|In 1993, a 10 year study called the Diabetes Control and Complications Trial was concluded. It showed that people who kept their blood sugars as close to normal as possible were less likely to develop long-term complications that involve the eyes, kidneys and nervous system.
Management is a Team Effort
In Canada alone there are about 1.4 million people who have diabetes. There are many healthcare professionals who specialize in diabetes and can help you to understand and better manage your diabetes. Management is a team effort.
The team is:
- Your Doctor
- Your Diabetes Educators (nurses, dieticians, pharmacists etc.)
- Doctors with special training in eyes, diabetes, feet of diabetics etc.
Learning about diabetes is lifelong, so keep in touch with your team!
Feelings About Diabetes
People react differently to things that happen to them. Most people go through a range of feelings while they try to adjust to having diabetes. Suddenly you have to watch what you eat and you may have to change your eating habits. You might have to take pills, give yourself a needle and prick your finger for glucose monitoring. The first thing to remember is that learning to live with diabetes is lifelong.
What is Diabetes?
Diabetes is a condition in which the body cannot properly use the energy from the food you eat. When you eat food, it is broken down into a form of sugar called glucose. Glucose is the body's main fuel. This sugar (glucose) enters the blood and goes to the cells where it is used as energy.
Insulin is made by an organ in the body called the pancreas. Insulin is needed to help sugar leave the blood stream and enter the body cells. When your body cannot properly use the insulin it makes, you develop diabetes. Either way, sugar stays in the blood and your body cells do not get the fuel they need to make energy.
There are three types of diabetes
Type 1 Diabetes
Most people who develop type I diabetes are less than 30 years old and are usually diagnosed as a child. In type I diabetes, your body makes little or no insulin. When this happens, sugar cannot get into the cells for energy and stays in the blood. No one really knows what causes type I diabetes. However doctors believe that the following may somehow be linked to diabetes: Viruses (may damage your pancreas), Auto-immune response (your body's defence system may attack your insulin making cells by mistake, Stress (illness or injury)
Type 2 Diabetes
This is the most common type of diabetes. About 90% of the people who have diabetes have type II. In type II you still make your own insulin, but your body cannot use it properly. No one knows the exact cause of type II diabetes, but it is likely to occur in people who: are over 40 years of age, are overweight, have a family history of diabetes, have had gestational diabetes during pregnancy.
This is a type of diabetes that happens only to some women who are pregnant. The diabetes usually disappears after the baby is born. About half of the women who develop gestational diabetes will develop type II diabetes later on.
How to look after your diabetes
The tools that help you look after your diabetes include: education, meal planning, exercise, insulin, pills and how to cope with stress. The person who should know the most about your diabetes is you!
Education: learning about diabetes is lifelong. People learn in different ways. Find out how you learn best. There is help available, get involved and join the Canadian Diabetes Association. Our local hospital has a two day diabetic education program which most patients find excellent, and this website has many useful resources for diabetic education.
Meal Planning: healthy eating means eating well-balanced meals. This means eating a variety of food each day. Be sure to have three out of the four key food groups: Starch (bread, potatoes, rice, pasta etc.), Fruits & Vegetables (oranges, bananas, carrots, peas etc.), Milk (milk, yoghurt, Protein (lean meats, poultry, fish eggs, low fat cheese). You will most likely be referred to the dietitian for assistance with your meal planning.
Alcohol & Diabetes: drinking alcohol and not eating may cause you to have low blood sugar, alcohol has calories, some alcoholic beverages such as sweet wines and liqueurs have more sugar than dry wines. If you plan on drinking alcohol make sure you know how alcohol affects your blood sugar, choose a sugar-free mix for mixed drinks, have something to eat with your drink or have a drink after you have eaten, wear something that says you have diabetes, check your blood sugar before going to bed and have a snack if necessary.
Exercise: exercise makes you feel good, look better and be more fit. Exercise is a good way to help keep your blood sugars under control. Food makes blood sugar go up. Exercise makes your blood sugar go down. It also increases muscle tone, increases strength, improves circulation, lowers stress, improves how you feel about yourself and helps you achieve and maintain a healthy body weight.
Treatment of Diabetes
Diet & Exercise: for your diabetes you may only need proper meal planning and exercise to control your blood sugars.
Insulin: today, insulin is made in a laboratory and is like the insulin your body makes. It is called human insulin.
Pills: people with type 2 diabetes still make some insulin, but either their cells reject the insulin or their bodies do not make enough insulin. For these people there are pills which can help the body make more insulin or make better use of the insulin. These pills are called oral hypoglycemic agents. These pills are not insulin. There are different types of pills - some help the body to release more insulin from the pancreas and some help the body make better use of its insulin, for example Diabeta (glyburide), Diamicron (gliclazide), Glucophage (metformin). Some pills can cause low blood sugar. The one pill which does not seem to cause low blood sugars is Glucophage (metformin). It is important to follow your doctor's directions so your pill(s) and/or insulin will work best for you.
Blood glucose monitoring is one way you can find out the level of your glucose. Meter testing is using a blood glucose monitor, a special test strip and a small drop of blood. People test their blood sugar at different times for different reasons. You and your doctor will decide how often you should test. It is important to keep records of your blood sugar tests. Some glucose meters have the ability to download into a computer but you are encouraged even with these meters to keep a written record as your meter could be misplaced, computer could fail etc.
Blood glucose monitoring helps you look after your diabetes!
Tests Your Doctor Will Do
Glycosylated Hemoglobin or it may be referred to as your Hemoglobin A1c. Sugar is "sticky" and it sticks to proteins in your body. One of the body proteins sugar sticks to is hemoglobin, the part of the red blood cell that carries oxygen through the blood. A red blood cell travels in the blood for about 3 months. During that time, the cell picks up sugar from the blood. If your blood sugar is high during that time, the red blood cell will have a large amount of sugar on it. The Hemoglobin A1c test measures the amount of sugar that is on the red blood cells. The result tells what your average blood sugar has been during the past 3 months. This test is done at the doctor's office or laboratory and is done usually every 3 months.
24 Hour Urine Tests: Every 3 months you will have a urine test done at the doctor's for things such as protein. If your kidneys have been damaged by your diabetes, things such as proteins are found in the urine. A 24 hour urine test will show how much protein is lost and to what extent the diabetes has affected your kidneys.
Problems can occur after you have had diabetes for a long period of time. Research has found that the better you control your diabetes now, the less likely it is that you will develop problems. Potential problems include damage to small and large vessels, damage to nerves and more frequent infections. These complications can damage your eyes, kidneys, nerves, heart and the gums in your mouth.
Small Blood Vessel Problems: when your blood sugars stay too high for a long time, your small blood vessels may be harmed. This can cause problems with your eyes and kidneys. It can also cause problems with blood circulation to your feet and skin. High levels of sugar in your blood make it harder for the red blood cells to squeeze into very small blood vessels in your body. Sugar also makes the walls of your blood vessels less strong. When the red blood cells try to squeeze into the small blood vessels, they damage the vessels even more. This can make your blood vessels so weak they burst. If this happens, your eyes may be harmed and further problems, if not detected or treated, can lead to blindness (Diabetic Retinopathy). Your kidneys may also be damaged (Diabetic Nephropathy) and, if not looked after, may end up not working at all.
Large Blood Vessel Problems: high blood sugar can also damage your large vessels. This can cause heart attacks, strokes, high blood pressure and poor circulation to your arms and legs. As your red blood cells stiffen because of high sugar levels, they damage the inside of your blood vessel walls. Scars form inside these vessels. Your large blood vessels eventually become stiff, hard and thick. If this happens, your heart has to work harder to get the blood to all areas of your body.
Problems With Your Nerves (Diabetic Neuropathy): the nerve cells in your body can also be harmed when your blood sugar is too high. Body cells swell and scar, making the nerves unable to send signals properly. This can result in numbness in your feet and lower legs. This means that you cannot feel cuts, bruises or other injuries to your feet. Taking proper care of your feet and your diabetes will help prevent these problems. Nerve damage can also occur in other parts of your body. Your stomach may have a delay in emptying after eating, you may get diarrhea more often, your bladder may not empty completely causing bladder infections, men have difficulty getting an erection and your blood pressure may drop when you stand causing dizziness or fainting.
Frequent Infections: if your blood circulation becomes poor because of high blood sugar, you can get more frequent infections in your mouth, on your feet, or whenever you cut or scrape yourself. In your mouth, gum disease can develop. When this happens your gums may be damaged and your teeth may become loose. If your nerves are damaged, you may not know you have hurt your feet. Infection can then occur. If you have poor circulation, it may be more difficult to heal your infection. This may result in gangrene and the dead tissue may have to be cut away (amputated).
The most important way to stop or reduce these problems is to follow your diabetes management plan, keep your blood sugars under good control, take your insulin or pills, lower your cholesterol by eating less fatty foods, have your blood pressure checked regularly, stop smoking, know the early signs for these complications, see your doctor and diabetes educator regularly and have your eyes checked by an ophthalmologist (eye doctor) every year.
What causes problems in the diabetic foot?
Diabetics have an increased risk of developing serious foot problems for the following reasons:
- Changes or disturbances to the sensory nerves that affect the feeling in your feet or to motor nerves that can result in muscle weakness
- Worsening of the circulation in your feet
- Increased risk of infections
- Difficulty in healing
Very often, small injuries such as scratches can progress to ulcers of the foot and worsen, causing gangrene. Gangrene often requires foot amputation, which is a devastating complication.
How can amputation be avoided?
- Inspect your feet every day for changes in the skin colour, swelling, blisters, cracks, calluses, ulcers and rashes, particularly between the toes. Check the bottom of your feet using a mirror. If your vision is impaired ask a family member for help with these inspections. Notify your doctor if you develop calluses, blisters or sores.
- Inspect your shoes before wearing them; be sure they are empty and smooth inside. Shoes should be comfortable and made of leather uppers, rubber soles and removable insoles.
- Wash feet daily; avoid high temperatures of water and always test the water with your hand or elbow before bathing. Dry your feet carefully, especially between the toes. If you have dry skin, use good lubricating cream or oil. Do not put cream between the toes.
- Wear properly fitted stockings and change them daily; avoid stockings with seams. Do not wear shoes without stockings. In the winter, wear wool socks and protective footgear.
- Learn proper nail care. Cut nails straight across. Do not cult corns or calluses. Do not use chemical agents or corn plasters for the treatment of corns or calluses. Do not use strong antiseptic solutions or any adhesive tape on your feet.
- Avoid hot surfaces like sand or cement; do not walk barefooted. Do not apply hot water bottles or heating pads or soak your feet in hot water if they feel cold.
- Avoid crossing your legs, as this can cause pressure on the nerves and blood vessels.
- Notify your podiatrist that you are a diabetic.
By following these recommendations, and being under the close supervision of your physician, you can be satisfied with your feet for a lifetime.
Low Blood Sugar (Hypoglycemia)
Taking too much insulin, missing a meal, exercising too hard without taking necessary precautions may make your blood sugar go too low (below 3.5 mmol/L). When this happens, you are experiencing what is called "hypoglycemia", an "insulin reaction", or "low blood sugar". Low blood sugars can happen quickly. It is very important that you take care of them right away.
Signs of mild hypoglycemia
- Feeling hungry
- Feeling shaky or light-headed
- Feeling nervous or irritable
- Cold sweats
- Feeling weak
- Your heart beats faster
- Feeling confused
- Numbness or tingling in your tongue or lips
Signs of moderate hypoglycemia
Feeling unusually sleepy, not able to see clearly, feeling or acting angry or sad for no reason, acting as though you were intoxicated
Signs of severe hypoglycemia
Seizures, unconsciousness. Seek medical attention immediately.
How to treat low blood sugar
When you have one or more of these signs you should:
- test your blood sugar.
- eat or drink a fast-acting sugar such as 4 oz. of orange juice, a tablespoon of honey or 4-6 "Life Savers".
- wait 10 minutes, then test your blood sugar again.
The common problem here is that instead of waiting 10 minutes and checking their glucose, patients keep eating sugar and then end up with a blood sugar that is extremely elevated.
If it is still low:
- eat or drink a fast-acting sugar again.
- if your next meal is more than 1/2 hour away, eat a snack such as 1/2 a sandwich or cheese and crackers. If your blood sugar gets so low that you pass out or can't swallow, you will need Glucagon.
Remember to always carry fast-acting sugar, and always carry something that says you have diabetes.
Glucagon is a substance that makes your blood sugar go up very fast. It can be injected just like insulin. If you need glucagon, someone else will have to give it to you. Your family, friends or co-workers can learn how and when to give glucagon.
High Blood Sugar (Hyperglycemia)
High blood sugar is when your blood sugar is high and stays high. High blood sugar feelings usually come on slowly.
Warning signs of hypoglycemia
- Going to the bathroom a lot
- Poor healing of sores or infections
- Dry itchy skin
- Blurred vision
Some people may not feel different with high blood sugar. It is important to test your blood sugar often.
Do not ignore high bloods sugars, it may lead to serious problems.
Being sick is not fun for anyone. It can be more of a problem because you have diabetes. Stress makes your blood sugar go up. Being sick is stressful. There are some general rules to follow when you are sick.
- Always take your insulin or pills, even if you cannot eat.
- Test your blood sugar often (every 2 to 4 hours).
- Call your doctor if you have high blood sugar.
- Rest as much as you can.
- Drink plenty of fluids. If you are not able to eat or drink fluids that contain sugar call the doctor.
- If you are vomiting and cannot keep fluids or food down, call you doctor.
- Talk to your doctor or diabetes educators to make a sick-day plan before you get sick.
- Take extra insulin or pills with you. Your type of insulin or pills may not be available in some countries.
- Keep all insulin or pills in hand-carried bags in case your bags are lost by airline etc.
- Talk to your doctor if you are travelling in different time zones, you may have to make some changes to the way you take your insulin or pills.
- Test and record your blood sugar while travelling. This is the best way to tell how your new routine is affecting your diabetes control.
- Always carry something that says you have diabetes. Always carry candy or fast-acting sugar.