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Self-care guidefor people with

diabetes

Supported by an unrestricted grant from

English Version

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When the diagnosis is diabetes . . . . . . . . . . . . . . . . . .03

What is diabetes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .04

What are the signs and symptoms of diabetes? . . . . .04

What are the different types of diabetes? . . . . . . . . . . .05

Is a ‘hypo’ the same as low blood sugar? . . . . . . . . . .06

What are high blood sugar levels? . . . . . . . . . . . . . . . .08

Measuring blood sugar levels . . . . . . . . . . . . . . . . . . .09

What type of diet should I eat? . . . . . . . . . . . . . . . . . .10

Should I worry about my cholesterol level? . . . . . . . . .13

What about sport and exercise? . . . . . . . . . . . . . . . . .13

Should I reduce my alcohol intake? . . . . . . . . . . . . . . .14

How often should I have my eyes tested? . . . . . . . . .14

What types of medication will I need? . . . . . . . . . . . .14

Will I have to pay for my medications? . . . . . . . . . . . .15

How does diabetes affect driving? . . . . . . . . . . . . . . .16

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When the diagnosis is diabetes

Get answers to yourquestionsThe aim of this booklet is to:

■ help answer your questionsabout diabetes;

■ explain the different types ofdiabetes; and

■ outline how you caneffectively manage yourdiabetes.

How does someoneget diabetes?You develop diabetes whenyour body can’t use glucose(sugar) properly. Instead ofburning up the sugar throughyour everyday activities, theaverage amount of sugar inyour blood rises.

What are thecomplications ofdiabetes?If this abnormally high sugarlevel is not treated it can harmdifferent parts of the body. Thecomplications diabetes cancause include damage to:

■ the eyes;■ kidneys;■ heart;■ blood vessels; and■ nerves.

If diabetes is detected early, itcan be treated and the risk ofdeveloping serious problemscan be greatly reduced.

How many people inIreland have diabetes?It is estimated that 200,000people in the Republic of Irelandhave diabetes. This number isexpected to increase becauseour population is growing and

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ageing, and obesity rates arerising. If you are older andoverweight, you are atincreased risk of developingtype 2 diabetes.

What is diabetes?

Diabetes is a condition thatmakes it difficult for the body touse the glucose (sugar) in theblood. The body normallyproduces a hormone calledinsulin. Insulin is produced bythe pancreas. The pancreas isan organ found in the tummyarea quite close to thestomach. Insulin allows theglucose in our food to be takenfrom the blood and used bythe body for energy.

■ People with diabeteseither don’t have enoughinsulin or the insulin thattheir pancreas producesdoes not work effectively.

This means the body cannotmove the glucose out of the

blood, so the sugar levels inthe blood remain high.

This extra glucose in the bloodcauses significant problems forthe body's functions.

What are the signsand symptoms ofdiabetes?

You may be diagnosed afteryou go to your GP (familydoctor) because:

■ you feel tired or ill;

■ you have been losing weight;

■ you have an infection thatis slow to clear up;

■ you are always thirsty – theincreased glucose in yourblood brings more waterthrough the kidneys to bepassed as urine causingthirst and dehydration;

■ your vision is blurred –extra glucose can beabsorbed into the eye andcause blurred vision.

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What are the differenttypes of diabetes?

There are a few different typesof diabetes. The most commonare ‘type 2 diabetes mellitus’and ‘type 1 diabetes mellitus’.Approximately 9 out of 10 peoplewith diabetes will have type 2.

Women can sometimes getdiabetes when they are pregnant.This is called ‘gestationaldiabetes’ because it usuallyonly lasts during the pregnancy.

What is ‘type 1diabetes mellitus’?When someone has type 1diabetes:

■ their pancreas has stoppedproducing insulin.

The exact cause of this conditionis still unknown. It usuallyoccurs in people under 35years of age, but there areexceptions to this.

What is ‘type 2diabetes mellitus’?When someone has type 2diabetes, the pancreas stillproduces some insulin, but:

■ the pancreas is notproducing enough insulin tomeet the body’s needs; or

■ the insulin that is producedis not working very well.

Older people are more likely todevelop type 2 diabetes, butthere are exceptions to this.

How is ‘type 1’diabetes treated?People with this type ofdiabetes need to inject insulinor use an insulin pump.

How is ‘type 2’diabetes treated?There are various ways to treattype 2 diabetes. The choicedepends on many factors and

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differs between individuals.Treatment may include any ofthe following combinations:

■ diet and exercise;

■ diet, exercise and tablets;

■ diet, exercise, tablets andinsulin;

■ diet, exercise and insulin.

How is ‘gestationaldiabetes’ treated?In gestational diabetes, theextra demands of pregnancymean that the mother does nothave enough insulin to meether body’s needs.

This type of diabetes is firsttreated by controlling thequantity and type of themother’s food and drink. If thisis not enough to treat thecondition, the mother may begiven extra insulin as aninjection.

It is vital for the baby’s healththat the mother does not havehigh blood sugar levels

because the extra sugarsupplies can cause the babyto grow too big.

Is a ‘hypo’ the sameas low blood sugar?

Hypoglycaemia or a ‘hypo’ iswhen the glucose level in theblood (‘blood sugar level’)drops below the normal range.Below normal is when it is lessthan 4mmol/L (70 mg/dl).

Some tablets and insulin cancause a hypo especially if:

■ meals are delayed; or

■ they are taken after unusuallystrenuous physical activity.

What are the ‘hypo’warning signs?If you have a ‘hypo’ you mayfeel symptoms such as:

■ sweating;

■ shaking;

■ dizziness; and

■ blurred vision.

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What should I do if I think I’m getting a hypo?If you feel your blood sugargoing low, you should treat itas soon as possible. Neverdelay treatment of a low sugar level.

A hypo can be corrected bytaking something sweet to drinkor eat, such as (for an adult):

■ 100mls of Lucozade; or

■ three glucose sweets.

If you will not be eating aproper meal within the nexthour, you should eat somecarbohydrate (starchy) food likea cereal bar or sandwich orfollow the instructions that yourdiabetes team gives you. Thiswill make sure that your bloodsugar does not go low again.

Always tell your doctor ordiabetes nurse about anyhypos, unless you know why ithappened, so that they candecide if your medicationneeds to be altered.

How can I prevent‘hypos’?■ Try not to miss a meal.

■ Try to eat carbohydrate atevery meal (for example,pasta, bread or rice).

■ If you exercise, eat a snackand test your glucose levelsevery few hours – a ‘hypo’can occur even a significanttime after exercising.

■ Always carry some form ofsugar with you such asglucose sweets or drinks,such as Lucozade, in caseyou experience a hypo.

It is very important to carryidentification that shows youhave diabetes, such as anidentificationbracelet, whichyou can buy onwww.diabetes.ie.

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What are high bloodsugar levels?

‘Hyperglycaemia’ or high bloodsugar levels are when theblood glucose level is abovethe target set for you.

In the short term, high bloodsugars will leave you feelingunwell and tired.

If you have high blood sugarsfor a long time, it can lead to:

■ eye disease;

■ heart problems; and

■ foot ulcers.

Diabetes is also associatedwith high blood pressure.

If your blood glucose levels areconstantly high, you shouldcontact your doctor.

What causes highblood sugar levels?People with diabetes may havehigh blood glucose levelsbecause:

■ they have not taken theirinsulin;

■ they have an infection orillness; or

■ they have eaten too muchfood.

Even if you cannot eat, illnesscan cause your blood sugarlevel to rise.

Will I need moreinsulin if I am ill?If you are ill, you should checkyour blood glucose levels morefrequently and never forget totake your insulin. You mayneed to increase your insulinduring illness.

If your blood glucose level ishigher that 15 mmols (270mg/dl), for more than one hour,check your blood or urine forketones. If ketones are presentyou should follow your diabetesteam instructions or contactthem.

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Measuring bloodsugar levels

Why do I need tomeasure the sugarlevel in my blood?The best way to monitor yourdiabetes is by measuring yourblood sugar levels. You do thiswith a finger-prick blood test.

If you find it difficult to dofinger-prick blood tests, urinetests are another way of testingsugar levels. However, urinetests are not as accurate, butthey are appropriate andadequate for some people.

What is my ideal bloodsugar level?Target blood sugar levels varyfrom person to person and youshould ask your diabetes teamto set a personal target for you.But generally the ideal targetblood sugar levels should be:

■ less than 10 mmol/l (180mg/dl); or

■ less than 8 mmol/s (145mg/dl) in younger people.

Ask your doctor or nurse whatyour targets are.

What are my targetblood sugar levels?Fasting

Before Meals

After Eating

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When should I do myblood tests?You should test your bloodsugar level:

■ when you wake in themorning; and

■ before meals.

Your tests will tell you how welldiet, medication and exercise areworking together to control yourdiabetes. They also provideuseful information for your doctor.

How often should I domy blood tests?Generally you should measureyour glucose levels betweenone and four times a day. Yourdoctor or nurse will have thebest advice on how often youneed to test.

During illness or if you changeyour lifestyle, you will need totest more often.

What type of dietshould I eat?

The ideal diet for people withdiabetes is very much like theideal diet for everybody else. A healthy diet is an essentialpart of treatment for peoplewith diabetes and thereforeneeds to be followed for life.

Healthy diets are:

■ low in refined sugar;

■ low in saturated fat;

■ high in fibre, vitamins and minerals.

If you are overweight it isessential that you lose weightby changing your diet andexercising. This helps toimprove your diabetes controlbecause the insulin youproduce works better andthere are less demands onyour body. Anyone diagnosedwith diabetes should be givenan appointment with a dieticianto help them with their diet.

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Are there any tips forhealthy eating?Eat regular meals

Eat regular meals every day,especially breakfast.

Check with your diabetes teamif your insulin regime meansyou need to take a snackbefore going to bed at night.

Eat starchy foods

As the main part of each meal,eat a starchy food like one ofthe following:

■ bread;

■ cereal;

■ potato;

■ pasta; or

■ rice.

Try to eat the same amount of starchy foods at your mealseach day. Choose high fibrefoods like:

■ Weetabix;

■ porridge;

■ Bran Flakes;

■ wholemeal breads;

■ wholegrain rice; or

■ pastas.

Don’t take in toomuch sugarLimit the intake of sugar andsugary foods. When you dotake them as a treat, eat themwith your meal. Use an artificialsweetener instead of sugar inhot drinks. It is best to avoid or take in moderation thefollowing foods:

■ sugar;

■ chocolate and sweets;

■ honey and glucose;

■ regular jams andmarmalades;

■ cakes and sweet biscuits; and

■ regular squash and sugary fizzy drinks.

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Keep your fat intake lowChoose lean cuts of meat,remove visible fat and use low-fat methods of cooking like:oven baking, stewing, roasting,grilling, boiling, poaching,steaming or microwaving.

■ Choose low-fat dairyproducts.

■ Use low-fat spread insteadof butter or margarine.

■ Limit the amount of spreadused.

■ Use low-fat milk instead of regular milk.

Eat oily fishEat oily fish at least twice aweek. Include fish like:

■ mackerel;

■ salmon;

■ sardines;

■ trout;

■ fresh or frozen tuna; and

■ herrings.

Eat vegetables and fruit Eat plenty of vegetables andfruit. Aim to have at least fiveportions each day – spread outover the day.

Reduce your saltYou should not add salt to yourfood at the table and youshould reduce your intake ofsalty foods like:

■ processed meats;

■ packet sauces;

■ gravies;

■ smoked fish;

■ crisps; and

■ nuts.

‘Diabetic’ foods are notusefulYou are not advised orrecommended to buy specialdiabetic foods like sweets,chocolate and biscuits. This is because these foods arehigh in fat and therefore high in calories.

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Should I worry aboutmy cholesterol level?

It is important to control yourcholesterol level. A highcholesterol level may speed upthe hardening of the arteriesand increase your risk of aheart attack.

A healthy low-fat diet withplenty of high-fibre starch helpsto control your cholesterol level.

According to Europeanguidelines:

■ people with diabetesshould aim for acholesterol level of below4.5 mmol/l. However, thisvaries from person to person.

Ask your doctor to set apersonal cholesterol target foryou. Your doctor may prescribesome medication to help controlyour cholesterol level.

What about sport and exercise?

Exercise is important to helpyou manage your diabetes.Exercise helps you to:

■ lose weight;

■ lower your blood pressure;

■ reduce your blood sugarlevels; and

■ allow your insulin and tabletsto work more effectively.

It is always useful to increaseyour level of movement. Alwayscheck with your doctor ornurse before starting a newexercise routine. You can askyour diabetes team to help youto develop an exercise plan.

Should I reduce myalcohol intake?

Alcoholic drinks contain a lot ofcalories – almost as many asfats – and very few or nonutrients. You must be carefulabout how much you drink.

You don't have to give it up,but remember that alcohol:

■ lowers your blood sugar; and

■ hides the signs ofhypoglycaemia (low blood sugar).

It is recommended that:

■ women have fewer than two standard drinks ofalcohol a day; and

■ men have fewer than three standard drinks ofalcohol a day.

■ It is recommended tohave two or three alcohol-free days each week.

A standard drink is a regularpub measure.

How often should Ihave my eyes tested?

When you have diabetes youshould have your eyes checkedevery year by the doctor -including a full examination ofthe back of the eye.

This is different to a vision testfor glasses.

What types ofmedication will I need?

People with type 1 diabetes willneed to take regular injections ofinsulin or use an insulin pump.

People with type 2 diabetes canbe treated by exercise and diet.

However, some people mayneed tablets and, or, insulin.

There are many different typesof tablets available for thetreatment of type 2 diabetes.Many of these tablets workdifferently from each other andoften more than one type oftablet is used.

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Your doctor will prescribe atreatment which is best suitedto you.

Your medications help tocontrol your blood sugar levelsin combination with a healthydiet and regular activity.

Will I have to pay for my medications?

Long Term Illness Scheme (LTI)Diabetes is covered under theLTI scheme for people residentin the Republic of Ireland. Thismeans that all medication fordiabetes and related conditionsis available to you free ofcharge under this scheme.

This includes medication forhigh blood pressure and highcholesterol and glucose-testing strips.

How to apply for the LTIIf you want to register for theLTI scheme:

■ ask your doctor to completethe LTI application form; and

■ submit this form to the localHealth Service Executiveoffice. Your doctor shouldbe able to tell you where thelocal office is located.

When you are registered underthe LTI scheme, you willreceive an LTI book in the post.It shows your registrationnumber. Registered patientsmay get their medication fromany pharmacy.

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How does diabetesaffect driving?

If you take tablets or insulin fordiabetes, you must inform thedriving licence authority thatyou have diabetes. You canfind the number for your localdriving license authority in thetelephone book.

Do I need to tell my carinsurance companythat I have diabetes?You must inform your carinsurance company that youhave diabetes.

If you don’t it may mean youare at risk of driving withoutinsurance.

Your car insurance will not costmore when you have diabetes.

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Acknowledgements Ms Helen Burke,

Advanced Nurse Practitioner in Diabetes

Ms Demelza Dooner,Clinical Nurse Specialist in Diabetes

Ms Anna Clarke,Diabetes Federation of Ireland,

Health Promotion and Research Manager

The content of this booklet reflects the guidelines of the Diabetes Federation of Ireland at the time of print.

The production of this booklet was made possible by anunrestricted educational grant from Merck Sharp & Dohme

Ireland (Human Health) Ltd.

This booklet can be downloaded from www.diabetes.ie free of charge.

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Notes

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Notes

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Helpline 1850 909 909

www.diabetes.ie

Diabetes Federation of Ireland 76 Lower Gardiner Street, Dublin 1

Tel: 01 836 3022 Fax: 01 836 5182 Helpline: 1850 909 909 E-Mail: info@diabetes.ie

Get more informationFor more information on diabetes in your own language, go to the

website of the Diabetes Association from your homeland or visit www.idf.org

You can use the internet at any public library.