information on diabetes

",i*

InsulinThingsYou Should Know

This information has been designed to answer some of the questions you may have

about starting on insulin.We hope it will also help to take au'ay some of the fears

and worries you may be feeling about giving yourself or someone )rou care

about a needle.

Thousands of Canadians take one or more injections a dav. Most of them reportthat it is much easier than they had expected. We have gir.en you some questionsto ask your doctor or diabetes educator. Ask them to fill in the spaces.This way,

the information in this document is personalized for vou.

What is diabetes?Diabetes is a disease in which your body cannot properly store and use fuel lorenergy. The fuel that your body needs is called glucose, a lorm of sugar. Glucose

comes from foods such as breads, cereals, pasta, rice, potatoes, fruits and some

vegetables. To use glucose, your body needs insulin. Insulin is made bv a glandin vour bodv called the pancreas. There are three types of diabetes: tvpe 1 , type 2

and gestational diabetes. Gestational diabetes only occurs during pregnancy.

ls diabetes serious?Yes. Diabetes is a life-long condition. High blood glucose ler-els over a long

period of time can cause blindness, heart disease, kidney problems, amputa-

tions, nerve damage, and erectile dysfunction. Good diabetes care and manage-

ment can delav or prevent the onset of these complications.

You can live a long

and healthy life by

keeping your bloodglucose levels in

your tarSet ran8e.

You can do this by:

Eating healthy

meals

Exercising

Taking diabetes

medication,

including insulin

Your doctor will tell you what type of diabetes you have and s'har \,- * r-cc i i-do.You can also ask your doctor to refer you to a Diabetes Education r: -::i:'.There, trained health professionals can teach you about diabetes and insu^::.

IJ I have qlpe 1 diabetes, what do I need to knov'?

Tp. 1 diabetes occurs when the body makes little or no insulin. It used to be

called insulin-dependent or juvenile diabetes.

No one really knows what causes type 1 diabetes.

There is nothing you could have done to prevent type 1 diabetes, even ifyouhad been to see the doctor sooner.

The body's defence system may attack your insulin-making cells by mistake,

but we don't know why.

People usually find out they have type 1 diabetes before the age of 30, most

often in childhood or during their teens.

It is not caused by eating too much sugar.

If I have typ" 2 diabetes, what do I need to know?

Typ" 2 diabetes occurs when your body can't use the insulin it makes. If r-ou

have type 2 diabetes, you may be able to keep your blood glucose ler-els in a

target range by healthy eating, exercising and taking diabetes medication.

Over time this may not be enough to keep blood glucose levels in a target

range since type 2 diabetes is a progressive condition. Some people u'ith tlpe2 diabetes need to use insulin to achieve good blood glucose control.

You may feel guilty or feel like you have failed because you must norv takeinsulin and you may also be feeling nervous at the thought of having to takeinsulin injections every day. Please don't!

A number of factors may have contributed to you needing to take insulin. Forexample, your body may have lost its ability to make insulin and your medicationmay no longer work for you.

What you can do to feel betterShare your feelings with your family and friends. Tell them what you needfrom them to help you manage your diabetes well.

Just because you have diabetes does not mean that you have to stop doing thethings that you and your family enjov.

Learn as much as you can about your diabetes.The more you learn, the Iess

fear you will have. Even if you have had diabetes for years, attend a DiabetesEducation program.

Things you shouldknow about insulin

When insulin u-as first discolered and made alailable for people with diabetes,there was only one kind of short-acting insulin. This required several injectionsa day. As time went on, ne\\' insulir.rs t'ere deleloped that lasted longer, requiringfewer injections, but requiring strict attention to timing of meals.

Now, there are different types of insulin alailable, made from different sources.This gives more flexibility in the number and timing of injections, making iteasier to maintain target blood glucose lelels, based on your lifestyle. One tofour injections a day may be suggested to lou for optimal control of your bloodglucose. Ask your healthcare team about the best insulin plan to meet your needs.

The following are general guidelines onlr'.

It is not unusual tofeel scared, shocked,

overwhelmed and

even angry whenyou first hear thatyou have diabetes.

You may also be

feeling nervous

at the thought ofhaving to take

insulin injections

every day.

A positive and

realistic attitudetowards yourdiabetes can helpyou to maintain good

blood glucose levels.

The following pages

will help you everystep of the way.

Talk to others whohave diabetes - ask

your local Canadian

Diabetes Association

branch aboutjoining a supportgroup or visiting an

information session.

Ask your doctorabout diabetes

education.Your

healthcare team

can answer all yourquestions and tellyou more aboutdiabetes.

Your team may

also include a:

NurseDietitianPharmacist

Social workerPsychologist

Foot care specialist

EndocrinologistOphthalmologist

Insulins inTyPe

Rapid-actinginsulin

Short-actinginsulin

lntermediate-acting insulin

Long actinginsulin

Premixedinsulin (%R %N)

Premixedinsulin analog

CanadaName

Humalog@

Regular (R),

orToronto

NPH (N),

Lente (L)

Ultralente (U)

I 0/90, 20/80, 30/70

40/60, s0/s0

Humalog@

Mix25rM

Starts towork in

5-15 minutes

30 - 40 minutes

| - 3 hours

4 - 6 hours

r/z - I hours

5-15 minutes

Peakaction

r/z-lr/zhours

2-4 hours

4-12 hours

l2-18 hours

2- I 2 hours

Duration

3r/z- 4rlr hours

6-8 hours

I 8 -24 hours

24-28 hours

l8-24 hours

r/o-2 /r hours l8-24 hours

Syringes, pens, injectors and pumpsSyringes, pens, jet injectors and pumps all have one thing in common ther'

deliver insulin. Each carries insulin through the skin and into the lattv tissue

underneath so that it can be absorbed and used by the bodv.

Today's syringes are smaller, have finer needles and have special coatings on the

needles so injecting is as painless as possible. If you can, try ser-eral brands

before you commit to one. Ask yourself the following questions:

Does your svringe match your insulin dosage? Using a s1'ringe that matches

your dose will help you draw up your insulin more accurately. For example,

if you take less than 30 units of insulin, use a 3O-unit syinge.

Do you want a short or long needle? Which is more comfortable for you?

Some syringes have shorter needles; however, the depth of the injection does

affect the absorption of the insulin. This is something you will want tomention to your diabetes educator or doctor.

Will you reuse your syringe? Insulin syringes are approved and designed to be

used one time only. Discuss with your diabetes educator or doctor if you are

considering reuse of syringes.

Insulin pens look similar to a slightly oversized writing pen.The insulin comesin 1.5 mL or 3.0 mL cartridges containing 300 units of insulin.The cartridgeis inserted into the pen and remains there until all the insulin is used. A shortneedle is attached to the end of the pen. Many people find insulin pens conven-ient, accurate and those on a multi-dose regimen often prefer them to syringes.The cartridges come in many different varieties of insulins, including premixedinsulins. Disposable pens are also now available and are disposed of once theinsulin is finished. Ask for instructions in the use of the pen to ensure that youare injecting the correct amount of insulin.

People who are visually impaired may also prefer insulin pens as some modelsmake a'clicking' sound that helps to measure the required amount of insulin.

Jet injectors, on the other hand, have no needles at all. These devices, release a

tiny stream of insulin, which is forced through the skin by pressure. Some peoplefind that bruising occurs at the injection site.You should consult with yourdiabetes healthcare team before buying one of these devices.

Also, be sure that you learn how to properly use your pen or jet injector, andhow to care for it and troubleshoot should something malfunction.

Insulin pumps are fast becoming a popular choice for people who want greaterflexibility or an improvement in their blood glucose control. An insulin pump isa microcomputer, about the size of a pager, that can deliver insulin in incrementsas small as V10 of a unit. A syringe reservoir is filled lr'ith regular or rapid-actinginsulin and is placed inside the pump.A thin tube called an 'infusion set' isconnected to the reservoir. At the end of the set is a small needle, which isinserted into fatty tissue and left there.The infusion set is changed every two tothree davs.

The pump is programmed to deliver a continuous infusion of background or'basal' insulin. \Arhener-er food is eaten the user delivers a 'bolus' or surge ofinsulin. For pump therapr-to be safe, it is essential to check the blood glucosea minimum of four to six times per dar'. Carbohl,drate counting and diabetes

problem solling are other important components of successful pumping. To

ensure sale and effective pump therapl vou u-ill require assistance and intensiveeducation from lour diabetes healthcare team.

lnsulin worksdifferently in

different peopledepending on

factors such as:

injection site,amount ofinsulin, etc.

Yes. Ask yourdoctor or diabetes

educator about thedifferent ways toinject and whatmethods are best

for you. Make

sure that you

have instructionsin how to use thepens and/or othermethods ofinlections.

How do I give insulin?

Insulin comes in vials or cartridges. In Canada, most insulins are available as

"U 100," or 100 units of insulin in every milliliter (mL) of liquid. The short-acting

and rapid-acting insulins are clear and colourless. The longer acting and premixed

insulins are cloudy or milky in appearance. Always check the expiry date and

the appearance of your insulin u'hen you buy it and before you inject it.

The name(s) of the insulin(s) you use

The amount of each insulin you should use

At what times during the day should you inject your insulin?

When does your insulin work the hardest?

The vial of insulin you are using can be kept at room temperature for 28 days

after opening.

Keep extra unopened insulin in the refrigerator door. Once opened, it is good

for 28 days or, unopened, until the expiry date.

Make sure your insulin does not freeze or get too hot (i.e. when Ieft in the

car or in direct sunlight).

Your doctor or diabetes educator may modify some of these steps to fit your needs.

Gather supplies: insulin, syringe and alcohol swab (if desired).

Wash vour hands.

Gently rotate the cloudy insulin to make sure the contents are uniformlycloudy or milky.Clean the rubber stopper with an alcohol swab (if desired).

Remove the cover from the needle.Pull the plunger back until the tip of the

plunger is at the line for the number of units you need. This allows air into

the syringe.

Push the needle through the rubber stopper. Push in the plunger to Put the air

into the vial. Keep the needle in the vial.

Tirrn the vial and the syringe upside dou'n. Make sure the tip of the needle is

in the insulin. Pull back the plunger until it is five units past your dose.

Look at the insulin in the syringe.There may be a small air bubble. Flick the

syringe so the bubble rises to the top. Push the air and extra units back into

the vial and stop at your dose.

Double-check your dose.

Pull the needle out of the rubber stopper.

Insulin must be injected under the skin for it to work, but not directly intothe blood.

Insulin should be injected in the fatty part of the abdomen, upper arms,thighs or buttocks. The fastest and most consistent absorption is fromthe abdomen.

Insulin is absorbed from different parts of your body at different rates and can

also be affected by the amount of physical activity you are doing. Discuss a

pattern for injections with your doctor or diabetes educator and mark themon the next page.

Choose the site for your injection.Clean the skin with an alcohol swab (if desired).Pinch up a large area of skin. Push the needle into the skin going straight in(9O-degree angle).When using a very short needle, 5 mm in length, there is

usually no need to pinch up the skin.

Push the plunger all the way down. Release the pinched skin.Pull the needle out. If insulin leaks out of the skin after removing the needle,try waiting for five to ten seconds before removing the needle next time.Do not worry if a small drop of blood appears at the site.

Dispose of the needle in a puncture-proof container (e.g. syringe disposalsystem or an opaque bleach container). Discuss vvith members of your localtrash disposal authorities the options for disposing of this container in yourcommunity.If you are overweight and find that vour blood glucose levels rise when youuse short needles, talk to your doctor about other needles that will give betterinsulin absorption.

What iJ I need two dffirent kinds oJ insulin?Some insulins come alreadt' mixed. In this case, just follow step 3 in the previoussection. If vou need to mix the insulins r-ourself, review the following:

Mv clear (rapid or short-acting) insulin is called:

Mv dose of clear insulin (a):

Mv cloudr-insulin is called:

Mv dose of cloudv insulin (b):Add 1a; * 1b1 together =Clean the tops of the lials s'ith an alcohol sr,r.ab (if desired).

units

unitsunits

Draw back the plunger of the svringe to the number of (b) units you need.

Put the sr.ringe into the cloudv vial and press the plunger down. This injectsair into the r-ial. Remole the needle from the vial without taking insulin out.Repeat using the (a) units for the clear insulin. Leave the syringe in the vial.

lnsulininjection sites

Turn the vial and the syringe upside down. Hold the vial with one hand and

the spinge with the other. Pull back the plunger to five units past the your dose.

If you get an air bubble, flick the syringe so the so the bubble rises to the top.Then push the air back into the vial. Adjust insulin to the correct dose.

Remove the needle from the clear insulin vial.

Gently rotate the cloudy insulin vial to mix the insulin.Put the needle with the clear insulin into the cloudy vial, and turn upside

down as before.

Pull back the plunger until you have the total number of units required

(a) + (b) units. Do not go past the total dose.

Make sure you do not push any of the clear insulin into the cloudy vials. If youpull up too much of the cloudy insulin into the syringe, throw it out and startagain. Do not put the insulin back into the vial (never use the clear insulin if ithas become cloudy).Remove the needle from the cloudy vial and inject as stated in Step 5 in the

previous section.

What do I need to knowabout blood levels?

A blood glucose meter is used to test your blood glucose at home. Meters can

be purchased at most pharmacies. Talk with your diabetes educator or pharma-cist about which model is right for you. When you decide, make sure youreceive the proper training before you go home.

Ask your diabetes educator about:

The size ofthe drop ofblood needed

The type of blood glucose strips to use

How to clean the meterHow to check if the meter is accurate

How to code your meter

glucose

Give you a quick measurement of your blood glucose level at'that' time.Tell you if you have a high or low blood glucose level at'that' time.Show you how your lifestyle and insulin are affecting your blood glucose levels.

Help you and your diabetes healthcare team to make changes to your lifestyleand insulin dosage that will improve your blood glucose levels.

4-7 7.t- t0mmol/Lr+ mmol/L

5.0- il il.t- t4mmol/L mmol/L

Less than 0.07- 0.0840.07

Overl0 mmol/L

Over 14

mmol/L

Over0.084

lf you have diabetes,

you should try tokeep your bloodglucose as close totarget range as Pos-sible.This will help

to delay or preventcomplications.

Maintaining healthy

eating habits, an

active lifestyle and

taking insulin, willhelp you stay in

your target range.

The Conodion Diobetes

Associotiont Clinicol

Proctice Guide/ines

for the Monogement

of Diobetes in

Conodo provides

people with diabetes

goals for levels ofglucose control.

Levels of glucose control Jor people with diabetes.(odults ond odolescents)

Optimal Suboptimal lnadequate "MyTargetRangett

target gool oction moy be required aaion required ask your doctor

Glucosebefore meals

Glucose l-2 hrsafter eating

HbAl6(depending on lab)

xvaries for children *xmillimoles of glucose per litre of blood

This informotion is only o guide,Tolk to your doctor oboutYOUR blood

glucose torget ronges.

Low blood glucose

Low blood glucose may be caused by:

More physical activity than usual

Not eating on timeEating less than you should have

tking too much medication

The effects of drinking alcohol

Lorl,' blood glucose can happen quickly, so it is important to take care of itright arvay.

When the amountof blood glucose

has dropped below4 mmol/L, it is called

low blood glucose

or hypoglycemia.

You may feel:

Shalg, light-headed

Nervous, irritableConfused

HungryYour heart rateis fasterSweaty, headachy

WeakA numbness ortingling in yourtongue or lips

If your blood glucose drops very low you may:

Become confused and disoriented

Lose consciousness

Have a seizure

You will need assistance from another person. Make sure you always wear yourMedicAlert@ identification, and talk to your doctor or diabetes educator aboutprevention and emergency treatment for severe low blood glucose.

Check your blood glucose immediately. If you don't have your meter with you,treat the symptoms anyway. It is better to be safe.

Eat or drink a fast-acting carbohydrate (15 grams):

5 glucose tablets

3/4 crtp (175 mL) of juice OR regular pop8 Lifesavers@ OR 5 hard candies

3 teaspoons (15 mL) of honey

Wait 10 to 15 minutes, then check your blood glucose again. If it is still low:

Tieat again

If your next meal is more than one hour away, or you are going to be active,

eat a snack, such as a half-sandwich or cheese and crackers (something with15 grams of carbohydrate and a protein source.)

High blood glucose

High blood glucose can result when food, activity and insulin are not balanced.

High blood glucose may happen when you are sick or under stress.

If you have type 1 &abetes, it is important that you test your urine for ketones.

You should also call or see your doctor.You may need to:

Adjust your medication and,/or insulinAdjust your meal planIncrease your physical activity

What lifestyle changesshould I make?

Eat three meals and a bedtime snack each day.

Include a food from each of the food groups at each meal.If you are thirsty, drink water or diet pop.If you are overweight, eat smaller portions. Reduce your intake of fat.Limit sweet and fatty foods.

Thlk to your diabetes health care team to learn how to adjust your insulin and

food to prevent low blood glucose levels while exercising.

Carry some form of sugar with you and extra food.Carry your meter with you. Be prepared to stop and test during exercise ifyou feel any symptoms.Wear a MedicAlert@ identification.Carcy a record of the names and amounts of insulin you use and any othermedications that you use regularly.Wear comfortable shoes and socks.

Test your blood glucose before exercising. If lower than(have your doctor fill out) you may need extra food before you start.Stop exercising if you have pain or feel tired.Enjoy yourself.

mmol,/L,

When the amount ofblood glucose rises

above I I mmol/L,

it is called high

blood glucose

or hyperglycemia.

You may:

Be thirstyUrinate moreoften

Be tired

The Canadian


works to preventdiabetes and improve

the quality of lifefor those affected,

through research,

education, service

and advocacy.

Canadians can turnto the Canadian


for answers and

help in accessing

diabetes resources

across the country.

Operating throughmore than 150

locations, theCanadian Diabetes

Association's strong

network of assistance

includes volunteers,

employees, health-

care professionals

and partners.

Don't forget

If you experience severe low blood glucose, you will need help. Talk to yourdoctor or diabetes educator about prevention and emergency treatment, and

tell your family, friends and co-workers how they can help.

Always wear your MedicAlerto identification.

In most provinces and territories a licensed driver who has diabetes must reporttheir condition immediately to the motor vehicle licensing office.

People with diabetes may find it more difficult to obtain or renew insurance ofall types: vehicle, mortgage, life and travel.

The Canadian Diabetes Association offers its members the opportunity topurchase both travel insurance, which covers all diabetes-related emergencyexpenses and credit life insurance.

There is no evidence that people who have diabetes are a greater safety risk at

work than people who do not have diabetes.You should not need more timeaway from work due to illness than other employees. If you think that you are

not being treated fairly in your workplace, contact your local Canadian Diabetes

Association branch.

Becoming a member, volunteering or making a donationAccess to travel and Credit Life Insurance for people with diabetes

Joining a local support groupObtaining the most up-to-date information on diabetes

Canadian Diabetes Association National Office:l5 Toronto Street, Suite 800,Toronto, ON M5C 2E3

Phone: (4 I 6) 363-3373 Fax: (4 l6) 363-7465

| -800- BANTING (226 -8464) www.diabetes.ca Email address: [email protected]

Where do I go to learnmore about my diabetes?

Your doctor

Your doctor can refer you to a Diabetes Centre in your

area. For the location of Diabetes Centres in Nova Scotia,

visit the Diabetes Care Program of Nova Scotia website

www.diabetescareprogram.ns.ca. This website wil I

link you to other reliable diabetes websites.

Canadian Diabetes Association

The Nova Scotia Division of the Canadian Diabetes

Association (1-800-326-771 2) and their website

(www.diabetes.ca) can direct you to valuable resources

and information.

Your pharmacist

Your pharmacist will be happy to answer questions

about diabetes, your metel strips, and any medications

you take.

Diabetes Assistance

This brochure was developed by the Self-Care Committee of the

Diabetes Care Program of Nova Scotia.We would like to acknowledge

and thank our partners for their contributions:

. The Canadian Diabetes Association

. The Pharmacy Association of Nova Scotia

. Nova Scotia's Diabetes Educators

A special thank-you to the many individuals with diabetes, whose

knowledge, expertise and comments are reflected in these materials.

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xovlctru,Health

l*eahtlty Livingand, self-careLivingwithDiabetes

First in a series onhow tomanageyour diabetes

i t+"^Ltlry Living: and self-carei LivingwithDiabetes

i ftris is the first in a series of four

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i Nouu Scotia Diabetes Assistance

' Prooram.This information does notaJ

' replace contact with your doctor or

] other members of your diabetes team.

I These materials are designed to provide

I tips and help you find the supports youa. need to manaqe your diabetes.

:

' Other handouts in the series include:

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What is heabhy Living?Healthy living means making good choices, such as

choosing healthy foods, getting regular activity or

exercise, and managing the stresses in your life. Through

healthy living, you can gain and keep control of your

diabetes. Making the right choices helps you to take

care of yourself. When you take care of yourself, you feel

better about yourself.

Tips for healthy living apply to everyone. What is good

for you is good for your whole family. Here are some

ideas to get you started.

Tips to eatwe\l.o Don't forget breakfast - eating three meals a day

helps prevent overeating.

. Limit high fat foods. Try skim or 1 per cent milk.

Limit gravy and fried foods.

. Watch your portion sizes.

. Choose whole grains, fruits, and vegetables more

often.

Tips to start moving. Any type and every bit of activity counts. Try taking

the stairs. Park far away from the door.

Start slowly. Minutes add up - try 10 minutes at

a time. Build up to 30-60 minutes of moderate

activity, such as brisk walking, on most days.

Make it fun, and get your family and friends

involved.

Be a role model - turn off the TV and ...

Join or form a walking group with friends, family,

neighbours, or people from work.

a

a

Tips to manage stressEnjoying life and managing stress are important parts of

diabetes care.

. ldentify your stresses.

. Make a plan on how to deal with these stresses.

Focus on the things you can do something about.

. Recognize unhealthy ways of dealing with stress.

Do you overeat? Smoke? Drink? Try to come up

with healthier choices, such as talking to a friend or

joining a quit smoking program.

. Find time to have some fun and relax - go for a

walk, pick up a book, listen to your favourite music.

r Get lots of rest.

What is selLcare?Self-care means caring for yourself. lt means making

decisions and taking action to improve your health

and stay healthy. lf you have diabetes, it also means

learning all you can about diabetes and how to care for

it. Taking care of your diabetes will reduce your chances

of getting complications, such as heart, kidney, nerve, or

eye disease.

Who is my diabetes team?Along with your doctor, core diabetes team

members include nurses, dietitians, and

pharmacists, with special training in diabetes.

Learning all you can about diabetes and how to care

for it are important first steps in self-care. This new

information and the skills you learn will increase your

confidence to better manage your diabetes. lt will also

help you to

. Talk with your doctor and other members of your

diabetes team about your diabetes treatment plan.

. Set realistic goals.

. Solve problems.

o Know when to seek help and who can help you.

o Develop a more positive attitude about your

d iabetes.

. Find and build supports among family and

friends.

Ilow often should I see

my doctor?See your doctor and other members of your diabetes team

regularly - about every 3 to 4 months. These visits will

. Keep you, your doctor, and your diabetes team up to

date about your diabetes.

. Allow you to ask questions.

. Ensure that needed tests are done and discussed.

Remember, you cannot always see or feel some of the

problems that develop with diabetes. Do not wait for

something to go wrong.

What tests should I get?l{ow often should I betested?Regular testing lets your doctor and diabetes team know

if your diabetes treatment needs to change. These tests

also show if you are developing any complications from

your diabetes or if your complications are getting worse.

These tests also help your doctor decide what are the

best medications for you.

Every visit to the doctor you should get your

. Blood pressure checked.

. Home blood sugar tests reviewed.

. Specific questions about your diabetes answered.

At least twice a year you should get

. An 41C (pronounced A one C) test. This test

measures your diabetes control over the last 3

months. lf you take insulin, you may need to have

this test done more often.

Once a year you should get

. A dilated eye examination. Ask to make sure an

eye specialist uses eye drops to see the very back of

the eye.

. A foot examination. This can be done by a foot

care specialist or doctol or at the Diabetes Centre.

See your doctor more often if you are having any

kind of foot problem including corns, blisterl cuts

that do not heal, redness, pain, or loss offeeling.

. Blood and urine tests. These will help check your

kidneys and overall diabetes control, and let your

doctor know if there are any other problems,

A flu shot, This will reduce the risk of serious

illness. lllness of any kind (flu, cold, surgery) will

affect blood sugars and overall health.

A dental exam. This will help to identify and

prevent gum disease and loss of teeth.

What should I do tomanage my diabetes?Pay attention to your diabetes all the time. Sometimes

this is hard, but getting into a routine will make

managing your diabetes easier.

Every day try to

. Follow a healthy eating plan.

o Be active.

. Take all of your medications as prescribed.

o Test and record your blood sugars.

. Look at your feet. Wash and dry them well. Report

any problems.

. Deal with your stresses.

. Keep a positive outlook.

Didyouknow?Yearly eye examinations and flu shots are free for

people with diabetes living in Nova Scotia.


Your doctor




www.diabetescareprogram.ns.ca. This website wil I





(wwwdiabetes.ca) can direct you to valuable resources

and information.

Your pharmacist


about diabetet your meter, strips, and any medications

you take.


Diabetes Care Program of Nova Scotia. We would like to acknowledge

and thank our partners for their contributions:. The Canadian Diabetes Association




knowledge, expertise and comments are reflected in these materials.

manageyour diabetes

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Nov}6rnHealth

Diabetes Assistance

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WIty test my blood sugars?Testing your blood sugars (glucose) will give you

important information that can help you manage your

diabetes. Use the test results to

. Know if your blood sugars are too high, too low or

in the best range for you.

. Understand how your food, activity, and diabetes

medications affect your blood sugars.

. Decide when to see your doctor or other diabetes

team members. Besides your doctol diabetes team

members include nurses, dietitians, pharmacists,

and others with special training in diabetes.

Too much food

Not enough exercise

or activity

Cold, flu, other illness,

or infection

Not enough diabetes

medication

(insulin or pills)

Not enough food

lncreased activity

or exercise

Delayed meal or snack

Too much diabetes

medication

What should my bloodsugar numbers be?

You should set your blood sugar goals with your doctor

or diabetes team.

Usual blood sugar goals for adults:

. before meals and before bedtime snack (if you take

one):4.0 to 7.0 mmol/l.

. 2 hours after meals: 5.0 to 10.0 mmol/l.

Children and pregnant women with diabetes wi// have

different goals. Ask your doctor what is best for you.

lf your test results are above or below your goals and

you do not know why, see your doctor or diabetes team,

They will help you change your treatment plan.

When should I test?Ask your doctor or diabetes team when you should

test. Best times vary depending on your treatment plan.

Sample testing routines:

lf you are taking insulin, test 4 times a day:

. Test before each meal and before your bedtime

snack, ifyou have one, or at bedtime.

o Test 2 hours after a meal 1 to 2 times a week. This

will help you see how well your insulin is working

with this specific meal.

lf you are having /ow or high blood sugars you may

need to test more often.

lf you are taking diabetes pills, test 2 times a day, 3 to

4 times a week:

. Day 1, test before breakfast and supper.

. Day 2, test before lunch and bedtime.

r Test 2 hours after a meal 1 to 2 times a week.

/f your nedicine is being adiusted to improve your

blood sugar5 you may need to test up to 4 times a day.

lf you manage your diabetes with a meal plan (diet)

and exercise (no diabetes pills), test 'l to 2 times a

day,3to4timesaweek:

o Test before a different meal each day. Day 1 before

breakfast, day 2 before lunch, and so forth.

. Test 2 hours after the meal 1 to 2 times a week.

Testyour blood sugarsmore often. When you are ill with a cold, flu, fever or

infection.

o Before and after strenuous or unplanned

activity if you are taking insulin or diabetes

pills.

. Before driving or using heavy equipment

or machinery if you are taking insulin or

diabetes pills.

RememberAlways test as soon as you feel your blood sugar is

low. Feeling dizzy, shaky, hungry sweaty, or weak are

symptoms of low blood sugar.

Tips (or usingyour meter,Lancets, and strips

Wash your hands with soap and warm water before

each test.

Meter. Ask a pharmacist or diabetes team member to show

you how to use your meter. lf you change meters,

ask how to use the new meter. Keep the user

manual for this new meter handy.

. lf your meter needs special coding, do this each

time you open a new box of strips.

o Have your meter checked for accuracy at least once

a year, when you have blood work done at the lab.

. lf you have problems with your meter, look in the

meter's user manual or call the 1-800 toll-free

phone number in the manual for help.

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LancetsUse lancets only once.

Discard your used lancets in a "sharps" container.

Ask your pharmacist for a sharps containers. Return

sharps containers to the pharmacy when they are

full.

Stripso Store your strips carefully. Extreme heat, cold, or

humidity can damage your strips, Keep your strips

in their original container. Do not store strips in the

bathroom.

r Don't use strips after their expiry date.

Testing is very imp ortantUse your results to make decisions on how to care

for your diabetes. Test as often as recommended.

Always share these results with your doctor and

diabetes team.


Your doctor




www.diabetescareprogram.ns.ca. This website wi ll





(www.diabetes.ca) can direct you to valuable resources

and information.

Your pharmacist


about diabetes, your meter, strips, and any medications

you take.

Diabetes Assistance



and thank our partners for their contributions:

. The Canadian Diabetes Association




knowledge, expertise and comments are reflected in these materials,

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StryingWellwithDiabetesVsingl*eakh andCommunity Supports

Third in a series onhow tomanage your diabetes

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This is the third in a series of four

handouts that you will get from the Nova

Scotia Diabetes Assistance Program.

Other handouts in the series include:

. lteakhy Ltvlngand self-care

,. You andYourBlood Sugars

. Makingthe Mostof Your Medications

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Living well with diabetes takes a lot of effort and the

help of many people. lt requires teamwork, and the most

important team member is YOU! Along with the medical

professionals who are part of your team, your family,

friends, and others who live in your community are also

very important.

Where do I get the bestcare for my diabetes?Diabetes is complicated. You should get your ongoing

diabetes care from a team. The core members of your

team include your doctor, along with nurses, dietitians,

and pharmacists with special training in diabetes. Each

member of the team brings a set of special skills.

Nova Scotia has many Diabetes Centres. The staff in

these programs work with your doctor to provide advice

and information for you and the people who support you

in your care. When you attend one of these programs,

members of your diabetes team will

. Help you learn more about your diabetes and the

steps you can take to stay healthy.

. Link you to community supports and services such

as the Canadian Diabetes Association and other

diabetes groups.

r Arrange for you to see other experts, if needed.

These could include a diabetes specialist such as an

endocrinologist or an internist, social worke; other

medical and foot care specialists, and even fitness

experts.

lnformation about diabetes is constantly changing. lf it

has been more than two years since you have visited a

Diabetes Centre or you feel you need more information

or support, ask your doctor to send you again. You will

need a doctor's referral. lf this is your first visit, try to

bring along a key support person.

llow do I talkto myhealth care team?You may find it difficult to talk to your doctor or other

members of your diabetes team. You might be shy,

worried, or just ovenruhelmed. Always remember, these

people are there to help you. ln order for your team

members to do their jobs well,

. Give correct information and ask questions.

Asking questions lets them know how they can help

you and what is of greatest interest to you.

o Be honest in the information you provide. Feeling

you need to always give the "right answer" may

not help in the care and advice they give you about

diabetes. ln fact, incorrect information could make

things worse.

. lf you need more help, let them know, You will

be getting a lot of new information. lt is normal to

need to ask the same questions a few times before

you understand well.

llow should I prepare (ora visit with my doctor ordiabetes team?

Make a list of the questions you want to talk

about at your visit.

Give your list of questions to your doctor or

diabetes team members at the beginning of your

visit. lf you have many questions, you may need

to make another appointment to get all of your

questions answered.

Take your record of home blood test results

with you.

Take the list of all your medications, including

vitamins or herbal medicines.

Bring along a family member or friend who can

listen, take notes, or help with your questions.

RememberPrograms offered in your communi$ are one of

the best ways to stay connected and gain support

in managing your diabetes. You are not alone.

Many people want to help.

What do I needto know llow can I get supportto make the most of ry from those around me?visits?r Know what the different diabetes tests are for, how

often these tests should be done, the target value

for you, and what you need to do to reach your

target. Know yourABCs:

AI C (pronounced A one C). This test measures

your diabetes control over the last 3 months.

This is a very important test, and it should be

done at least twice a year. The target for most

people with diabetes is less than 7 per cent.

Blood pressure. High blood pressure makes

your heart work too hard. Over time this can

lead to strokes and problems with your kidneys,

eyes, and feet. Have your blood pressure

checked at each visit. The target is less than

130/80 mmHg.

Cholesterol. Certain types of cholesterol and

other fats can build up in your blood and cause

the vessels to narrow and harden. This can

lead to a heart attack. Have your cholesterol

checked at least once a year. Ask your doctor or

diabetes team for your targets.

Get involved with your team. Set goals for yourself

and help to make a treatment plan for your diabetes.

Ask for your most recent test results and keep a

record.

Find out when you should come back. Make the

appointment before you leave the office.

Sometimes, the people closest to us do not always know

what they can do to help. Be open and honest with your

friends and family. Tell them exactly how they can help

you with your diabetes. Here are some ideas:

. Plan meals with the whole family so everyone has

something they can enjoy.

Find a buddy to help you stick to an activity plan.

Help the people around you learn more about

diabetes.

Ask for help if you are feeling stressed.

Talk about how you are feeling and what is

important to you.

Research tells us that the more support you get from

others the better able you are to keep your diabetes in

good control. Make sure to tell your family and friends

what they do that helps you the most.

Look for people and services in your community that can

help you to live well with diabetes:

. Join a local recreation or community centre for

programs that interest you.

. Take advantage of the programs and services

offered in local grocery stores and pharmacies.

. Find people with common interests (reading, yoga,

or diabetes or other self-help groups) to provide

support and outside interests.

. Get involved with work or school-based programs

aimed at healthy living-walking groups, quit

smoking programs, or special interest groups.

. Volunteer your time to help others in your community.

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Your doctor




www.diabetescareprogram.ns.ca, This website wil I





(wwwdiabetes.ca) can direct you to valuable resources

and information.

Your pharmacist


about diabetes, your metel strips, and any medications

you take.



and thank our partners for their contributions:. The Canadian Diabetes Association. The PharmacyAssociation of Nova Scotia


A special thank-you to the many individuals with diabetet whose

knowledqe, expertise and comments are reflected in these materials.

Diabetes Assistance

Fourth in a series onhow tomanage your diabetes

MakingtheMost of yourMedications

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Makingthe Mostof Your Medications

This is the fourth in a series of four

handouts that you will get from the

Nova Scotia Diabetes Assistance

Program.

Other handouts in the series include:

, t+eaLthy Livingand seLf-care

, YorL andYour' Blood Sugars

Why do I needmedications?

When you have diabetes, medications help to control

your blood sugars (glucose). Keeping your blood sugars

near normal will reduce the risk of complications from

diabetes such as eye, kidney, nerve, and heart disease.

Diabetes medications, including pills or insulin, help the

body use the food we eat. Food provides us with energy

to complete our daily activities, perform our best when

we work or exercise, and to stay strong during times of

stress and illness.

Diabetes pillsDiabetes pills used to treat diabetes are not

insulin. These pills help your body make more

of its own insulin or use its own insulin more

effectively.

lnsulinlnsulin can only be given by injection (needle).

This injection gives your body the insulin it needs

but cannot make itself.

Diabetes pills and insulin injections are not a cure

for diabetes, but allow people to live healthy lives.

You may also be taking medication for other medical

problems such as high blood pressure or a heart

condition. All of these medications are very important.

For these medications to do the best job possible, they

need to be taken regularly as advised by your doctor.

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Will my medicationschange?Yes, quite likely. When you first develop diabetes, you

may not need medication. Over time, this will change for

most people,

. As we grow older and the longer we have diabetes,

the more help our body will need to keep blood

sugars in control.

. Taking a new medication such as insulin or more of

the same medication does not mean you have failed

at managing your diabetes. lt does not mean your

diabetes is any worse than the next person. Having

the right amount of insulin improves blood sugars

and helps you to feel better.

. The decision to add a new medication or increase

the amount of your current medication is something

you and your doctor should make together. These

decisions can only be made if you see your doctor

regularly to discuss your diabetes.

llow will the doctorknow i( this is the bestmedlcation (or me?

The doctor considers your type of diabetes, blood test

results, new diabetes research, and what is presently

happening in your life when choosing the best

medication for you.

. When you see your doctor; make sure you share

any signs or symptoms that you may be having as

a result of your medications. Tell your doctor if you

have skipped any medications.

o Always share the results of your home blood

sugar tests. This will help your doctor decide if the

medication you are taking is right for you. Too little

medication will not keep blood sugars where they

should be.Too much medication may make you feel

unwell. lt takes time for some medications to work

their best.

Tips fur using medlcations W o rking w ith y o ur phar macisto See your doctor routinely to review your

medications. lt might be time to add another or to

increase the amount you need.

. Always talk to your doctor or pharmacist

before taking any new medications.

Medicationsr Know your medications. Ask yourself the following

questions:Why am I taking it? What does it do?

How do I know if it is working? How will it make

me feel? What side effects may I expect? lf you

don't know the answers, ask!

r Never substitute one medication for another. Do not

share medications.

. Report any side effects or symptoms to both your

doctor and pharmacist.

. Always carry an updated list of your medications

with you. Share this list with your doctor and other

members of your diabetes team whenever you visit.

Just ask your pharmacist to give you a complete list,

and remember to update it regularly.

. Let your doctor know about any and all medications

you are taking. This includes over-the-counter

medications like cough syrup, herbs, vitamins, and

minerals. Make sure you add these to your listl

Use one pharmacy. This helps your pharmacist check

for medication side effects and drug interactions.

When some medications are taken together; they

produce unexpected or harmful results.

Know your pharmacist. You are more likely to ask

questions if you know the pharmacist by name.

Talk to your pharmacist about ways to remember

when and how much of your medication you should

take. Ask for directions in writing.

What to do about illnessWhen you are sick and unable to eat, it is

important to take your diabetes medications. ln

fact, some illnesses may increase your blood sugar.

. Talk to your diabetes team about how to

manage on sick days.

. lf you are sick and unsure about what to do,

call your doctor or diabetes team members.

Take care with a\coho|Drinking when you have diabetes can be very

dangerous.

. Talk to your doctor, pharmacist, or other

diabetes team member about how to drink

safely.

. Alcohol can cause serious problems when

taken with some medications. lt can also

increase the risk of low blood sugar when

taken with insulin or some diabetes pills.

information on diabetes

Documents

type of diabetes

gestational diabetes

diabetes educator

diabetes medication

juvenile diabetes

types of diabetes

diabetes serious

diabetes education r