Sweet - Your life, Your choice

Alcohol and Drugs

Alcohol Consumption

It is against the law to drink alcohol if you are under 18 years of age. If you are over 18 years and you drink alcohol and you have diabetes then you need to know the following information:

alcohol, particularly sweet alcohol drinks can initially raise the blood glucose levels and later cause them to fall
alcohol may inhibit glucose release from the liver, increasing the risk of a ‘hypo’
alcohol can mask the early symptoms of a hypoglycaemia
alcohol can lead to confusion which may affect your ability to manage a ‘hypo’ and may cause you to forget to take your insulin
your friends and others can mistake the signs of a severe ‘hypo’ (reduced level of consciousness) with being drunk and leave you to “sleep it off”.

Tips on Preventing Problems with your Diabetes

Hangovers

If you are feeling ‘sick’ or you are vomiting and can’t eat, you still need insulin. Insulin must never be stopped. Make sure you know your ‘sick day’ plan.
If you want to go back to sleep after having your insulin, set an alarm (on your mobile phone) so you will be woken in 2 hours to do another BGL.
If vomiting continues, see a doctor or go to the emergency room at the local hospital.

Note: If you are ‘hung over’ and can’t eat anything then you may need to take less insulin. However, never stop your insulin. Make sure you take your BGL’s frequently so you know what’s happening with your diabetes. Start your ‘sick day’ plan and check for ketones if your BGL is above 15 mmol/L.

Alcohol and Sex

Alcohol impairs your thinking and your judgement and some people are more likely to engage in unsafe sex when they have been drinking. Be aware that getting drunk can increase the risk for girls being ‘date’ raped.

Drug Taking

Taking drugs even if it is only occasionally, can affect you making decisions about your diabetes as well as increase your risk of developing mental health problems. Most recreation drugs alter mood, perception and thinking ability which can lead you to forgetting to take your insulin or ignoring ‘hypo’s’. Some drugs make you feel like you don’t want to eat which can lead to hypoglycaemia.

Marijuana is different as it may cause you to get the ‘munchies’ and really over-eat causing high BGL’s. It may also stop you from feeling ‘sick’ and stop you from vomiting which can disguise the early symptoms of diabetic ketoacidosis (DKA). DKA can make you really sick and in some cases be life threatening. Remember to check your BGL and if it is over 15 check for ketones.

For more information check out these websites:

The National Drug and Alcohol Research Centre | www.ndarc.med.unsw.edu.au/ndarc.nsf
Children, Youth & Women's Health | www.cyh.com.au
Australian National Council on Drugs (ANCD) | www.ancd.org.au
Reachout | www.reachout.com.au
Reality Check | www.realitycheck.org.au
Diabetes Australia NSW | www.diabeteskidsandteens.com.au

This is your life and you need to make the right choices for you and not be pressured into anything that does not feel right. It’s OK to say NO.

Driving, Diabetes & You

Research shows that people with diabetes don’t have more car accidents than anyone else. That’s good news! But there are a few things you will need to know about driving and having diabetes.

Medical Conditions and Medications

New laws came into effect in Queeesland on 1 March 2006, commonly known as 'Jet's Law', introducing a mandatory requirement for driver licence holders to report any long term or permanent medical conditions to Queensland Transport that may affect their ability to drive safely.

Diabetes is one of those medical conditions that Queensland Transport requires us to report (along with heart and lung conditions, arthritis etc). Diabetes has the potential to impact on your ability to drive safely particularly if it is poorly controlled. Your doctor will need to provide a certificate or medical report stating your fitness to drive.

Remember your doctor can only give you a favorable medical report if your diabetes is under control.

Reporting Forms

A number of reporting forms to help streamline the process for informing Queensland Transport of a medical condition have been developed and are available on their website at www.transport.qld.gov.au

Applying for a Learner licence

The first step you need to take before learning to drive a vehicle is to obtain a learner licence for that class of vehicle.

To apply for a learner licence you must...

The links to Queensland Transport will give you all the information you need to apply for a learner licence

Applying for a Driver's licence

The Queensland Government has introduced a graduated licensing system to reduce fatalities on our roads - particularly among young drivers. The aim of the system is to encourage safer and more proficient drivers and riders.

Obtaining an open driver licence in Queensland.

Driving and Hypo's

Having diabetes means that hypoglycaemia (low BGL’s) can occur at any time which means it could happen while you are driving. It is important to have a good knowledge about your hypo’s including being able to recognise your usual hypo symptoms.

It is a good idea to always test your BGL before starting your car. It is also a good idea to carry some ‘hypo’ food with you in your car.

Drink Driving and Drug Taking

It is against the law to drink alcohol and take drugs while driving. The effects of alcohol and drugs can affect your decision making and you are more likely to take risks which could lead to you having a car accident.

Remember, if you plan on drinking or taking drugs - don't drive
Arrange for one of your friends (who is not drinking or taking drugs) to be the designated driver or catch a taxi home
If you are taking insulin and drinking you are at risk of having a delayed ‘hypo’

Staying Safe while Driving

Always check your BSL before starting off
Keep some 'hypo' food in the car - who cares if the can of softdrink is hot? It's better than nothing!
Never drink alcohol and drive
Never take drugs and drive
Remember to buckle up!

Resources

Web: www.transport.qld.gov.au

Maps: The RACQ has developed maps for learner drivers to ensure they gain a range of experience while learning to drive. By following the routes on these maps you will practice different skills and experience a variety of driving situations.

Handbooks: Handbooks for learner drivers are also available from Queensland Transport Driver Centres around the State and in downloadbale PDF format from the website.

Insulin Pump Therapy

Insulin pump therapy is simply another way to receive insulin. Instead of taking injections of insulin (sometimes up to 4 or 5 each day), insulin can be given by a small electronic device called a ‘pump’. The pump is filled with insulin and is connected to the body by a thin plastic tube which is connected to a needle. This needle stays in for about 3 days at a time.

How it Works

The pump delivers a small dose of insulin all the time (called a 'basal' rate which is preset) and then it delivers a bigger dose or ‘bolus’ to match each serve of carbohydrate that is eaten throughout the day. The user needs to enter information into the pump, like how much carbohydrate they are eating or drinking as well as their BGL’s. Some pumps can then work out how much insulin is needed to cover the meal or snack. The user then needs to direct the pump to administer the insulin.

What they Look Like

An insulin pump looks a bit like a mobile phone or a doctor’s beeper and they come in all sorts of colors. Most people wear them on their belt or in a pocket. Some girls wear them in their bra or strapped to their leg and use a remote control device to give a bolus of insulin. You can disconnect the pump to have a shower, swim or play contact sports (e.g. football) but shouldn’t have it off for longer than 1 hour.

What do they Cost?

Insulin pumps have been around for a long time and have been particularly popular in America. In the past 5 years insulin pumps have become more popular in Australia but they are still a bit expensive.

An insulin pump usually costs between $5000 and $8000. In 2006 the pump consumables (the disposable bits that connect from the pump to you) became available on the NDSS which meant the cost of disposables went down from approximately $200 per month to $25 per month.

If you have private health cover you may be covered for the cost of the pump. You will need to check with your health insurance company to find out what you are covered for.

Advantages of Pump Therapy

Using an insulin pump means:

eliminating individual insulin injections
delivering insulin more accurately than injections
Improving HbA1_c levels
fewer swings in blood glucose levels
diabetes management is easier – if your glucose level is high or you feel like eating extra ‘carbs’, figure out how much insulin you need and push the button on the pump to deliver more insulin
more flexibility around when and what you eat
improving your quality of life
reducing severe ‘hypo’s’
reducing unpredictable effects of intermediate or long-acting insulin
reducing the need to eat large amounts of carbohydrate when exercising

Disadvantages of Pump Therapy

Although there are many good reasons as to why using an insulin pump can be an advantage, there are also some disadvantages:

Can cause weight gain
Can cause diabetic ketoacidosis (DKA) if your catheter (tube) blocks or comes out and you don’t get insulin for hours
Can be expensive
Can be bothersome since you are attached to the pump most of the time
Can require a hospital stay or maybe a full day in the outpatient center to be trained

Even though using an insulin pump has disadvantages, most pump users agree the advantages outweigh the disadvantages.

For more information talk to your diabetes doctor or educator or have a look at the following websites:

www.medtronic-diabetes.com.au

www.cozmore.com

www.diabetes.org/type-1-diabetes/insulin-pumps.jsp

Hypoglycaemia & Exercise

Exercise is really important for everyone whether they have diabetes or not. It is essential for physical fitness and is a good way of maintaining a healthy weight. Regular exercise helps insulin work more effectively and may even reduce the amount of insulin that you need. However, exercise can cause the blood glucose level to fall and cause a 'hypo'. There are 2 ways you can avoid 'hypo's' which are related to exercise:

Eat extra carbohydrate (CHO) to cover the exercise
Reduce your insulin dose that is working at the time that you are exercising. You may also need to reduce the insulin dose which is given before bed particularly after a big exercise day.

A lot of people exercise as a way of keeping in shape, so the last thing they want to do is eat a whole lot of extra CHO to avoid 'hypos'! If you are unsure of which insulin to reduce or by how much, speak to your diabetes educator.

Tips to help prevent 'hypo's' when exercising

Have some quick-acting carbohydrate (CHO) drinks such as fruit juice, cordial or ordinary soft drink available when exercising.
It is a good idea to check your BGL before and after exercise so you get to know how much your BGL is likely to change with different types of exercise. Where performance is really important or if the exercise is prolonged, also check your BGL during exercise eg. at half time
You can either take extra CHO before exercise or reduce your dose of insulin. Even if you have reduced your dose of insulin, if the exercise is prolonged you may still need to take some CHO during the exercise e.g. marathon, iron man competition.
It is a good idea to take a blood glucose level (BGL) before bed on days when you have done lots of exercise. Exercise can continue to lower your BGL hours after the exercise has stopped. You may need to reduce your 'before bed' dose of insulin to prevent a hypo during the night.
If you are involved in exercise at a time when you are usually resting (e.g. evening karate class or even a dance), either take less insulin or take some extra carbohydrate.
For endurance sports like marathons or triathlons you may find sports drinks useful (providing they contain adequate glucose). You will need to discuss this with your dietician.

Remember! Always carry some 'hypo' food with you

For more detailed information about hypoglycaemia, go to the Queensland Government's Diabetes Care Advance website module 5 – Hypoglycaemia.

Travel & Diabetes

Having diabetes doesn’t mean you can’t travel. Planning is the key to a having a great trip.

It is a good idea to make an appointment with your diabetes doctor and educator around 4 – 6 weeks before you leave. You will need to get a letter from your doctor containing your medical history. This can be given to a doctor if you need to seek medical attention while you are away. You also need to develop a ‘plan’ for looking after your diabetes during the trip.

If traveling by air you will also need a doctor’s letter to carry with your medications in case you are asked to produce ‘proof of need’ for your medications and supplies. Your National Diabetes Services Scheme (NDSS) card can also be used as ‘proof of need’.

Your ‘plan’ will need to take into account the following situations:

the length of the journey
the possibility of delays
the timing between insulin injections and meals
the availability of carbohydrate foods
access to medical services and diabetes supplies
changes in your usual diet
changes in activity levels
changes in meal and sleep routines (especially when crossing time zones)
a plan for managing illness when away from home.

Overseas Travel

From the 31 st of July, 2007 new regulations were introduced regarding restrictions of carry on items such as liquids, aerosols and gels on board flights in and out of Australia. These new rules also apply when transiting on international flights within Australia.

Prescription Medications and Medical Devices

Prescription medicines (e.g. insulin) and prescribed medical devices (e.g. Blood Glucose Monitor) are allowed to be taken in your carry-on baggage. As stated earlier you must provide ‘proof of need’ for these items. Either a doctor’s letter or NDSS card can be used for this.

Non-prescription medications

For non-prescription medications (e.g. Panadol) you may only take on board the amount you will require for the flight.

Taking Medications through the Security Check

Ensure you have your medications sealed in a 20 X 20 cm clear plastic zip-lock bag. When you are about to go through the security check tell the security officer that you are carrying medications. The plastic bag containing your medications should be removed from your hand luggage and placed separately on the X-ray conveyer belt. Keep your doctor’s letter with your medications as you may be asked to produce evidence that your medications are essential.

The name on the label of the medications must match the name on your boarding pass. Some airlines suggest that you also travel with copies of your prescriptions as well. Before traveling contact the airline you are traveling on to see if they have any other requirements.

For more detailed information regarding carry-on luggage go to the Australian Government – Department of Transport and Regional Service website.

Developing an ‘Plan’ for Managing Your Diabetes During the Flight

Your diabetes educator will be happy to assist you in developing a ‘plan’ for your flight (as well as for the rest of your trip). To assist with this it is a good idea to get a copy of the ‘flight’ plan which contains the departure and arrival dates and times. Airlines can also give approximate times and the number of meals that will be served during the flight. They can even provide you with a meal menu if needed.

Adjustment to insulin doses for the flight can be managed in several ways but will depend on the time of departure and the duration of the flight e.g. if going to New Zealand which is a 4 hour flight, you probably don’t need to make any changes to your usual insulin routine.

Insulin adjustment on long flights

The following suggestions apply to young people who are on 2 to 4 injections of insulin a day:

Keep your watch on the time of the place of departure (origin) and keep to the usual routine e.g. if on two injection per day eat at approximately same times as usual. You may need to carry some extra carbohydrate to make this possible.
If taking 4 injections a day, give pre-meal rapid/short-acting insulin during the flight
Give the intermediate/long-acting insulin as the passengers are settling for sleep.
Once you have arrived at your destination then give insulin and food according to the local time.

Traveling with an insulin pump

Having an insulin pump can make glucose control easier when you travel. You can adjust boluses for meals that come at odd hours or are larger or smaller than usual. If you don’t want to eat a meal then you just don’t give a meal bolus. You can also make adjustments for your lack of activity/exercise during the flight. If you usually have multiple basal rates you may wish to use a temporary basal rate during the flight. You need to discuss the various options with your doctor or educator before you go.

Some More Tips for Traveling

Diabetes Supplies

Diabetes Supplies (on an insulin pump)