Living well with diabetes

WHAT IS DIABETES?


Diabetes is a complex condition and it is

NOT the same for every person.


Diabetes is when one of the important systems within the body no longer works properly. This is the system that moves glucose (which is produced from the carbohydrate food that we eat) out of the blood stream (by a hormone called insulin produced in the pancreas) and into the cells where it is needed and used for energy, thinking, healing, and just about everything else! Unfortunately, diabetes gets worse over time and there is no cure.

 

Pancreas

 

If Diabetes is not controlled, (if the blood glucose is too high too often) there is a risk of heart disease and heart attack, stroke, kidney problems, blindness, amputation, sexual problems, and other major complications.

However, it is absolutely possible to be in control of your diabetes.

Genetics plays a big part in the development of Type 2 diabetes, as well as lifestyle choices. You may have inherited a pancreas that cannot rise to the demand of having extra work placed upon it. Being overweight, and doing low amounts of exercise increase the work load on a pancreas.


 

DIABETES
There are a number of ways that the system may have gone wrong for you – below are the three most common ways, which often all go wrong and get worse at differentrates –

  1. A Failing Pancreas By the time a Type 2 diagnosis is made approximately 60% of the pancreatic beta cells (which produce insulin) no longer function.
  2. Insulin Resistance (Rusty Gates) Glucose is unable to get into the cells. There are lots  of things that can contribute to insulin resistance (including obesity, smoking, and pregnancy hormones).
  3. Liver  The liver produces too much glucose.

With the development of insulin resistance, the beta cells in the pancreas work harder to produce more insulin to overcome the resistance. They manage to achieve this reasonably well for 7 – 10 years. However, after this, they are no longer able to keep up. When they are no longer able to keep up, the gates no longer open easily, the
blood glucose rises and the person gets the diagnosis of diabetes.
With the blood glucose no longer able to enter the cells properly, the cells begin to “complain” as they are not
provided with the fuel they require. The cells without fuel send a message out to the liver which responds by
increasing its levels of glucose into the bloodstream – so the levels of glucose rise higher in the blood!
The lack of fuel to cells is often felt by people as - tiredness, depression, short term memory loss, poor
brain function, poor sleep or being too sleepy, being thirsty and going to the toilet often, blurred vision, urinary
and skin infections, slow healing...

 

 

THE BEST WAY TO MANAGE TYPE 2 DIABETES

NO. 1 GETTING ACTIVE, MAINTAINING A HEALTHY BODY WEIGHT AND BEING SMOKEFREE (to help get those rusty gates open)

Get A FREE Green Prescription from your GP for support and low cost exercise options. Contact QUITLINE for help with being Smokefree Ph 0800 778 778

NO. 2 EATING WELL (to manage blood glucose levels)

  • Choose foods low in fat, salt and sugar
  • Choose foods high in fibre such as vegetables and wholegrains
  • Learn about food – some foods affect your blood glucose levels more than others.

Make a FREE appointment with the diabetes dietitian at the Hawkes Bay Specialist Diabetes Service ph (06) 873 4806, no referral necessary

NO. 3 TAKING YOUR MEDICATION

Talk with your GP or Practice Nurse to make a Treatment Plan for you and YOUR diabetes.

Ask them to explain what your prescribed medications are for, why it is important that you take them, what to look for (side effects or desired results of medication).

Make sure your GP or Practice Nurse has talked with you about what to do with your medications if you are sick.
 

NO. 1 ALL EXERCISE IS GOOD

Frequent (daily if possible) exercise is one of the best ways to lower blood glucose levels. Exercise acts like insulin and allows your muscle cells to take up glucose from the blood. Your muscles start taking up glucose as soon as you start moving. This brings your blood glucose levels down and the effect can last for hours, providing long-term benefits for your body.

Getting active can also help you to lose weight. Even losing a few kilograms of body fat can make your body more sensitive to insulin, can improve your blood glucose levels, reduce the risk of diabetes issues and boost your energy levels.

Losing weight can possibly be the best thing you can do to manage your type 2 diabetes. It is recommended to  exercise for at least 30 minutes every day if possible, at a moderate intensity. Find something you enjoy and do it! – even  if you break that 30 minutes down to 3 x 10 minute bursts of energy if that is more manageable, it will still be beneficial!

Some Suggestions -

  • walking is a great form of exercise and is free and can be done at a time and place that suits, and  can be done on your own or with a friend or in a walking group (there are quite a few of these groups around Hawkes  Bay) 
  • swimming, water walking, water exercises 
  • group classes 
  • joining a Gym and doing classes or weights or curcuits 
  • tai chi, gentle exercises

Your GP / Practice Nurse can write you a “Green Prescription” and Sport Hawkes Bay  (0800 22 84 83) will support you with information, motivation, and low cost exercise classes.

 

  No. 2 MAKING HEALTHY FOOD CHOICES

1. Healthy eating is one of the corner-stones of looking after your diabetes. The Hawke’s Bay Specialist Diabetes Service offers a FREE dietitian service. Your doctor can refer you to the dietitian or you can contact the diabetes service directly if  you want to make an appointment with a dietitian. You can choose to have a one-to-one appointment or come to one of  the popular groups.

2. Try to have three regular meals a day and take your diabetes medication (if any) as prescribed. Some people
who use insulin or those with high energy needs may need to have snacks between meals – check with your doctor or nurse until you get individual advice from your dietitian.

3. Having snacks that you don’t need can make it more difficult to  control your weight. 4. Aim to follow the advice in the “Diabetes and Healthy Food Choices” booklet in this pack. 

  • Avoid  drinking sugar-sweetened drinks and fruit juice
  • Avoid eating foods high in sugar
  • Choose foods low in fat
  • Include whole grains and other foods high in fibre
  • Eat some carbohydrate food at each meal

 

The Diabetes NZ Healty Plate
 

Suggested meal plan for people with diabetes

People with diabetes do not need to buy special foods or cook separate meals

BREAKFAST

  • Cereal such as porridge, Weet-Bix, All Bran or Muesli with a piece of fresh fruit or stewed or tinned fruit without sugar. Low fat or trim milk. Low fat yoghurt, with a little artificial sweetener if needed
  • Bread or toast – choose wholegrain and high fibre – with a little margarine, peanut butter, avocado, Vegemite or Marmite, jam or honey, or an egg or baked beans
  • Water, tea, or coffee are the preferred drinks to have

LUNCH

  • Wholegrain bread or roll, or wholegrain, high fibre crackers such as Ryvita with small serving of lean meat, chicken, egg, fish or low fat cheese or cottage cheese and lots of salad or vegetables. Piece of fresh fruit Low fat quiche with salad or vegetables and a piece of fresh fruit
  • Tomato based soup or spaghetti or baked beans on toast
  • Low fat yoghurt with fresh fruit

DINNER

  • Small serving lean meat, fish or chicken – cook in small amount of vegetable oil, small serving of potato or kumara, large serving of vegetables or salad
  • Rice or pasta with vegetables or salad
  • Fresh or stewed or tinned fruit without sugar or diet jelly

SNACKS (if required)

  • Piece of fresh fruit, slice of wholegrain bread, fruit loaf or fruit bread, small scone or low fat fruit or bran muffin, crackers with low fat cottage cheese, or plain biscuits or an occasional small piece of plain cake, handful of nuts.

ARTIFICIAL SWEETENERS

Nutrasweet (Equal), Sucaryl and Splenda which can be used in hot drinks, baking and cooking. These are also used in “diet” products such as fizzy drinks, cordials, jellies etc.

 

 

SELF MANAGEMENT AND REGULAR CHECKUPS

You may have been given a hand held blood glucose meter, or you may like to request one from your GP, with the Pharmac changes you may have to pay for a meter and test strips.  Ask your GP.

Make sure you are shown when, why, and how to use your blood glucose meter correctly.  If unsure, Diabetes Hawke's Bay Inc. can help.

Click here for further information on blood glucose testing!

3 MONTHLY - Current Recommendation is that people with diabetes have an HbA1C blood test (this test measures the average blood glucose levels during the previous 2 – 3 months) every three months. This is important so you and your GP can track the control of your diabetes over time and prevent long-term complications that diabetes can cause including amputation, vision loss, heart failure, heart attack, and stroke.

 


Generally the lower the HbA1c the better. Talk   with your GP about YOUR ideal level. It is measured in mmol/L and 53 (the old measuring unit is 7%) is considered a  good level for most patients. If you are close to this level, heading towards it, or over it - talk with your GP.


Your regular  checkups will include checking your Cholesterol and Blood Pressure (BP). It is extremely important that your BP is kept in  a healthy range.

 

 

KNOW YOUR DIABETES!

Everyone is different, everyone’s disease will be different, with different parts of the system going wrong at different rates.

Find out about what is happening FOR YOU and why. Find out about the support that is offered.

There is your GP and  Practice Nurse for information and support and to work with you on YOUR Treatment Plan. You may benefit from a Care  Plus Support Package available at your GP. It is important to have your 3 monthly blood test and talk with your Nurse or Doctor about any concerns or anything you are not sure of.  Take a support person with you if you wish.


Find out what you can about diabetes – use the internet   www.diabetes.org.nz  

  www.healthnavigator.org.nz/health-topics/diabetes   - they have a great little 4 minute video


If you are on medication, or are about to go on medication, talk with your GP or Practice Nurse and ensure you know what  the medication does and how it works and what you can expect.

Give us a call – Diabetes Hawke's Bay Inc. (06)  8453912. We can talk with you about your lifestyle and look at areas you would like to make some changes, or fill in some  of those information gaps so you have a better understanding of your illness and how to manage it.

There is the  Hawkes Bay Specialist Diabetes Service. Specialist nurses, physicians, podiatrist, and dieticians are part of the team at  Villa 16 at the Hastings Hospital.  They also support people  of all ages with type 1 diabetes.

 

 

HOW DO I KNOW IF MY DIABETES IS UNDER CONTROL AND I AM MANAGING WELL?

 

  • You are feeling well
  • You are no longer having symptoms of high blood glucose levels, eg – tiredness, being thirsty and peeing a lot, sore or  tingling hands or feet, depression, short-term memory loss, poor brain function, poor sleep or being too sleepy
  • You are taking your prescribed medication
  • You are eating the foods and food combinations that look after your pancreas
  • You are exercising regularly and keeping a healthy weight for yourself
  • You and your GP are happy with your 3 monthly HbA1C and other blood test results

If you do not think you are managing well - talk with your GP or Practice Nurse – it may be that your diabetes is progressing and your medication needs to be increased or changed.

It is very important that YOUR diabetes is controlled to avoid irreversible and even deadly complications that will have a huge effect on you and your whanau / family.

 


IF YOU ARE NOT HAPPY WITH HOW YOUR DIABETES IS GOING, ASK YOUR GP FOR A REFERRAL TO EITHER OF OUR FREE SPECIALIST SERVICES

 

WHAT IS TYPE 1 DIABETES?

 

Type 1 diabetes is an “auto-immune” condition. The body sets up an attack against the cells within the pancreas that make a hormone called insulin. We don’t know why this happens. The auto-immune process happens over time. So, a person recently diagnosed with Type 1 diabetes will still have some insulin being produced in their body. But, over time their own insulin production becomes less and less, and finally most people with Type 1 are producing none of their own insulin.

 

Type 1 diabetes can occur at any age. Of all the people with diabetes about 10% of them have Type 1 diabetes.

 

Type 1 diabetes cannot be prevented and

currently there is no cure but it can be managed with insulin, healthy food choices and exercise

 

Insulin is essential for moving the glucose (which comes from our food) out of the bloodstream and into the cells of the body where it is needed for energy, healing, thinking, and just about everything!

If Diabetes is not controlled, (if the blood glucose is too high too often) there is an increased risk of heart disease and heart attack, stroke, kidney problems, blindness, amputation, sexual problems …

 

MANAGING TYPE 1 DIABETES

 

The aim is to keep the blood glucose level as close to normal as possible (4.0 – 8.0mmol/L). This reduces the risk of long-term damage and complications and increases the likelihood of living a long and healthy life. It also means that you will feel better on a day-to-day basis.

 

Insulin must be given by injection – it cannot be given as tablets because the acid in the stomach would destroy it.

 

When you start on insulin the pancreas is able to rest and there may be a small window of recovery when it will produce insulin. This is called the honeymoon period and less insulin is required at this time. Not everyone experiences a honeymoon period.

 

Insulin therapy is an essential part of the treatment – but healthy eating and physical activity also have a role in achieving a healthy, balanced lifestyle.

 

Your GP and Practice Nurse are there to support you and your family / whanau, and will assist you in the ongoing management of your diabetes.

 

NO. 1  INSULIN

 

Initially your GP will prescribe the dose and combination of insulin you will need. The dose will be adjusted until your blood glucose levels are within the recommended range.

 

As time goes on you will learn how to safely make your own insulin adjustments to fit in with

your daily routine, any illness and

changes in your lifestyle.

 

Self-testing your blood glucose levels is an important part of your diabetes management and allows you to monitor your blood glucose control and make adjustments to your insulin doses. It helps you to detect highs and lows and treat them appropriately. It also means you can adjust your insulin for physical activity and illness.

 

You will be given a blood glucose monitor and shown how and when to use it and how to use the results to keep well.

 

There are different types of insulins – short acting and ultra-short acting, and intermediate and long-acting insulin. Insulin also comes in pre-mixed combinations and your diabetes team will discuss the best regime with you.

 

It is normal to feel some anxiety at the thought of needing insulin and having to self-inject. Often people say they feel much more energetic on insulin and hadn’t realized how tired they were. They also say it is much easier than they had expected and not painful to inject.

 

Note - Insulin is not the only medication you may be on for your diabetes. There are a number of other medications that help you to be in control of your diabetes. If you are on other medication, ask your GP about them so you know what you are taking and why.

  WHAT TO DO IF YOUR BLOOD GLUCOSE IS TOO HIGH –  

 

Hyperglycaemia is the term for a blood glucose level that is too high (the healthy range is 4-8mmols/L). Nearly everyone with diabetes will have some readings above their target range. As long as this rise above your target is short-term (hours not days), you don’t need to worry. It will however be a good idea to try and work out why your level was higher than it should have been. Eg – eating more carbohydrate than usual, less physical activity, insulin dose too low, stress, infection, illness…

 

Your GP can teach you how to correct a

High with insulin

 

You may have some warning signs when your blood glucose levels are too high, such as, feeling thirsty, needing to pass urine often, tiredness, loss of energy, getting infections, having blurred eyesight, having a dry mouth. However, you may have no symptoms, so it is important to test your blood glucose as recommended with your moniter.

 

WHAT TO DO IF YOUR BLOOD GLUCOSE IS TOO LOW -

 

Hypoglycaemia is the term for a blood glucose level that is too low – under 4mmol/L. It is often called a hypo.

The main causes of hypos are: extra physical activity, missed meals, eating later than usual, drinking alcohol without food, not eating enough carbohydrate, taking too much insulin…

 

Symptoms usually occur when the blood glucose levels drop too far, including paleness, hunger, sweatiness, double vision, headache, weakness, anxiety, irritability, light headedness, confusion, dizziness, pins and needles around the lips and tongue.

 

It is important to treat a hypo immediately

 

Treat a hypo immediately, do not delay – take some glucose or something that is “sugary” to raise the blood glucose levels quickly.

 

Wait approximately 5-10 minutes. Test your blood glucose level. If it is below 4mmol/L or you still feel hypo – treat again with more glucose. Wait another 10-15 minutes then if your blood glucose is above 4mmol/L or you feel better, have a meal if it is due or a carbohydrate snack.

 

Discuss with your GP or Practice Nurse – Hypos are usually preventable and it is important for your health to avoid hypos as much as possible.

 

WHAT TO DO IF YOU ARE SICK –

 

Illnesses such as colds, flu, infections, vomiting or diarrhea may create special problems for people with diabetes, as illness can cause high blood glucose levels.

 

Test your blood glucose every 2-4 hours. If it is more than 15mmol/L on two consecutive tests, and/or you feel really unwell, then test your blood or urine for ketones. Make sure your diabetes team have explained about ketones and shown you how to do this test.

 

Know who to contact for advice when you are sick.

 

You may need more insulin when you are sick.

 

WHAT TO DO IF YOU ARE DRIVING

 

If your diabetes is well controlled you can drive a private care safely. However, there are times when you need to take precautions.

 

Check your blood glucose levels regularly. Treat any low blood glucose levels accordingly. Choose not to drive if you are unwell or tired. Always have meals and snacks before and during long journeys.

NO. 2  EXERCISE

 

Frequent (daily if possible) exercise can help to lower blood glucose levels. Exercise acts like insulin and allows your muscle cells to take up glucose from the blood. Your muscles start taking up glucose as soon as you start moving. This brings your blood glucose levels down and the effect can last for hours, providing long-term benefits for your body.

 

Because of these good effects, start any exercise programme slowly and monitor your blood glucose levels closely as you will need to reduce your insulin requirements so you don’t go too low.

 

Some Suggestions for being active / exercising -

 

  • walking is a great form of exercise and is free and can be done at a time and place that suits, and can be done on your own or with a friend or in a walking group (there are quite a few of these groups around Hawkes Bay)
  • swimming, water walking, water exercises
  • group classes
  • joining a Gym and doing classes or weights or curcuits
  • tai chi, gentle exercises

 

Your GP / Practice Nurse can write you a “Green Prescription” and Sport Hawkes Bay (0800 22 84 83) will support you with information, motivation, and low cost exercise classes.

No. 3 Healthy Eating

 

  1. Healthy eating is one of the corner-stones of looking after your diabetes. The Hawke’s Bay Specialist Diabetes Service offers a FREE dietitian service. Your doctor can refer you to the dietitian or you can contact the diabetes service directly if you want to make an appointment with a dietitian. You can choose to have a one-to-one appointment or come to one of the popular groups.

 

  • Avoid drinking sugar-sweetened drinks and fruit juice
  • Avoid eating foods high in sugar
  • Choose foods low in fat
  • Include whole grains and other foods high in fibre
  • Eat some carbohydrate food at each meal

 

 

SELF MANAGEMENT AND REGULAR CHECKUPS

 

You will have been given a hand held blood glucose meter. Make sure you are shown when, why, and how to use your blood glucose meter correctly.

 

3 MONTHLY - Current Recommendation is that people with diabetes have an HbA1C blood test (this test measures the average blood glucose levels during the previous 2 – 3 months) every three months. This is important so you and your GP can track the control of your diabetes over time and prevent long-term complications that diabetes can cause including amputation, vision loss, heart failure, heart attack, and stroke.

 

Talk with your GP about YOUR ideal HbA1C level. When you are on insulin, having an HbA1C that is too low can be a problem, as well as an HbA1C that is too high.

 

Your regular checkups will include checking your Cholesterol and Blood Pressure (BP). It is extremely important that your BP is kept in a healthy range.

 

HOW DO I KNOW IF MY DIABETES IS UNDER CONTROL AND I AM MANAGING WELL?

 

  • You are feeling well
  • Your blood glucose levels are in a safe range
  • You are no longer having symptoms of high blood glucose levels, eg – tiredness, being thirsty and peeing a lot, sore or tingling hands or feet, depression, short-term memory loss, poor brain function, poor sleep or being too sleepy
  • You are taking your insulin and any other prescribed medication
  • You are eating a healthy, balanced diet
  • You are exercising regularly and keeping a healthy weight for yourself
  • You and your GP are happy with your 3 monthly HbA1C and other blood test results

 

If you do not think you are managing well - talk with your GP or Practice Nurse.

 

It is very important that YOUR diabetes is controlled to avoid irreversible and even deadly complications that will have a huge effect on you and your whanau / family.

 

IF YOU ARE NOT HAPPY WITH HOW YOUR DIABETES IS GOING, ASK YOUR GP FOR A REFERRAL TO EITHER OF OUR FREE SPECIALIST SERVICES

 

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