UNDERSTANDING DIABETES

Type 1 diabetes (sometimes called juvenile diabetes) can occur at any age, but it is most often seen in children and young adults. With type 1 diabetes, your body makes little or no insulin.

A management plan for type 1 diabetes includes taking insulin as prescribed, eating a well balanced diet, staying physically active and testing your blood sugar levels regularly.

Type 2 diabetes is the most common form of diabetes. About 90% of people with diabetes have type 2. Type 2 diabetes usually happens as people age, but it has become more common in younger adults and children.

In type 2 diabetes, your body produces too little insulin or your cells become resistant to the insulin it does produce, so it does not do its job as well.

A treatment plan for type 2 diabetes includes eating a balanced diet, being physically active, managing stress, controlling blood pressure, taking medication as prescribed (if prescribed), and testing your blood sugar regularly.

Gestational diabetes (GD) is high blood glucose that occurs in pregnant women who have not had diabetes before. About 5% of pregnant women develop gestational diabetes, usually around the 24th week of pregnancy when the body produces large amounts of hormones to help the baby grow. These hormones cause insulin resistance. If the body can’t produce insulin to compensate, blood glucose levels will get too high. GD must be treated to reduce the risk of problems for both mom and baby.

Moms with GD are at increased risk for:

• Urinary tract infections because bacteria grows better when blood glucose is high
• Caesarean section
• Pre-eclampsia – a serious condition resulting in high blood pressure, protein in the urine, swollen face, hands, and feet, and greater weight gain
• Polyhydramnios – or too much amniotic fluid, which can cause the baby to be born too early

Women with GD are also at increased risk of developing type 2 diabetes later on in life. In fact, as many as 30% of women who have had GD will go on to develop type 2 diabetes within 15 years.

When a woman has GD, her baby is also at risk for health issues. Although typically not serious, these include:

• Macrosomia (larger than normal baby) - because extra insulin and glucose make the child grow bigger and fatter than normal. This can also make it difficult for mom to deliver the baby vaginally.
• Hypoglycemia (low blood glucose) - after delivery, extra insulin can cause the baby's blood glucose to drop too low, putting him or her at risk for complications of hypoglycemia.
• Jaundice of the newborn - a condition that makes a newborn's skin appear yellow. Before delivery, the baby makes extra red blood cells. After delivery, the baby's liver breaks down and disposes of the extra cells, leaving a waste product called bilirubin. Too much bilirubin causes the skin and whites of the eyes to turn yellow.

Fortunately, managing blood glucose levels can help prevent some of the health risks associated with gestational diabetes. Treatment of GD includes eating a balanced diet, being physically active, managing stress, controlling blood pressure, possibly taking insulin, and testing blood sugar regularly.

Recognizing the symptoms of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) and knowing what to do should they occur is important for people living with diabetes.

Hypoglycemia occurs when blood sugar is too low. It is not always easy to tell if you have hypoglycemia. The best way to check is by testing your blood glucose with your CONTOUR^®NEXT meter. Your blood glucose reading will usually be below 4 mmol/L and you may experience:

• Anxiety
• Confusion
• Difficulty concentrating
• Difficulty speaking
• Dizziness
• Drowsiness
• Headache
• Hunger
• Mood changes
• Nausea
• Palpitations (rapid or irregular heart beat)
• Sweating
• Tingling
• Trembling
• Vision changes
• Weakness

Sometimes there are no symptoms.

Treatment for hypoglycemia depends on how low your blood glucose is.

Hypoglycemia is usually considered mild to moderate when:

• You have symptoms,
• Your blood glucose is less than 4.0 mmol/L, and
• You can treat yourself.

Remember: The ONLY way to know your blood glucose value is to test your blood with your blood glucose meter.

Treatment for mild to moderate hypoglycemia

Remember the 15:15 rule:

• Eat 15 g of carbohydrates. Retest in 15 minutes.
• If after 15 minutes, your blood glucose is still less than 4.0 mmol/L, retreat with another 15 g of carbohydrates.

Once the hypoglycemia has been reversed, prevent repeated hypoglycemia by:

• Eating your usual meal or snack that is due at that time of the day.
• If your usual meal is more than 1 hour away, eat a snack (including 15 g of carbohydrates and a protein).

• 15 g of glucose in the form of glucose tablets
• 15 mL (3 tsp or 3 packets) of table sugar dissolved in water
• 175 mL (3/4 cup) of juice or a regular soft drink
• 6 Life Savers® (1 Life Saver® = 2.5 g of carbohydrates)
• 15 mL (1 tbsp) honey

*** Always tell your healthcare team about all episodes of hypoglycemia. ***

Hypoglycemia is usually considered severe if:

• Blood glucose is less than <2.8 mmol/L
• Help is needed from another person
• You go unconscious

Remember: The ONLY way to know your blood glucose value is to test your blood with your blood glucose meter.

Treatment for severe hypoglycemia

Severe hypoglycemia is a medical emergency.

If you are conscious:

• Eat 20 g of carbohydrates, preferably as glucose gel or tablets
• Retest in 15 minutes, and if your blood glucose is still less than 4.0 mmol/L, retreat with another 15 g of glucose

If you are unconscious:

• Someone must call 911
• You must be given an injection of 1 mg of glucagon (if you are on insulin, ask your physician for a prescription for glucagon and teach your family, co-workers and support people how to use it)

Tell your healthcare team as soon as possible about any episodes of severe hypoglycemia.

Recurring hypoglycemia

If hypoglycemia tends to be a recurring problem, talk to your healthcare professional. You may need your treatment adjusted, or you may need to revisit your meal plan or exercise routine.

Hyperglycemia is the opposite of hypoglycemia. Hyperglycemia occurs when there is too much sugar in the blood. Usually, this means a fasting blood glucose reading at or above 11 mmol/L.

If your blood glucose values are too high, some possible causes might be:

• Exercising less than usual
• Eating more than usual
• Taking diabetes medications and/or insulin at the wrong time
• Forgetting to take diabetes medications and/or insulin
• Needing a different dose of your diabetes medications and/or insulin (never change any medication dose without seeing your physician)
• Needing different diabetes medications and/or insulin
• Sickness (such as a cold, or flu or infection)
• Stress

Keeping track of your blood glucose values can help you and your healthcare team figure out when and why you are having hyperglycemia. Your healthcare team can help you make the changes you need to keep your blood glucose values at target.

Some common signs of hyperglycemia are:

• Sugar in your urine (pee)
• Needing to urinate (pee) more often than usual
• Feeling thirstier than usual

BUT… many people have NO symptoms. The only way to actually know if you have hyperglycemia is to test your blood with your blood glucose meter.