Manage Sick Days

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Testing
Unwell? Start here
Keytones?


TESTING – SICK DAY MANAGEMENT

Ok, it might be time to dust off the sick day rules. This is the main reason people with diabetes ring their nurse! That’s part of the management plan but there are quite a few things you can do first. Maybe ask the doctor next time you have an appointment to put blood ketone sticks and an Optium Neo meter on the prescription if you don’t already have one.

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UNWELL? START HERE…

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WHAT ARE KETONES?

Ketones are acids that are produced when the body ‘burns’ fat for energy. The body normally uses glucose to create energy.  This process requires insulin, which allows glucose to pass from the bloodstream to body cells where it is ‘burned’ for energy.  When there is not enough insulin, glucose accumulates in the blood causing high blood glucose levels (hyperglycaemia).  The body is unable to use this glucose without insulin and will switch to ‘burning’ fat as an alternative fuel for energy.

In people with Type 1 diabetes, ketones can build up in the bloodstream and cause an emergency condition called Diabetic KetoAcidosis (DKA) also known as diabetic coma.

DKA is a major life threatening condition for people with Type 1 diabetes (and rarely in Type 2 diabetes)

 WHEN ARE KETONES MOST LIKELY TO OCCUR?

  • during episodes of illness or infection – even if blood glucose levels are relatively normal
  • when blood glucose levels are high (the level can vary from person to person and episode to episode but generally at 17 mmol/L or higher)
  • when insulin has been forgotten or omitted for some reason

A small amount of ketones (usually less than 0.5mmol/L on blood test) may be seen in people who fast (don’t eat) for several hours, after vigorous exercise or in children overnight when fat is commonly used as an energy source. These do not require treatment.

WHEN SHOULD I TEST FOR KETONES?

  • When you have an infection or feel unwell, especially if you have vomiting and diarrhoea, even if your blood glucose levels are relatively normal (from 4-15mmol/L)
  • If your blood glucose is 17 mmol/L or higher, particularly if you feel unwell or your blood glucose level remains elevated twice or more in one day
  • If you have symptoms of hyperglycaemia or DKA – eg. greatly increased thirst or volume of urine, feel unusually drowsy, feel nauseated, have rapid laboured breathing, abdominal pain or a fruity/acetone smell on your breath

HOW DO I TEST FOR KETONES?

  • Ketones can be tested in the blood in the same way that you test blood glucose
  • Blood ketone testing is more accurate than urine ketone testing
  • Blood ketone testing can only be done on the Optium Xceed meters (which all Type 1s can get on prescription)
  • Optium Ketone Test Strips are available on prescription

WHAT DO THE RESULTS MEAN AND WHAT SHOULD I DO IF I HAVE KETONES?

Blood ketone level

   Action

0.5mmol/L

or less

Normal level

  • Continue to take insulin (rapid acting and long acting) as usual even if you are not eating
  • If you are too unwell to eat contact your diabetes health professional for advice
  • Treat a high blood glucose level appropriately and re-test blood glucose in 2-3 hours
  • If 17 mmol/L or higher or your feel unwell, repeat ketone test

0.6-1.5mmol/L

  Contact a health professional as ketoacidosis could be developing

  • You may require extra insulin and fluids
  • In general inject the dose of rapid acting insulin that you would normally take to treat a high blood glucose level*
  • Drink at least 250-500mls (1-2 cups) of sugar-free fluids every 30 mins
  • Re-check blood glucose and ketone level every 2-3 hours until your ketones are less 0.5 mmol/L (negative – trace)
  • Repeat rapid acting insulin injection if ketones are 1.0 mmol/L or higher (small – moderate) after 3 hours
  • Don’t forget to take your long acting insulin as usual

1.5mmol/L

or higher

Contact a health professional urgently as ketoacidosis could be developing

  • You will need additional rapid-acting insulin and fluids
  • In general inject 1.5 times the dose of rapid-acting insulin you would normally take to correct a high blood glucose level*
  • Drink at least 500mls (2 cups) of sugar-free fluids every 30 mins
  • Re-check blood glucose and ketone level every  2-3 hours until your ketones are less than 0.5 mmol/L (negative – trace)
  • Repeat rapid acting insulin injection if ketones are 1.0 mmol/L or higher (small – moderate) after 3 hours
  • Don’t forget to take your long acting insulin as usual
  • If after 3-4 hours you are unable to reduce your ketone level or keep fluids down go to the nearest After Hours Medical  Centre or Hospital Emergency Department

3.0 mmol/l

or higher

CONTACT A HEALTH PROFESSIONAL You are at risk of DKA. The ketone level must be reduced urgently

  • You urgently need additional insulin and fluids
  • Inject 1.5 times the dose of rapid-acting insulin you would normally take to correct a high blood glucose level*
  • Drink at least 500 mls (2 cups) of sugar-free fluid every 30 mins
  • Re-test your ketone and blood glucose level every 1-2 hours until your ketones are less than 0.5mmol/L (negative – trace)
  • Repeat rapid acting insulin injection every 2 hours if ketones are 1.0 mmolL or higher (small – moderate)
  • Don’t forget to take your long acting insulin as usual
  • if after 3-4 hours you are unable to reduce your ketone level or keep fluids down go to the nearest After Hours Medical  Centre or Hospital Emergency Department

* refer to “correction insulin dose calculation guidelines” or ask your Diabetes Nurse about this

 

 HOW TO USE OPTIUM KETONE ELECTRODES

  • open the foil packet by tearing at the notch
  • with the contact bars (3 black stripes) facing up, insert the contact bars into the meter
  • push the electrode in until it stops
  • prick your finger to obtain a drop of blood
  • touch the drop of blood to the purple target area while the “apply blood” message is displayed

  until the meter begins a 10 second countdown

  • your result will be displayed after the 10 second countdown is complete

                                                                                 

 

BLOOD KETONE READING INDICATIONS

Above 1.5 mmol/l
Readings above 1.5 mmol/l in the presence of hyperglycemia indicate that you may be at risk for developing diabetic ketoacidosis (DKA). Contact your healthcare provider immediately for advice.

0.6 to 1.5 mmol/l
Readings between 0.6 and 1.5 mmol/l may indicate the development of a problem that may require medical assistance. Follow your healthcare provider’s instructions.

Below 0.6 mmol/l
Readings below 0.6 mmol/l are in the normal range.

 

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Read more about my diabetes

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Supporting Someone

On this page

Diabetes Education and Psychology
Diabetes Burnout
Diabetes Support
Leaving Home

Diabetes Education and Psychology

Dr Lisa Engel is a Health Psychologist and Diabetes Educator. She has worked with people with diabetes for over 20 years and has a practice in Sandringham and South Yarra (in Melbourne, Victoria). You can see more about her on http://t1dn.org.au which is a fantastic Australian website for young adults with type 1 diabetes.

Diabetes and psychology

Finding a psychologist who understands the unique challenges posed by living life with type 1 diabetes can assist people to recover quickly from setbacks and prevent deterioration in their mental and physical health.

My job as a psychologist does not involve the nuts and bolts of blood glucose management. That role is filled by other health professionals. Rather, my work involves collaboratively working with a person to understand past and present issues that prevent them from achieving their diabetes goals, treating any psychological problems such as anxiety and depression, eating problems and sleep difficulties to name a few.

The most common reason for someone with diabetes coming to see me is diabetes burnout. This mood state involves feeling overwhelmed with the demands of diabetes self-care, feeling scared about getting off-track with diabetes management and worrying about living with complications in the future.

Practices that build resilience such as learning to have a relationship with difficult thoughts and feelings rather than being identified or fused with these internal phenomena can improve a person’s mood fairly quickly. Acceptance strategies can assist clients to understand they are much more than their diabetes. Whilst the demands of diabetes are relentless, psychological therapy can help a person put them into perspective. Rather than becoming overwhelmed, a diabetes self-care regimen is seen as being a small part of a rich, full and meaningful life, enabling a person to cultivate a non-judgemental attentiveness to their lived experience of diabetes.

Over time, continued efforts to build resilience by gaining mastery over the mind can have a profound impact, resulting in actual changes in the structures of the cerebral cortex. Research using MRI scans have shown increased activity in the brain correlated with reduced anxiety and depression and increased pain tolerance.

This is a short video about supporting someone with depression which may help you if you are depressed or may help the people who are supporting you to understand.

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DIABETES BURNOUT

Burnout is not the same thing as depression. It’s when diabetes just feels overwhelming, things are not going well, you’re fed up / frustrated / irritable / etc etc etc

William H. Polonsky has written a great book called Diabetes Burnout and it’s worth reading this. He also has lots of short clips on You Tube (just search by his name) and his website is also worth a look: http://behavioraldiabetesinstitute.org

So if you are feeling burned have a go at the PAID Questionnaire in the section of the website (PAID = problem areas in diabetes, sadly doesn’t involve payment!). This comes from the Joslin Centre in Boston, USA which is a great centre for diabetes management, research and treatment.

Do the questionnaire, print it off and take it to your next diabetes appointment, either with your nurse or doctor. You may be surprised at your responses and it may help break through some of the negative stuff you are dealing with.

Polonsky also recommends:

  • Give yourself a break instead of beating yourself up when things go wrong
  • Be honest with yourself and use positive self talk
  • Find support that is encouraging for you
  • Identify barriers to your management of your diabetes
  • Make a plan and stick to it each dayDIABETES SUPPORT – HOW TO GIVE AND RECEIVE IT!

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DIABETES SUPPORT

HOW TO GIVE AND RECEIVE IT!

YOU

Ask for help, there are lots of people happy to help (family, friends, diabetes nurse, doctor, websites, peer support, online communities, blogs…)

FRIENDS

DO

  • like your friend for who they are
  • read the notes in Diabetes Food Police
  • read the notes in what is diabetes so you know stuff that’s true about it
  • support them when they are hypo / sick / drunk especially if they ask for help
  • call 111 if they collapse on you – better to be red-faced than sorry if they don’t really need the ambulance
  • check on them the morning after the night before especially if you are in a hostel or a flat and they had been drinking and dancing

DON’T

  • judge, you don’t have diabetes, it’s 24/7 for your friend and they get tired of it
  • turn in to the Diabetes Police (food, injections, tests, exercise etc)m
  • make jokes about their behaviour when they are seriously hypo, they won’t remember and it’s potentially embarrassing

PARENTS – IT’S THEIR DIABETES NOT YOURS!

DO

  • stay in the background during the teen years
  • keep up to date with diabetes information, it changes a lot
  • negotiate “catch up time” with your teen and make it like a “business meeting” checking the blood sugars for the last week or so and making any adjustments. This is not a nagging time if they haven’t tested, have missed some insulin or generally not taken care of their diabetes
  • accompany them to diabetes clinic but let them go in on their own and you come in for the last 5-10 minutes
  • let them ask and answer questions in the diabetes clinic
  • offer good support especially if they are sad, unwell, frustrated, fed up
  • have someone outside of the diabetes circle that you can vent to / talk to /cry with
  • prepare your teen for leaving home and independence – it will happen!*check out websites for parents – http://behavioraldiabetesinstitute.org has Diabetes Etiquette for Parents of Teens, some videos, a questionnaire for parents and other support things; www.childrenwithdiabetes.com also has lots of parent support ideas and practical help

DON’T

  • baby them
  • pretend their diabetes isn’t important; they live with it 24/7 and research shows that parents who stay involved at whatever level can be negotiated between the teen and the parent, the teen will do better with their diabetes management
  • ask them what their blood sugar is unless it is business meeting time
  • blame them – help to fix the problem not the blame!

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LEAVING HOME

THE FOLLOWING IS AN ARTICLE FROM DIABETES NZ MAGAZINE, SUMMER 2012. FIRST PUBLISHED IN DIABETES MAGAZINE (SUMMER 2012) SEE WWW.DIABETES.ORG.NZ TO SUBSCRIBE.

The prospect of a teenager leaving home to live on their own for the first time is stressful for many parents. But there are things you can do to help the transition go smoothly, as diabetes nurse specialist Kirsty Newton explains.

Leaving home is a time of transition – for the teen as they anticipate independent living, and for the parents as they learn to let go. Parents whose children were diagnosed with diabetes at a young age can find this transition period hard as their teen’s diabetes management has become an extension of their own lives.

Negotiating the transfer of diabetes knowledge, responsibility and management to your teenage child can be a difficult experience for everyone, but it must be done if the teen is to be successful and independent.

The literature shows that teens whose parents have an arms-length supporting role do better long term. How much support has to be negotiated between the teen and parents.

Establish good habits

The time of transition is an active process in that teens should be self testing, giving insulin and making decisions about managing high or low blood glucose levels.

Teenagers must also learn to keep to the management regime, to delay or prevent complications in the future. This can be a difficult concept for an age group that lives in the present and who may consider themselves ‘bullet proof’ and therefore not vulnerable to the future complications of diabetes, even though they know about them.

One of the significant issues in diabetes management in this age group is the random approach many of them have towards insulin injections and testing. Good habits established in early to mid teens carry on into adulthood, along with the benefits of good control which are long lasting. Sadly the reverse is also true.
There are three aspects of managing to live with a chronic condition – choices, control and empowerment. Empowering your teen (see side panel) will enable them to develop the capacity to take responsibility for their diabetes.

Disempowerment can lead to them feeling overwhelmed by the responsibility.

Watch out for worrying signs

Anxiety and depression are common among teens/young adults with diabetes. Suddenly they have a lot of things on their plates, such as independent living, adjusting to living with peers and possibly engaging in some risky behaviours (alcohol, drugs, sexual activity).

Some may struggle to manage their academic workload. There is also the issue of accessing health services, managing prescriptions, hypos, hypers and sick days without the usual support of family and their usual diabetes team.

Keep an eye out for the warning signs of anxiety and depression. These include: Sleep disturbances, poor concentration, irritability, feelings of hopelessness, anxiety attacks, self medicating (eg alcohol and drugs), not taking their insulin regularly, self harming/cutting, social isolation, failing grades/missing classes.
There are good support services available for teens/young adults who need some help and direction. If they are at university or other institution there will be a student health service with links to counselling and student support services. If they are working there is often the option of the Employee Assistance Programme or counselling through their GP service. The main thing to ensure for any teen with diabetes leaving home and living somewhere else is that they engage with some kind of health service.

Manage risks

My best advice for parents is to prepare for the departure of their teen well in advance. Make sure they know how to manage their diabetes

As a diabetes nurse specialist working with teens and young adults, I have found over the years that there are basically three groups of teens with Type 1 diabetes.

  1. There are those who leave home with reasonably good diabetes management skills. They may have their ups and downs as everyone does but they have accepted their diabetes and are well prepared for life after school and independent living.
  2. There are those who have never really accepted their diabetes, find their management difficult and living away from home and studying or working puts them under a lot of pressure which doesn’t help their diabetes control.
  3. There are those who have never taken on the responsibility for their diabetes management, still need to rely on a lot of support from home and often struggle with anxiety and depression.

Plan with them, well in advance of their departure date.Throughout adolescence, encourage them to take on more responsibility for diabetes management – for

Throughout adolescence, encourage them to take on more responsibility for diabetes management – for example testing, insulin doses, carb counting, safety in exercise, stress management, sick day management.Get them to attend clinic appointments on their own; join them for the last five to 10 minutes.

Get them to attend clinic appointments on their own; join them for the last five to 10 minutes.

Promote resilience! Give them tasks to do such as taking their script to the chemist and learning to manage repeats.

Teach them how to cook and shop.

Teach them to manage money.

Claim a disability allowance (if a student, they get this through Study Link).

Make sure they are referred to the diabetes service in the place they are going to (your current diabetes service should do this).

Get them to sign up with a GP near their new home – research possible options that may have good diabetes awareness, for example youth one-stop shops, medical centre or university health service.

Ask your diabetes nurse educator for handouts on alcohol, sick days, physical activity, drugs and smoking.

Talk to your teen about safe sex, safety with alcohol and other behaviours that may impact on their diabetes. Prepare with them and plan to support them from a distance. But don’t over-manage them. If you find you are doing so, ask yourself ‘Whose diabetes is it?”

Risk taking is a normal part of adolescence. Talking to your child about these risks can help mitigate the dangers.

Make sure they know the most common reasons for hospital admission, which are:

  • too much alcohol
  • random use and under-dosing of insulin
  • not managing sick days.

The two main messages to get across to your teenager are:

  • they must take their insulin and
  • they must treat hypos correctly

Kirsty Newton works for Capital and Coast District Health Board as a Diabetes Nurse Specialist with teenagers and young adults.

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More Info for Whānau

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Diabetes Food Police

You know the scenario – you’re about to put a beautiful piece of chocolate cake on your plate in a crowded gathering and all of a sudden this person says (feels like they shout it!) “you can’t eat that!”. What to do?

Do you:

  • Make it an educational moment when you bore them rigid with complicated explanations of carbohydrate metabolism and insulin requirements?
  • Think “they mean well” and put it back?
  • Think “get lost” and eat it anyway?
  • Walk off and sulk?
  • Suck it up, do it anyway (and enjoy it!) and have a quiet word with them later?

You could link them to Diabetes Etiquette found on http://www.behavioraldiabetes.org

Lots of blog on this topic! Google Diabetes Food Police.

 

Remember: it is your diabetes, you’re in charge and you have options:

  • Educate people
  • Ask them to encourage you, not judge and embarrass you
  • Have good control so you know it’s ok to eat whatever and cover it with insulin
  • Get a best friend / partner / spouse/sibling /whoever as your support coach and ditch The Nagger
  • Give a straightforward short answer and don’t get into debate

More Info for Whānau

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Issues with Type 1

On this page:

Acute complications
Related conditions
Complications

ACUTE COMPLICATIONS

KETOACIDOSIS – DKA

Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, will cause the body to become acidic – hence the name ‘acidosis’.

DKA is a life-threatening emergency

The most likely times for DKA to occur are:

  • At diagnosis. (Some people who do not realise they have Type 1 diabetes do not get diagnosed until they are very unwell with DKA.)
  • When you are ill.
  • During a growth spurt/puberty.
  • If you have not taken your insulin for any reason.
  • DKA usually develops over 24 hours but can develop faster particularly in young children. Hospital admission and treatment is essential to correct the life-threatening acidosis. Treatment involves closely monitored intravenous fluids, insulin and glucose.
How to recognise DKA:
  • High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. If your levels are consistently above 15mmol/l you should check for ketones
  • Ketones in the blood
  • Frequently passing urine
  • Thirst
  • Feeling tired and lethargic
  • Blurry vision
  • Abdominal pain, nausea, vomiting
  • Breathing changes (deep sighing breaths)
  • Smell of ketones on breath (likened to smell of pear drops)
  • Collapse/unconsciousness
What to do if you have symptoms of DKA

If you have high blood glucose levels and any signs of DKA you must contact your diabetes team immediately. Left untreated, DKA can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid in hospital.

  • Make sure you check for ketones if your blood glucose is over 15mmol/l.
  • You may need to take extra insulin.
  • You may need to test your blood glucose and ketone levels frequently (e.g. every two hours).
  • Drink plenty of unsweetened fluid.

If you are unable to eat, replace meals with snacks and drinks containing carbohydrate to provide energy (e.g. sips of sugary drinks, sucking boiled sweets).
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RELATED CONDITIONS

COELIAC DISEASE

Coeliac disease is a common autoimmune disease that affects 1 in 100 people, but only 10–15 per cent are diagnosed. Gluten triggers an immune reaction in people with coeliac disease and gluten damages the lining of the small intestine. Other parts of the body may be affected.

Coeliac disease is more common in people who already have Type 1 diabetes, as both are autoimmune conditions and so are genetically linked. Some people with Type 1 diabetes find it is only after starting insulin that the symptoms of coeliac disease become noticeable. Some people with Type 1 diabetes have a ‘silent’ form of coeliac disease, which means no symptoms are apparent and it is only diagnosed by screening. Screening is done by an annual blood test looking for coeliac antibodies.

If you think you may have coeliac disease you should:

  1. Discuss your symptoms with your GP, diabetes doctor or nurse
  2. You can then take a simple blood test to look for an antibody made by the body in response to eating gluten
  3. Your GP / diabetes doctor can refer you to a gut specialist doctor (gastroenterologist) for a simple test called a ‘gut biopsy’. Small samples of gut lining are collected and later examined under a microscope to check for abnormalities that are typical in coeliac disease. You need to be having gluten daily for the biopsy to show any signs of coeliac disease. 2 slices of bread daily is sufficient gluten intake prior to the biopsy being performed. It is done in hospital under light sedation and you are free to go once you have recovered from the sedation effects.

Current clinical guidelines recommend that all children and young people with Type 1 diabetes are screened for coeliac disease on diagnosis. It is also recommended that adults with Type 1 diabetes are assessed for coeliac disease. Testing should also be offered to anyone if signs and symptoms of coeliac disease are present.

THYROID DISEASE

The thyroid gland is a small butterfly shaped gland with two lobes. It is situated in the front of your neck, just below the Adams Apple. The two lobes are joined together by tissue called the isthmus. The thyroid gland is one of the glands of the endocrine system.

The thyroid gland has two main functions: the first function is to control metabolism. Metabolism is the rate at which all the chemistry of the body works. The second function is to control growth in early life.

The normal thyroid produces a number of different hormones. The main hormones are called thyroxine (T4) and triiodothyronine (T3). The thyroid produces approximately 80% T4 and 20% T3.

T4 is generally considered to be a pro-hormone because it is inactive and only becomes active when converted to T3.

T3 is an active hormone and does all the work of regulating the body’s metabolism.

There are two types of thyroid disorder: hypothyroidism (where the body doesn’t produce enough thyroid hormones) and hyperthyroidism (where it produces too much).

Thyroid problems are more common in people with diabetes than those without diabetes, especially those with Type 1, because the body’s cells can attack the thyroid and destroy the cells as they do the insulin producing cells in the pancreas. Adults and children can be affected, and hypothyroidism is more common in people with Type 1.

Neither hypo- nor hyperthyroidism can be cured, but both can be treated successfully with tablets. Once a year you should have a blood test to check your thyroid function.

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COMPLICATIONS

RETINOPATHY – EYE DISEASE

Diabetic retinopathy or ‘retinopathy’ is damage to the retina (the ‘seeing’ part at the back of the eye) and is a complication that can affect people with diabetes. Retinopathy is the most common cause of blindness among people of working age in New Zealand. Every one who has diabetes is entitled to a free eye photo in the retinal screening programme which is run through nominated providers. Your GP / diabetes doctor / diabetes nurse / practice nurse can refer you for this. You are screened every 2 years. If there are any changes to your eye you may be screened more often and can be referred to the ophthamology department at the hospital.

WHAT CAUSES RETINOPATHY?

To see, light must be able to pass from the front of the eye through to the retina, being focused by the lens. The retina is the light-sensitive layer of cells at the back of the eye – the ‘seeing’ part of the eye. It converts the light into electrical signals. These signals are sent to your brain through the optic nerve and your brain interprets them to produce the images that you see.

A delicate network of blood vessels supplies the retina with blood. When those blood vessels become blocked, leaky or grow haphazardly, the retina becomes damaged and is unable to work properly. Retinopathy is damage to the retina.

RISKS TO YOUR EYES

Persistent high levels of glucose can lead to damage in your eyes. To reduce the risk of eye problems, blood glucose, blood pressure and blood fats need to be kept within a target range, which should be agreed by you and your healthcare team. The aim of your diabetes treatment, with a healthy lifestyle, is to achieve these agreed targets.

Smoking also plays a major part in eye damage so, if you do smoke, stopping will be extremely helpful.

TYPES OF RETINOPATHY

There are different types of retinopathy: background retinopathy, maculopathy and proliferative retinopathy.

BACKGROUND RETINOPATHY

The earliest visible change to the retina is known as background retinopathy. This will not affect your eyesight, but it needs to be carefully monitored. The capillaries (small blood vessels) in the retina become blocked, they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates).

MACULOPATHY

Maculopathy is when the background retinopathy (see above) is at or around the macula. The macula is the most used area of the retina. It provides our central vision and is essential for clear, detailed vision. If fluid leaks from the enlarged blood vessels it can build up and causes swelling (oedema). This can lead to some loss of vision, particularly for reading and seeing fine details, and everything may appear blurred, as if you are looking through a layer of fluid not quite as clear as water.

PROLIFERATIVE RETINOPATHY

Proliferative retinopathy occurs as background retinopathy develops and large areas of the retina are deprived of a proper blood supply because of blocked and damaged blood vessels. This stimulates the growth of new blood vessels to replace the blocked ones. These growing blood vessels are very delicate and bleed easily. The bleeding (haemorrhage) causes scar tissue that starts to shrink and pull on the retina, leading to it becoming detached and possibly causing vision loss or blindness.

Once the retinopathy has reached this stage it will be treated with laser therapy. Beams of bright laser light make tiny burns to stop the leaking and to stop the growth of new blood vessels.

KIDNEY PROBLEMS – NEPHROPATHY

Your kidneys are like a big sieve and they sieve out the normal constituents that make up urine. If your kidneys come under pressure from prolonged periods of high blood glucose levels and/or high blood pressure then the sieve can get holes in it and sieve out larger molecules not normally found in urine. These molecules are protein. In the early stages it is referred to as microalbuminuria – small amounts of protein in the urine. Left unchecked it can progress over years tomacroalbuminuria – large amounts of protein in the urine – and eventually dialysis will be needed.

However, prevention is better! This is why we give you that annoying urine container once a year, annual blood tests and monitor your blood pressure at each appointment.

Taking care of your kidneys is an essential part of managing your diabetes.

  • Attend all your medical appointments
  • Keep your blood glucose levels and blood pressure levels within your target range
  • Have your urine tested for protein and a blood test to measure kidney function at least once a year
  • Get help to stop smoking
  • Eat healthily and keep active

If protein is detected more than one time on a test, then your doctor may talk to you about treatment. Usually you are prescribed an ACE inhibitor which lowers blood pressure and has a protective effect on the kidneys to prevent further damage. It is suggested that you take the tablet at bedtime so if it does make you feel dizzy due to lowered blood pressure, you will be lying down and not be affected. A common side effect of ACE inhibitor tablets is a dry annoying cough and if you get that you should go back to your GP and ask for a “cousin” of the tablet you have which hopefully won’t cause a cough. Sometimes you can come off these tablets after a period of treatment depending on your urine test results. Working on your blood glucose management will really help.

Kidney disease is not the only reason for protein to appear in the urine. If you have a urinary tract infection (UTI) this can lead to protein being passed out in the urine. People with poorly controlled diabetes can be more prone to urinary tract infections because glucose in the urine provides a breeding ground for bacteria. This might need treatment with antibiotics. And if you are female, don’t do a urine test for protein if you have your period.

Anatomy of Kidney

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More Info for Whānau

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What is Diabetes?

On this page:

Why does it occur?
Treatment
The Pancreas, insulin and diabetes
Insulin, food and energy
Ketoacidosis

This might be a good place to start if you are new to diabetes; someone you know has just been diagnosed; you are thinking about supporting someone who has type 1 diabetes…

Type 1 diabetes occurs when the immune system destroys the beta cells in the pancreas, stopping insulin production and leaving the body unable to use glucose for energy. Insulin is a hormone which allows the body to use glucose from the food we eat for energy. When there is a lack of insulin the blood glucose level rises and the person gets symptoms which may include thirst, going to the toilet a lot, weight loss and dehydration. To stay alive and maintain good health, daily management involves balancing, simultaneously, injections of insulin with carbohydrate intake and exercise.

WHY DOES IT OCCUR?

Some people carry the genes that can make it more likely that they get diabetes. Some environmental trigger causes the immune system to start attacking the pancreas and eventually the person will start having symptoms, once more than 90% of health beta cells have been destroyed. This process may take weeks, months or years. So far, there is nothing that can be done to stop this auto-immune destruction.

There are still lots of things not fully understood about why Type 1 diabetes develops. A lot of research is going on into different aspects of diabetes. The triggers are not fully understood but may be common things in our environment like viruses or foods which are harmless to most people but may cause diabetes to develop in other people. If there is a family history of type 1 diabetes then there is a slightly increased risk of developing diabetes. For many families, however, the development of type 1 diabetes is a random event.

Diabetes cannot be caught from another person and it is not caused by eating too much sugar or not getting enough exercise. There is nothing parents can do to stop type 1 diabetes developing.

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TREATMENT OF DIABETES

Young adults with diabetes will have a multidisciplinary team looking after them which includes an endocrinologist or diabetes specialist doctor, diabetes nurse specialists, dietitian, psychologist and others as required.

The main aspects of diabetes care are:

  • Replacement of insulin by insulin injections
  • Health eating with carbohydrates at every meal
  • Testing blood glucose levels and dealing with highs and lows
  • Regular exercise
  • Regular appointments at the diabetes clinic and with members of the team as required

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THE PANCREAS, INSULIN AND DIABETES

INSULIN AND THE PANCREAS

The pancreas is a gland situated behind the stomach. It has 2 jobs – it makes enzymes to help digest food and produced insulin to move glucose into the cells for energy. Diabetes does not affect enzyme production.

In Type 1 diabetes the pancreas can’t make enough insulin to keep the blood glucose level normal. Young adults with type 1 always need treatment with insulin injections.

INSULIN, FOOD AND ENERGY

When we eat food the food goes down into our stomach so it can be digested. The carbohydrates (sugars and starches) in our food are broken down into glucose. When this process starts happening, insulin is released by the beta cells and enters the blood stream along with the glucose.

Insulin is like a key that unlocks the cell door and moves the glucose from the blood into the cells where it can be used for energy.

Glucose is the unit of energy your body needs to do its work. Most of the glucose we eat is used by the brain to keep us thinking and a little bit each time is stored in the liver as glycogen. This can be released when your blood glucose level is dropping. The remaining glucose is used for energy or stored as fat.

As you haven’t been making much insulin lately you have had a lot of glucose in your blood so none of the glucose has been used for energy. You may have been feeling more tired than usual and lacking energy, and that’s because your glucose (fuel for energy) has been unable to get into the cells.

Ketones are another source of energy that the body can use if it can’t get glucose. In people with diabetes ketones mean that there is a lack of insulin and glucose in the blood that cannot be used for energy. Ketones can make you feel sick and give you stomach ache. If your body has been using alternative sources of energy (energy stored in muscles, fat and the liver) you may have lost some weight.

One of the ways the body gets rid of the extra glucose is to send it out in the urine. Glucose is not usually present in urine and when it is it draws a lot of water out with it. So you may have been in a cycle of being very thirsty and going to the toilet a lot. Once you start getting insulin this cycle will stop and you will start replacing the stores of energy and fluids that you have been using. You can be very hungry for a few weeks! This is all part of your normal recovery.

Signs and Symptoms

  • Frequent passing of urine
  • Increased thirst
  • Weight loss
  • Tired
  • Mood changes

SOMETIMES YOU CAN ALSO HAVE

  • Skin infections or thrush
  • Stomach pains
  • Decreased energy and ability to concentrate
  • Excessive hunger

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KETOACIDOSIS

When diabetes comes on quickly or is found late,you can become very ill. You will have high levels of glucose and ketones in your blood, severe dehydration, rapid breathing, a smell of acetone on your breath and coma may occur. This called diabetic ketoacidosis or DKA.

Diagnosis

In most cases this is straight forward. The doctor will test your blood (and maybe your urine) for glucose and ketones. Then you are usually referred to the hospital as diabetes in young adults is usually managed by the diabetes team at the hospital.

HONEYMOON

Once insulin treatment starts and the extra glucose is cleared away, some of the pancreatic cells may recover for a short time and produce some insulin. This is known as the ‘honeymoon’ phase and occurs in most people, but not everyone. Often only small doses of insulin are needed during this time. Unfortunately the pancreas cannot recover from the auto-immune damage that has already occurred. Eventually these cells will stop producing insulin and all the body’s needs will have to be met by injections.

Acknowledgement: Children and Adolescents with Diabetes in Australia and New Zealand

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More Info for Whānau

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Apps

MYSUGR APP REVIEW FROM A YOUNG WOMAN WITH TYPE 1:

“MySugr is a colourful, fun app to log your blood glucose and insulin intake during the day. Well designed, well functional and has a scoring system in place to make it into a game with your other diabetic friends and family. Challenges are also incorporated into the app in My Sugr Pro as well as other customisable aspects. Either subscribed to it, or not, it’s very helpful to keep track with your phone which is more likely to be on your person than a pen and logbook. Displays your blood glucse with graphs instead of just numbers which is great when you want to see how you are over a day or weeks. Highly recommended.” August 2016

TRY THIS: GLOOKO – THIS APP WILL SYNC YOUR BLOOD GLUCOSE READINGS FROM ONE OF AROUND 30 COMPATIBLE METERS TO YOUR SMARTPHONE, TO WHICH YOU CAN ALSO ADD YOUR CARB INTAKE, ACTIVITY DATA AND INSULIN / MEDICATION DETAILS. YOU CAN SHARE THE DATA VIA THE INTERNET WITH YOUR DIABETES TEAM. SUITABLE FOR ANDROID OR IOS. IF YOU HAVE ANDROID IT IS NOT COMPATIBLE WITH CARESENS BUT APPLE PHONES ARE!  IF YOU DO TRY IT PLEASE REPORT BACK VIA THE FACEBOOK PAGE!

 

This is an article on diabetes apps from James Nuttall, a dietitian in Auckland who surveyed a bunch of young adults in Auckland. If you have any feedback on particular apps please put it on the Facebook page – thanks!

Which diabetes app?

Smartphones may not be for everyone, but many people in New Zealand now own one. Apps are one reason why smartphones are smart, and for people with diabetes, there are thousands of apps designed for diabetes management and tens of thousands for supporting a healthy lifestyle. So, can these diabetes apps help you manage your diabetes better than you already are?

Just as there is no diabetes management plan that suits everyone, there is not one app that will suit everyone. Knowing how you want the app to help you and what you want to use it for are important to consider when deciding if an app will support your diabetes management. From our research at the Auckland Diabetes Centre in a small group of people with type 1 diabetes, most did not know what is available and would be more likely to use apps if given guidance.

To help you decide if apps can help you manage your diabetes, I have highlighted and compared the main features of five apps in the table. These are not the “best” available apps because no app has been proven to be better than another. You will find many websites with lists of the “best diabetes apps”, these are often not very helpful as many of these apps are not available in New Zealand and they are generally reviewed at face value. Since there are so many apps, I included the names of similar apps where possible to provide you with other options if these do not work for you.

What do these apps do? Most diabetes apps include functions for health monitoring (such as blood glucoses, medications, weight) and providing nutrition information (carbohydrate counting, healthy recipes, calorie counting). In a recent survey conducted in Waitemata DHB, the main reasons why people with diabetes are using apps for diabetes management is: tracking diabetes data; accessibility and convenience; carbohydrate counting; and insulin calculations.

If your main goal is managing your food intake, then there are many apps that can help with this. Most of these apps focus on encouraging you to record what you eat and tell you how much calories, carbohydrate and other nutrients are in the foods you eat. One example, MyFitnessPal, is the most downloaded health and fitness app in New Zealand. This app focuses on weight loss as its main goal through calorie counting, which can be an effective tool for weight management. However, many people with type 1 diabetes use this app for carbohydrate counting. One issue with doing so is that most of the food data is entered by users and this information is not checked for accuracy. For this reason, I would not recommend this as the first app people use for carbohydrate counting. However, an experienced carbohydrate counter may be able to spot when there is a major error with a food product, which could allow this app to be used safely.

If you are looking to use an app as your main method of blood glucose monitoring, then finding an app that works easily for you should be the priority. One benefit of the tracking functions of these apps compared to a log book is they often have colourful graphs, charts and the ability to set reminders. One issue is that entering data on a daily basis can become tedious, and the difficulty of doing so varies greatly between apps. Some apps attempt to overcome this by using gamification, in essence making a game out of monitoring your diabetes. One example, mySugr Companion, uses a diabetes monster that you tame each day by logging enough information into the app to 50 points.

There are very few apps for healthy eating or diabetes management developed here in New Zealand. This means even fewer use a New Zealand food database such as EasyDietDiary. At Auckland DHB we run a programme called DAFNE (Dose Adjustment For Normal Eating) for people with type 1 diabetes. Thankfully this is changing with Foodswitch and the upcoming Saltswitch, as well as a Dietitian working in Waitemata called Zhuoshi Zhang is developing a healthy eating app for type 2 diabetes for her PhD. For people with type 1 diabetes wanting something made in New Zealand, one of our DAFNE graduates at ADHB who is a software developer will be launching his own diabetes management app prior to Christmas called Type 1 with a New Zealand carbohydrate counting database included.

A major drawback of diabetes management apps is they are rarely designed based on scientific evidence shown to help improve blood glucose levels or go through any rigorous testing. So, if you are happy with your diabetes management and already have access to sources of information you trust, then apps may not provide you with much additional benefit at this stage. As a dietitian working with people who have diabetes, I see the important role health professionals have in providing the best advice around apps. Myself and a small group of dietitians are reviewing nutrition and health apps. Our aim is to provide patients and health professionals with some guidance around what is available, how well they achieve their aims and who these apps can benefit. Watch this space!

 

App Carbs and cals RapidCalc Foodswitch New Zealand MyFitnessPal mySugr Companion
Most useful for Visual people who want to estimate their nutritional intake. Technical people who want the calculations built into most insulin pumps. Comparing food products with a visual scale. People who want to track their food and exercise to manage weight. People who want to monitor variables influencing their diabetes.
Platform Apple and Android Apple only Apple and Android Apple, Android and Website Apple and Android
Cost (NZD) $7.99 $9.99 Free Free Free (Pro version $28.36)
Food database UK and US foods, with food photos and can add own meals/recipes. None Yes, includes only NZ food products Yes, includes entries by company and users None
Export records via email No Yes No Yes Yes
Reminders/warnings No Reminders for basal insulin doses and post-meal blood glucose recording NA Reminders for meal logging, warning when you eat far too few calories No (Pro version – for logging)
Monitoring functions e.g. blood glucose, weight, meds Blood glucoses (Android only, no summary); carbohydrate in grams and portions; rapid and basal insulin doses. Blood glucoses with graphs and summary.
Carbohydrate in grams or portions.
Rapid and basal insulin doses.
NA NA Blood glucoses with graph and summary. (Pro version – insulin pump basal rates)
Rapid acting insulin dose suggestion (for people with Type 1 diabetes) Yes – basic, can include a correction dose. Yes – complex. Includes:  carbohydrate count with ratios; blood glucose target; insulin on board ; exercise/activity; alcohol and recent hypo. NA NA No
Nutrition analysis Nutritional allowance based on personal variables No Traffic light scale for comparing similar food products Nutritional allowance based on personal variables No
Similar apps Figwee Portion Explorer (Apple, $2.59) Insulin bolus calculator (Android $4.20), Insulin calculator (Apple, Free) Foodeye (Apple, Free) Calorie counter by Fat Secret (Apple & Android, Free), EasyDietDiary (Apple, Free) OnTrack Diabetes (Android, Free) Social Diabetes (Apple & Android, Free), Dario (Apple & Android, Free)

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Clinics

On this page:

All about visiting clinics

This website is about Transition – when you move from children’s outpatients adolescent clinic to the young adult or adult clinic.

Lots of questions can arise:

WHO WILL YOU SEE?

In Wellington, Kenepuru or Kapiti, you will see a diabetes doctor (usually either Dr Carroll, Dr Krebs, Dr Barrington-Ward, Dr Delahunt, Dr Hall or Dr Wilson depending on where you live) but you will no longer have a dietitian or nurse in the room as well.  If you need follow up between clinic appointments you will be referred to the dietitian, nurse, psychologist, podiatrist etc

HOW OFTEN WILL YOU BE SEEN?

Appointments are unlikely to be every 3 months like they were in teen clinic. This is where you need to involve your General Practitioner (GP) again. They get a copy of the letter from the clinic appointment which will tell them your insulin types and doses, your HbA1c and any issues.

Inbetween appointments at the diabetes clinic you need to get more prescriptions from your GP. The clinic will not write prescriptions for you. There are some options for choosing a GP if you don’t want to go to the family doctor or you have moved away from home. See the bit about Evolve Youth Health below…

WHAT’S DIFFERENT AT YOUNG ADULT / ADULT CLINIC?

You won’t be seen as often; scripts come from your GP between appointments; you will have to go to the lab for your bloods and urine tests; you need to ask for help if you need it between clinic appointments by contacting your diabetes nurse or asking your GP for a referral if you don’t know who that is.

WHO CAN COME TO APPOINTMENTS WITH YOU?

You can bring a support person – friend, parent – with you but generally the doctor will expect to see you on your own and maybe bring your parent in for the last few minutes of the consultation.

WHAT ELSE AM I EXPECTED TO KNOW?

As you are becoming independent with your diabetes management you need to be sure that you know what to do. You might be really good at the basics – testing, giving insulin, treating hypos – but do you know how to correct a high blood glucose level safely? Can you manage a sick day on your own? How do you deal with alcohol? What are the HbA1c targets for your age group? How will you manage your prescriptions / repeats?

If you don’t know the answers or you’re not sure then please ask your nurse for some more education! We are happy to help you.

WHY DO I NEED TO GO TO DIABETES CLINIC AT ALL?

Diabetes needs you to do your stuff – test, give insulin, treat hypos, eat healthily and exercise! The clinic needs to check how you are doing overall; screen for related diabetes conditions; keep your treatment plan up to date with what’s available in New Zealand; treat any complications.

Wellington staff are now doing diabetes clinics at Student Health, Victoria University and at Evolve Youth Health in downtown Wellington.

PRIMARY CARE OPTIONS – YOU NEED A GP!!

The following options are suggestions for you to use if you have recently moved to Wellington and need a GP, or if you live here already but want to swap to a GP that is not your family doctor.

EVOLVE YOUTH HEALTH SERVICE

Evolve is a youth service based in central Wellington. We offer free & confidential health and social services for young people aged 10-25. We offer a range of services, activities and events in one awesome location to make it as easy as possible for young people to get what they need.

At Evolve everything is free. We won’t judge you or patronise you. We’re really discreet which means we won’t tell other people your business and you don’t have to feel embarrassed about anything here.

Young people are actively involved in keeping it real at Evolve. We have young people as staff members and as volunteers on our Board.

Thousands of young people from all kinds of backgrounds, cultures and lifestyles have visited Evolve since we opened in 2004.

HEALTH CARE

Evolve has a team of friendly, non-judgemental doctors and nurses (clinicians) who provide primary healthcare services to meet pretty much all your health needs including sexual health, mental health, general check-ups, treatment and referrals. Clinics are available at Evolve every weekday and also at some schools around Wellington.

COUNSELLING

Our counsellors come from a range of backgrounds and have different skills and interests to suit different people. You can get a referral from our nurse for up to 6 free counselling sessions if there is something you’d like to talk through or work on with support from a professional.

Counselling sessions are by appointment only.

SOCIAL SUPPORT

We have social workers and youth workers who can help with things like finding a job or somewhere to live. They provide social work, group work, advocacy, information and advice.

YOUTH TEAM

Evolve’s youth team is a diverse group of young people who look after our reception space and lounge areas. They can help arrange appointments, provide peer support and supply information about services at Evolve and elsewhere. They also coordinate projects, events and activities that anyone can join in with. See our website for details of what’s on at Evolve.

APPOINTMENTS

Evolve is open every weekday from 10am. Check our website for closing times.

To book an appointment with a nurse or doctor please phone or call into reception during opening hours

You can choose to register as a casual patient or enrol with our PHO.

All services are free* for 10-25 year olds.

* Charges apply for non-New Zealand residents.

WHERE TO FIND US

Level 2, James Smiths Building, Corner Cuba & Manners Streets

PO Box 9076, Marion Square, Wellington 6141

Phone: 04 473 6204

Fax: 04 473 6216

Email: evolve@evolveyouth.org.nz

www.evolveyouth.org.nz

OTHER OPTIONS:

  • Any GP practice in the city
  • Student Health Service if you are enrolled in tertiary education
  • Vibe Youth Health in Lower Hutt
  • Kapiti Youth Support in Paraparaumu

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Health Care

PRIMARY HEALTH CARE OPTIONS IN WELLINGTON CITY

You need to have a General Practitioner (GP) as well as a connection to the diabetes clinic with a hospital diabetes specialist. The notes following are good options for a GP if you don’t want to go to your family doctor anymore or you have moved away from where that is and now live in Wellington.

EVOLVE YOUTH HEALTH SERVICE

Evolve is a youth service based in central Wellington. We offer free & confidential health and social services for young people aged 10-25. We offer a range of services, activities and events in one awesome location to make it as easy as possible for young people to get what they need.

At Evolve everything is free. We won’t judge you or patronise you. We’re really discreet which means we won’t tell other people your business and you don’t have to feel embarrassed about anything here. 

Young people are actively involved in keeping it real at Evolve. We have young people as staff members and as volunteers on our Board.

Thousands of young people from all kinds of backgrounds, cultures and lifestyles have visited Evolve since we opened in 2004.

 

HEALTH CARE

Evolve has a team of friendly, non-judgemental doctors and nurses (clinicians) who provide primary healthcare services to meet pretty much all your health needs including sexual health, mental health, general check-ups, treatment and referrals. Clinics are available at Evolve every weekday and also at some schools around Wellington.

COUNSELLING

Our counsellors come from a range of backgrounds and have different skills and interests to suit different people. You can get a referral from our nurse for up to 6 free counselling sessions if there is something you’d like to talk through or work on with support from a professional.

Counselling sessions are by appointment only.

SOCIAL SUPPORT

We have social workers and youth workers who can help with things like finding a job or somewhere to live. They provide social work, group work, advocacy, information and advice.

YOUTH TEAM

Evolve’s youth team is a diverse group of young people who look after our reception space and lounge areas. They can help arrange appointments, provide peer support and supply information about services at Evolve and elsewhere. They also coordinate projects, events and activities that anyone can join in with. See our website for details of what’s on at Evolve.             

 

APPOINTMENTS

Evolve is open every weekday from 10am. Check our website for closing times.

To book an appointment with a nurse or doctor please phone or call into reception during opening hours

You can choose to register as a casual patient or enrol with our PHO.

All services are free* for 10-25 year olds.

* Charges apply for non-New Zealand residents. 

 

Where to find us

Map

 

Level 2, James Smiths Building, Corner Cuba & Manners Streets

 

PO Box 9076, Marion Square, Wellington 6141

Phone: 04 473 6204

Fax: 04 473 6216

Email: evolve@evolveyouth.org.nz

www.evolveyouth.org.nz

 

OTHER PRIMARY HEALTH CARE OPTIONS

Any GP practice in Wellington region

Student Health Service if you are enrolled at a tertiary institution

Vibe Youth Health in Lower Hutt

Kapiti Youth Service in Paraparaumu

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Exercise Stuff

Exercise is good for you and part of your diabetes management plan.

 REGULAR EXERCISE MAKES YOU

  • Insulin sensitive so your insulin works better
  • Lower your blood pressure
  • Lower your cholesterol
  • Keep your weight in the normal range for your age and height
  • Create a sense of well being
  • Strengthen your heart and lungs

 

THINGS THAT AFFECT BLOOD GLUCOSE LEVELS DURING EXERCISE:

  • Carbohydrate foods
  • Insulin levels
  • Intensity of the exercise
  • Duration of the exercise
  • Recent high or low blood sugars
  • Timing of exercise to recent food and insulin
  • Blood glucose before you start
  • Adrenaline in competitive sport

 

GETTING STARTED (NOW THAT YOU HAVE DIABETES)

  •  If you have just been diagnosed with diabetes or are starting a new activity or just getting off the couch the more likely it is that your blood sugars will go low and you will need less insulin. Talk to your diabetes nurse or doctor for advice!
     FUEL SOURCES
  • First fuel available for exercise is glucose which is quickly used up
  • Second source is release of glucose from the muscle and then the liver
  • Third source is fat – stored energy – which is used when the insulin level falls

Blood glucose

Effects of glucose and insulin on metabolism

Impact on performance

Too much insulin and not enough glucose available for the cells

Tired, poor performance. Correct low blood glucose before starting exercise.

4-10 mmols

Efficient fuel flow

Maximum performance

 

>10 mmols

If insulin level is OK then blood sugars will fall

Performance may be reduced but ok to do exercise

>15 mmols

Glucose likely to rise as not enough insulin on board

Tired, poor performance, check for ketones, have insulin and wait before exercising

 

INSULIN LEVEL

If you have too much insulin on board when starting to exercise your blood glucose level will rapidly drop. You will need to have a carb snack before exercising or you will need to stop to eat or drink during the exercise.

 If you have high blood sugars before starting exercise you don’t have enough insulin on board. It makes it difficult for glucose to get to your muscles so you will not do well at exercise and you will have even higher blood sugars afterwards.

 If you are between 5-10mmols you will be able to access body fat for fuel and keep your blood sugars stable.

 AVOIDING LOWS AFTER EXERCISE

  • Test before and after exercise
  • Keep a log book so you can see what you did last time you exercised
  • Have some glucose and snacks with you
  • Talk to your diabetes team about lowering insulin and increasing carb before and after exercise
  • Strenuous or long duration of exercise can cause delayed hypos, often during the night
  • Don’t forget to drink! Talk to your diabetes team about sports drinks and their appropriate use

GOOD RECOVERY DRINK RECIPE:

trim milk / 2 spoonsful of skim milk powder / 2 spoonsful of flavouring e.g. Nesquik

shake it up and drink it down within 30 minutes of finishing exercise. It will replenish your energy stores really quickly and help prevent hypos later.

GOOD REFERENCE SOURCES

John Walsh author of “Pumping Insulin” has excellent exercise notes in this book for people with type 1 diabetes. He has type 1 himself and is on a pump but the exercise principles apply if you are on a pump or daily injections

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Food

On this page

Carbs
Protein
Fat
Other important info

The great news is that eating with diabetes is just the same as the way that everyone should be eating!

There are a couple of things that a person with diabetes has to make sure of with their meals that other people don’t have to worry about so much – but in reality people without diabetes tend to do these things anyway!

Eating with diabetes is just the same as regular healthy eating

You need to eat regular meals and snacks

You always need to include a carbohydrate food in your choices (see below)

These guidelines help you to maintain a nice stable blood glucose levels, avoid hypos and be a healthy weight.

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CARBOHYDRATES

Carbohydrate foods are the most important foods when it comes to your diabetes. The amount and timing of carbohydrate foods that you eat will directly affect your blood glucose levels, and whether these are too high, normal or too low (hypo).

If you eat too much carbohydrate you will need more insulin to keep your blood glucose levels stable, or they will be too high and if this happens regularly you increase the risk of developing nasty diabetic complications.

If you eat too little carbohydrate you could have a hypo.

The best way to manage your carbohydrate intake is to have three regular meals (4-5 hours apart) that are made up of about half the foods below and about half with other foods like meats/veges/fruit.  In between meals you could also have 2-3 snacks that also have some carbohydrate in them depending on your insulin type, how much exercise you do / don’t do and how hungry you are (for example, if you are still growing or recovering from being newly diagnosed with type 1 diabetes).

See the ‘carbohydrate snacks’ section for good snack ideas.

Carbohydrate containing foods:

  • Bread and bread rolls
  • Breakfast cereals
  • Dairy and soy milk, yoghurt, ice cream and custard
  • Fruit and fruit juice
  • Starchy vegetables like potato, sweet potato and corn
  • Rice, pasta and noodles
  • Baked beans and lentils
  • Snack foods like biscuits, chips, muesli bars
  • Sugars and sugary foods
  • Takeaway foods like pizza, fries and burgers

 

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PROTEIN

Protein-containing foods should be about a quarter of your plate. This is like 1-2 palmfuls of the foods below per day. It doesn’t matter when you eat these foods in your day because unlike carbohydrates, these foods won’t affect your blood glucose levels.

Protein-containing foods:

  • Meat 
  • Fish 
  • Chicken 
  • Eggs 
  • Nuts 
  • Cheese

These foods are important for growth and repair in your body. You need protein foods to build muscle too!

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FAT

We need some fat in our food choices too, but not too much or it can lead to weight gain and other bad side effects like high blood lipids.

Fatty foods are:

  • Butter 
  • Margarine 
  • Oil 
  • Cream

BUT there are also lots of places in the diet where fat hides as well, such as:

  • Crisps, chips and fries
  • Biscuits
  • Chocolates
  • Cakes
  • Donuts
  • Takeaways
  • Fatty meats – chicken skin, meat fat, salami, bacon etc
  • Fried foods

SO it is a good idea to only eat from this group of foods as a treat.

GOOD SOURCES OF FAT IN THE DIET ARE:

  • low fat milk, yoghurt and cheese
  • vegetable oils/margarine for cooking
  • nuts/seeds
  • avocado
  • fish

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OTHER IMPORTANT STUFF:

TIMING OF MEALS

Depending on the insulin you’re on, you might need to eat a meal or a snack every 3 hours or so. If you forget to eat, skip meals or leave it too long until you eat, you might have a hypo. If you have an insulin pump, you can be a bit more flexible with the timing of your meals.

SUGARY FOODS

High glucose foods like fizzy drinks, cordials and lollies can make your blood glucose levels go too high. It is best to drink diet fizzy or cordials.

These foods can be used in small amounts to treat a hypo, which means they cause a quick rise in blood glucose so you know that means if you eat them when you’re not having a hypo they will make your blood glucose level rise quickly then too!

HYPO TREATMENT

To treat a hypo, you need to quickly eat or drink something sweet, wait 10 minutes and then eat something else straight away to stop the hypo from coming back.

To treat a hypo, quickly eat or drink something sweet like:

  • Mentos or
  • Dextrotabs or Vita tabs or
  • 125 – 200ml fruit juice or 
  • 1/3 – ½ can regular soft drink (not diet) or 
  • Honey or jam (2 teaspoons) or
  • 2-3 tablespoons of glucose powder dissolved in half a glass of water

Then eat something else to stop the hypo from coming back, like:

  • A piece of fruit or 
  • A slice of bread or 
  • Two plain sweet biscuits or 
  • A glass of milk 
  • If it’s just before a meal, eat or drink something sweet then eat your meal

Don’t forget to always carry glucose and snacks with you. Make sure you don’t ignore a hypo even if you’re worried about what everyone else will say. No one likes to be embarrassed, but ignoring a hypo can make you feel worse and can be more embarrassing if you don’t treat it.

HEALTHY FOOD AT SCHOOL/ UNI / WORK

Here are some ideas for lunch:

  • Sandwiches

try different types of breads like rolls, grain bread, Turkish bread, bagels, lavash or pita bread
use fillings like salad, low fat cheese, vegemite, ham, chicken, tuna, salmon, egg, baked beans, spaghetti or banana

  • Pasta, potato or rice salad
  • Fresh pieces of fruit eg. apples, pears, mandarins, oranges
  • Chopped fruit eg. rockmelon, pineapple
  • Fruit in zip lock bags eg. grapes, cherries
  • Crispbreads, rice cakes or corn thins
  • Pikelets, scones or low fat muffins
  • Low fat yoghurt or dairy desserts
  • Dried fruit boxes eg. sultanas, apricots
  • Dried fruit and nuts
  • Low fat milk drinks
  • Rice crackers or rice crisps

If buying food from the canteen/ café / dairy look for sandwiches or rolls, corn on the cob, reduced fat mini pizzas, pasta, soup or rice dishes as healthy options.

CARBOHYDRATE SNACK IDEAS

For snacks between meals, choose your favourites, stock up on

  • Fruit  eg. apple, pear, banana, orange 
  • Chopped fruit – rockmelon, pineapple, honeydew 
  • Fresh fruit salad 
  • Grapes or cherries 
  • Canned fruit snack pack eg. two fruits, peaches, pears, fruit salad 
  • Dried fruit boxes eg. sultanas, fruit salad, sultanas and apricots 
  • Low fat yoghurt 
  • Low fat dairy desserts 
  • Low fat custard 
  • Corn on the cob (frozen, defrost in microwave)
  • Pikelets or scones 
  • Fruit loaf, fruit bun or hot cross buns 
  • Crispbread or rice cakes with low fat toppings e.g. tomato, low fat cheese 
  • Popcorn 
  • Crumpets or English muffins 
  • Rice crackers with low fat dip 
  • Rice crisps 
  • Low fat fruit bars

FOOD FOR EXERCISE

Exercise or sport uses up blood glucose extra quickly so it can mean that you need some extra carbohydrate to stop you from having a hypo. Eating an extra carbohydrate snack for every 30-40 minutes of sport is a good guide.  Hypos can happen for 12-16 hours after you stop exercising, so keep an eye on your blood glucose levels and top up your carbs if you need to.

BEFORE SPORT:

  • A piece of fruit 
  • A small flavoured milk 
  • A muesli bar 
  • A fruit snack pack 
  • A crumpet or slice of raisin toast 
  • A ‘fun size’ chocolate bar

DURING SPORT:

  • A 100% fruit juice 
  • A cup of sports drink 
  • A piece of fruit eg. banana, orange

HEALTHIER TAKEAWAY OPTIONS

You may find as you get older you start eating out and eating more takeaways. Once a week is a good amount to fit in with a healthy diet.

Some healthy takeaway options:

  • Meat or chicken salad roll / wrap 
  • Doner kebab with lots of salad 
  • Plain hamburger with lots of salad 
  • A grilled chicken burger with lots of salad 
  • Baked potato (skip the butter) 
  • Toasted sandwich 
  • Corn cob
  • Sushi roll 
  • Vegie pizza or gourmet pizza
  • Toasted sandwich or focaccia 
  • Bowl of pasta with tomato based sauce 
  • Stir fried vegetables with noodles or plain rice

Try and have a similar amount of carbohydrate when eating out as you would usually have at mealtimes, and try and choose the options that are lower in fat.

  • A piece of fruit or 
  • A slice of bread or 
  • Two plain sweet biscuits or 
  • A glass of milk 

If it’s just before a meal, eat or drink something sweet then eat your meal and have your insulin when you’re half way through the meal. Do NOT forget to take your insulin! You may decide to reduce the amount of rapid acting insulin slightly because of the low pre-meal.

try different types of breads like rolls, grain bread, Turkish bread, bagels, lavash or pita bread

use fillings like salad, low fat cheese, vegemite, ham, chicken, tuna, salmon, egg, baked beans, spaghetti or banana

Acknowledgement: Dietitians NZ


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