What is Diabetes?
Type 1 Diabetes
Type 1 diabetes is a condition where the pancreas makes little or no insulin. If there is not enough insulin, the glucose cannot get from the blood stream into the body cells where it is used for energy. The glucose accumulates in the blood stream and causes the blood glucose level to rise.
Signs & Symptoms
The signs and symptoms of diabetes are caused by high blood glucose levels:
- Going to the toilet a lot
- Feeling thirsty
- Feeling tired
- Losing weight
- Experiencing mood changes
- Having blurry vision
Type 1 diabetes is caused by an auto-immune process where the body makes antibodies which destroy the insulin producing cells in the pancreas. This process is probably triggered by a viral infection in someone who has a genetic susceptibility to diabetes.
Treatment
The treatment and management of Type 1 Diabetes includes:
- injections of insulin every day (usually 2-4 injections per day or via an insulin pump)
- a well balanced diet
- a meal plan that involves eating carbohydrate at regular intervals throughout the day
- frequent monitoring of blood glucose levels
- regular exercise
For more detailed information follow the link to the Queensland Government Diabetes Care Advance Website Module 1: Type 1 Diabetes in Childhood and Adolescence
Type 2 Diabetes
Type 2 or Non-Insulin-Dependent Diabetes
Type 2 diabetes usually occurs in adults, though it is on the increase in children and adolescents. Most young people with Type 2 diabetes are overweight or obese which makes insulin work less effectively.
Treatment
Type 2 Diabetes can be treated by:
- Weight loss
- Exercise
- A healthy eating plan (which is low in fat)
- Medications (tablets) to help the insulin work better
- Insulin injections are sometimes needed
For more detailed information follow the link to the Queensland Government Diabetes Care Advance Website Module 2: Type 2 Diabetes in Childhood and Adolescence
Diabetes Control
Yes! We all know young people with diabetes don't like to write down their blood glucose levels. We have heard all the excuses such as:
- 'being too busy and not having the time'
- 'can remember the results so don’t need to write it down'
- 'can't find the BG book'
- 'can't find a pen'
Whatever the reason for not recording your blood glucose levels (BGL's), it results in you not thinking about what your levels mean. Seriously, there's no point in taking your BGL if you're not going to think about what the results mean.
If you at least write your BGL's down it gives you a chance to see if there are any patterns in the levels e.g. consistently high in the mornings, consistently low at dinner time.
Staying on top of what's going on with you and your diabetes will mean fewer problems and more time to just enjoy life.
Why do I need Good Diabetes Control?
Too much glucose in the blood stream for a long time can cause diabetes complications. High blood glucose levels (BGL's) can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. By keeping your BGL's as close to normal a possible (between 4 and 8 mmol/L most of the time) your long term health will be better and more importantly you will feel better and have a lot more energy as well as reduce the risk of developing diabetes complications.
BGL's Monitoring & Recording
It is important to understand that your blood glucose level will vary with your day-to-day activities. For example, your blood glucose level will usually go down after exercise, and will go up after you have eaten or if you are unwell or stressed.
Knowing how your blood glucose changes in response to these things helps you to plan your day and adjust your insulin to help control your BGL. Monitoring your BGL also tells you how well your insulin doses and dosage adjustments are working.
I know it's a drag but writing down your blood glucose levels in a log book will help you see patterns in your blood glucose levels e.g. if every morning your BGL is above 15 mmol/L then you need more overnight insulin. If you are not writing the levels down you might not notice patterns and therefore not make any insulin dosage changes to fix the levels. If you can't remember or don't have the time to write them down every day what about just writing them down 3 days per week. This is not perfect but it will at least give you some information to make adjustments to your insulin doses.
What is a HbA1c?
A HbA1c test shows the average amount of glucose that has been in your blood stream during the past 2 to 3 months. This test is usually done every 3 months and gives you valuable information about your diabetes control. Most hospital clinics have a machine that can test the HbA1c and give you the result in just a few minutes and is usually done by taking a finger prick blood test.
The result is given as a percentage e.g. 9%. This does not mean that your average BGL has been 9 mmol/L for the past 3 months.
For more detailed information follow the link to the Queensland Government Diabetes Care Advance Websites Module 4: Monitoring and Control.
Hypoglycaemia
What is Hypoglycaemia?
Hypoglycaemia (or a 'hypo' as it is commonly known) means a low blood glucose level (BGL). Hypoglycaemia occurs when the blood glucose level (BGL) is less that 4mmol/L, or where there are symptoms of a ‘hypo’ at a level close to this.
What causes Hypo’s
- not enough or missed carbohydrate at meals or snacks (for the dose of insulin taken)
- exercising without eating extra carbohydrate, or exercising without reducing your insulin
- having too much insulin for the amount of food eaten
- having too much insulin (either accidentally or dose needs changing)
- when sick and not being able to eat or if unable to keep food down because of vomiting
How do you feel?
How you feel and behave when you are ‘hypo’ is different for everyone.
Here are some of the common signs and symptoms you may feel.
How to treat Hypo's
If you can, it is a good idea to do a BGL if you think you are ‘hypo’. If your BGL is less than 4 mmol/L, take some quick acting carbohydrate (glucose) straight away.
After you have treated your 'hypo', wait about 10 minutes for the carbohydrate to work, and then repeat the blood test. If your BGL is still less than 4 mmol/L, then repeat the quick -acting carbohydrate.
Continue taking extra carbohydrate until your blood glucose rises above 4mmol/L. If the ‘hypo’ has occurred near a snack or a meal-time then treat the ‘hypo’ to raise the BGL and then eat your usual meal.
Examples of some quick-acting carbohydrate
Tips for Treating 'Hypo's'
Lucozade® is a glucose drink that works really quickly to raise your blood glucose level. It is better for treating ‘hypo’s’ than ordinary soft drink or cordial as you don’t need to drink very much. 100mls is all you will need to make you feel better and as it is not carbonated it goes down quickly.
One of the problems that occurs when you are ‘hypo’ is that you may keep eating till you feel better. Lucozade® is great because it works so quickly that you don’t feel the need to keep eating. This is particularly great if you are concerned about weight gain. It is readily available in supermarkets (Coles, Woolworths) and comes in several flavours and is great to keep in the house for when you need it.
Note: Plain Lucozade® (the original) contains less glucose than the flavoured ones.
- Don’t forget to always carry some ‘hypo’ food with you.
- Carbohydrates high in fat e.g. chocolate and ice cream, are not good for treating ‘hypo’s’ as they work too slowly
For more detailed information follow the link to go to the Queensland Government Diabetes Care Advance Website Module 5: Hypoglycaemia
For information on Hypoglycemia and Exercise go to the ‘You life, Your Choice’ section of this websites.
Sick Day Management
Young people with well controlled diabetes are at no greater risk of getting sick with infections or illnesses than someone without diabetes. However, when you do get sick, much greater care and attention is necessary to ensure your diabetes does not become unstable.
An illness, even a simple cold or flu, can affect your diabetes control. When you get sick your blood glucose levels (BGL’s) rise because stress hormones are released in the body. These hormones also have an ‘anti-insulin’ effect, so the insulin you are taking doesn’t work as well. This is called insulin resistance.
If, during an illness, high blood glucose levels remain untreated, ketones will develop in your bloodstream. The presence of ketones increases the risk of developing diabetic ketoacidosis (DKA).
For more detailed information follow the link to the Queensland Government Diabetes Care Advance Websites Module 6: Sick Day Management
What is Diabetic Ketoacidosis (DKA)?
Ketoacidosis is a very serious illness that occurs when the blood glucose and blood ketone levels are high. Ketoacidosis always results in a hospital admission and if severe, can be life threatening. The good news is the DKA can be prevented if you follow the ‘sick day’ action plan below:
What to do if you are sick with high BGL’s?
If you are sick with BGL above 15mmol/L and have ketones in your blood or urine, you will need to take the following steps to prevent Diabetic Ketoacidosis (DKA):
- Contact a member of your diabetes team immediately
- If you are using a syringe or pen, you will need to take extra insulin. Usually the dose is 10-20% of the total daily dose as rapid (or short) acting insulin eg. Total daily dose = 50 units then give 5 to 10 units of rapid or short acting insulin.
- If on an insulin pump, you will need to give a correction bolus. You may need to also increase the dose of the bolus.
- You may need several extra insulin injections or several extra correction boluses (from your pump) during your illness' to lower the BGL and clear the ketones.
You are not expected to manage sick day episodes by yourself. Contact your diabetes doctor or educator for help.
For more detailed information follow the link to the Queensland Government Diabetes Care Advance Website Module 7: Diabetic Ketoacidosis
Diabetes Education Programs
Dose Adjustment For Normal Eating (DAFNE)
DAFNE stands for Dose Adjustment For Normal Eating and it refers to a particular approach to managing diabetes by working out how much insulin to give, based on what you want to eat.
“I already do that” I can hear you saying, but DAFNE gives you lots of skills and techniques to very accurately work out how much insulin you need, rather than just guessing. With DAFNE you can eat what you want, when you want providing you match the food with insulin.
Currently many centres around Australia are offering D.A.F.N.E training for people with Type 1 diabetes who are 17yrs and older. If you would like to know more click here to link to the OzDAFNE website www.dafne.org.au
References
- Ambler, G., Barron, V., May, C., Ambler, E., Cameron, F., Caring for Diabetes in Children and Adolescents – A Parent's Manual. Second Edition, 2001.
- Stillman, J., Lang, E., Grieve, C., (2003) Paediatric and Adolescent Diabetes Education Manual, For Health Professionals. Queensland Health, Queensland Government Publication. Module 5
- Silink, M., APEG Handbook on Childhood and Adolescent Diabetes. Australasian Paediatric Endocrine Group. Second Edition, 2004
