meals Strong

Minidiab 5mg 2.5 - 40mg 18-24Hrs 1-2 Times Day With Meals Strong

Diamicron 80mg 40 - 320mg 18-24Hrs 1-2 Times Day With Meals Strong

Diabex Diaformin Glucophage 0.5gm 0.5 - 1.5gm 12Hrs 2-3 Times Day With/After Meals Weak

Side Effects

Jaudice
Low plasma
sodium
Flushing with alcohol

Hypoglycaemia, Gastrointestinal Disturbance Weight Gain, Blood Disorders

Hypoglycaemia is rare.
Anorexia
Diarrhoea
Lactic
Acidosis

Other

Care in the elderly

Care in elderly,
renal & liver
disease

There are a lot of different insulins available they can either be human or beef and they can act for different lengths of time. The table bellow shows the different kinds of insulin and how long they last. To change any of your insulins please talk to your doctor before doing anything about them:

TYPE OF	INSULIN
Generic Name	Trade Name	TIME OF ACTION	START OF EFFECT Hours	MAXIMUM EFFECT (Greatest Chance of Hypoglycaemic Reaction - Hours)	END OF EFFECT Hours	APPEARANCE OF SOLUTION	ORIGIN OF INSULIN
Insulin Acid	Insulin 2	Short acting	1 - 2	3 - 6	7 - 8	Clear	Beef
Neutral (Soluble)	Actrapid HM Humulin R Hypurin Neutral Velosulin Human	Short acting	1/2 - 1	2 - 5	6 - 7	Clear	Human Human Beef Human
Isophane (NPH)	Humulin NPH Hypurin Isophane Insulatard Human Isotard MC Protaphane HM	Intermediate acting	3 - 4	8 - 12	16 - 24	Cloudy	Human Beef Human Beef Human
Insulin Zinc Suspension (Lente)	Humulin L Lente MC Monotard HM	Intermediate acting	3 - 4	7 - 15	16 - 24	Cloudy	Human Beef Human
Isophane plus Neutral Mixed Insulin	Actraphane HM Mixtard Human	Mixed Short & Intermediate acting	1 - 2	3 - 8	16 - 24	Cloudy	Human Human
Insulin Zinc Suspension (crystalline)	Humulin UL Ultratard HM Ultralente MC	Long acting	4 - 6 4 - 6	8 - 22 10 - 28	28 36	Cloudy	Human Human Beef
Protamine Zinc Insulin (PZI)	Protamine Zinc Insulin MC	Long acting	4 - 6	14 - 24	36	Cloudy	Beef

Hypoglycemia Hypoglycemia is a low blood sugar condition which is also called an insulin reaction. Check your blood sugar if you suspect you are hypoglycemic. If your blood sugar is below 3.5mmol/l (60mg/dl), you can experience any or all of these symptoms:

Shaking
Dizziness
Sweating
Weakness in Limbs
Grouchiness
Drowsy
Hungry
Rapid Heart Beat
Slurred Speech
Headache
Confusion
Tremors
Tingling of Lips
Nervousness

If a Hypo isn't treated quickly enough, a person can experience loss of consciousness and even lapse into a coma. A hypo should be treated by eating someting that contains sugar like lollies, non diet fizzy drink or plain sugar. I treat my hypos with jelly babies and juice. This should be followed with a complex carbohydrate like bread, juice or biscuits.

Hyperglycemia

Hyperglycemia is when your blood sugar level rises above normal and stays there. Hyperglycemia can occur gradually and without symptoms, or it can occur rapidly. Usually, you will be able to lower your own blood glucose. There are times, however, when emergency care is needed. The symptoms you should watch for are:

Fatigue
Headaches
Nausea
Extreme Thirst
Frequent Urination
Blurry Vision
Dry Mouth and Skin
Unexplained Weight Loss
Increased Hunger

Hyperglycemia can be treated by injecting a few extra units of insulin or doing exercise. Exercise is not encouraged if your blood sugar level is too high. If a person has ongoing hyperglycemia this can result in complications later in life. And if a persons blood glucose level rises too high, they can lapse into a coma or even die. Hypoglycaemia/Hyperglycaemia

	Hypoglycaemia (low blood glucose)	Hyperglycaemia (high blood glucose)
Cause	Too much insulin Too little food Food not digested (anxiey, nausea) Excessive exercise Alcohol.	Not enough insulin, or omission of insulin dose. Too much food Failure to test urine, or ignoring positive tests. Infection and illnesses. Injury and Stress.
Onset	Good health immediately before. Rapid onset.	Ill health for hours or days. Gradual onset.
Symptoms and Signs	Hunger, sweating, pallor, nervousness, headache, dizziness, palpitations. Tingling sensations in tongue and lips. Weakness. Progressing to:- Confusion, mood change, belligerence. Clumsiness, slurred speech. Drowsiness. Unconsciousness or coma. Convulsions and fitting.	Excessive thirst, excessive passage of larger volumes of urine, dramatic weight loss, weakness, lack of energy over a period of days. Progressing to:- Nausea and vomiting, abdominial pains, increased breathing. Smell of ketones (acetone) on breath. Drowsiness and dehydration. Unconsciousness or coma.
Urine	Negative for glucose, providing the bladder has been recently emptied.	Glucose ++++ Large ketones
Blood	Low blood glucose, usually less than 3.5mmol/l (60mg/dl).	High blood glucose higher than 15mmol/l.
Treatment	Immediate glucose, sweets, or sweet drinks by mouth. Alternatively carbohydrate food of any sort, biscuits, bananas etc. If uncooperative, try honey or syrup placed inside the cheek. Do not attempt to give solid foods by mouth. If unconscious, Glucagon injection either subcutaneously or into muscle will generally improve symptoms of hypoglcaemia in 10-15 min. If unconscious, lie on one side and ensure a good airway and lift the chin to enable more easy breathing. If fitting or convulsing, lie on one side, restrain excessive movements, prevent falls (from bed) until the fit subsides.	Test blood glucose level every 2-4 hours and record the results. Test the urine for glucose and ketones. More than the normal dose of insulin is usually required. Seek advice concerning small doses of short-acting insulin, e.g. Soluble/ Actrapid/Humulin-R/ Velosulin insulin 4 units every hour for adults subcutaneously. If vomiting occurs contact the doctor concerning treatment. Maintain at least the normal dose of insulin. If symptoms do not respond, hospitalisation is necessary as an emergency.

Glucagon is the first line of defence for a child. Glucagon Glucagon is a protein made by the pancreas. Just as insulin pulls the blood glucose down, glucagon pushes the blood glucose up. This "push pull" control keeps blood glucose stable in people without diabetes. In people with diabetes, glucagon is useful to push glucose up when too much exercise, insulin or medication have pulled it down to far and the person can't or won't take sugar or food. In this case, glucagon can be injected and will push glucose out from stores in the liver and in to the blood. Then the person will become cooperative and can eat something. Glucagon comes as a dry powder to be mixed with a fluid. The idea is to mix the fluid with the powder (swirl, don't shake), inject the glucagon as you would insulin and rub vigorously. The glucagon usually takes several minutes to work. In the meantime, make sure the person is lying safely on his/her side and that the airways are clear. If you are not sure how to do this, go to a First-Aid course. When the person awakes, food should be given and you should make sure someone goes with the person, in case the hypo comes back. The last point to remeber to ask WHY the hypo happened and to take necessary precautions (including getting new glucagon stocks). Sick Days When sick you should:

always take your normal insulin dosage or tablets even if you are too sick to eat.
test blood and/or urine for glucose every four hours, or more often.
test your urine for ketones.
Endeavour to Consume your normal carbohydrate intake.
Fluid by mouth is essential.

Medical attetion is required if:

vomiting persists
Ketones are present and particularly if they increase in concentration
The blood glucose gets higher
The sick person appears drowsy or confused
The method of giving additional insulin is not understood
The nature of the intercurrent illness is not known
Commonsense indicates the need

USUAL FOOD

Bread or toast (1 slice)
Cereal - cornflakes or rice bubbles (3/4 cup)
Rolled oats (3/4 cups)
Saos (2)
Arrowroot biscuits (2)
Crumpets (1/2)
English muffins (1/2)
Boiled rice (1/3 cup)
Canned Soups (3/4 cup made up with water)

SICK DAYS

Sweetened jelly (1/2 - NOT low cal)
Ice cream (1/2 cup)
Custard with sugar(1/2 cup)
Honey (3 tsp)
Sugar (1 tablespoon)
Sweetened ice block(1 small or 90ml)
Egg flip - sweetened (8oz)
Tea or Coffee + 4 tsp sugar
Milk (10oz)
Coke, lemonade or other sweetened sof t drink (3/4 cup - Not low calorie)
Unsweetened tinned fruit (3/4 cup)
Orange juice (3/4 cup)
Apple juice(1/2 cup)
Pineapple juice (1/2 cup)
Orange (1 medium)
Banana (1 small)
Unflavoured yoghurt (100g, 1/2 carton)
Flavoured (sweetened) yoghurt (200g, 1 carton.)

Complications

Virtually every major organ system in the body is damaged by diabetes.Complications Include:

Blindness
Kidney Failure
Heart Disease
Stroke
Amputation of Extremities
Loss of Nerve Sensation
Early Loss of Teeth
High-Risk Pregnancies
Babies Born with Birth Defects
Feet Problems
Stress
Depression

FACTORS COMPLICATIONS OF DIABETES

responsible for damage	Blood vessel blockage in heart, brain & legs	Eye damage	Kidney damage	Infections of vagina, bladder & kidneys	Nerve damage
High blood glucose levels	+	+++	++	+++	+++
High blood pressure	+++	++	++	-	-
Tobacco smoking	+++	++	+	-	-
High blood fats and cholesterol	+++	-	-	-	-
Excess alcohol	-	-	-	-	++
Lack of exercise	++	+	-	-	-
Overweight	++	+	-	-	-
Duration of diabetes	++	+	+	-	+

Tips For Exercise

Take extra carbohydrate before and during
Adjust insulin and medication
Take care of feet

Diet Foods which are the right foods The major nutrients which you will need for good health are cabohydrate, protein, fat, vitamins, minerals, fibres and water. To control your diabetes and provide adequate nutrition your meals should be

High in carbohydrate
High in fibre
Low in fat
Low in Sugar

Glycaemic Index Glycaemic index is a system which ranks foods according to the rate at which the carbohydrate reaches your blood stream in the form of glucose. There are many influences on Glycaemic index, for example:

Preparation methods
Processing methods, canned, frozen, fresh
Other ingredients in the food
differences in different people for the same food

But based on what can be observed from the results of research into Glycaemic index the following broad guidelines can be given:

Eat legumes (dried beans, peas, lentils) and oats more often.
Choose food containing fibre; ie vegetables, fruit and whole grain products.
Avoid foods with a high sugar and/or fat content

Food Choice List To help you balance you carbohydrate intake with your insulin or oral hypoglycaemic tablets and your exercise, your dietitian will assist you in developing a meal plan. This list of food may help you add variety to your diet.

BREAKFAST

breakfast cereal - preferably whole-grain such as porridge, wheat flakes, or processed bran cereal, plain unsweetend museli - with low-fat milk.
fruit
bread or toast - preferably wholegrain - with thinly spread margarine or butter(if desired)
tea, coffee or water

LUNCH

Soup (if desired, preferably homemade).
bread, roll or biscuit - preferably wholemeal or wholegrain - with thinly spread margarine or butter (if desired)
Starchy vegetables, rice, pasta, or pulses.
Salad vegetables.
a small serve of lean meat, skinless chicken or turkey, fish. egg or low-fat cheese.
fruit.
tea, coffee or water.

DINNER

Soup (if desired, preferably homemade).
Starchy vegetables, rice, pasta, or pulses.
other vegetables (include freely.)
a small serve of lean meat, skinless chicken or turkey, fish. egg or low-fat cheese.
bread or roll - preferably wholemeal or wholegrain - with thinly spread margarine or butter (if desired)
fruit or low-fat milk dessert.
tea, coffee or water.

Common Medication That May Raise Blood Glucose Please check with doctors or pharmists before using any of these medications

Medication	Mechanism	Insulin	Tablets	Diet
Antibiotic syrups for children	Contain sugar	++	N/A	N/A
Antihistamine syrup for children	Contain sugar	++	N/A	N/A
Corticosteroids	Oppose insulin action	++	++	++
Cough mixtures in syrup	Contain sugar	++	++	++
Diuretics	Block insulin secretion	+	++	++
Nifedipine (Adalat)	Delays insulin action	+	+	+
Oral contraceptives	Oppose insulin action	+	N/A	N/A
Phenytoin (Dilantin)	Block insulin secretion	+	+	+
Phenothiazine Tranquilisers	?	+	+	+

N/A Not applicable Common Medication That May Lower Blood Glucose Please check with your doctor or pharmist before taking any of these

Medication	Mechanism	Insulin	Tablets	Diet
Alcohol	Stops liver producing glucose	++	++	+
Allopurinol (Zyloprim)	Increases amount of Sulphonylurea in blood	-	+	-
Angiotensin Converting Enzyme inhibitors (Capoten, Renitec)	Increase insulin action	+	+	-
Asprin	Increases amount of Sulphonylurea in blood	-	++	-
Beta-blocking drugs	Oppose action of Adrenaline	++	++	-
Clofibrate (Atromid-S)	?	+	++	-
Monoamine oxidase antidepressants	Interfere with adrenaline action	++	++	-
Non-steroidal anti-inflammatory drugs	Increase amount of Sulphonylurea in blood	-	++	-
Oxytetracycline	Slows insulin removal	++	+	-
Sulphonamide antibiotics	Increase amount of Sulphonylurea in blood	-	++	-
Warfarin	Increase amount of Sulphonylurea in blood	-	++	-

Medications That May Interfere With Urine Tests

Medications (Generic Name)	Clinitest Tablets	Stick and Tape Tests
Ascorbic Acid (Vitamin C)	+ -
Cephalosporins	+ 0
Chloral Hydrate	? +	0
Isoniazid	+	0
Levodopa	+	-
Methyldopa	+	0
Malidixic Acid	+	0
Probenecid	+	0
Salicylicates (Asprin)	+	0
Sulphonamides	? +	0
Teracyclines	? +
Nitrofurantoin	? +	0
Phenazopyridine	0	- sticks + testape

Key                     - False Negative
                           + False Positive
                           0 No known effect
                           ? Possible effect (not fully proven)

Diabetes involves the whole body and it is therefore necessary to think about the whole system when using any other medication. The medication rules are:

Always make sure that any doctor or pharmacist you see knows that you have diabetes and knows what treatment you are taking.
Never take a new medication wwithout making sure that you know if it may affect your diabetes and, if so, what precautions you should take
Realise that problems are most likely to occur at times of dose change or stopping or starting medications. At these times take extra care.

Health Care Professionals The following is a list of Health professionals that you can come in contact with. If you would like to see any of these professionals, your doctor or another health care team member can refer you.

Professional	What they Do?
Dentist	People with diabetes are at higher risk for periodontitis, a form of gum disease. It's good to make your dentist a member of your health care team. Have regulardental check-ups, and always tell any dentist you see that you have diabetes. Keep smiling!
Diabetes Nurse	There are various kinds of nurses. Diabetes nurses provide in-patient and out-patient care and assessment, and will help you learn the knowledge and skills to control your diabetes.
Dietitian	Provides dietary education, assessment and counselling regarding meal planning. Your dietitian will help you determine your nutritional requirements according to your weight, life-style, activity level, medication and other health concerns. He or she can then help translate those requirements into specific meal plans for weight loss, fat and cholesterol and salt control.
Endocrinologist	Medical specialist (physician) who treats people who have disorders of the endocrine glands, such as the pancreas. A "diabetologist" is another name for this team member.
General Practitioner	A key member in the team. Your general practitioner will work with you and the other members to coordinate your care and ensure a consistent approach over the years ahead.
Obstetritian	A specialist who cares for pregnant women. Some obstetritians have a special interest in diabetes during pregnancy.
Ophthalmologist	Medical specialist who treats the eye. Your eye doctor will monitor any changes in your eyes, particularly those associated with diabetes, detemine what those changes mean, and arrange any necessary treatment.
Optometrist	Measures errors in refraction and prescribes glasses to correct the refractive errors.
Orthopaedic Surgeon	A surgical specialist who treats the musculoskeletal system.
Paediatrician	Medical specialist who treats children for various health problems.
Pharmacist	A person liceced to prepare and dispense drugs and medicine. Your pharmacist knows of medications used in diabetic management and is a resource person for information about diabetes-care products.
Physical Therapist	Uses physical measures (heat, cold, water, etc) to evaluate and treat disease and disability. Therapeutic exercises and training procedures are also used.
Podiatrist	A professional trained in the treatment and prevention of foot disorders. Your podiatrist can advice and help you keep your feet healthy.
Psychiatrist	Medical specialist who treats people who have emotional or psychological difficulties.
Psychologist	Counsels people regarding psychological or emotional difficulties, also trained to conduct psychological testing.
Social Worker	Counsels individuals and families regarding personal, family, or marital problems. Medical social workers also counsels people regarding the emotional aspects of illness. Social workers provide information as to community resources.
Urologist	A surgical specialist in disorders of the uninary system, who can also help men who suffer with impotence.
Vascular Surgeon	Surgical specialist who treats the blood vessels supplying body tissues.

Eight Golden Guidelines For Lifestyle They are

Don't get fat. Stay trim, taut and terrific.
Don't eat fat.
Eat Complex carbohydrate. Fruit, Vegetables and cereals.
Spread your complex carbohydrates out throughout the day
Take thirty minutes of moderate activity a day.
Take time out. Stress is a real problemso try to do some regular activity or take some time to do somehting you like.
Qui tfor life. Smoking really does damage your health
Drinkwise - Four men & women two.

Overweight - lot of energy you wont need.
Loss of judgement
Low blood glucose level.

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