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Starting Insulin: Type 2 Diabetes (Part 2)

October 28, 2014 by Imagine_David Leave a Comment

Following Starting Insulin: Type 2 Diabetes (Part 1)

I can’t pay as close attention to my diet as insulin treatment requires

Using insulin you may not need to make any changes to your diet, depending on the tablet medication that you have been using. It is always helpful to consult with your Accredited Practising Dietitian when you are having a change of medication to ensure your current meal plan matches and is safe with any new medication/s.

I can’t organize my day as carefully as insulin treatment requires

For people with type 2 diabetes starting insulin should not have a big impact on your day f you currently have a safe and effective diabetes self management plan. If you have been ‘burned out‘ by diabetes, and have been off track for a while, then starting insulin may be a good time to re-evaluate your plan.

Injections in public are embarrassing to me. Pills are more discreet

Injecting insulin in our society is often seen as ‘drug use’ and can be a problem, especially if being done in a public place e.g. restaurant or cafe.

Giving insulin today is quick and simple with a good technique. Demonstration of commonly used insulin device HERE

A good strategy in this situation is to inform the people around you in advance a) that you have diabetes b) that you will need to inject discreetly at the table, or be shown a quiet secluded space to inject (NOT the toilet)

Another strategy is to discuss with your health care professionals a type of insulin to use where you do not need to inject in public.

**Balancing your medication with your meal plan and exercise is essential**

Regular insulin treatment causes feelings of dependence

This is certainly one to discuss with you psychologist or counsellor. For people with type 2 diabetes insulin injections are not ‘emergency’ or ‘life saving’ or even essential i.e in almost all circumstances missing an occasional dose will not cause any immediate consequences.

When people inject insulin, it makes them feel like drug addicts

This feeling is common for people when they start to inject diabetes medication. If this is an issue for you, discuss with your psychologist or counsellor. Advocating against discrimination against people with diabetes is one way to reduce this issue.

An insulin overdose can lead to extremely low blood-sugar levels (“hypoglycaemia”). I am afraid of the unpleasant accompanying symptoms

This is true. Insulin lowers the blood glucose level, sometimes to a point of being too low.

Keep in mind that it is also possible to have a low blood glucose level when using certain diabetes tablet medications.

What can cause your BGLs to drop?

The most common causes:

Taking too much glucose lowering medications e.g. due to a mistake in dose
Not eating enough carbohydrate
Missing or delaying a meal
Being more active than usual
Drinking alcohol
Illness, infections and stress
Interactions of diabetes medication with other medications

Ideally the insulin dose that is prescribed will start small, and with careful monitoring of the blood glucose level be increased at a rate that is safe and effective.

By understanding the causes and strategies used to lower your risk, and also having a treatment available at all times (carried on your person) you can reduce your risk of this becoming a problem that is unmanageable. More information HERE

An insulin overdose can lead to extremely low blood-sugar levels (“hypoglycemia”). I have concerns about possible permanent damage to my health

If this is a concern for you discuss with your prescribing health care professional. High blood glucose levels are more dangerous in the longer term.

Loss of the symptoms of hypoglycaemia are possible, but ore often in people living with type 1 diabetes. Los of symptoms will usually only occur if hypoglycaemia is happening very frequently.

**Learn how to self adjust your doses of insulin in collaboration with your health care professionals**

Next

If your doctor has already opened discussions with you about the possible need to start insulin, it may help you and your health care professional team to print this blog and scale these concerns with a score of 1-10. Then take this and talk to your team.

Self Adjusting Insulin Doses

If you are new to insulin it is best to work closely with your health care professionals in finding the best dose and type of insulin.

There are many different types of insulin. Discuss your needs with your prescribing health care professional.

DO NOT adjust your dose of insulin without appropriate knowledge and skills. Your diabetes educator can guide you here.

In the meantime, if you have any questions of comments please post below.

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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Starting Insulin: Type 2 Diabetes (Part 1)

October 20, 2014 by Imagine_David Leave a Comment

If you’re starting insulin injections, it’s helpful to know what to expect so there are no surprises along the way and you can be prepared to easily navigate complications or challenges.

Ideally you will already have a well established health care team including a diabetes educator, dietitian, psychologist/counsellor, exercise physiologist etc who you can talk to about how to get the most from your newly prescribed medication.

**People who use insulin can do anything**

Professor Frank Snoek developed a tool to help you and your health care professionals start insulin with safety and confidence. This

‘Barriers to Insulin Treatment Questionnaire’

consists of the following frequently identified concerns of people who are about to start or who have been prescribed insulin:

I am afraid of the pain when injecting insulin.
Besides the pain, I am just afraid of injections.
I am afraid of the pain during regular blood-glucose checks.
Insulin works better than pills.
People who get insulin feel better.
Insulin can reliably prevent long-term complications due to diabetes.
I just don’t have enough time for regular doses of insulin.
I can’t pay as close attention to my diet as insulin treatment requires.
I can’t organize my day as carefully as insulin treatment requires.
Injections in public are embarrassing to me. Pills are more discreet.
Regular insulin treatment causes feelings of dependence.
When people inject insulin, it makes them feel like drug addicts.
An insulin overdose can lead to extremely low blood-sugar levels (“hypoglycemia”). I am afraid of the unpleasant accompanying symptoms.
An insulin overdose can lead to extremely low blood-sugar levels (“hypoglycemia”). I have concerns about possible permanent damage to my health.

**It may be helpful to you and your team to scale those concerns 1-10 and discuss with your health care professionals.

Pain

Insulin injections can be slightly painful for some people – many individuals will experience tenderness or soreness at the injection site. These symptoms usually aren’t unbearable or long-lasting, however, and many needles are now thinner and shorter, which can decrease sensitivity.

Besides the pain, I am just afraid of injections and

I am afraid of the pain during regular blood-glucose checks

If you have a fear of injections and blood tests then it may be the time to enlist the help of your psychologist or counsellor to guide you with some strategies. FREE (for Australian residents) counselling with our team can be found HERE

Insulin works better than pills

Insulin is prescribed for people with type 2 diabetes when pills / tablet medication no longer is effective in helping you achieve health blood glucose levels.

The need for insulin is not a sign of failure on your part. It is due to the natural progression of type 2 diabetes where the body can no longer make sufficient insulin to process your carbohydrate food.

"Now I have started insulin I feel like exercising; I have so much more energy" — ***“Now I have started insulin I feel like exercising; I have so much more energy”***

People who get insulin feel better

Theres no guarantee to this. Sometimes insulin is prescribed early, before the blood glucose level gets high enough to be causing symptoms.

Quite often though insulin is prescribed long after it could have been, when the symptoms of high blood glucose level are no longer tolerable.

If you have symptoms, as the dose of insulin is adjusted towards the most effective dose, you are likely to have more energy and less trips to the loo.

Insulin can reliably prevent long-term complications due to diabetes

Again, no guarantee here. Unless the dose of insulin is adjusted to achieve normal blood glucose level then simply using insulin is not going to achieve much. Ideally the dose will be commenced on a low – medium level, and increased 10-20% 1-2 times per week by your prescribing health care professional. Doses can only be safely adjusted by assessing the pattern of your blood glucose level.

Once a safe and effective dose of insulin is found , yes, this will help reduce the chances of those horrible long term complication such as kidney failure etc that we all fear.

I just don’t have enough time for regular doses of insulin

Using insulin may require a little more work than you have been used to in recent years. Ask yourself a few questions:

What is my long term health goal?
Am I able to function day to day at present as efficiently as I would like to?
Am I willing to take the risks of long term high blood glucose levels?

Your psychologist may have worked with you already to find some other specific questions for you.

Weight gain

It’s not uncommon to experience a little weight gain when you begin insulin injections. This weight gain is due to the anabolic effects of insulin, increased caloric retention, stimulated appetite or “defensive” eating due to hypoglycemia.

Once you get the hang of your insulin injections and it becomes a more regular part of your lifestyle and routine, you may see this weight naturally drop off. Ideally you will have a dietitian on your team to help you use your insulin safely and effectively. Also, have a plan for insulin adjustments with your prescribing doctor: reviewing your blood glucose level once a week and making small changes to your dose/s of insulin.

Hypoglycaemia

When you begin to balance your blood glucose with insulin injections, you may find it hard to match this with an appropriate carbohydrate intake, at first. This can result in episodes of low blood glucose, or hypoglycaemia (less than 4mmols). It’s important to familiarise yourself with the symptoms of hypoglycaemia so you can treat it safely and effectively. Most of the time this involves eating a HIGH GI carbohydrate source, like a glucose sweet or a glucose tablet. This treatment is going to be on your person at all times, so that as soon as any symptoms occur, you can simply reach for it and start your treatment immediately

Storage

You’ll also need to learn how to store your insulin properly when you first start injections. Never leave insulin in the freezer, and keep your extra supply in the refrigerator. Avoid shaking or handling the insulin roughly, as this can cause clumping.

Make sure to check the expiration date on your insulin boxes before you buy them, and also ensure you are buying the right kind.

Traveling

Another part of taking insulin injections is learning how to travel safely. Remember to regularly check your blood sugar during trips, especially if you are switching time zones or changing your eating schedule.

Make sure your insulin supplies are clearly labeled in order to get through airport security faster.

It’s always a good idea to prepare for worst-case scenario, so make sure you travel with two to three times the amount of insulin you think you’ll need.

Finally, keep your insulin supplies away from extreme temperatures.

Part 2 to follow

If you would like to understand the action of insulin take a look at the American Diabetes Associations Link for Life multimedia presentation HERE

Please ask any questions about safe and effective use of insulin.

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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Rahh!! Why is my BGL so High!

October 6, 2014 by Imagine_David 3 Comments

Living with diabetes is not only a roller coaster of often unpredictable Blood Glucose Levels, its also an emotional roller coaster ride. Often we hear those words of exasperation “why is my Blood Glucose Level so high!”

Lets explore some of the more common causes of Blood Glucose Levels above target.

What is the Target?

It is generally accepted that optimum Blood Glucose Level is on waking between 4 – 6 mmols, and 2 hours after meals between 4 – 8 mmols. (*this is ideally individualised in collaboration with your usual health care team*)

Hyperglycemia is defined by the World Health Organisation as:

Blood glucose levels greater than 7.0 mmol/L
(126 mg/dl) when fasting
Blood glucose levels greater 11.0 mmol/L
(200 mg/dl) 2 hours after meals

**Even positive stress can elevate your Blood Glucose Level e.g. your football team winning the competition!**

I remember when I first started working as a diabetes educator I had a phone call from a young man – lets call him Fred – living with type 1 diabetes. His Blood Glucose Level was about 40% higher than usual. Not high enough to put him at risk of DKA, but high enough to be concerned.

We talked on the phone for about 45 minutes, going through the usual checklist of causes of high Blood Glucose Level.

Carbohydrates: Eating meals and snacks that contain too many carbohydrates for the energy needs of that moment. Consulting with your dietitian about how much carbohydrates are correct for you is an essential part of your safe and effective diabetes self care plan.

Medication: Examples…. forgetting to take your medication; the prescribed dose is not being effective; the prescribed medication is not being effective – a change of medication is required; taking a dose of insulin and then a having change in plan where your level of activity is less than expected; or not giving sufficient insulin for your meal total carbs.

Stress: Both positive and negative emotions can play a role in causing hyperglycaemia. When the body is stressed chemicals (hormones, such as adrenaline ) are released in the body. One of the effects of adrenaline is to cause the liver to release glucose > elevated Blood Glucose Level

Less Physical Activity Than Usual: Very simply, if you think of glucose as your bodies main source of fuel….. if you are not using your muscles then the body is using less glucose. Example: If you have eaten your usual amount of carbs for dinner, but then go and sit down to watch tv instead of your usual evening walk, then the Blood Glucose Level is going to be higher than usual. Or on a weekend you don’t take your bike out for a ride but eat the same amount of carb as if you were going for a ride, then the Blood Glucose Level is going to be higher.

Infection, illness, or surgery: With illness, blood glucose levels can rise. This is a physical stress on your body. For people with type 1 diabetes this is a high risk time for DKA.

Other medications: Certain drugs, especially steroids, can affect blood glucose levels.

Fred and I could find nothing amongst the usual suspects. I advised him i would go and talk with my team – who were much more experienced than me – and see what they could suggest as possible reasons for Fred’s higher than usual Blood Glucose Levels.

I returned Fred’s pone call after consulting with my team. In the meantime Fred has found the answer: he had been away for 5 weeks to the Northern Territory. He had not stored his insulin nor his test strips correctly. He found some new insulin, some new test strips, and his ‘problem’ was solved.

Meter inaccuracy

A few years ago, the International Standards Organization (ISO), in conjunction with international regulatory authorities, health care providers, and device manufacturers in many countries, established a standard for evaluating the accuracy of blood glucose meters. Called ISO 15197, the standard calls for a minimum accuracy. Ninety five percent of all measured values should fall within:

20% of glucose values above 75 mg/dl (4.1 mmols)
15 mg of glucose values below 75 mg/dl (4.1 mmols)

Possible Solutions to Inaccuracy

Besides user error e.g lack of hand washing, using outdated strips etc other sources of error occur.

Insulin / Medication Storage

Check with your pharmacist as to how best store you medications.

In Fred’s case, it was more likely to be an error of strip storage than medication storage.

Your Experiences?

What things cause your Blood Glucose Level to rise? Please share your experiences below in the comments section. Its always helpful for others to get that first hand lived experience from people like you.

If you would like some individual guidance with your diabetes self care plan, please send us a request

Kind Regards

David

Diabetes Educator @ Diabetes Counselling Online

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The prick of a thing about blood glucose monitors

September 25, 2014 by Helen-Edwards 1 Comment

Image via http://www.mein-diabetes-blog.com/tag/stechhilfe/

Do you check your blood glucose regularly? I don’t ask in judgement, because we are all different when it comes to diabetes – some of you will check your blood many times a day, others not at all. It all depends on your type and stage of diabetes, management and personal preference. I am asking because I have been thinking a lot lately about how dependent we are on the technology for managing diabetes and how that is both great and not so great.

As a teenager I rebelled against checking my blood, after this replaced urine testing. You would think I would have embraced it as it is far better than checking your pee. But for me it was one change too many in a short space of time. Another thing to learn. Another sign of my diabetes. Another moment of distress in each day. And in those days it was an enormous process! There were many steps and it took a lot longer than the quick machines we have today. It wasn’t the kind of thing you carried with you. I had a testing station in my bedroom and that was where my tests were done.

After a while I mostly stopped checking and made up my results for my parents and the doctors. I could not have cared less about what my blood sugar was doing. I cared far more about being a teenager and having a good time.

This lancet machine (which I still have!) may have been part of the reason I rebelled! It really actually bloody hurt!!

Oh how that has changed. Now I am the complete opposite! I carry my machine everywhere and check up to 20 times a day. We have 5 second machines and virtually painless prickers. If I do not check before driving, eating, exercising, sleeping…..I feel stressed, anxious. I learnt that knowing what my blood glucose is doing gives me power. Power to make adjustments and changes. Power to deal with highs and lows. And peace of mind.

this is the meter I had to use back in the day! Pic via Pinterest and originally via http://americanhistory.si.edu/collections/search/object/nmah_738655

I never go out without it but lately have had a few cases of losing my machine and it was very scary and stressful. I realised how much I rely on this little machine each and every day. The last time I lost one was a few weeks ago. I was an hour away from home and there was nobody to help me. I could not find it anywhere in my bag. I drove home totally stressed about not knowing what my levels were, made worse by the fact I had high levels on arrival at the person I was visiting and had a bolus of insulin, so needed to track the fall. I got home and pulled the house apart to find my back up machine. Later the person I was visiting found it on the road, fallen out from my car.

It was not a case of losing my machine but forgetting it, that caused me more stress this week. I was out for a lunch time run and went to check my levels…..no machine. I NEVER exercise without it and always check during my run as I can drop fast. My parents were away and my husband at work. There was nobody to bring my machine to me. I made the call to cut the run short and head home. Luckily, as I was 4 mmol on arrival at home. It was a stressful run back and it struck me how much it sucks to have type 1 diabetes and not even be able to do a simple thing like going for a run without all this stress…..

Don’t you hate it when diabetes stops you doing something so simple? And the reliance on that machine is both wonderful that we have them, and terrible that we have to be so dependent on them. That’s the prick of a thing about blood glucose monitors.

Have you had a similar experience? Would love to hear

I am off for a finger prick!

Helen

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5 Tips for managing diabetes at events where food choices are likely to be poor

September 22, 2014 by Sally Leave a Comment

With party season well on its way, one of our members has suggested that it would be helpful to have a few easy to remember tips to help him from overeating and spinning out not only his weight that he’s been working so hard to keep under control, but also his blood glucose levels that he also works hard to keep managed through lifestyle measures. It’s such a great topic to suggest! So many of us do exactly that when we go to a party or a reception or even just out with friends to a buffet style lunch.

If you fail to plan then you plan to fail.

As is often the case with diabetes, a little forward planning goes a long way. So if we have a just a few (well 5) top tips to think through, hopefully you’ll find it much easier to manage and will feel so much better afterwards. We all know that post-party feeling of regret for the bad food choices we made.

I’d also like to remind you that diabetes is not a game of perfect. These tips aren’t meant to restrict you from enjoying a little of what you might not have access to in your usual life with diabetes, but more to make it easier to do so without extreme consequences of high BGLs and weight gain.

1) Before you go, eat and exercise

If it’s not a meal based event, such as a cocktail party, then ensure you eat a well balanced meal before you go so you won’t be hungry and can be more mindful of the choices you make.
Give yourself a target of about 5 tastings of food on offer so you don’t miss out.
One of our admins, Helen, suggests going for a big walk before the party to help minimise the BGL impact of birthday cake, as well as being extra careful in the surrounding days – great ideas Helen!
Don’t be afraid of saying ‘Not just at the moment thanks’ or ‘No thanks’ with a smile.

2 ) Look over what’s available before just diving in so you consider your choices

If it’s a buffet meal, don’t just go to the queue to join the buffet, but take a few moments to look over people’s shoulders to see what foods are offered on the table. This will help you to choose wisely and know you won’t be missing out so you won’t have to stack your plate just in case.

3) Memorise what the healthy plate looks like and fill up the veggie half first

After checking out the buffet, aim to fill at least half the plate with salad and undressed veggie options first. This can help to fill you up before you start on the more energy dense foods.
Look for healthier lower fat, lower GI carb sources to keep your BGLs happy, and then go for the lean proteins such as cold meats and seafood for the last quarter.
Try not to stack your plate, remembering that you wouldn’t do that at home and so you really don’t need the extra food.

Choose nutritious and unprocessed foods wherever possible (including avoiding marinades, sauces and creamy dressings that are high in sodium and kilojoules/calories)

4) Take a healthy plate with you to share if it’s a BBQ or private event

Skewered vegetables to go on the BBQ.
A salad contain low GI carbs such as legumes or quinoa or barley and other interesting ingredients.
A hummus dip with fresh veggies for dipping. It’s amazing how popular these items will be. You’ll be the star of the party.
Fresh fruit platters work well for afters.

5) Eat slowly and be mindful of how much you need

Wherever you are, the more slowly you eat, the more awareness you’ll have of when you’ve had enough to eat

If you’re worried that people will call you a party pooper, here are a couple of member suggested tricks so you can still enjoy the party without putting your health at risk.

Excuse yourself then go to the kitchen to fill your beer stubbie with water. Then no-one knows you’re not drinking beer.
Another of our members suggests, “I just get very selective. I hit on the chicken drumsticks and salad which are reliable offerings. Then it depends on how upmarket the buffet is. At our favourite buffet restaurant I gorge on seafood and then follow my nose to the cheese plate. A little bit of potato/rice/pasta salad to provide the carbs.” Go easy on the cheese Tiger!

Hoping this will help you get through the Spring and early Summer party season while managing your diabetes and overall health to the best of your ability. Remember to that it’s important for your wellbeing to be sociable and enjoy the celebrations that life brings.

It’s all about balance and a bit of planning.

Sally.

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a list of all Sally’s Diabetes Counselling Online blogs here.

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