TYPE 1 DIABETES WHAT YOU NEED TO KNOW

TYPE 1
DIABETES
treatment
food
Lifestyle
WHAT YOU
NEED TO KNOW
Newly diagnosed with type 1 diabetes?
There’s a revolutionary new way
to help keep you safe at night.
Introducing
for
accurate, non-invasive detection
of sleep-time hypos
As someone newly diagnosed with type 1 diabetes,
the number one concern you will face in the years ahead
is the prospect of night-time hypoglycaemic events and
their potentially serious consequences.
Indeed research has shown that it is impossible to identify a
pre-sleep glucose level that minimises risk of hypo1 and that over
half of severe hypos (BGL<2.8mmol/L) occur during sleep.2
This has led to use of various monitors associated with invasive
procedures – as that is all that has been available… UNTIL NOW
Over 10 years of extensive research and development has
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that sets new standards of performance and comfort.
What HypoMon users say:
“I’m delighted with HypoMon.
Not only is it simple to put on,
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the chest and, most importantly,
sleep with.”
Young Adult – Female
“Having had diabetes for 20 years
I’m naturally sceptical of so called
non-invasive alternatives. But HypoMon
is not only easy to use, it truly works.
It detected and alerted me of a hypo
within the first few nights of use.”
Young Adult – Male
A safer night’s sleep.
● Outstanding accuracy – detects and alerts users
to >80% of night-time hypos.
● Non-invasive and comfortable – no implanting or
inserting required; sensors, comfortably belted to the
body, monitor and transmit the body’s physiological
markers of hypoglycaemia.
● Simple and easy to use – the HypoMon belt is easy
to fit and wear. Once set up it logs the physiological
changes and a hypo will trigger the alarm with a sequence
of flashing light and sound alarm of up to 85 decibels.
● Enhancing diabetes management – the HypoMon
supplements other diabetes management practices to
identify additional nocturnal hypoglycaemia events
which would typically be missed.
MKT17
If you are aged 10–25 with type 1 diabetes, HypoMon could be for you.
For more information please visit www.hypomon.com or talk to your diabetes advisor.
© 2010 AIMEDICS PTY LTD All rights reserved. AIMEDICS and HypoMon are registered trademarks of AIMEDICS PTY LTD
This information is for people with diabetes. Use only as directed and see your healthcare professional for medical advice.
1. American Journal of Medicine, 1991; 90(4): 450-9 2. Matyka KA Pediatric Diabetes 2002; 3:74-81
Testing
Pumps
16
Education
Healthy eating
30
13
Welcome
Welcome to What You Need to Know – Type 1
Diabetes. This is an introductory guide for adults
who’ve recently been diagnosed with the condition,
but it’s also a handy refresher for those who’ve had
Type 1 diabetes for some time.
Following diagnosis it’s perfectly understandable
that you may be experiencing a wide range of
emotions. You may feel upset, angry, confused
and even guilty. You may be asking yourself the
question, ‘Why me?’ – and wondering how
you’ll cope.
This guide will answer a lot of your questions and
address your doubts and concerns by giving you
the facts. It will also tell where you need to go for
further information.
This guide will take you through diabetes care and
living your day-to-day life – from work and illness,
to socialising and travel. We’ll also shed light on
the complications that you need to be aware of
and the steps you can take to prevent them.
Plus, there’s lots of information about how
Diabetes UK can support you as you continue
to live your life to the full.
Eating out
52
36
what’s
inside...
INTRODUCTION
5 Debunking the myths
6 What is diabetes?
DIABETES CARE
8Insulin
10Injections
13Pumps
16Testing
18 Hypos & hypers
23 Long-term testing
24 The care to expect
30 Education
31 Health information online
32 Associated conditions
34 Eating disorder
FOOD
36 Healthy eating
41 Balanced diet
42 Carbohydrate counting
44 Food GI
45 Food labelling
48 Healthy cooking
52 Eating out
54 Questions & answers
2013 Type 1 diabetes
3
Physical activity
Pregnancy
62
Work
Travel
92
80
74
LIVING WITH DIABETES
56 Weight management
62 Physical activity
66 Accepting diagnosis
68 Telling people
70 Love life
72Contraception
74 Pregnancy & labour
78 Illness & infections
80 Work & discrimination
82 Driving
84Travel
86 Religious festivities
88 Alcohol, smoking & drugs
92Festivals
Editor: Angela Coffey
Sub Editor: Nick Myall
Designers: Clara Medves, Wendy Riley
Photography: Phil Starling
Printer: Newnorth Print Ltd
Advertising Manager: Claire Barber, Ten Alps Media
Published in April 2013 by Diabetes UK, 10 Parkway,
London NW1 7AA
Tel: 020 7424 1000
Website: www.diabetes.org.uk
Email: [email protected]
© Diabetes UK 2013
Product code: 6954
Festivals
84
complications
94 Cardiovascular disease
96Retinopathy
98Neuropathy
100Nephropathy
FURTHER INFORMATION
102About Diabetes UK
With thanks to all the contributors and advisors, and the volunteers
who participated in photoshoots.
ARTICLES & ADVERTISEMENTS
Products and services advertised in this guide are not necessarily
recommended by Diabetes UK. Although the utmost care is taken to ensure
products and services advertised are accurately represented, it is only
possible to thoroughly check specialist diabetes equipment. Please exercise
your own discretion about whether or not an item or service advertised is
likely to help you personally and, where appropriate, take professional advice
from your medical advisor. Please note also that prices are applicable only to
British buyers and may vary for overseas purchases.
Paid adverts do not necessarily represent the views of Diabetes UK.
Complaints regarding advertised services or products should be addressed
to: Claire Barber, Advertisements Manager, Ten Alps Publishing, One New
Oxford Street, London WC1A 1NU. Diabetes UK policy statements are
always clearly identified as such. ©Diabetes UK 2013 A charity registered in
England and Wales (no. 215199) and in Scotland (no. SC039136).
debunking theTESTIN
myths
diabetes
myths
INTRODUCTION
There are many myths surrounding
diabetes – here are some of the main ones
Myth: People
with diabetes
can’t play sport
Myth: It’s not
safe to drive
if you have
diabetes
If you are responsible and have
good control of your blood
glucose levels, you’re just the
same as everyone else on
the roads. Nevertheless, the
myth persists that people with
diabetes are unsafe to drive.
Myth: People
with diabetes
cannot have
sugar
Having diabetes doesn’t
mean having to have a
sugar-free diet. People
with diabetes should
follow a healthy, balanced
diet low in fat, salt and
sugar, but you should still
be able to enjoy a wide
variety of foods, including
some with sugar.
People with diabetes are
encouraged to exercise
as part of a healthy
lifestyle. Keeping active
can help reduce the risk of
complications, such as heart
disease. Sir Steve Redgrave,
Olympic gold medal-winning
rower, is an example of
someone who has achieved
great sporting achievements
while living with diabetes.
• For more on exercise,
see p62.
• For more on driving,
see p82.
Myth: People
with diabetes
should eat
‘diabetic’
foods
‘Diabetic’ labelling tends to be used
on sweets, chocolate, biscuits and
similar foods that are generally
high-calorie and often have
lots of fat. Diabetes UK doesn’t
recommend ‘diabetic’ foods for
people with diabetes because
these foods still affect blood
glucose levels, are expensive and
can cause diarrhoea. If you want
to treat yourself occasionally, then
you should go for the real thing.
• For more on food, see p36.
• For more on food and
healthy eating, see p36.
2013 Type 1 diabetes
5
Introduction
TESTINis diabetes?
what
Type 1 diabetes
Explained
You’ll hear a lot of differing opinions
and rumours surrounding diabetes and
how it affects people, so it’s important
to have all the facts from the outset
It‘s important to keep
physically active
D
iabetes is a condition where
your body can’t produce
the hormone insulin, or doesn’t
produce enough, or where your
insulin doesn’t work properly.
Insulin is a chemical messenger
that helps your body use the
glucose in your blood to give
gullet
liver
stomach
pancreas
6
Type 1 diabetes 2013
you energy. And if you don’t
have the right amount of insulin,
or if your insulin isn’t doing its job
properly, you can get very ill.
So what should happen?
Our bodies need glucose for energy.
Glucose enters the bloodstream
when you digest carbohydrate from
various kinds of food and drink,
including starchy foods (such as
bread, rice, potatoes), fruit, some
dairy products, sugar and other
sweet foods. Glucose is also
produced by the liver.
In people without diabetes,
insulin carefully controls the
amount of glucose in the blood.
Insulin is made by an organ called
the pancreas, which lies just behind
the stomach. Insulin acts as the ‘key’
that ‘unlocks’ the body’s cells to let
the glucose in. The body’s cells then
convert the glucose into energy.
What happens in someone
with Type 1 diabetes?
Because Type 1 diabetes
develops when the pancreas
doesn’t produce any – or very little
– insulin, glucose is unable to enter
their cells to be converted into
energy and this is why people with
untreated diabetes often feel tired.
As glucose can’t provide energy,
the body tries to get it from elsewhere
and starts to break down stores of
fat and protein instead, which can
cause weight loss. Because the
body doesn’t use the glucose it
ends up passing into the urine.
This can mean lots of trips to the
loo and dehydration, which then
causes extreme thirst.
what is diabetes?
TESTIN
INTRODUCTION
no
“There’s
reason for
diabetes
to stop
you living
a healthy,
happy and
successful
life
”
Q& A
Symptoms
The main signs of
untreated diabetes are:
• frequent urination
• increased thirst
• extreme tiredness
• weight loss.
If diabetes is not well managed,
these symptoms can return.
How is diabetes treated?
Type 1 diabetes can be successfully
treated with insulin, either by
injections or via a pump, and by
following a healthy, balanced diet
and regular physical activity.
Looking after diabetes needs
planning and attention, which may
feel overwhelming, but there’s no
reason for it to stop you living a
healthy, happy and successful life.
How does Type 1 differ
from Type 2 diabetes?
There are two main types of diabetes –
Type 1 and Type 2. Unlike people with
Type 1, those with Type 2 still have some
insulin-producing cells, but either not
enough insulin is produced or it doesn’t
work properly. In most cases, Type 2 is
linked with being overweight and usually
appears in people over the age of 40 or
over 25 in South Asian people. Recently,
however, more children are being
diagnosed with Type 2. Type 2 diabetes
is treated with lifestyle changes, such
as a healthy diet, weight loss and
increased physical activity. Medication,
including insulin, may also be needed.
There are also other, quite rare, forms
of diabetes, such as Maturity Onset
Diabetes of the Young (MODY) and
neonatal diabetes. Information about
these conditions can be found at
www.diabetes.org.uk/What_is_diabetes
2013 Type 1 diabetes
7
Diabetes care
Insulin
ins and outs
of insulin
Insulin is a necessary treatment
for people with Type 1 diabetes.
Let’s find out more about it...
I
nsulin is a type of hormone (a
chemical messenger) that is
produced by the pancreas.
Your insulin will come from
one of two sources – animal or
human insulin. Human insulin
isn’t made from humans, but is
genetically engineered so it’s
identical to human insulin.
Some people use animal
insulin, which is made from the
pancreas of cows or pigs, but
it’s unlikely that you will be started
on animal insulin. Before human
insulin was developed, these
were the only types of insulin
available. There are also
analogue insulins, where the
chemical structure has been
changed to make them act
8
Type 1 diabetes 2013
more quickly or more slowly
than regular human insulin.
insulin types
There are different insulins
to choose from:
Rapid-acting analogues
• injected immediately
before a meal
• peak action is at around
two hours after injecting
• lasts for around four hours.
Short-acting insulins
• injected approximately
15–45 minutes before a meal
• peak action is at around
2–4 hours after injecting
• lasts for around 6–8 hours.
Medium/long-acting insulins
• injected once or twice a day
• peak action up to 12 hours
after injecting
• lasts around 20–24 hours.
Long-acting analogues
• injected once or twice a day
(at the same time each day)
• lasts around 24 hours (there’s
no peak, they stay at
the same concentration).
Mixed insulins
• a mixture of rapid-acting analogue
or short-acting insulin and
medium/long-acting insulin
• usually injected before
breakfast and dinner
• peak action 2–8 hours.
Insulin
diabetes care
top
how often should
insulin be taken?
Four times a day (or basal bolus):
most people who are newly diagnosed
with Type 1 diabetes are likely to be on
this regime, which mimics the action of a
healthy pancreas more closely and there’s
less chance of a hypo. Basal bolus also
allows more flexibility with meal times
and the amount you can eat, but for
best results you’ll need to learn to
carbohydrate count (see p42).
Twice a day: this is less common but
involves needing to eat at similar times
each day and take in similar amounts
of carbohydrate at each meal.
Q& A
Does insulin go off?
Yes. Clear insulin will go cloudy when
it’s off. It will also go a bit lumpy and
stick to the side of the container. If
you’re not sure, don’t use it and check
the expiry date.
How do I know what the best
regimen is for me?
You and your diabetes healthcare
team will decide which is the best insulin
or combination of insulin for you. This will
depend on your diabetes control and your
lifestyle. The most common combination
is basal bolus. You will know when you are
on the right regimen as your blood glucose
levels will be managed well and it will fit
into your lifestyle.
tips
Storing insulin
1
2
Keep any insulin that you’re not using in the
fridge, between 2–8oC.
With the insulin that you are using, keep it at
room temperature (under 25oC) as this will
make it more comfortable to inject.
3
Don’t let insulin get too hot – never place it
near a radiator, in direct sunlight or on top
of electricals, like a TV or computer.
4
5
6
Don’t let insulin freeze – this will stop it from
working properly.
Check the expiry date and don’t use if it has
passed this date.
Keep spare vials or cartridges of insulin in their
boxes in the fridge so you always have expiry
date details.
7
If you need to transport insulin (eg when
travelling) keep it cool in a Frio bag or
flask (see p84).
insulin will come from
“Your
one of two sources –
animal or human
”
2013 Type 1 diabetes
9
Diabetes care
Injections
Injecting
insulin
By following some
simple guidelines,
injections can become
just another part
of daily life
Your stomach is one of the main
places you can inject insulin
I
nsulin needs to be taken via a
pen injector or small syringe,
or via a pump (see p13). That’s
because insulin is a protein, so
it can’t be given as a tablet –
otherwise the stomach would
digest it in the same way as
other types of protein, such as
meat and fish.
The needles used are very
small because insulin only
needs to be injected under the
skin – not into a muscle or vein.
Once it’s been injected, insulin
soaks into small blood vessels and
is absorbed into the bloodstream
where it gets to work. Injections
can be a little painful, especially
the first few, because you may be
10
Type 1 diabetes 2013
tense. But as your confidence
grows and you become more
relaxed, they’ll get easier and
will soon become second nature.
Keep on moving
It’s really important that you rotate
or change the area where you
inject. If you keep injecting into
the same site, small lumps can
build up under the skin. These
won’t look or feel very nice, and
can also mean that the insulin
doesn’t work properly because it’s
harder to absorb through the
lumps. Also, be careful not to inject
in the same spot within each site –
change it each time. By rotating
injection sites and spots you can
help avoid getting lumps
(any that may have formed
will slowly disappear).
Different insulins are absorbed
at different rates from different
injection sites. Several things
can speed up the action of
insulin after it’s been injected:
• heat – sunbathing or a hot bath
• exercise – using a limb you’ve just
injected, eg injecting into your leg
and then going running
• massage.
All these things can make a hypo
more likely, so, if you’re doing any
of these activities, you’ll need to
test your blood glucose levels
more often.
Injections
Where to inject
How to inject
There are
four main
places:
1
2
diabetes care
Make sure your hands and the area you’re
injecting are clean.
Eject two units of insulin into the air to make
sure the tip of the needle is filled with insulin
(called an ‘air shot’).
3
4
Choose an area where there is plenty of fatty
tissue, eg tops of thighs or the bottom.
Arms*
Stomach
Bottom
Thighs
* check with your diabetes
healthcare team as arms
aren’t suitable for everyone.
5
6
ACTION
POINTS
• If you don’t feel confident with your
injection technique ask your diabetes
healthcare team to review it.
• Are you rotating and changing
injection sites regularly? Keep a log
of the places you use each week to
make sure.
If you have been advised to, lift a fold of skin (the
lifted skin fold should not be squeezed so tightly
that it causes skin blanching or pain) and insert
the needle at a 90° angle. With short needles
you don’t need to pinch up, unless
you are very thin. Check with your diabetes
healthcare team.
Put the needle in quickly. If you continue to find
injections painful, try numbing an area of skin by
rubbing a piece of ice on the site for 15–20
seconds before injecting.
Inject the insulin, ensuring the plunger (syringe)
or thumb button (pen) is fully pressed down and
count to 10 before removing the needle.
7
8
Release the skin fold and dispose of the used
needle safely.
Remember to use a new needle every time.
Reusing a needle will make it blunt and can
make injecting painful.
o avoid lumps, change the spot
“ Twhere
you inject each time
”
2013 Type 1 diabetes
11
ACCU-CHEK and ACCU-CHEK MOBILE are trademarks of Roche. © 2012 Roche Diagnostics Limited.
Accu-Chek® Mobile
Strip Free, Simple, Smart.
NEW for INSULIN USERS
All-in-one system: test whenever, wherever.
Visit www.accu-chek.co.uk/DUKmobile
or ask your healthcare professional
Experience what’s possible.
Roche Diagnostics Limited, Charles Avenue, Burgess Hill, RH15 9RY.
Company registration number: 571546
PUMPS
diabetes care
pump
it up
As an alternative to
pens, insulin pumps can
help to improve overall
diabetes control and
allows more freedom
Using a pump means you can
have a more flexible lifestyle
O
ver recent years, insulin
pump therapy (also known
as continuous subcutaneous
insulin infusion or CSII) has risen
in popularity. A pump – about
the size of a small mobile phone
– delivers a steady flow of rapidacting insulin round the clock
from a reservoir, which usually
holds about two to three days’
supply of insulin.
This insulin is delivered through
an infusion set – a very fine tube
that runs from the pump to a
cannula (a very thin and flexible
plastic tube), which is inserted
under the skin. The cannula can
be left in for two to three days
before needing to be replaced
and moved somewhere else
on the body.
The pump is battery operated
and delivers a varied dose of
rapid-acting insulin continually
during the day and night, at a rate
that is pre-set according to your
needs (known as a basal rate).
Then, when you have something
to eat, you can give extra insulin
(known as a bolus dose) by
pressing a combination of buttons.
Your nurse or dietitian will
teach you how to work out the
carbohydrate content in your food,
so that you’re able to give the right
bolus dose. A bolus can also be
given if blood glucose levels have
risen too high. While pumps are
popular, bear in mind that they
aren’t suitable for everyone. If you’re
considering it, talk to your diabetes
healthcare team to find out whether
or not it’s right for you.
pros & cons
Advantages
• fewer injections – the cannula
is only replaced two to three
times a week
• your lifestyle can be more
flexible – you don’t have to plan
so carefully or eat at set times
• you may be able to reduce the
total dose of insulin as your
diabetes control improves
• as you can give a bolus dose
whenever you need to, a
pump gives you better
control of your diabetes.
Disadvantages
• you need to test your blood
glucose levels more frequently
– the insulin is short-acting so
it’s important you are always
aware of your insulin needs
• you may forget your bolus
doses – this is usually while
you get used to using a pump
• infection may develop at the
insertion site
• you may get scarring at the
insertion site, which means
changing the infusion set
more often.
2013 Type 1 diabetes
13
Diabetes care
Pumps
Q& A
Can I use a pump?
The National Institute for Health and Clinical
Excellence (NICE) has published certain criteria that
people should meet in order to use a pump (you can
access this criteria by visiting the NICE website at
www.nice.org.uk). Talk to your healthcare team about
this criteria and whether or not pump treatment is
suitable for you.
What types of pumps are available?
There are a number to choose from. Your healthcare
team will help you with your choice. While basic
features are largely the same, there are differences
in colours, battery life, screen size and extra features.
Some pumps come with a remote control and one
is even disposable.
How will I know how to use it?
You should receive training from your healthcare
team when starting to use a pump and you should
receive ongoing support. Many healthcare teams
have experience in using them but in some cases
you might need to see another team for your pump
care. You can also get a lot of support from the
company that makes your pump – most have
helplines and a representative may even be there
when you start using a pump. There are also support
groups for pump users and those wanting to use a
pump: INPUT (www.input.me.uk) and Insulin
Pumpers (www.insulin-pumpers.org.uk).
Who pays for the pump?
If you and your healthcare team decide pump
therapy is right for you – and you meet the criteria set
by NICE – funding for the pump, tubing and needles
should come from the NHS. If you don’t meet the
criteria, you will have to pay for everything – except
the insulin – yourself. Pumps cost between £2,000
and £2,500, and should last between four to eight
years. The disposables cost about £1,500 per year.
If you use a pump you need to test your
blood glucose levels more frequently
A pump delivers a steady
“flow
of rapid-acting
insulin round the clock
”
ACTION
POINTS
• If you’re considering a pump speak to your
diabetes healthcare team first to discuss
whether it’s suitable for you.
• If you are using a pump, join a support
group for pump users (see left). This will
increase your confidence when using it.
14
Type 1 diabetes 2013
WHAT DID YOUR METER
TELL YOU TODAY?
Meet OneTouch® Verio®IQ.
The meter with Verio® PatternAlert™ Technology.
NEW
Every time you test, it looks for hidden patterns of high and low
blood sugar and alerts you when it finds one — right on screen.
On insulin treatment?
OneTouch® Verio®IQ may be suitable for your needs.
Put it to the test.
Call OneTouch® Customer Care to order your FREE* trial:
0800 279 4142 (UK) quoting code AE243
Or visit www.LifeScan.co.uk/Bal
Receive personalised meter training and on-going
support from OneTouch® Customer Care: 0800 279 4142
Lines open 8.30am-6pm Mon-Fri, 9am-1pm Sat
*TERMS AND CONDITIONS
Offer open to those who are on insulin and making their own insulin dosing decisions (e.g. Multiple Daily Injections of insulin), aged 16 or over and resident in the UK and Republic of Ireland, including users of meters other than OneTouch® meters. Applicants who currently
use a OneTouch® meter must have had their meter for 12 months or more and not received a free OneTouch® upgrade during this period. Offer closing date 31st Dec 2012. Those eligible to participate in the free meter trial will be offered a OneTouch® Verio®IQ Blood Glucose
Monitoring System, 25 test strips and a questionnaire about their experience of using the OneTouch® Verio®IQ to complete and return in the reply paid envelope provided. Only one free OneTouch® Verio®IQ trial per person. Meters are subject to availability. This offer is limited
to a maximum of 4,000 free OneTouch® Verio®IQ meters. Allow 28 days for delivery. LifeScan, LifeScan Logo, OneTouch® and OneTouch® Verio®IQ are trademarks of LifeScan Inc. © 2012 LifeScan, Ortho-Clinical Diagnostics. AW 099-111A. 12-144
Diabetes care
TESTING
time
to
tesT
It’s recommended to prick the side,
rather than the middle, of your finger
B
lood testing is an integral
form of treatment for
people with Type 1 diabetes,
as it gives you an accurate
‘real time’ picture of your
blood glucose levels. It can
help you to maintain day-today control, find out if you
are hypo (hypoglycaemia
– low blood glucose levels),
and also help to provide
information that can be
used to prevent long-term
complications. Simply
relying on how you feel isn’t
recommended, as you might
not always notice when your
blood glucose levels are too
high or too low.
What testing involves
To test your blood glucose,
you prick the side (as
opposed to the pad) of
your finger with a special
device and put a drop of
blood on a testing strip,
which is then read by a
16
Type 1 diabetes 2013
blood glucose meter. Your
diabetes healthcare team
should provide education that
teaches you self-monitoring
skills so that you’re confident
in knowing how to act on your
results, which may include
adjusting your treatment or
activities accordingly.
Good control of blood
glucose levels (and blood
pressure) greatly reduces
the chance of developing
the long-term complications
of diabetes. Regularly
testing and responding
to the results appropriately
helps you to keep good
control and protect against
these complications.
Your healthcare team
should assess how you
monitor your blood
glucose levels every year
(or more often if it’s needed),
as well as check that you
know what to do with
your results.
Regular testing can put you
in control of your diabetes.
Let’s find out more
How to test
1
Wash your hands rather than using
wet wipes (these contain glycerine
that could alter the result).
2
Make sure your hands are warm –
if they are really cold it’s hard to
draw blood, and finger-pricking will
hurt more.
3
Prick the side of a finger (not the
index finger or thumb) – don’t prick
the middle, or too close to a nail,
because this can really hurt.
4
5
Use a different finger each time and
a different part – this will hurt less.
Keep a diary of your test results,
this will help your diabetes
healthcare team suggest
adjustments to your treatment,
if needed. Try the Diabetes UK
Tracker Smartphone app.
www.diabetes.org.uk/tracker-app
TESTINg
When to test
It’s often recommended to
test at the following times:
• before a main meal
• before bed
• if you feel unwell
• before and after
physical activity
• if you feel hypo
• before driving.
Your diabetes healthcare
team may also ask you to
test at other times, too (eg
during the night), in order to
get an overall view of your
diabetes control. There are
also other circumstances
when you’ll need to test
more often, such as if
you’re planning to conceive
and during pregnancy.
If you have recently been
diagnosed it’s even more
important to test regularly
so that you get a good idea
of what’s happening with
your blood glucose levels.
What is ‘good
diabetes control’?
It means keeping your
blood glucose levels as
near normal as possible
(see ‘Your target range’,
right). But don’t panic if you
have an occasional high or
low test – this happens to
everyone. Good control also
means understanding how
your medication, food and
activity affect your blood
glucose. This will give you
the confidence to adjust
your treatment, activity, and
what and when you eat, in
order to avoid high or low
blood glucose levels. Then
you can fit diabetes into
your life, rather than
planning your life around it.
Good control also means
taking the complications of
diabetes seriously and
minimising your risks – you
need to make sure you are
receiving all the essential
checks and 15 healthcare
essentials – see 29. It
also means keeping your
blood pressure under
130/80mm Hg, as this can
also greatly reduce the risk
of complications later in life.
As with all targets, everyone
is different so discuss with
your healthcare team what
your ranges should be.
Choosing a meter
Most people are given a
meter by their healthcare
team, but if you need to
choose a blood glucose
meter, it can be complex.
The Medical Devices
Agency evaluates all blood
glucose meters that are
available in the UK and
ensures that they meet
international standards.
If you’re at all unsure
about the most suitable
equipment for your needs,
contact your healthcare
team. They should help
you to understand blood
glucose monitoring, support
you in using a meter that
meets your needs and
devise a care plan that
suits you (see p24).
diabetes care
Q& A
My doctor always does a blood test, even
though I take my results book with me to
check-ups. Doesn’t he trust my records?
The test which your doctor does measures
your overall control for the last few weeks –
it is not the same test as the ones you do at
home. There are different types of this test.
HbA1c is the most common and gives your
average blood glucose level for the previous
8–12 weeks. This, along with the tests you
do at home, helps your doctor to see how
well your treatment is working and to make
any changes necessary. See p23 for more
on the HbA1c test.
Your target range
Target ranges are agreed between you and
your diabetes healthcare team. For guidance,
the general blood glucose target ranges
for people with Type 1 diabetes are:
– 4–7mmol/l before meals
– less than 9mmol/l two hours after meals.
ACTION
POINTS
• Ask your diabetes healthcare team what
blood glucose targets you should be
aiming for and what you should do about
high/low results.
• Make sure you know how to quality-
check your blood glucose meter and
how often you should do this.
2013 Type 1 diabetes
17
Diabetes care
hypos & hYpers
managing
highs & lows
People with Type 1 diabetes
may be at risk of hypos and
hypers. Understanding these
will help you to manage them
T
he key to controlling
diabetes is to balance
your food, activity and
insulin. But it’s not always
easy. When the balance
isn’t right, you may develop
hypoglycaemia (hypo – when
blood glucose drops too low)
or hyperglycaemia (hyper –
when blood glucose rises
too high).
Hypos
Hypoglycaemia (or hypo)
means when the blood
glucose level drops below
4mmol/l. In people without
diabetes, low blood glucose
levels trigger the body to
stop producing insulin and
to release stored glucose to
keep the body going. But, in
people with Type 1 diabetes,
while this mechanism still
works, it’s not so effective
because the insulin they have
injected can’t be ‘switched
off’. So it will continue
to work, even though
blood glucose is too low.
Explaining what hypos are all about
to your friends is a good idea
18
Type 1 diabetes 2013
Spotting the symptoms
Hypos can come on quickly
and you’ll tend to develop
symptoms that will indicate
that your blood glucose
levels are dropping too low.
Everyone has different
symptoms, but common
ones are:
• feeling hungry
• trembling or shakiness
• sweating
• anxiety or irritability
• going pale
• fast pulse or palpitations
• tingling lips
• blurred vision.
Why do hypos happen?
There’s no hard and fast
rule why they happen, and
sometimes there’s just no
obvious cause. But there are
some things that can mean
it’s more likely:
• too much insulin
• a delayed or missed
meal or snack
• not enough carbohydrate
• unplanned physical activity
(see p62).
• drinking large quantities of
alcohol or drinking alcohol
without food (see p88).
Explaining hypos to others
Some people find explaining
hypos to family, friends and
work colleagues tricky, but it’s
better to let them know in
advance what might happen
so that if and when you have a
hypo, they can help you deal
with it. Explain why they’ll
sometimes see you eating or
hypos & hYpers
diabetes care
tend to develop symptoms that
“You’ll
will signal you are having a hypo
”
drinking sugary things, and tell them
what to do if you can’t manage on
your own. Some people find that
they get irritable or stubborn when
they go hypo, so you’ll need to let
people know what to do to get you
to eat or drink something.
treating a hypo
There are a series of steps to
take when treating a hypo:
Immediate treatment
If you have tested your blood
glucose levels and they are low or
you notice your hypo warnings,
take action quickly or it’s likely to
become more severe, and you
may become confused, drowsy or
possibly even unconscious or
have a fit. Immediately treat with
15–20g of a fast-acting
carbohydrate such as:
• a sugary/non-diet drink
• glucose tablets
• sweets, eg Jelly Babies
• fruit juice
• glucose gel – this can be useful
if you’re feeling drowsy and
someone can help you, but
should not be used if you are
unconscious (glucose gel is
available on prescription if you
are treated with insulin).
Hypo treatments vary, and the
quantities vary from person to
person. Choose the treatment
that works best for you Avoid food
and drinks containing fat (eg
chocolate, biscuits, milk). This is
because fat delays the absorption
of sugar, so won’t treat the hypo
quickly enough.
carbohydrate, such as:
• half a sandwich
• fruit
• a small bowl of cereal
• biscuits and milk
• the next meal, if due.
Retest
Check your blood glucose after
15–20 minutes and, if it’s still low,
repeat with the same treatment.
severe hypos
Follow-on treatment
To prevent your blood glucose levels
dropping again, you may need to
follow with 15–20g of a longer-acting
A severe hypo is when you need
help from another person to treat it.
If a hypo is untreated there is a risk
that you may become unconscious.
While this is not common, it’s
important that you know what
to do so you can be prepared:
• If possible, you should be placed
Hypos & everyday life
There are a few things that you need to be aware of when it
comes to day-to-day activities and hypos:
Driving
Hypos are most dangerous when you need all your concentration
and co-ordination, such as driving a car. Even a mild hypo, because
of its effects on the brain, can seriously impair your ability to drive.
See p82 for details.
Exercise
Exercise will generally lower blood glucose levels, so you might
need to eat some carbohydrate or reduce your insulin beforehand.
The effect of strenuous or long periods of exercise can last for
several hours, so you may have to alter your insulin doses and
carbohydrate intake accordingly and keep some fast-acting
glucose, such as a non-diet drink close by. See p62 for details.
2013 Type 1 diabetes
19
Diabetes care
hypos & hYpers
in the recovery position (on your
side with your head tilted back)
• If you have been given a glucagon
injection kit (available as GlucaGen
HypoKit), someone else can help
you by injecting it, but only if the
person you are with has been
trained to use it. If you don’t have a
glucagon kit available or you have
not recovered within 10 minutes of
receiving the glucagon injection,
the person you are with should put
you in the recovery position and
call an ambulance immediately.
• If you are unable to swallow or are
unconscious, you should not be
given anything by mouth and
ambulance staff should be called
straight away. Make sure your
family and friends are aware.
• Always tell your diabetes
healthcare team if you have
had a severe hypo as your
treatment may need to be altered.
hypos at night
Many people worry about having a
hypo at night and that they may not
be woken by mild symptoms. This
means that the blood glucose levels
may drop further and the hypo may
become more severe. Keep hypo
treatments by your bed just in case.
If you’ve had a night-time hypo
and haven’t been aware of it, you
may wake up in the morning feeling
very tired, perhaps with a headache
or a hangover feeling, and find it
difficult to concentrate. When you
test your blood glucose it may be
higher than expected. The best way
of telling that you’re having hypos at
night is testing during the night. Ask
your healthcare team about the best
time to do this as it can depend on
your insulin regimen. To help prevent
a night-time hypo, have a longeracting carb snack, eg milk, half
a sandwich, fruit or yogurt before
bed. But if you do find that you
keep having hypos at night, talk to
your team – you might need to
adjust your insulin dosage. Don’t
forget that having sex can be
strenuous exercise and may
cause a delayed hypo.
top
tips
1
heck your blood
C
glucose at times
when your hypos are
most likely to happen.
2
3
eep hypo treatments
K
with you at all times.
If you have had a hypo during the night, you
may wake up in the morning feeling very tired
20
Type 1 diabetes 2013
Hypos
Make sure you carry
some form of ID, an
identity card, bracelet
or necklace. This
will help if you
become unwell or
if you’re unable to
communicate in an
emergency because
people will be aware
that you have
diabetes. Visit https://
shop.diabetes.org.uk
hypos & hYpers
diabetes care
Q& A
Should I keep my blood glucose
levels high to avoid hypos?
No. It can be harmful for you if you try to keep
your blood glucose levels consistently very high
in order to avoid hypos. You may start to feel
thirsty, go to the loo a lot and feel tired – basically
you may start to feel like you did before you were
diagnosed. You may also develop ketones (see
p22) and long-term high blood glucose levels
can lead to complications (see from p94).
What are the main reasons for hypos?
The most frequent cause is missing or delaying
a meal, but occasionally it might be a mistake
in your insulin dose or due to unplanned exercise.
Stress, or very hot or cold weather, also cause
some people to have hypos. If there’s a simple
explanation for the odd hypo, there’s no need
to adjust your treatment. It’s only if you have
frequent hypos at similar times or if you have a
severe hypo that you may have to look at what
you eat or your insulin doses. Speak to your
diabetes healthcare team for advice or if you
have any concerns. You may also find that it
helps to do more blood glucose tests. That
way, you’ll be able to spot when your levels
are likely to drop and take action, without
running your levels too high all the time.
How do hypos affect my
blood glucose levels?
After a hypo, your blood glucose level
may actually rise. Don’t be tempted to
increase your insulin dose. This rise may
have occurred because you felt incredibly
hungry during the hypo and ate to correct
this. Your levels may also rise because
hypos cause the body to mobilise its
own glucose stores.
Why do some people have severe
hypos without any warnings?
Research suggests that people who keep
their diabetes very tightly controlled may have
problems in recognising hypo warnings. Research
also shows that if you have one severe hypo
without warnings, you’re more likely to have
repeated episodes. And once you’ve had one
severe hypo, you’re at risk of more, so you should
take particular care. There’s also some evidence
that people who’ve had diabetes for a long time
may have lost their hypo warnings. However, they
can often regain them by adjusting their diabetes
treatment. If you’re having problems, talk them
through with your diabetes healthcare team.
They’ll be able to give you tailored advice.
I’ve heard about someone having an
islet cell transplant – what is this?
For some people with severe problems with
hypoglycaemia, islet cell transplants are available.
This is where insulin-producing cells (called islet
cells) are taken from donated pancreases and
injected into the liver, where they start to produce
insulin. It takes three to four pancreases to give
one person a sufficient amount of islet cells.
Can I die from a hypo?
In most cases, even if you become
unconscious and don’t treat the hypo,
your body will slowly respond by
naturally increasing blood glucose levels
and you’ll eventually become conscious
again. Despite this, it’s important to
treat a hypo. On very rare occasions,
excessive alcohol or the
administration of huge
insulin doses may cause a
hypo that results in death.
2013 Type 1 diabetes
21
Diabetes care
hypos & hYpers
HypERs
At the other end of the scale
are hypers (hyperglycaemia),
which happen when blood
glucose levels go too high.
Some of the reasons are:
• missing an insulin dose
• injecting too little insulin
• eating too much carbohydrate
• over-treating a hypo
• stress
• being unwell with an infection.
Symptoms include:
• increased thirst
• frequent urination
• headaches
• extreme tiredness.
Treatment
If your blood glucose level is high
for just a short time, emergency
treatment won’t be necessary.
But if it stays high you need to
take action to prevent yourself
from developing diabetic
ketoacidosis:
• Check your blood or urine for
ketones if your blood glucose
level is 15mmol/l or more (see
p78 on how to do this)
• If ketones are present it’s likely
sure you drink
“Make
plenty of sugar-free
fluids
”
that you don’t have enough
insulin in your body, so you
may need to increase the dose
or give an extra dose. Talk to
your diabetes healthcare
team about how to do this.
• Make sure you drink plenty
of sugar-free fluids
• If you have ketones and feel
unwell, especially if you are
vomiting, you must contact your
healthcare team as soon as
possible for advice.
Diabetic Ketoacidosis (DKA)
DKA is when a severe lack of
insulin upsets the body’s normal
chemical balance and causes
ketones to be produced.
Ketones are poisonous
chemicals, which if left unchecked,
will cause the body to become
acidic, hence the name ‘acidosis’.
DKA can develop:
• When you are first diagnosed
with Type 1 diabetes
• When you are ill
• If you have not taken your
insulin dose(s). DKA generally
develops over a long period of
time, possibly over 24 hours
or more. It has to be treated in
hospital, as you will need a drip
and an insulin infusion.
Signs of DKA
• ketones in the blood/urine
• abdominal pain
• nausea/vomiting
• rapid breathing.
If you have high blood glucose
levels and any signs of DKA,
contact your diabetes healthcare
team immediately. If DKA is left
untreated it could cause you to
become unconscious. But if picked
up early it can easily be treated
with extra insulin and fluid.
ACTION
POINTS
• Try to understand the
main causes of hypos and
hypers and take steps to
keep yourself safe.
• Familiarise yourself with
If you have any signs of DKA
“you
must contact your diabetes
healthcare team immediately
”
22
Type 1 diabetes 2013
your warning signs and
symptoms for hypos
and hypers, and try to
have the right treatment
available at all times.
long-term testing
diabetes care
long-term control
You’ll be invited for various tests to check on
your overall health now that you have diabetes,
and there are particular targets to be aiming for
M
onitoring your health when you have
diabetes is crucial to prevent some
of the complications associated with the
condition. This involves knowing your blood
glucose, blood pressure and blood fat levels,
and there are targets you should be aiming
for. As well as day-to-day blood glucose
testing, the HbA1c test (usually done from a
fingertip blood test) measures your diabetes
control over two to three months. This target
and the others are:
• HbA1c: below 48mmol/mol but 58mmol/l
or below for those at risk of severe
hypoglycaemia
• Blood pressure: 130/80mm Hg or less
• Blood fats:
– total cholesterol: below 4mmol/l
– LDL (bad fat): below 2mmol/l
– HDL (good fat): 1mmol/l or above for men, 1.2mmol/l or above for women
– triglycerides: 1.7mmol/l or below.
Remember, target ranges are individual and
your diabetes healthcare team may suggest
a different target to you.
• See p29 for 15 healthcare essentials.
For more on complications, see p94.
Q& A
I have sickle cell anaemia
and my doctor says that he
can’t do the HbA1c test on
me. Why is this?
HbA1c measures the amount
of glucose that is being
carried by the red blood cells
in the body. But red blood
cells are affected if you are
anaemic, or have a condition
like sickle cell anaemia or
thalassaemia (all of which
involve a lack of, or abnormal
type, of haemoglobin – the
‘oxygen carrying’ part of the
blood). So this means that the
test will give a false result.
2013 Type 1 diabetes
23
Diabetes care
The care to expect
Your care explained
It takes a team of professionals to provide the best
possible diabetes care. Find out what care and
services to expect and who will be looking after you
Y
our diabetes healthcare team
is made up of all the healthcare
professionals who are involved in
your care, but you won’t see them
all together at the same time.
Your diabetes care may be
provided in different places
depending on your specific
needs, but most likely at your
local hospital. It is best to discuss
with your nurse or consultant the
roles and responsibilities of those
providing your diabetes care. It’s
important to identify the key
members of your healthcare team
and agree the name of the key
contact, who you are likely to see
most often. You may see some
members of your team more often
than others and they may change
over time.
To achieve the best possible
diabetes care, it is essential for you
to work in partnership with your
diabetes healthcare team and use
your combined experience and
expertise to agree what care and
support you need. Remember, the
most important person in the team is
you – because the decisions made
will affect you. (See ‘Planning your
diabetes care’, right).
Your healthcare
team will have a
wealth of experience
`
Planning your
diabetes care
The partnership between you
and your diabetes healthcare
team, where you are actively
involved in deciding how your
diabetes will be managed, is a
process called ‘care planning’.
During your appointments,
you should:
• discuss your concerns
and questions with
members of your
diabetes healthcare team
• work together to set
realistic goals
• decide how you are going
to achieve these goals.
The goals you agree during
your discussions will form the
basis of your care plan, which
is the written summary of
what you and your diabetes
healthcare team are both
going to do to help you to
manage your diabetes. A
paper copy of your care plan
should be given to you by a
member of your diabetes
healthcare team. If not, ask
for one.
Type 1 diabetes 2013
The care to expect
diabetes care
top
tips
What to expect
Appointments
It is important that you understand your diabetes and
the healthcare you can expect so that you are an
effective member of your own diabetes healthcare
team. There are different stages that your care will
go through:
When you have just been diagnosed
with diabetes, you should:
• Have a full medical examination and discuss with a
member of your diabetes healthcare team any
immediate treatment you need; your concerns
and unanswered questions; your feelings and
reaction to being diagnosed.
• Receive an explanation of what’s on offer for you to
learn more about diabetes and keeping well. This
includes diabetes education and self-management
courses (see p30), as well as other sources of
information and support.
• See a registered dietitian to talk about what you
usually eat, how this relates to your condition, and
what other information and support will help you
manage your food and diabetes.
Before
• decide what you need to know
• write down the points you want to raise
• bring your blood glucose meter and results
record with you
• bring any news features/stories or research
that you have any questions about.
Once you have received initial information
and treatment, your ongoing care includes:
• A yearly formal care planning review with a doctor or
nurse experienced in diabetes. This should include a
discussion of your test results and examinations, as
well as your experiences of living with diabetes and
any other concerns, needs or anxieties.
• Full review every year to check for complications
(see the 15 Healthcare Essentials p29)
• Regular access to your healthcare team to assess
your diabetes control. This could be every four to
six months, or as agreed in your care plan. You
should have the time to ask questions and to
discuss your care.
ccess to a member of your healthcare team for
• A
specific support and advice when you need it.
This could be in person, by phone, email or text.
During
• listen actively – ask questions, give feedback
and ask for clarification if you’re unsure of
anything
• make notes to help you remember what has
been said
• check you’ve covered your list.
After
• review what’s been said and agreed
• make a note of anything you need to
do before your next appointment.
As part of your ongoing care your healthcare
team is there to support you to manage your
diabetes. They will:
• Provide continuity of care, ideally from the same
doctors and nurses, or if this isn’t possible, doctors
or nurses who are fully aware of your medical history
and background and are experienced in diabetes.
They’ll work with you to continually review and
update your care plan, including your diabetes
management goals.
2013 Type 1 diabetes
25
Diabetes care
The care to expect
• Make sure that you understand
and are involved in the decisions
about your treatment or care.
This means having access to
your results with information
about what they mean, so you
can ask questions and make
sure your personal goals are
reflected in copies of any letters
written about your diabetes.
• Ask you how you are feeling
and give you information on
available emotional and
psychological support.
• If you need it, organise
pre- and post- pregnancy
advice together with your
obstetric team.
• Encourage you to gain support
from your friends, partner and/or
relatives and from other people
with diabetes.
• P
rovide you with ongoing
education sessions,
appointments and information
on different ways you can learn
about diabetes.
• Offer you a medication review,
which may be via your
pharmacist.
• Give you information on the
effects of diabetes and
treatments when you are ill or
taking other medication.
• Help you access specialist
services when you need them,
for example specialist foot
services.
Your care should also include:
• Contact (face-to-face, telephone,
email or text messages) with your
diabetes healthcare team. This
will be frequent at first, as you
learn how to inject, look after
your insulin, syringes, insulin
pen, or insulin pump and how
to dispose of needles and
lancets (sharps).
• Being shown how to test your
blood glucose and test for ketones
and be informed what the results
mean and what to do about them.
• Being given supplies of, or a
prescription for, the medication
and equipment you need.
• A discussion about hypos and
hypers, when and why they
may happen and how to deal
with them.
• An examination of your injection
sites to check insulin can be
absorbed properly.
• How illness can affect blood
glucose levels and how to manage
diabetes during these times.
Prescriptions
Your GP will be responsible for the care
you receive at your local surgery
26
Type 1 diabetes 2013
In the UK, people with
diabetes who take diabetes
medications are entitled to
free prescriptions, but you’ll
need a prescription
exemption certificate. Talk
to your GP, diabetes nurse
or pharmacist about how
to apply for one.
Equipment such as test
strips, lancets, syringes,
insulin pens, pen needles and
sharps boxes are all available
on prescription. Your diabetes
specialist nurse will usually
provide you with a blood
glucose meter and
finger-pricking device.
The care to expect
Hospital stay
If you are admitted to hospital for any
reason (diabetes related or not), here
are a few tips to bear in mind:
• If you have a planned operation,
discuss a plan for your diabetes
care in hospital at your preassessment appointment. The
plan should include information
about what will happen before,
during or after your procedure.
• If you wish to manage your
diabetes care during your stay in
hospital, you should have access
to your own medication, hypo
treatment and equipment
(including blood glucose
monitoring equipment). If you
don’t have everything to manage
your diabetes, the appropriate
hospital staff should be able to
provide you with what you need.
• If you’re admitted unexpectedly
and you would prefer to use your
own diabetes equipment and
snacks, you could ask a friend,
carer or relative to bring them
in for you.
• If you have any concerns about
your diabetes care, speak to
the hospital staff – they can
contact the diabetes healthcare
team if necessary.
• After your stay in hospital, if any
changes have been made to
your treatment, you and your
usual diabetes healthcare team
should be informed of them and
receive information about
ongoing management.
The most important
“person
in your diabetes
team is you
”
diabetes care
Q& A
I’m not happy with my
healthcare. What can I do?
If you are unhappy or dissatisfied
with the care you are receiving,
try to deal with minor irritations
at the time and with the person
involved. Look carefully and
honestly at what happened.
Persistent problems should be
taken up with the person in
charge of the surgery or clinic.
If you are still unhappy, you can
take your complaint further.
There are a different series of
steps to follow in each country
within the UK. For more details,
visit www.diabetes.org.uk/
your-concerns
copy of your care plan should be
“Agiven
to you by a member of your
diabetes healthcare team
”
ACTION
POINTS
• Discuss the roles and responsibilities of
those providing your diabetes care with
your GP, so you know who to contact as
and when.
• Find out who the key members of your
diabetes healthcare team are and agree
the name of the person you’ll see most
often. They will become your main contact.
2013 Type 1 diabetes
27
Diabetes care
The care to expect
Meet your team
Your GP provides you with
your prescriptions and will
deal with any other medical
issues or problems. They
might also be involved in
your diabetes care.
Practice nurses are
based at your surgery. Some
may have specialist knowledge
of diabetes.
Diabetes specialist nurses
(DSNs) have special expertise
in diabetes. They will usually
provide telephone advice
between your appointments.
Some may advise on how to
alter your medication. Most
hospitals and community clinics
have DSNs and some GP
surgeries have DSNs visiting
during diabetes clinics.
Diabetologists are consultants
who specialise in diabetes. They
28
Type 1 diabetes 2013
are usually based at a hospital
clinic or specialist diabetes
centre, although some areas
have community diabetologists
who provide diabetes care and
support in community clinics.
Registered dietitians work
with you to assess your eating
habits and help you make
lifestyle and food choices in
order to manage your diabetes.
Everyone with diabetes should
see a registered dietitian for
individual dietary advice.
Registered podiatrists
manage foot problems related
to diabetes. They advise on
shoes, and check and treat
conditions of the foot and
lower limb. You should be
referred from your hospital
clinic or GP surgery,
if necessary.
Ophthalmologists are
doctors with specialist training
in the diagnosis and treatment
of conditions that affect the
eye. You should be referred
from your hospital clinic or
GP surgery.
Pharmacists are based
in all pharmacies and
chemists. They give you
supplies of your medication
when you provide them
with a prescription from
your GP. Many also provide
lifestyle advice and
medication reviews.
Psychologists help you
to cope with the impact
that your diabetes has
on your life. You should
be referred from your
hospital clinic or GP
surgery, if necessary.
The care to expect
diabetes care
15 healthcare essentials
Having the right care is essential for the wellbeing of all people with diabetes. There is a minimum level of
healthcare that every person with diabetes deserves and should expect. Here are the 15 essential checks
and services you should receive. If you aren’t getting all the care you need, take this checklist to your
diabetes healthcare team and discuss it with them.
1
10
2
3
11
4
12
5
13
6
14
7
8
15
et your blood glucose levels measured at least
G
once a year. An HbA1c blood test will measure your
overall blood glucose control and help you and your
diabetes healthcare team set your own target.
Have your blood pressure measured and recorded
at least once a year, and set a personal target that
is right for you.
Have your blood fats (cholesterol) measured every
year. Like blood glucose levels and blood pressure,
you should have your own target that is realistic
and achievable.
Have your eyes screened for signs of retinopathy
every year. Using a specialised digital camera, a
photo of each eye will be taken and examined by a
specialist who will look for any changes to your
retina (the seeing part at the back of your eye).
Have your feet checked – the skin, circulation and
nerve supply of your feet should be examined annually.
You should be told if you have any risk of foot
problems, how serious they are and if you will be
referred to a specialist podiatrist or foot clinic.
Have your kidney function monitored annually. You
should have two tests for your kidneys: urine test
for protein (a sign of possible kidney problems) and
a blood test to measure kidney function.
Have your weight checked and have your waist
measured to see if you need to lose weight.
Get support if you are a smoker, including advice
and support on how to quit. Having diabetes already
puts people at increased risk of heart disease and
stroke, and smoking further increases this risk.
Receive care planning to meet your individual
needs – you live with diabetes every day so you
should have a say in every aspect of your care.
Your yearly care plan should be agreed as a result
of a discussion between you and your diabetes
healthcare team, where you talk about your
individual needs and set targets. If you live in
Northern Ireland, care planning is different.
9
ttend an education course to help you
A
understand and manage your diabetes. You
should be offered and have the opportunity to
attend courses in your local area.
Receive paediatric care if you are a child or young
person. You should receive care from specialist
diabetes paediatric healthcare professionals. When
the time comes to leave paediatric care, you
should know exactly what to expect so you have a
smooth change over to adult health services.
Receive high-quality care if admitted to
hospital. If you have to stay in hospital, you
should still continue to receive high-quality
diabetes care from specialist diabetes
healthcare professionals, whether you have
been admitted due to your diabetes or not.
Get information and specialist care if you are
planning to have a baby as your diabetes control
has to be a lot tighter and monitored very closely.
You should expect care and support from
specialist healthcare professionals at every stage
from preconception to post-natal care.
See specialist diabetes healthcare professionals
to help you manage your diabetes. Diabetes
affects different parts of the body and you should
have the opportunity to see specialist
professionals, such as an ophthalmologist,
podiatrist or dietitian.
Get emotional and psychological support.
Being diagnosed with diabetes and living with a
long-term condition can be difficult. You should
be able to talk about your issues and concerns
with specialist healthcare professionals.
Checks and services for children. Children
should receive more frequent HbA1c measurements
and regular weight, height and general health checks
from their healthcare team. Formal screening for
complications generally begin at age 12.
2013 Type 1 diabetes
29
Diabetes care
Education
Following
the right
course
Courses can either be taught in
group form, one to one or online
D
iabetes UK advocates that
all people with diabetes,
should receive the education
and support they need to
enable them to manage their
own condition. It is also part
of the 15 healthcare essentials
(see p29).
Diabetes is a lifelong
condition and having the
understanding, knowledge
and skills to effectively
manage it can make a big
difference to your life. This
is why education is very
important and should be
offered to you. There are lots
of different education courses
available for people with
diabetes and they vary in
length and the types of things
covered. They should include
information about how
to manage your diabetes
through diet, physical activity
and medication. The courses
can take place in groups,
30
Type 1 diabetes 2013
With a broad range of educational
courses available for people with
diabetes, to help you learn about and
manage your condition, it is important
to pick one that is right for you
one-to-one sessions or even
online.
When choosing an education
course, ask the following
questions.
• Is the programme relevant
to my type of diabetes?
• Can I commit enough
time to complete the
programme in full?
• Is the programme run
by qualified healthcare
professionals?
• Do I meet the requirements
set out by the programme?
• Am I happy to take a more
involved and proactive role
in my diabetes care?
It is important that the
course suits you, so talk to
your nurse and/or dietitian
about what is available.
i For examples of the types
of courses available, visit
www.diabetes.org.uk/
structured-education
Q& A
What is structured education?
It is a course that meets the
criteria set by the National
Institute for Health and Clinical
Excellence (NICE).
What are the criteria that the
course should have?
• a patient-centred philosophy
• a structured, written curriculum
• trained educators
• be quality assured
• be audited.
ACTION
POINTS
• Speak with your diabetes
healthcare team about what
local courses are available.
health informationTESTIN
online
diabetes care
caught in
the web?
Not all the information found on the
internet is 100 per cent accurate.
Here are some tips that will help
you sift out the quality advice
A
s we rely more and more on
the internet for information, it’s
tempting to accept that everything
we discover is truthful. But when
it comes to health information, it
always pays to be cautious.
Following some simple guidelines
will help you to steer clear of any
unscrupulous traders and ditch
out-of-date information and advice.
• If there’s any health-related
articles online that interest you,
talk them through with your
healthcare team. Remember
to take a copy with you.
• Ask your healthcare team to
recommend good, relevant sites.
• Be cautious about buying medical
products via the internet. In most
countries, selling and buying
medical products online is an
illegal activity. You’re far better
getting your medical products at
pharmacies or through your
healthcare team.
• Beware of sites offering a cure
for diabetes. Research advances
every day, but there’s no cure.
heck that links on the site
• C
are still ‘live’. ‘Dead’ links tend
to indicate that other information
on the site will also be out of date.
• Be critical. Remember that
if it sounds unbelievable, it
probably is.
• Don’t be fooled by the use
of high-tech websites. Just
because a site looks good,
doesn’t necessarily mean that
the content will be high quality.
• If you’re unable to check online
information with your GP or
member of your diabetes
healthcare team, Diabetes UK
Careline may be able to help you
– call 0845 120 2960 or email
[email protected]
• Don’t rely on search engines to
find information and use a reliable
source instead. See right for
some recommended sites.
There are also several good
online diabetes forums. Generally
the advice, shared knowledge
and experience you’ll receive is
Online forums are a good place to
share your experience of diabetes
very useful, but don’t change
treatments or make any
alterations to your lifestyle
until you have discussed them
with your healthcare team.
Sites you can trust
Diabetes UK
www.diabetes.org.uk
Diabetes Support Forum
www.diabetessupport.co.uk
NHS Direct
www.nhsdirect.nhs.uk NHS Choices
www.nhs.uk
National Institute for Health
and Clinical Excellence
www.nice.org.uk
Health Protection Agency
www.hpa.org.uk/HPA
2013 Type 1 diabetes
31
Diabetes care
Associated conditions
On guard
Coeliac
Disease
M
Thyroid problems can
be treated with tablets
Having Type 1 diabetes can raise the risk
of developing other autoimmune conditions
ThYroid problems
T
he thyroid is a gland in the
neck, situated just below the
Adam’s apple, and it produces
hormones to regulate the body’s
metabolism (the chemical
reaction that occurs in the
body’s cells to convert food to
energy). There are two types of
thyroid disorder: hypothyroidism
(when the body doesn’t produce
enough thyroid hormones)
and hyperthyroidism (when it
produces too much). Symptoms
include the following:
Hypothyroidism
• tiredness
• feeling cold all the time
• constipation
• more frequent hypos.
32
Type 1 diabetes 2013
Hyperthyroidism
• weight loss
• feeling warm all the time
• diarrhoea.
What can cause
thyroid problems?
Type 1 diabetes is where the
body’s cells attack the pancreas
and destroy the insulin producing
cells. In a similar way, thyroid
conditions can occur if the
body’s cells attack the thyroid.
For this reason, thyroid problems
are more common in people who
have Type 1 diabetes, particularly
hypothyroidism.
Neither hypo- nor
hyperthyroidism can be cured,
but both can be treated
successfully with tablets.
ore common in people with
Type 1 diabetes, coeliac
disease is where the body reacts
to gluten (a protein found in
wheat, barley and rye), which
damages the gut lining and affects
absorption of food. Symptoms can
include stomach ache, diarrhoea,
constipation, anaemia, poor growth
and unexplained hypos. But
sometimes there are no symptoms.
You should be assessed for
coeliac disease if you are displaying
symptoms. This is done by a blood
test. If the blood test is positive, the
diagnosis will be confirmed by a gut
biopsy under general anaesthetic.
The only treatment is a permanent
change in diet to avoid gluten, and it
is essential that you see a dietitian
who can advise on both diabetes
and coeliac disease.
If you think you might have coeliac
disease, discuss your symptoms
with your GP. You shouldn’t start a
gluten-free diet until you have a
definite diagnosis. Following a
gluten-free diet before a test for
coeliac disease may give an
inaccurate result.
i www.coeliac.org.uk
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The Paradigm Veo is the only insulin pump that can
actively protect against severe hypoglycaemia – even at
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Unlike any other pump, the Paradigm Veo uses sensor
data to recognise when your child’s glucose levels are
dangerously low. It then responds by suspending insulin
delivery for two hours, giving you both the peace of mind
you need to live life to the full.
The MiniMed Paradigm® Veo™ System
Live More, Worry Less
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ARE YOU AN
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For an unforgettable experience contact
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or call 020 7424 1000
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2013 Type 1 diabetes
33
Diabetes care
eating disorder
sharing a secret
People with diabetes who cut back on the
amount of insulin they take, in order to shed
the pounds, are putting themselves at risk
of developing long-term complications
S
ometimes people
with Type 1 diabetes
deliberately skip insulin
injections in an attempt to
lose weight. This pattern of
behaviour is referred to as
‘diabulimia’ (initially coined
by the media to describe
the phenomenon). However,
diabulimia is not currently
recognised as a formal
diagnosis by the medical
or psychiatric communities,
but that doesn’t mean that
it shouldn’t get some
serious attention.
It’s estimated that about
one in three women with
Type 1 diabetes under the
age of 30 may be abusing
insulin because of a fear of
weight gain (or have done in
the past). But diabulimia is
often a hidden condition,
so these numbers may
be higher. And, of course,
it can also affect men.
About one in three women with Type 1 diabetes
under the age of 30 may be abusing insulin
34
Type 1 diabetes 2013
eating disorder
diabetes care
Diabulimia is often a
“hidden
condition but
it’s really important
to get some help
”
Skipping insulin
If your body doesn’t have enough
insulin, it can’t move the glucose
from your blood into your body cells,
which need it for energy. When this
happens, it tries to get the energy it
needs elsewhere by breaking down
your fat stores instead – this makes
you lose weight.
Health effects
When you haven’t got enough
insulin in your body your blood
glucose rises. This can seriously
affect your health both in the short
and long term.
In the short term, it can cause
diabetic ketoacidosis (DKA, see
p22). If you’ve been missing your
insulin doses you’ll have a lot of
glucose in your blood that can’t
get into your body cells to give you
energy. But your body still needs
energy to work properly, so it starts
to break down fat as this is another
source of energy. As fat breaks
down, acidic chemicals called
ketones are released into your
blood stream. This leads to
breathlessness and vomiting and
eventually the high level of acidic
ketones can lead to unconsciousness
and, if untreated, death.
In the long term, continuous
high blood glucose can damage
your small and large blood
vessels, which can increase your
chances of developing the serious
complications of diabetes, such as
stroke, blindness, heart attack,
kidney disease and amputation.
warning signs
• weight loss
• fear of gaining weight
• distorted perception of body
shape or weight
• denying there’s a problem
• changes in personality and
mood swings
• symptoms of high blood glucose
levels – thirst, passing urine
frequently (especially at night),
and extreme tiredness.
Getting help
If you’re stuck in a cycle of skipping insulin and can’t seem to break
out of it, it’s really important you get some help. You’re risking your
health and, potentially, even your life. But it can be difficult to do it
alone, so try to open up to somebody:
• your family and friends can be a great source of support
in helping you to break the cycle
• your healthcare team will have come across this before
and can refer you on to a psychologist if necessary
• call Diabetes UK Careline on 0845 120 2960 or email
[email protected]
• seek help from Diabetics with Eating Disorders – a registered
charity which provides support and advocacy for people with
both diabetes and an eating disorder, www.dwed.org.uk
2013 Type 1 diabetes
35
FOOD
HEALTHY EATING
Food matters
No food is out of bounds, but food choices are
an important part of your diabetes management
Bread, rice, potatoes, pasta
and other starchy foods
Fruit & vegetables
can
Foods
can
““Foods
bebe
divided
divided
into
fivefive
main
into
main
food
groups
food
groups
””
Meat, fish, eggs,
beans and other
non-dairy sources
of protein
E
ating the right foods should
be seen as part of your
diabetes treatment, like taking
your medication, testing blood
glucose and being active.
A healthy, balanced diet is
recommended – but what is that?
Foods can be divided into five
main food groups. The ‘Eatwell
plate’ (above) represents the
proportions of the food groups in a
balanced diet. Foods from each of
these should be eaten to provide
36
Type 1 diabetes 2013
Milk & dairy foods
Foods & drinks high
in fat and/or sugar
all the nutrients needed for
good health – no single food
group can provide everything
we need to stay healthy. See
p41 for a portion size guide.
Fruit & vegetables
They contain essential vitamins and
minerals that are important for good
health. Fruit and veg can help to
protect against strokes, heart
disease, high blood pressure and
some cancers. They also contain
fibre to maintain a healthy gut and
prevent constipation. At least five
portions a day is recommended
– this can be hard to manage but
HEALTHY EATING
fresh, dried, frozen or tinned fruit and veg all count
towards your ‘five a day’. Variety is best, so try eating
as many different colours as possible.
Bread, rice, potatoes, pasta
& other starchy foods
Carbohydrate is a nutrient that is an important source
of energy in the diet. All carbohydrates are broken
down into glucose, which is used by the body’s cells
as fuel. Glucose from carbohydrate is essential fuel
for the body, especially the brain, and high fibre
carbohydrates play an important role in the health of
the gut. Carbohydrates increase blood glucose, so
it’s important to be aware of how much you eat and
include them in your sums if you are carbohydrate
counting (see p42).
FOOD
Milk & dairy foods
These foods contain calcium, which helps to keep
your bones and teeth strong. But some are high in
fat so try to choose lower fat options – this will reduce
your intake of saturated fat – the type linked to
heart disease.
Most dairy products contain lactose (a natural
milk sugar), which will have an effect on blood
glucose. Cheese is an exception and doesn’t
contain carbohydrate – the process that turns
milk into cheese uses up the lactose.
meat, fish, eggs, beans & other
non-dairy sources of protein
These foods are high in protein, which is important for
growth and repair. Some are high in iron, which is
needed for producing red blood cells. Omega 3 fats,
which are found in oily fish such as mackerel, salmon
and sardines can help protect the heart. Good sources
of protein for vegetarians are beans, pulses, lentils,
soya, tofu and Quorn.
Protein doesn’t have a direct effect on blood
glucose, but can affect the digestion and absorption
of carbohydrate foods.
2013 Type 1 diabetes
37
FOOD
HEALTHY EATING
Foods & drinks
high in fat and/
or sugar
These foods should make
up the smallest part of your
diet. It is important to be
aware of the amount and
type of fat you eat.
There are two main
types of fat: saturated and
unsaturated (monounsaturated and polyunsaturated). Eating too
much saturated fat can increase your risk of heart disease. The
type of fat found in oily fish is protective against heart disease.
All fats (eg, butter, cream, oil, margarine) don’t have a direct effect
on blood glucose levels, but will delay the digestion and absorption
of glucose from carbohydrate-containing foods. Too many foods from
this group can lead to weight gain.
Watch
the salt
Too much salt can lead
to high blood pressure,
which can damage the
kidneys. Beware of hidden
salt in processed foods,
such as:
• bacon, ham, cheese,
sausages, meats
• breakfast cereals,
bread, cakes
• crisps, nuts,
savoury snacks
• ready-made soups,
sauces, tinned vegetables,
ready meals.
Balancing act
Try to have a balanced main
meal every day. Using your
plate as a rough guide will
help you to eat foods in the
recommended proportions,
as shown in this example.
This will help if you are aiming
to maintain your weight, but
if you’re trying to lose weight
see p56.
38
Type 1 diabetes 2013
HEALTHY EATING
10
steps
Eating well
1
Eat regular meals
Avoid skipping meals and space out your
breakfast, lunch and evening meals over the
day. This will help control your appetite and
your blood glucose levels, especially if you
are on twice-daily insulin.
2
Eat starchy carbohydrates
Carbohydrates will have an effect on your
blood glucose levels, so it’s important to
be aware of the amount you eat. The actual
amount needed varies from person to person.
Examples of starchy carbohydrates include
bread, pasta, chapattis, potatoes, yam,
noodles, rice and cereals. Try to include those
that are more slowly absorbed (have a lower
glycaemic index) as these won’t affect your
blood glucose levels as much.
Better choices of starchy carbs include:
pasta, basmati or easy-cook rice, grainy
breads such as granary, pumpernickel and
rye, new potatoes, sweet potato and yam,
porridge oats and natural muesli.
FOOD
3
Cut down on the amount of fat you
eat, particularly saturated fats
A low-fat diet will benefit your health.
Choose unsaturated fats or oils, such as
monounsaturated or polyunsaturated fats
(eg olive, rapeseed and sunflower oil), as
these types can help maintain healthy
cholesterol levels. Eating less fat will help
you to lose weight if you need to. Here are
some tips to help you cut down:
•use less saturated fat by having less butter,
margarine and cheese
•choose chicken, turkey, lean meat and
fish as low-fat alternatives to fatty meats
• remove the skin from poultry
• choose lower fat dairy foods such as
skimmed or semi-skimmed milk, low-fat
or diet yogurts, reduced-fat cheese and
lower-fat spreads
• grill, steam or oven bake instead of frying
or cooking with oil or other fats
• watch out for creamy sauces and dressings
and swap for tomato-based sauces or
low-fat dressings instead.
4
Eat more fruit & veg
Aim for at least five portions a day to provide
you with vitamins, minerals and fibre to
help you balance your diet. For example,
one portion is: a banana or apple, a handful
of grapes, one tablespoon of dried fruit, a
150ml glass of fruit juice or fruit smoothie,
three heaped tablespoons of veg or a cereal
bowl of salad.
5
Include more beans & lentils
Examples include kidney beans, butter
beans, chickpeas or red and green lentils.
These have less of an effect on your blood
glucose levels and may help to control
your blood fats. Try adding them
to stews, casseroles and soups,
or to a salad.
2013 Type 1 diabetes
39
FOOD
HEALTHY EATING
6
Try to eat at least
two portions of oily
fish a week
Examples include mackerel,
sardines, salmon and
pilchards. Oily fish contains
a type of polyunsaturated
fat called omega 3 which
helps protect against heart
disease.
7
Limit sugar &
sugary foods
This doesn’t mean you
need to eat a sugar-free diet.
Sugar can be used in foods
and in baking as part of
a healthy diet. Using
sugar-free, no-addedsugar or diet fizzy
drinks and squashes
instead of sugary
versions can be an easy
way to reduce the sugar in
your diet. Sugary drinks are
best used as a treatment
for hypos. Sweeteners
can also be used as an
alternative to sugar.
8
Reduce your daily salt
intake to 6g or less a day
More than this can raise
your blood pressure, which
can lead to stroke and heart
disease. Limit the amount
of processed foods you eat,
as these are usually high in
salt, and try flavouring foods
with herbs and spices
instead of salt.
40
Type 1 diabetes 2013
9
Drink alcohol in
moderation
That’s a maximum
of 2–3 units of
alcohol per day for
a woman, and 3–4
units per day for a
man. For example,
a single pub
measure (25ml) of
spirit is about 1 unit,
or half a pint of lager, ale,
bitter or cider has 1–1½
units. Over the years the
alcohol content of most
drinks has gone up. A drink
can now contain more units
than you think – a small
glass of wine (175ml) could
contain as much as 2 units.
Never drink on an empty
stomach, as alcohol can
make hypoglycaemia (low
blood glucose levels) more
likely to occur. Remember,
alcohol contains empty
calories so think about
cutting back further if you
are trying to lose weight.
10
tay away from
S
diabetic foods
They offer no benefit to
people with diabetes.
They will still affect your
blood glucose levels,
contain just as much fat
and calories as the
ordinary versions, can
have a laxative effect
and are expensive.
for at least
“Aim
five portions
of fruit and
veg a day
”
balanced diet
FOOD
what’s in a portion?
People have different ideas about what
a portion of food is – let’s find out more
T
he number of food portions you require from each food group
will depend on your needs. The portion ranges below are only a
guide and you should speak to your dietitian for specific advice about
how many portions of each food group you should eat every day.
Bread, cereals, rice,
pasta & potatoes
One portion is equal to:
• 2–4 tbsp of cereal
• 2–3 tbsp of rice, pasta, couscous, noodles or mashed potato
• 1 slice of bread
• half a small chapatti
• 2 new potatoes or half
a baked potato
• 2–3 crispbreads
or crackers
Daily portion range: 5–14.
Meat, fish & alternatives
One portion is equal to:
• 2–3oz (60 – 85g) of meat, poultry
or a vegetarian alternative like
soya or Quorn
• 2 eggs
• 2 tbsp of nuts
• 4–5 oz (120 –140g) of fish
• 3 tbsp of beans, lentils or dahl,
chick peas, mung beans, pulses
Daily portion range: 2–3.
Choose the lower-fat types
whenever possible and eat more
beans and pulses.
Fruit & vegetables
One portion is equal to:
• a banana or apple
• a handful of grapes
• a slice of melon
• a cereal bowl of salad
• 2 plums
• 3 heaped tbsp of vegetables
• 1 medium glass of fruit juice
or smoothie
• 3 dates
Daily portion range: 5 or more. Choose
a wide variety of foods from this group,
including fresh, frozen, dried and tinned.
Milk & dairy
One portion is equal to:
• ¹∕ 3 of a pint milk
• 2 tbsp of cottage cheese
• a small pot of yogurt
• 1½oz of cheese (40–45g,
matchbox size)
Daily portion range: 3. Choose
lower-fat versions of milk
and dairy foods.
Fatty & sugary foods
One portion is equal to:
• 2 tsp of spread, butter, oil, or salad dressing
• 1 mini chocolate bar
• 2 tsp of sugar, jam or honey
• half a sausage
• 1 scoop of ice cream or 1 tbsp cream
• a rasher of bacon
• half a pack of crisps
• ¹∕ 3 of a vegetable samosa
• 1 tbsp of Bombay mix
Daily portion range: 0–4. Cut down on
sugary and fatty foods.
2013 Type 1 diabetes
41
FOOD
CARB COUNTING
The carb
connection
Carbohydrate is an essential form
of energy, but what exactly is it,
and how can the amount you
eat affect your glucose levels?
T
here are two main types
of carbohydrate:
Starchy
These include bread, pasta,
chapattis, potatoes, yam,
noodles, rice and cereals.
Sugars
These can be broken down as:
• natural sugar, eg fruit sugar
(known as fructose) and milk
sugar (known as lactose)
• added sugar, which includes
table sugar (eg caster,
granulated), glucose, glucose
syrup, invert syrup and honey.
ugars can often be identified on
S
food labels as those ingredients
ending in –‘ose’.
Both the amount and type of
carbohydrate you eat and drink
will have an effect on your
glucose levels.
Another type of food that can
affect blood glucose levels are
nutritive sweeteners, including
42
Type 1 diabetes 2013
polyols. If you’re not sure what
these are, they tend to end in -ol, eg
sorbitol, maltitol, xylitol and mannitol.
Why you need
carbohydrate
carbohydrate on a day-to-day basis.
Work with your dietitian or diabetes
healthcare team to find the right
balance for you.
Carbohydrate
Carbohydrate is the body’s preferred counting
source of energy in the diet. All
carbohydrates are broken down
into glucose, which is essential fuel
for the body – especially the brain.
High-fibre carbohydrates, such
as wholegrains and fruit, play an
important role in the health of
your digestive system.
how much you need
The amount of carbohydrate that
the body needs varies depending on
your age, weight and activity levels.
For good health, most of the
carbohydrate you eat should be
from starchy carbohydrate, fruits
and some dairy foods. Carbohydrate
from added sugar or table sugar
should be limited.
If you are on a fixed insulin
regimen, you may find it beneficial
to have consistent amounts of
Carb counting means that insulin
can be individually matched to your
food choice at the time of eating.
It’s a vital part of making the most
of intensive diabetes management,
whether you use injections or a
pump (it’s less likely to be used
on mixed insulin regimens). It
means portion sizes can reflect your
appetite rather than a fixed amount
of carbohydrate to match a fixed
amount of insulin. It doesn’t mean
total food freedom as this would be
unhealthy for anyone, although
special occasions and treats can be
more easily incorporated and insulin
adjusted to match. Carb counting
can mean more work at first –
working out or weighing foods
to calculate the carbohydrate, but
it does get easier. Once you’re
confident you should be able to:
FOOD
CARB COUNTING
• vary the times you eat and the
amount of carbohydrate you eat
• predict blood glucose responses
to different foods
• enjoy a wider variety of foods.
Working it out
Carbohydrate can be counted in
grams or, carbohydrate portions
(CPs). Your diabetes healthcare
team will help you determine your
insulin to carbohydrate ratio; for
example 1 unit of insulin for 10g
of carbohydrate. This will depend
on your age, weight, activity levels
and how long you have had
diabetes. If you know how many
grams (or portions) of carbohydrate
are in a meal and your
carbohydrate-to-insulin ratio,
then you can work out the
number of units for the meal.
Nutrition information labels on
packaged foods can tell you how
much carbohydrate (in grams) is in
100g or in a portion of that food.
Use the ‘total carbohydrate’
figure, not the ‘of which sugars’
value when matching insulin.
(See p45 for information on
food labelling.)
Your diabetes healthcare team
may provide you with a list of foods
and the amount of carbohydrate
they contain. Diabetes UK provides
a downloadable carbohydrate
reference list. (See the end info,
below). There are also books
often aimed at people trying to
lose weight (called calorie
counters), they list the grams
of carbohydrate, either per 100g
or per portion. And books and
apps are available, which include
photos of food portions and their
carbohydrate values.
i Download a free copy of
Carbs count, as well as the
carbohydrate reference list, at
www.diabetes.org.uk/carbcount
See overleaf for information on
the Glycaemic Index.
amount of
“The
carbohydrate you
need depends on
your age, weight
and activity levels
”
Carbohydrate & your insulin
In Type 1 diabetes the pancreas doesn’t release any insulin, so the aim of insulin
treatment is to mimic normal insulin production in someone without diabetes.
This is done using:
Basal insulin
This deals with the glucose produced by your liver. If you skip a meal,
your basal insulin alone should be able to keep your blood glucose levels stable.
Bolus insulin
While basal insulin influences your blood glucose levels in between meals, it’s
the bolus (fast-acting) insulin that deals with the carbohydrate contained in any
food and drink you have.
2013 Type 1 diabetes
43
FOOD
Glycaemic index
the gi
concept
What is the Glycaemic Index,
and how can it help you with
your blood glucose control?
T
he Glycaemic Index (GI) is
a ranking of carbohydratecontaining foods based on their
overall effect on blood glucose
levels. Slowly absorbed foods have
a low GI rating, while foods that
are more quickly absorbed will
have a higher rating. Foods are
given a GI number according to
their effect on blood glucose levels.
Some research has shown low
GI diets have benefited blood
glucose control, though the majority
of this research was in people with
Type 2 diabetes.
If you want to choose lower GI
carbohydrate-containing foods:
• Instead of instant cooked rice or
long grain rice choose basmati
or easy cook. You could also
try pasta or noodles instead.
• Switch white baked or mashed
potato for sweet potato
or boiled new potatoes.
• Choose granary, pumpernickel
or rye bread instead of white
and wholemeal bread.
• Swap rice snap breakfast
cereal or cornflakes for
porridge, natural muesli or
wholegrain breakfast cereals.
44
Type 1 diabetes 2013
A variety of foods contribute
to a healthy balanced diet
Eating to control your diabetes
isn’t just about GI ratings and
shouldn’t be used in isolation. It’s
important to stress it’s the total
amount of carbohydrate you eat
which will have the greatest effect
on your blood glucose levels
after meals. The overall balance of
your diet is also important and it
should be low in fat, salt and sugar
with plenty of fruit and vegetables.
i www.diabetes.org.uk/gi
the total amount
“It’s
of carbohydrate you
eat which will have
the greatest effect
on your blood
glucose levels
”
FOOD LABELLING
FOOD
Making healthier
choices
Making sense of food labelling
isn’t always easy. Here’s how
you can pick the options that
are right for you
T
here’s a huge variety of
food on the shelves. So
what to choose? Both Traffic
light labelling and Guideline
Daily Amounts (GDAs) on
food and drink labels can be
a starting point to help you to
see how healthy or unhealthy
something is. They also help
you to compare brands.
Traffic light
labelling
The traffic light colours on
some packaging tell you
whether the product has
low, medium or high
amounts of fat, saturated
fat, sugars and salt:
Red means high – keep an
eye on how often you are
choosing these foods.
Choose them less often or
eat them in smaller quantities.
All measures
per 100g
Low –
healthier
choice
OK choice
High – LEss
healthy
choice
Sugars
5g or less
5.1g–15g
More than 15g
Fat
3g or less
1.6g–20g
More than 5g
Saturates
1.5g or less
1.6g–5g
More than 5g
Salt
0.30g or less
0.31g–1.5g
More than 1.5g
Amber means medium –
it’s ok to have these foods
some of the time but when
you have a choice, try to
go for green.
Green means low – a
healthier choice. Most
foods will have a mix of
coloured lights so try to
choose more products
with green and amber and
less with red. You don’t
need to avoid all foods
high in fat, sugar or salt –
it’s the overall balance of
your diet that counts.
Eaten occasionally, or
in small amounts, red
foods won’t significantly
affect your overall diet.
If the traffic light label
doesn’t tell you enough,
check the back of packs
for detailed information.
The government has
announced that in 2013
all major manufacturers
will be using a consistent
system of food labelling:
including the traffic
light colours, text and
percentage Guideline
Daily Amounts.
2013 Type 1 diabetes
45
FOOD
FOOD LABELLING
Guideline Daily Amounts
Not all manufacturers use the traffic light system
so you may see a Guideline Daily Amount (GDA)
label on some of the foods you buy. This gives
information on the amount of sugar, fat, saturated
fat and salt as well as the number of calories in
each portion of the product.
The percentages refer to the proportion of the
total amount of the nutrient that is recommended
for an average adult per day. These figures are
based on GDAs for women, to encourage people
who need less energy to eat or drink fewer calories.
This system needs a greater level of interpretation
than the traffic light system.
Calories
Sugars
Fat
Saturates
Salt
116 11g 0.9g 0.5g 0.3g
6%
12%
1%
Amount in
product
Calories
Fat
(of which saturates)
Guideline daily amounts are
what an average adult of
normal healthy weight should
Carbohydrate
(of
which
total sugars)
eat per day. Needs vary
depending on age, weight
Salt
and activity levels, but here
is the average guide.
SODIUM
FIBRe
2%
6%
% of adult
guideline daily
amount
2,000 kcals
2,500 kcals
70g
20g
95g
30g
230g
90g
300g
120g
less than 6g
less than 6g
less than 2.4g
less than 2.4g
24g
24g
magazines for you
A quarterly magazine packed
with games and cartoons,
helping your child learn about
diabetes in a fun way.
Packed with news, features,
research, healthcare information,
celebrity interviews, columns and
prize giveaways, balance is a
lively, entertaining bi-monthly
magazine for anyone connected
to diabetes.
These are free to Diabetes UK members. Find out more by calling 0845 123 2399 or visiting
www.diabetes.org.uk/join.
Type 1 diabetes 2013
46
FOOD LABELLING
is it really healthy?
Most supermarkets now offer their own
‘healthy eating’ ranges. Although they can
help you find healthier options, you still have
to think about how that food fits into your diet.
It’s important not to rely on foods marked
as healthy options as a healthy diet is made up
of a variety of foods and some products may
be labelled as low fat but still be high in sugar,
and vice versa.
Products labelled ‘low’ contain less of that
nutrient (ie fat, salt, sugar, etc) than those
labelled ‘reduced’ – but whether a food is
labelled ‘diet’, ‘light’, ‘low’ or ‘reduced’, all
of them are a healthier choice than standard
versions of the same food.
But beware, the calorie, fat or sugar savings
made by choosing these versions may not be
as great as you think – especially foods which
are high in fat and/or sugar anyway, eg cakes,
biscuits and crisps.
Also, bear in mind that some foods are naturally
low in fat, sugar or salt, or high in fibre. Starchy
foods like cereals and pasta are always
low in fat, yet some brands are sold
with the claim ‘low-fat food’.
By checking the ingredients list, you can really
get to grips with the food’s nutritional value.
Remember, the proportion of ingredients in
a product are listed from the highest first.
food labels will list
“Some
Guideline Daily amounts
instead of using the
traffic light system
”
FOOD
Carb counting
Food labels can be a useful
and convenient way of finding
out the carbohydrate content
of foods and drink.
Here are some tips to help
you use the food label to
count carbohydrate:
• Double check whether
the value you are using
is per 100g.
• If it’s per portion or
serving, check portion
or serving size?
• The amount of
carbohydrate you should
count is the ‘Total
carbohydrate’ rather than
the ‘of which sugars’.
• Check whether the amount
of carbohydrate is for
the raw or cooked product,
especially with foods
containing pasta or rice.
• Consider what ingredients
make up the product you’re
looking at. If it’s a food that
contains a lot of very slowly
digested carbohydrates,
such as beans or tomatoes
you wouldn’t count this
carbohydrate. But the
carbohydrate value will
include them. Check the
ingredients list to get a
sense of how much of these
foods are in the product.
2013 Type 1 diabetes
47
FOOD
HEALTHY COOKING
Healthy food
for healthy
appetites
Adapting recipes to be
lower in fat, sugar and
salt involves some trial
and error. But these tips
will have you cooking
up a delicious meal
in no time
E
ating healthily will benefit you
in a number of ways, and it
doesn’t mean you have to miss
out on your favourite meals.
Depending on the type of food
you are preparing these following
tips will be useful:
South Asian foods
• Add millet or chickpea flour to
chapatti flour to make it lower
in GI (glycaemic index) and
more filling.
• Avoid adding (or reduce the
amount of) fat or oil when making
chapatti dough.
• Try using unsaturated fats, such
as rapeseed or sunflower oil
instead of ghee.
• Make low-fat paneer using
skimmed/semi-skimmed milk.
• Grill, bake, poach, steam, or boil
foods rather than cooking them
with added fat.
• Reduce any amount of coconut
cream or milk and try a reducedfat version instead.
• Measure the amount of oil you
use, don’t just pour. A good guide
is 1 teaspoon of oil per person.
• Reduce the amount of salt
used and go for spices and
herbs to add flavour.
• Limit foods such as pickles,
which are very high in fat and salt.
48
Type 1 diabetes 2013
HEALTHY COOKING
FOOD
• Cut back on snacks such
as chevda. Instead, try
plain popcorn or roasted
corn and keep an eye on
your portion sizes.
• Roast your poppadoms
instead of frying them.
African & Caribbean foods
• Use less saturated fat
such as palm oil, coconut
oil and butter.
• Choose chicken, turkey,
lean meat and fish as
low-fat alternatives to fatty
meats and remove the skin
from chicken.
• Choose lower fat dairy
foods, such as skimmed
milk, low-fat yogurts, and
reduced-fat cheese.
• Grill, steam or oven bake
foods such as jerk
chicken, jerk beef, corn
and pineapple fritters
instead of frying or cooking
with oil or other fats.
• Watch out for creamy
sauces and dressings and
swap for tomato-based
sauces instead.
• Skim the fat from
the top of stews and
one-pot meals
tops
tip
• Cutting down on foods such
as sugar cake, sweet potato
pie, duckunoo, pudding
and condensed milk can be
an easy way to reduce the
sugar in your diet.
• If you choose to have
more traditional foods
such as plantains, fish,
breadfruit, yams or
dumplings try to choose
healthier ways to cook
them, such as baking,
grilling, boiling
or poaching and avoid
re-frying leftovers.
for
“Go
spices
and herbs
to add
flavour
”
Cutting calories
By following some common sense advice
you can cut down on the calories and still
keep the flavour:
• Use low-fat dairy products where
possible, such as skimmed milk,
reduced-fat cheeses and low-fat yogurts.
• Try using stronger cheese for cooking.
You’ll find that you won’t have to use
as much for flavour. Grated cheese
tends to go further, too. You can also
try reduced-fat varieties.
• Use pulses such as peas, beans or lentils
to replace some of the meat in shepherd’s
pie, casseroles and lasagne. They’re low
in fat and high in fibre, and can also be
used in soups and salads.
• Use lean cuts of meat, remove visible
fat and remove the skin from poultry.
Dry fry and drain off any excess fat
before adding the remaining ingredients
(eg for casseroles or stir-fries).
• Use low-fat cooking methods where
possible, such as grilling or baking,
instead of frying.
• Reduce the amount of oil you use and
still avoid foods sticking to the pan by
cooking on a low heat and stirring often,
using a non-stick pan and a low-fat
spray, or using a splash of water.
2013 Type 1 diabetes
49
FOOD
HEALTHY COOKING
Desserts
Puddings can still be enjoyed – and
by making some small changes or
‘swaps’ you can keep the flavours
and save even more on the calories:
• Experiment by using less added
sugar in your baking recipes.
Most cakes will work even if the
sugar in the recipe is cut by a
half. Recipes such as fruit cakes,
fruit scones or teabreads can
be made without added sugar,
as they don’t need sugar for bulk
and the dried fruit will provide
sweetness.
• Recipes using a reduced amount
of sugar won’t keep as long as
traditional recipes, as sugar is a
natural preservative. To avoid
wastage, freeze in portions – but
check that the recipe is suitable
for freezing.
• When making jams and
marmalades, ordinary sugar will
do but try to reduce the traditional
ratio of 1lb fruit to 1lb sugar to
1lb fruit to ¾lb sugar.
• Use sweeteners to add extra
sweetness instead of sugar, eg
cold desserts and hot puddings.
• Light crème frâiche is heat stable
and ideal for use in savoury
sauces. It’s also delicious served
on hot or cold puddings instead
of double cream.
• Fromage frais is fresh skimmedmilk cheese, but is more like a
natural yogurt. It’s not heat
stable so is best used in
desserts and dips in place
of cream or Greek yogurt.
• When you feel nothing but cream
will do, spoon extra thick single
cream onto fruit or puddings
instead of double cream. Whip
up whipping cream rather than
double cream for filling cream
buns or cakes, or make a butter
cream using a low-fat spread.
• You don’t need to adapt your
recipes when baking if you only
eat cakes at special occasions
such as birthdays.
• Try using filo pastry instead of
normal pastry and spread with
beaten egg in between the
sheets instead of butter.
can
“You
reduce the
ratio of sugar
when making
jams
”
50
Type 1 diabetes 2013
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FOOD
EATING OUT
What’s on
the menu?
Eating out is something most of us
like to do, whether it’s a late-night
biryani or a lunchtime Italian. But
there are healthy choices you can
make without spoiling your fun
T
hese days we tend to have
more meals away from home,
whether it’s a meal in a restaurant
or grabbing a sandwich on the
run. But, away from home, we
tend to eat different portion sizes,
and the foods we choose tend
to be higher in fat than their
homemade versions.
A change in your usual routine
and diet when eating out can have
an affect on your diabetes control.
This can be balanced out by
adjusting the timing, the amount
and how you take your insulin.
Timing
Changes in meal times can have a
big impact on your timing of insulin
injections. If you’re going to eat a
meal later than usual, you may be
able to delay your insulin until you
are about to eat. If you are on
twice-daily insulin injections and
eating lunch later than usual, you
may need to have a snack before
you go out or to make sure you
have bread on the table when
you arrive. Doing this will help to
prevent a hypo.
52
Type 1 diabetes 2013
If it’s an evening meal that you are
having later than usual, it may be
possible to simply delay the timing
of your evening insulin. Being
on a flexible insulin regime can
make it easier to vary the timing
of all meals.
Adjusting your insulin
If you count carbs and are
confident with adjusting your
insulin you may be able to change
the amount you inject to fit in with
the food you eat. It may be difficult
to estimate the amount of
carbohydrate in your meal though
many large chains and takeaway
restaurants have websites that
list the amount of carbohydrate
in popular dishes. In some
restaurants, the main course may
not automatically come with starchy
carbohydrates, such as rice, pasta,
potato or chips. So make sure you
check this when you order, and ask
for extra side dishes if needed.
How you take your insulin
You may be choosing foods higher
in fats than usual. Fat slows down
the absorption of carbohydrate
into the bloodstream. So eating
something like a pizza, fish and
chips, or a curry can take hours
to affect your blood glucose
levels. This can mean when
you give your bolus insulin, it
might have finished working
before all your carbohydrate
has been absorbed, so you
may need to alter how you give
your insulin maybe splitting
your dose. If you’re on a multiple
daily injection regime, consider
dividing your insulin into more
than one injection.
Eating out is often a leisurely
event that can run over a few
hours. And although you may
not intend to have pudding,
sometimes they just look too
good to refuse. This means
you’ll need to think about when
to have your insulin: at the start
of the meal, in the middle,
or at the end. Alternatively –
if you are on a flexible insulin
regimen – you could divide
your insulin into more than
one injection.
EATING OUT
FOOD
Q& A
One of my favourite places for a drink before
I was diagnosed has hardly any diet drinks
and mixers. What can I do?
If you eat and drink somewhere on a regular basis
and they don’t serve what you want – like diet
drinks or low-calorie mixers – speak to the
manager. If they understand why people with
diabetes need diet drinks and if they value your
custom, then hopefully the restaurant or bar will
start to serve them.
How can I avoid any problems when
eating at a friend’s place?
Other people can panic about what they can
and can’t serve you. Tell them not to go to any
trouble and reassure them that you’re no different
from anyone else. There are a few things to bear
in mind though. If it’s a party rather than a meal,
don’t assume that food will be provided. Check
beforehand or eat before you go. Also, some
barbecues and buffets may not have enough
starchy food, in which case make a beeline
for the bread and don’t be afraid to ask for
something extra.
I regularly go abroad – do I need to
consider anything in particular about food?
The same eating advice applies abroad – but
obviously you may have to be extra careful if you
don’t understand the menu or are unfamiliar with
some dishes. If you’re travelling by plane be
aware that some airlines offer special ‘diabetic’
meals. It is actually better to avoid them because
they can be low in carbohydrate – caterers often
don’t realise that balance is the main thing, not
cutting down on carbohydrate. Also, it’s a good
idea to take extra carbohydrate snacks in your
hand luggage. See p84 for more on travel.
Eating out is not all about food. It is often
accompanied by a few glasses of wine or a
beer. You may even be going out clubbing
afterwards. Alcohol and activity can affect your
blood glucose levels and this will also need to
be taken into account when deciding what to
do with your insulin.
• See p88 for more on alcohol.
change in your
“Ausual
diet can be
balanced out by
adjusting the timing
and the amount of
insulin you take
”
ACTION
POINTS
• Check the websites of your favourite
restaurants so you can see what sort
of ingredients they serve. They may
even list carbohydrate counts.
• Remember to always carry hypo treatments
with you, such as glucose tablets.
2013 Type 1 diabetes
53
FOOD
Questions & Answers
Q& A
Can I still have some sugar in my diet?
Yes. Eating sugar doesn’t cause diabetes
and people with diabetes don’t need to have
a sugar-free diet. It’s ok to have foods like
chocolate and cakes occasionally
alongside a healthy diet.
But remember, sugary foods
provide empty calories.
Is it ok for me to take
a vitamin supplement
now that I have
diabetes?
Diabetes UK doesn’t
recommend that people with
diabetes take a supplement. If
your diet is deficient in some
nutrients then you may benefit
from taking one, but this should
be decided in conjunction with
your doctor and/or dietitian.
(Women with diabetes should
take a supplement of 5mg of
folic acid when planning
pregnancy and continue to
take it until the end of the 12th
week of pregnancy. This dose
of folic acid is only available on
prescription.) More information
is available at www.diabetes.
org.uk/mineral_supplements
54
Type 1 diabetes 2013
Is it true that I shouldn’t eat
bananas or grapes?
No. All fruit is good for you.
Eating more fruit can reduce the
risk of heart disease, some
cancers and some gut
problems. Eat a variety of
different fruit and vegetables
for maximum benefit.
I’d like to use a sweetener instead of
sugar in my tea but I’ve heard that
they aren’t safe. Is this true?
All sweeteners have to undergo rigorous
safety tests before they can be sold in the
UK. The government sets safe limits and
surveys groups of individuals to see
whether they are exceeding these
limits. At the moment there is no
evidence to suggest that the
general public is exceeding
these safe limits, but if you are
at all concerned then you can
minimise this risk by using a
variety of sweeteners.
Can people with diabetes
follow a vegetarian diet?
Yes. Although, following a
vegetarian diet does not
necessarily mean a healthier
diet. You still need to have a
good balance of different
foods. To make sure you’re
following a healthy balanced
vegetarian diet, visit The
Vegetarian Society’s website:
www.vegsoc.org.
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People with Diabetes
trust
Living with diabetes
WEIGHT MANAGEMENT
Weighty
issues
If you’re carrying some
excess pounds getting
your weight down is
a wise move. Not only
will you feel fitter, it
will help you manage
your diabetes better
I
f you need to lose weight it will
always be beneficial to your
health. Studies show that losing
just 10 per cent of your body
weight will bring about huge
health benefits, including helping
you to manage your, blood
pressure and cholesterol levels.
How to measure your waist
Find the bottom of your ribs and the top of your
hips. Measure around your middle at a point
mid-way between these (for many people
this will be the tummy button).
Guideline measurements are:
• White and Black men: below 94cm (37in)
• South Asian men: below 90cm (35in)
• White, Black and South Asian women:
below 80cm (31.5in).
56
Type 1 diabetes 2013
How do I know if I
need to lose weight?
There are several ways you can find
out if you’re overweight:
Measure your waist
If you need to lose weight,
reducing your waist measurement
will help to improve blood glucose
control and reduce your risk of
developing some diabetes
complications. See box, left, on
how to measure properly.
1
2
Compare weight and height
Body Mass Index (BMI) is a
measure of your weight in relation
to your height. It’s a good indicator
of what weight range you are in.
The chart to the right will help you
to determine your BMI.
WEIGHT MANAGEMENT
Living with diabetes
Key
Underweight: a BMI of up to 18.4, South Asian adult less than 18.5
Healthy weight: a BMI of 18.5–24.9, South Asian adult 18.5–22.9
Overweight: a BMI of 25–29.9, South Asian adult 23–24.9
Obese: a BMI of 30–39.9, South Asian adult 25–34.9
Morbidly obese: a BMI of 40 or more, South Asian adult 35 or more
underweight
Healthy weight
Overweight
Obese
Morbidly obese
1.91
1.88
1.85
1.83
1.80
1.78
1.75
1.73
1.70
1.68
1.65
1.63
1.60
1.57
1.55
1.52
1.50
1.47
Your height in metres
6’3
6’2
6’1
6’0
5’11
5’10
5’9
5’8
5’7
5’6
5’5
5’4
5’3
5’2
5’1
5’0
4’11
4’10
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Find the point where your height
and weight meet on the chart to
see what range your weight is in.
Weight classification is slightly
different for people of South Asian
origin as shown in the key.
It is important to remember that
the BMI measure can be inaccurate
at times for people who have a lot
of lean muscle such as rugby
players or weight lifters. You can
discuss your BMI with a member of
your healthcare team if you think
this might apply to you.
Your height in feet and inches
38
44.5
51
57
63.5
70
76.5
82.5
89
95.5
102
108
115
121
127
134
140
146
153
159
Your weight in kilograms
Your weight in stones
To calculate your BMI:
weight (kg)
height (m) x height (m)
For example, if you are 1.80m tall and 95kg, your BMI would be
95
(1.8 x 1.8)
= 29 (BMI)
1ft = approx 0.3m
1lb = approx 0.45kg
2013 Type 1 diabetes
57
Living with diabetes
WEIGHT MANAGEMENT
Getting motivated
If you do need to lose weight, beforehand you may
find it helpful to prepare yourself mentally and motivate
yourself by thinking about the benefits. Consider the
possible challenges it will pose and the changes you
will need to make to your current lifestyle. While there
may be many things that can get in the way of losing
weight, here are some ways to overcome some
common barriers:
Too busy?
Try shopping in advance and pre-planning your week’s
meals, That way you won’t have to think about what
you’re going to cook and buy food every day – a real
time saver. There are also healthy cookbooks for fast,
fuss-free recipes.
put the weight back on. There are many different
approaches to losing weight, and no one way is better
than another and it is important that you find a diet that
you enjoy and fits into your lifestyle. It’s not the diet you
follow that’s the most important factor but being able
to choose a diet that you enjoy and can stick to.
Following a combination of a healthy, balanced diet
and physical activity together will result in more weight
loss in the long term, than diet or activity alone. To start
with, it’s important to understand the general principles
of healthy eating, which are explained on p36.
different ways to lose weight
Controlling your portions
This plate model offers a guide on what to eat
on a daily basis:
On a budget?
Canned and frozen fruit and vegetables are just as
good for you as fresh and they’re much cheaper. If
you do want to buy fresh, chose fruit and veg that’s in
season or on special offer – both good ways to save.
Feel like diets don’t work?
Try to understand what triggers you to eat and keep
motivated by reminding yourself of the benefits
of losing weight. If for instance you want to eat
because your bored or stressed, perhaps go for
a walk instead.
Also, think about benefits losing weight could bring:
• you might get back into some old clothes
• enable you to play with the children without
getting out of breath
• improve your diabetes control and help prevent
some complications.
How to lose weight
To lose weight the calories you take in from your food
and drink must be less than the energy you burn off
through daily living and physical activity. A calorie is
a unit of energy. If you wish to lose weight aim for a
realistic weight loss, losing weight slowly (0.5–1kg /
1–2lb a week). If you try to lose weight more quickly
you may not be able to stick to it and are more likely to
58
Type 1 diabetes 2013
This gives you an idea of what the size of your portions
should be for your main meal, whether it’s lunch or
dinner. You can reduce the calorie content of your meal
by filling up one half of your plate with vegetables or
salad, one third with starchy foods such as bread, rice,
potatoes, or pasta and the remainder with low-fat
varieties of protein such as meat, fish, chicken, lentils,
or beans.
This might be more difficult to work out for meals
where food groups are mixed, such as lasagne and
stir-fry noodles. The following examples may help:
Lasagne: The pasta sheets will count towards the
starchy foods and the meat will contribute to the protein
on your plate. Fill half the plate with lasagne and use
salad or vegetables to fill up the rest of your plate.
WEIGHT MANAGEMENT
Beef noodles: The noodles and the beef will count
towards the starchy foods and the protein. Add a
large portion of vegetables to the stir-fry to make
up the vegetables. Serve plenty of veg and salad
with your meals.
Calorie controlled plans
Balanced, healthy eating plans that contain 600
calories a day less than a person needs will achieve
sustainable weight loss. This can be through diet as
well as increasing your activity levels which will burn up
extra calories. Your activity levels, your weight, sex and
Living with diabetes
age will make a difference to how many you need.
If you step up your activity levels for example this will
help you burn more calories and help achieve long
term weight loss success. In the table overleaf are
some ideas to help you slash the calories without
sacrificing taste.
Low-fat diets
Gram for gram, fat provides twice as many calories as
carbohydrate or protein. Reducing how much fat you eat
will help you to reduce your calories. A recent large study
in the United States showed that changing your lifestyle,
Swap and save...
alories per
50 chalf
pint
Semi-skimmed milk,
instead of full cream milk
40
calories
per tbsp
Half-fat fromage frais,
instead of double cream
40
calories
per biscuit
Rich tea biscuit,
instead of digestive biscuit
45 cperalories
portion
Chicken breast without skin,
instead of chicken breast with skin
60
Reduced-fat cheddar cheese
instead of full-fat cheddar cheese
calories per
40g/1.5oz
alories per
50 c10g/0.35oz
Low-fat spread
instead of Margarine/butter
2013 Type 1 diabetes
59
Living with diabetes
WEIGHT MANAGEMENT
Replace this…..
Morning drink
Tall (12 fl oz) semi-skimmed latte
(150 calories)
Breakfast
1 paratha 75g (243 calories)
With this….
And save….
(calories)
Tall (12 fl oz) cappuccino with semi-skimmed
milk (90 calories)
60
2 wheat biscuits and 85ml (average serving for
cereal) semi-skimmed milk (170 calories)
70
2 medium slices of toast, 20g 70% fat
margarine and 30g jam (345 calories)
2 wheat biscuits and 85ml (average serving for
cereal) semi skimmed milk (170 calories)
175
Morning snack
Medium slice flapjack 60g (300 calories)
Individual slice of malt loaf 35g (100 calories)
200
Lunch
Prawn mayo sandwich
(2 medium slices of bread) (350 calories)
Low-fat prawn mayo sandwich (2 medium
slices of bread) (300 calories)
50
2 chapatti 110g (222 calories) spread with 4 2 plain chapatti 110g (222 calories) and 220g
teaspoons of ghee (180 calories) and lentil
lentil and vegetable curry (333 calories)
and vegetable curry 220g (333 calories)
30g packet of crisps (160)
1 medium pear (60 calories)
Standard sized chocolate bar
55g (280 calories)
Mid afternoon snack
High street coffee bar skinny blueberry
muffin (370 calories)
2 finger chocolate wafer biscuit (105 calories)
High-street coffee bar portion of fruit salad
(95 calories)
Dinner
Chicken curry 200g (411 calories), basmati Chicken curry 100g (274 calories), mung dahl
rice 180g (248 calories) and 2 chapattis
100g (70 calories), bowl of salad (30 calories)
110g (222 calories) spread with
and basmati rice 100g
4 teaspoons of ghee (180 calories)
2 grilled pork sausages (80g), medium
jacket potato (160g) and 2 teaspoons of
margarine, serving of peas (70g) and
carrots (60g) (420 calories)
Small roasted chicken breast (85g), medium
jacket potato (160g) serving of peas (70 g)
and carrots (60g) (315 calories)
150g pot of creamy yogurt (190 calories)
125g pot of low-fat yogurt (75 calories)
175ml glass of medium-dry white wine
(130 calories)
1 single measure of vodka and slimline tonic
water (55 calories)
180
100
175
275
549
105
115
70
Evening snack
2 chocolate digestive biscuits (170 calories)
60
Type 1 diabetes 2013
Medium banana (100 calories)
70
WEIGHT MANAGEMENT
including following a low fat diet significantly
reduced body weight, improved diabetes
control and reduced cardiovascular disease
risk factors. The table below can give you
some ideas on how to slash the calories and
fat by making simple, small changes. See
p50 for practical ways you can cut down
on calories and fat.
Low-carb diets
Carbohydrate is found in starchy foods such as bread,
potatoes, pasta, rice, beans and pulses, as well as in
fruit, most vegetables, some dairy foods and sugars.
All carbohydrate affects blood glucose levels. There is
evidence that shows low carbohydrate diets can help in
the short term with achieving weight loss and improve
diabetes control in people with Type 2 diabetes.
But there is little evidence to support the use of low
carbohydrate diets to support weight loss in people
with Type 1 diabetes.
Very low calorie diets
These are specially formulated to provide nutritionally
complete total diet replacements. There is evidence to
show that this diet can help achieve weight loss.
Meal replacement plans
These consist of liquid shakes, soups or bars designed
to be eaten in place of one or two meals daily, but
make sure the meal replacements are nutritionally
adequate. Evidence suggests they can help achieve
weight loss over the short term (six months).
Slimming clubs
These use a variety of approaches, including group
therapy, dietary advice and physical activity. There
hasn’t been any published evidence regarding their
effect on weight loss. If you’d like to meet other people
who are also trying to lose weight, a slimming group or
club could be useful. But these clubs may not run by
registered dietitians, so bear the following tips in mind:
• Ensure that the weight loss offered is realistic and that
a healthcare professional has been involved in
developing the programme.
• Check with your healthcare team before joining and
Living with diabetes
show them a copy of the diet plan. Your insulin
may need to be adjusted.
• Monitor your diabetes control carefully while
you’re slimming and consult your healthcare team
if you have any concerns.
• Always make sure that the meal plans include all of the
food groups or are nutritionally adequate if they contain
meal-replacement shakes.
• Even if the club advises you not to snack between
meals, do not cut out starchy snacks between meals
if your diabetes healthcare team has advised you to
continue them.
For specific advice on your eating habits and
to help you decide what diet is right for you it’s
important you have the support of a registered
dietitian, ask your GP to refer you.
Q& A
Can I get more active to lose weight?
Having diabetes doesn’t mean you can’t
become more active. The more activity you do
the more calories you will burn. The
Department of Health recommends at least one
hour of exercise a day if you want to lose
weight through physical activity alone. It’s also
important before you start any new activity that
you talk to your doctor.
I need more support to help with losing
weight and getting more active.
It’s important you get the right support and
advice when you’re trying to lose weight. Your
GP, practice nurse or dietitian can help. As you
eat less, become more active and lose weight,
you may need your insulin to be reduced. Talk
to your doctor or nurse if you need to know
how to do this.
Remember, you should also have support
of a registered dietitian, see above.
2013 Type 1 diabetes
61
Living with diabetes
TESTIN
PHYSICAL
ACTIVITy
Moving on up
Being active is not
only great for your
health, it can also
make you feel more
positive and give you
more energy
At first, take some simple steps
to increase your activity levels
62
Type 1 diabetes 2013
Living with diabetes
PHYSICAL ACTIVITy
P
hysical activity is an important
part of your diabetes
management. It can help to improve
blood glucose, as well as improve
fitness, prevent excess weight gain,
keep the heart healthy and lower
blood pressure. It also improves selfesteem and reduces the symptoms
of depression and anxiety. The
Department of Health recommends:
• Adults should aim to be active on
a daily basis.
• Working towards a target of at
least 150 minutes (2½ hours) over
the course of a week. Moderate
intensity activity can be done in
bouts of 10 minutes or more, so
you could aim for 30 minutes a
day on at least five days a week.
• If you choose to do vigorous
intensity activity, then 75 minutes
can be spread across the week.
• Include activities that increase
your muscle strength at least
twice a week.
What is moderate intensity?
This causes you to feel warmer,
breathe harder and your heart to beat
faster, but you should still be able to
hold a conversation, Examples are
brisk walking and cycling.
What is vigorous intensity?
This causes you to feel warmer,
breathe harder and your heart to
beat faster, but it would be difficult
to hold a conversation. Examples
include running, swimming or
playing sports, such as football.
What is musclestrengthening activity?
This involves using body weight
or working against resistance
Examples are: Dancing (stepping or
jumping), exercising with weights
or carrying or moving a heavy load,
such as food shopping.
If possible, get into good habits,
such as cutting down the time you
spend in sedentary (sitting)
activities, such as watching TV,
playing electronic games or using
the computer. The time spent in
these activities could be
interspersed with action, even just
doing some stretching exercises
or running up or down the stairs.
tops
tip
Increasing
activity
1
2
Use stairs instead
of a lift or escalator.
3
4
5
Physical activity
& diabetes
There are a few things to be
aware of:
• physical activity increases the
amount of glucose used by
the muscles for energy, so it
may sometimes lower blood
glucose levels
• being active helps the body use
insulin more efficiently, and regular
activity can help reduce the
amount of insulin you need to take
• being active helps to maintain
a healthy weight for your height,
this in turn will help with your
diabetes control.
ycle or walk short
C
journeys, rather than
using the car.
et off the bus or tube
G
a stop earlier.
Use your lunch break
to go for a brisk walk.
If you’re in a sedentary
job, try to get up and
walk about regularly.
6
7
Walk a dog regularly.
T
ake up swimming or
playing golf.
Remember, all activity
counts, but try to vary
the type of activity you do
so that you don’t get bored.
2013 Type 1 diabetes
63
Living with diabetes
PHYSICAL ACTIVITy
Food & fluids
• Eat or drink extra carbohydrate
as needed to avoid hypos and
to keep up your energy levels
needed for exercise.
• Keep carbohydrate-based foods
to hand during and after exercise.
i For more on physical activity,
vigorous
intensity activity
If you’re doing strenuous sports
there are some more specifics to
think about when you test your
blood glucose levels:
• It’s generally safe to exercise
if blood glucose levels are
between 7–12mmol/l.
• Avoid or delay your activity if
pre-exercise levels are above
12mmol/l and you have
ketones in your urine.
• If your levels are above 12mmol/l
but you don’t have ketones, don’t
take extra carbohydrate until your
levels come down.
• Have some extra carbohydrate
(about 30g) if your glucose levels
are below 7mmol/l.
• Check glucose levels before,
every 30 minutes during, and
after exercise. If exercise has
been particularly vigorous, also
check between 2–3am. This will
help you to pinpoint if you need
to change the amount of food or
insulin you have and understand
how different types of exercise
affect you blood glucose.
• Bear in mind that hypos can
occur during or soon after
physical activity or up to 24
hours afterwards.
64
Type 1 diabetes 2013
visit www.diabetes.org.uk/
Keeping-active
For more detailed information on
Type 1 diabetes and sport, visit
www.runsweet.com
ACTION
POINTS
• Take advice from your
diabetes healthcare team
on the types of activity most
suitable for you.
• Try to increase your activity
levels by introducing some
simple activities at first and
increasing duration/intensity
as you improve.
• If you belong to a gym,
tell your fitness instructor
that you have diabetes so
that they can carry out a
health review.
Keep it safe
• Make sure you warm up
before you exercise, and
cool down afterwards.
Warm-ups should consist
of 5–10 minutes of low
intensity aerobic exercise,
such as walking and 5–10
minutes of stretching. A
cool down should last
about 5–10 minutes,
(include the same exercises
as your warm-up, and slow
your heart rate down to
what it was before you
started exercising).
• Wear the right footwear
for your activity and wear
socks to prevent blisters.
• Keep your feet dry and
check your feet before
and after activity.
• Wear a diabetes medical
ID bracelet.
• Keep hydrated.
• Carry a small bag
containing all your
necessary diabetes kit,
blood glucose monitor,
hypo treatments and
a mobile phone.
• Avoid going into remote
areas when exercising.
• Let others know that
you are going out
exercising and when
you are expected back.
General diet
Berry
tasty
The same fast acting GlucoGel, now in a fruity flavour
Now available in triple pack (3 x 25g tubes)
Fast acting 40% glucose gel
Easy to carry, easy to use,
easy to swallow
Raises sugar levels fast
For people who require glucose,
or are in need of an energy boost
For more information visit www.glucogel.co.uk
or call BBI Healthcare on 01656 868930
Living with diabetes
Accepting diagnosis
Take time to adjusT
Being diagnosed with Type 1 diabetes often comes as a shock and the
implications may not be easy to fully understand at first. As Jane Matera
from Diabetes UK Careline explains, you, and those close to you, will
need time to absorb the news and discuss how you feel
Take some time out to discuss
how you feel about your diagnosis
D
iagnosing Type 1 diabetes is
often made after an episode of
unexplained illness that may have
resulted in a hospital admission.
It can be a confusing time, but
you’ll soon find that healthcare
professionals will help you to get
back on track. But you’ll need to
be aware that this will involve you
making some changes to your
lifestyle and routine.
Because Type 1 is generally
diagnosed as an emergency, the
main priority and focus in the first
few hours, days, and weeks, is on
66
Type 1 diabetes 2013
the practical: learning how to inject;
how much to inject, and when;
balancing the insulin dose against
food/exercise/stress; learning the
hows and whens and whys of
checking your blood glucose. But
don’t worry, although this may
initially seem daunting, with time
and help you will become more
relaxed and able to cope.
It’s important while learning all
these new things not to ignore the
shock and emotions you may be
feeling. The relief of explaining how
you’re feeling can be immense, so
it’s well worth taking some time out
to discuss how you feel about your
diagnosis with a nurse or doctor
and the people close to you, as
soon as you can.
But what if no one asks? Or,
if everyone, much too early, but
possibly thinking it’s for your
own good, urges you to adapt,
accept, be positive, and move on?
Or, if no one actually says
anything much at all? This is the
experience often described to the
Diabetes UK Careline by newly
diagnosed callers. What if you have
Accepting diagnosis
professionals will help
“Healthcare
you to get back on track
”
the basics explained, and are then
expected to return home, and carry
on after so much change?
Sometimes, the reaction of the
person diagnosed can contribute to
this situation. Often, because
you’re in shock, you seem to
accept the complicated instructions
that you’re given. It may be all that
you’re able to do. Your emotional
reaction may be like this: ‘How are
you?’ asks a kind nurse or doctor.
‘Fine,’ you say. ‘He/she seems ok
with it all,’ reports back the nurse.
‘Coping well!’ End of story. Except
that it might not be the case.
Recognise your need for
emotional expression
and support
It’s an extraordinary fact, but if
you’d been diagnosed with cancer
rather than diabetes, your need for
emotional and psychological
support would never be in question.
But is Type 1 diabetes any
different? Perhaps public
ignorance of the nature of Type 1
and a lack of understanding may
be to blame?
Your shock can be helped along
by the release of talking through
what you have experienced,
maybe over and over again, to
someone who’ll listen.
Talk about what your fears
are. Are you angry? Do you
feel it’s unfair?
But there can sometimes be a
huge obstacle in the way of this. It
is fear of knowing what diagnosis
means; fear and confusion as to
what it might mean now and in the
future. You may also be someone
who doesn’t easily talk about what
is important to you.
But the right kind of help at the
right time is what is most likely to
help you now and in the long run.
Don’t be afraid to be honest
about what you feel, it will help you
to gather up your strengths – and
the needed resources to get on
with your life.
Living with diabetes
Diabetes UK
Careline
Diabetes UK’s Careline
provides confidential support
and information to all people
affected by diabetes. Call
0845 120 2960, Monday
to Friday, 9am–5pm. Careline
accepts TypeTalk calls and has
an interpreting service. Please
check the cost of calls to 0845
numbers with your phone
provider.
Write to: Diabetes UK Careline,
10 Parkway, London NW1
7AA for a response within 21
days. Email [email protected]
org.uk for a response within
10 working days. Careline
cannot provide individual
medical advice.
2013 Type 1 diabetes
67
Living with diabetes
telling people
A new beginning
After being diagnosed some
people may feel like hiding it
from the world. But telling certain
people can really help you and is
also a good way of getting extra
understanding and support
Discussing your diabetes will help
your friends understand how they
can help you
68
Type 1 diabetes 2013
I
t’s perfectly understandable that
you may not be looking forward
to telling people about a newly
diagnosed condition like diabetes.
Initially, they will probably know
very little about it and how it may
affect your daily life. However, don’t
let this put you off, most people
find their employers, friends and
family are very understanding
once the news has been shared.
Also, they often find that they get
more support and are better able
to cope with their newly altered
circumstances.
Telling friends & family
Friends and family can provide you
with valuable support especially
when you are newly diagnosed or
when you’re struggling to manage
your diabetes. Telling them can also
help them understand the part they
can play to help diabetes fit into
your life, for example you may find
that sharing aspects such as how
you feel when you have a hypo
helpful (see p18). If your friends are
aware of what the symptoms are,
then they can help you to get the
right treatment and prevent
misunderstandings. Also, when you
are going out with friends it will give
them a better understanding of why
meal times or the type of food you
eat might matter to you.
Your partner, family or anyone
who is involved in preparing the
food at home will need to
understand why carbohydrates
matter to you. If they understand
what carbohydrates are and how
telling people
much they put in your meal, this
can help you calculate the correct
amount of insulin.
Telling hospital staff
If you have to go to hospital, tell
the staff you have diabetes – don’t
assume they already know.
Although your diabetes won’t
necessarily be affected, it is
sensible to make sure anyone who
is looking after your health knows
about it. This includes dentists,
opticians and podiatrists.
‘Alternative’ practitioners,
such as osteopaths, chiropractors,
aromatherapists, and anyone giving
massage or reflexology treatment,
will also need to know.
Telling gym staff
If you belong to a gym, the fitness
instructors or personal trainers
need to know about your diabetes
so they can carry out a health
review. The reason for this is that
your diabetes may increase your
risk of having high blood pressure
or heart problems. Also, your blood
glucose levels may be affected by
the exercise you do.
Telling your employer
& colleagues
There is no legal requirement to
tell your employer that you have
diabetes. But they will probably
want to know what has been
happening to you, especially if
you had time off work.
Accentuate the positive – stress
that diabetes means you must be
aware of time, have a regular
routine and try to follow a healthy
lifestyle, as well as having a thorough
medical each year. It may not be
something employers openly admit
to, but people with diabetes may
occasionally face discrimination
because of the misconceptions that
some people have about the
condition. The better informed you
are about your diabetes, the better
you will be able to explain why it
won’t interfere with your ability to
do your job. If you don’t tell your
employer about your diabetes, it
will be more difficult to pursue any
issues with reasonable adjustments.
i For more on diabetes
and work see p80.
Telling insurance companies
You must declare that you have
diabetes to any insurance
companies that you hold a
policy with.
Car: Your insurance could be invalid
if you have an accident and you
haven’t told your insurer that you
have diabetes. Also, because of the
increased risk of hypos, you will
have to tell the Driver and Vehicle
Licensing Agency (DVLA), or in the
case of Northern Ireland the Driver
and Vehicle Agency (DVA), that you
are treated with insulin. Your driving
licence will be reissued for a onetwo- or three-yearly term, and
you’ll have to reapply each time
(this is free of charge).
i For more on driving and
diabetes see p82.
Living with diabetes
Travel: Most travel insurance
policies exclude pre-existing
medical conditions (medical
conditions you had before the
policy was taken out), such as
diabetes. You should always
declare it for your travel insurance
to make sure that you are covered.
Some insurers will not give cover to
people with diabetes or they will
charge a much higher premium
i For more about travelling
see p84.
Home, mortgage
or life insurance:
Once you have been diagnosed
with diabetes, getting this type of
insurance can sometimes be
difficult, so Diabetes UK has
produced a factsheet to help.
i A free download is available at
www.diabetes.org.uk/How_we_
help/Financial_Services
more you
“The
know about
diabetes, the
more you
can explain
it to others
”
2013 Type 1 diabetes
69
Living with diabetes
Love life
staying close
Having diabetes shouldn’t affect
your desire for or ability to have sex.
However, diabetes can cause problems
which you need to be aware of
Safe sex
It’s important to practise ‘safe’
sex and this includes not only
protecting yourself against
sexually transmitted diseases
(STDs) by using a condom, but
also to prevent an unplanned
pregnancy. All forms of
contraception are suitable for
people with diabetes. See p72
for the different types available.
70
Type 1 diabetes 2013
Consult your doctor at an
early stage if you encounter
sexual problems
Love life
S
ex is an important part of
relationships for adults of
all ages. An unfulfilling sex life
can lead to feelings of guilt and
rejection, causing problems within
a relationship. Some people who
have diabetes may encounter
sexual problems. But by talking
about the issues with your partner
and consulting a doctor, you will
be taking the important steps to
resolving things. Here are some
things to be aware of:
Thrush
This is a common condition that is
made worse by high blood glucose
levels. The best way to limit your
chances of developing it is to
control your diabetes well. If you do
develop it, even though there are
creams that you can buy without a
prescription for treating it, it is better
to consult your diabetes healthcare
team about it, as they will help you
to sort out both problems.
Hypos
Insulin can increase the risk of a
hypo if you are very active during
sexual intercourse. Therefore, it is
important that you have some form
of hypo treatment to hand that’s
easy to take if needed. You might
want to tell your partner what to
expect if you have a hypo, especially
if they’re a new partner.
Problems
Around 50 per cent of men with
diabetes and 25 per cent of woman
with diabetes will experience some
kind of sexual problems or loss of
sexual desire as a result of their
diabetes. The most common sexual
problems experienced are erectile
dysfunction (and female sexual
dysfunction. Not everyone
experiences these problems.
Other possible causes are smoking,
drinking excess alcohol and the use
of some recreational drugs.
Tiredness, stress and poor
self-image can all contribute.
Erectile dysfunction (ED) or
impotence is the medical term for
being unable to get and/or keep an
erection for intercourse. Not only is it
important to talk to your doctor about
this because of your relationship, but
it can indicate other health problems,
such as heart disease.
There are various treatments
available for men with erectile
dysfunction, which include tablets,
injection, vacuum therapy and
implants. Men often feel
embarrassment and this leads them
to buy these products via the
internet. Do avoid this, as these
products may be expensive and
they may not contain the correct
amount of medication for you.
Treatment for ED is free on
prescription to men with diabetes,
so talk to your doctor as he/she can
discuss your choices and prescribe
the appropriate treatment for you.
Female sexual dysfunction can
cause dyspareunia (pain with
intercourse), loss of desire, arousal
and orgasm. Very little research has
been done into this area and there is
very little treatment, although a
vacuum device is available which
fixes onto the clitoris to encourage
blood flow and lubrication to the
genitalia and vagina.
Living with diabetes
Q& A
What are the physical
causes of sexual
dysfunction?
There are many possible
reasons:
• hardening of the arteries
(a complication of diabetes)
causes problems with
the blood flow needed
for arousal
• diabetic neuropathy can
damage the nerves involved
with sex
• surgery on the bladder,
bowel, or prostate, can
cause damage to nerves
• some medicines for high
blood pressure and heart
disease, and some
sedatives, tranquillisers and
antidepressants can affect
your desire and arousal,
and possibly lead to
orgasmic dysfunction.
I find it hard to talk to my
partner, what should I do?
Many couples are reluctant to
talk about their problems for
fear of causing each other
more stress. They often feel
embarrassed, frustrated and
guilty and their partners often
feel rejected and angry,
especially if they don’t know
or understand the cause of
the problem. Counselling or
sex therapy may be enough to
resolve any issues.
2013 Type 1 diabetes
71
Living with diabetes
Contraception
Contraception
options
There are lots of contraception options available.
We take a look at the pros and cons of each and
their impact on diabetes
H
aving diabetes shouldn’t affect
your desire for or ability to
have sex, but it is really important
to avoid an unplanned pregnancy.
This is because high blood glucose
levels at the time of conception can
affect the foetus, causing damage
to the developing heart and blood
vessels, and a lack of folic acid
could lead to neural tube defects,
such as spina bifida.
Concerns
Some women are concerned
that having diabetes means
they are unable to take the oral
contraceptive pill. Any form of
contraception that releases either
of the hormones oestrogen or
progesterone carry the risk of
raising blood pressure or causing
a blood clot (thrombosis).
Women with diabetes are
susceptible to the same – but no
higher – risks than any other
woman who uses contraception,
but if they have any diabetes
complications they should be
advised to avoid hormone-releasing
contraceptives. Another concern is
that contraception will affect
diabetes control. Some women do
experience a slight deterioration in
control when they first start using a
72
Type 1 diabetes 2013
form of contraception that contains
hormones. But this can be easily
monitored and controlled by a slight
change in diabetes medication.
Used correctly, most
contraception has more than
90 per cent effectiveness, but some
forms need more care than others,
eg remembering to take a pill at the
same time every day.
Your GP or a family planning
clinic will help to ensure that the
best choice of contraception is
prescribed for you.
THE COMBINED PILL
How it works There are several
types, but they all prevent the
ovaries from releasing eggs and
thickens the mucus at the neck of
the womb, which makes it harder
for sperm to enter.
Advantages Can make periods
lighter and less painful.
Disadvantages May cause
weight changes, breast
tenderness and headaches.
Women who have had diabetes
for more than 20 years should
avoid the combined pill, as well as
those who smoke or aged over 35.
Diabetes effects? The hormones
may affect blood glucose levels.
PROGESTOGEN ONLY
PILL (POP)
How it works Thickens the
mucus in the neck of the womb,
making it harder for sperm to
enter the womb. It also thins the
lining of the womb so that there
is less chance of a fertilised egg
implanting.
Advantages Providing there are
no medical problems, such as
heart disease or stroke, it can be
taken until menopause or the
age of 55.
Disadvantages Periods may be
irregular. Side effects at first can
include spotty skin, breast
tenderness, weight change and
headaches. It has to be taken at
the same time every day or it will
not protect against pregnancy.
Diabetes effects? The
hormone may affect blood
glucose levels.
VASECTOMY/TUBAL
LIGATION
How it works A vasectomy
(for men) cuts the tubes that
deliver sperm, and a tubal ligation
(for women) blocks the fallopian
tubes, so a fertilised egg can’t
reach the womb.
Advantages Very reliable.
Disadvantages Involves
surgical procedure.
Diabetes effects? No.
contraception
.
CONDOM
How it works Covers the penis,
preventing sperm from entering
the womb.
Advantages Protects from
sexually transmitted infections.
Only used when you have sex.
Disadvantages Can interrupt
sex. May break. Some people are
sensitive to the chemicals in latex
or spermicide.
Diabetes effects? No.
CAP/DIAPHRAGM
How it works Fits inside the
vagina and covers the cervix,
which prevents sperm from
entering the womb. A
spermicide (a chemical that
kills sperm) is also used.
Advantages Only has to be
used when you have sex.
Disadvantages Can interrupt
sex. Spermicide can be messy.
Can take time to learn how to
use it. Cystitis can be a problem
for some women. Some people
are sensitive to the chemicals in
latex or spermicide. All types
of diaphragm and cap need to
be kept in place for at least six
hours after intercourse and
no longer than 30 hours (latex)
or 48 hours (silicone). High
failure rate if used incorrectly
or they burst.
Diabetes effects? No.
IMPLANT
How it works A small flexible
rod is placed just under the skin
in the upper arm, which releases
a progestogen hormone that
acts in the same way as the
combined pill.
Advantages Lasts for three
years, so you don’t have to think
about it very often and may
reduce painful, heavy periods.
Disadvantages Requires a small
procedure to have it fitted and
removed. Side effects may
include headaches, breast
tenderness and mood changes.
May also cause weight gain and
increase blood pressure.
Diabetes effects? The hormone
may affect blood glucose levels.
INJECTIONS
How it works The hormone
progestogen is injected into a
muscle, and acts on the womb
lining in the same way as the
combined pill.
Advantages Depending on
which type you are given, it
lasts for eight or 12 weeks.
Disadvantages Fertility may
take a long time to return. If you
have any side effects you have to
put up with them for a long time.
May cause thinning of your
bones and should only be given
to those under the age of 18 after
careful evaluation by a doctor, as
it can affect bone development.
Can cause weight gain.
Diabetes effects? The
hormone may affect blood
glucose levels.
Living with diabetes
INTRAUTERINE DEVICE (IUD)
How it works A small plastic
and copper device that does
not contain any hormone, but
works by stopping sperm
reaching an egg due to the
release of copper. May also
work by stopping a fertilised egg
from implanting in the uterus.
Advantages It’s effective as
soon as it is inserted and lasts
for five years, although it can be
removed sooner.
Disadvantages Can be painful
to insert.
Diabetes effects? No.
INTRAUTERINE SYSTEM (IUS)
How it works A hormonereleasing version of the IUD
(above), which acts on the
womb lining in the same way
as the combined pill.
Advantages It’s effective as
soon as it is inserted and lasts
for five years, although it can
be removed sooner.
Disadvantages Can be
painful to insert.
Diabetes effects? The
hormone may affect blood
glucose levels.
2013 Type 1 diabetes
73
Living with diabetes
pregnancy & labour
Great
expectations
Having children is a big decision for anyone.
If you are a woman who has diabetes, however,
it is a decision that requires much more thought
and careful planning
M
ost women who have Type 1
diabetes have healthy
pregnancies and healthy babies.
But this isn’t to say that it’s an
easy experience – it requires a lot
of work and dedication on your
part. This is because diabetes can
increase risks to both you and
your baby of serious problems.
The information here is intended
to inform, not alarm. It’s important
that you are aware of the difficulties
so that you and your doctors can
discuss them together and work
to prevent them.
Contraception is the key to
avoiding an unplanned pregnancy,
(see p72) for the types available.
74
Type 1 diabetes 2013
Risks to you
Having diabetes and becoming
pregnant has a number of risks:
• Pre-existing retinopathy
This may get worse, so it is really
important that you have your
retinal screening done if it has not
been done in the last 12 months.
• Pre-existing nephropathy
This may get worse, so your
kidney function should be
checked as early as possible so
that you can be referred for
treatment as early as possible.
• Hypoglycaemia
As you try to manage your blood
glucose and get tight blood
glucose control, you may find that
you have more hypo episodes. It
is important to be aware of your
warning signs and always have
your treatment to hand.
There are risks involved with
pregnancy if you have diabetes
which you need to be aware of
• Hyperglycaemia
Although DKA is not common,
you would be admitted urgently
as it can be dangerous to both
you and your baby.
• Pre-eclampsia
Although all pregnant women are
at risk, diabetes increases the risk
of this happening. If your blood
pressure is high, you have fluid
retention and protein in your
urine, you will be closely
monitored until it is possible to
deliver your baby safely.
• Pre-term labour
You may need to deliver your
baby earlier than expected,
either for your safety or your
baby’s. Reasons include:
pre-eclampsia, your baby having
grown too large or deterioration
in your kidney function.
pregnancy & labour
“
Most women with diabetes
have healthy pregnancies
and healthy babies
Risks to
your baby
• Not developing normally
and having congenital
abnormalities,
particularly heart
abnormalities.
• Having a neural
tube defect, such
as spina bifida.
• Being large for
gestational dates, known
as macrosomia. This can
cause difficulties with a
vaginal birth and lead to
birth injuries.
• Being stillborn or dying
soon after birth.
How to reduce
these risks
Before pregnancy
• Tell your diabetes team
that you are planning to
become pregnant.
• Work on getting good
blood glucose control.
This reduces the risk of
your baby having
congenital abnormalities.
If your HbA1c is more
than 86mmol/mol you
should avoid pregnancy,
ideally it should be below
43mmol/mol. Your
diabetes healthcare
team can help you
with this.
”
• Start taking 5mgs folic
acid each day until the
end of the 12th week of
your pregnancy, to help
prevent neural tube
defects. This dose can’t
be bought over the
counter, but is prescribed
by your doctor.
• Check the tablets you
are on. If you are
prescribed statins or
certain blood pressure
tablets, such as ACE
inhibitors you must stop
taking them as they
could damage your
developing baby. Your
doctor will change you
to a type which is safe
for your baby.
• Ask to be referred to a
pre-conception clinic
which is usually run by
the diabetes midwife
and the diabetes
specialist nurse.
• Avoid alcohol while
trying to conceive.
Don’t panic if you find
you are pregnant before
you have had a chance
to do all this preparation,
bit do make an
appointment to see
your doctor as soon
as possible.
Living with diabetes
tops
tip
During pregnancy
Just like all pregnant women with or
without diabetes it is important to follow
these tips:
1
Alcohol. Alcohol should be
avoided by all women during
pregnancy because of the
health risks to the baby.
2
Stop smoking. The chemicals in
cigarettes are taken in your bloodstream
to your unborn baby. This reduces the
essential nutrients such as oxygen
reaching your baby, causing your baby’s
heart to beat faster and so work harder.
It can also affect your baby’s growth rate
and the development of your baby’s brain.
3
Eat a healthy, balanced diet. Discuss
your recommended weight gain with
your diabetes healthcare team. ‘Eating
for two’ is not necessary and can cause
more harm than good.
4
Stay active. If you were inactive before
you became pregnant, don’t suddenly
take up strenuous exercise. Choose
an activity you like and feel comfortable
doing. Remember that you may need
to slow down as your pregnancy
progresses. Physical activity can
also help you to maintain good
blood glucose control.
2013 Type 1 diabetes
75
Living with diabetes
pregnancy & labour
Once you are pregnant
‘Morning sickness’ can cause
problems with your blood
glucose control.
• Try to eat small, regular starchy
snacks, such as soup and
crackers or plain biscuits.
• Try sipping a drink before getting
out of bed in the morning.
• If you don’t feel like eating, drink a
sugary drink to avoid going hypo,
but always remember not to stop
taking your insulin.
If this doesn’t help, your doctor
may be able to prescribe a safe
medicine to control the vomiting.
If you have repeated vomiting
and/or a large level of ketones
on testing, you should seek
medical advice as soon as
possible to prevent the ketones
from harming your baby.
You should be offered joint antenatal
and diabetes clinics where your
diabetes and pregnancy teams can
plan and discuss your pregnancy
with you. You should also be offered
an appointment with a dietitian.
You will already have a blood
glucose meter for testing, but you
may need to increase the number of
times you test each day and so will
need more test strips. Your diabetes
healthcare team will advise you
about when to test and why, but as
a minimum you should be testing
before breakfast, one hour after
each meal and before you go to
bed. Your personal target should be
76
Type 1 diabetes 2013
agreed between you and your team,
but in general the rule is to aim for a
fasting blood glucose of between
3.5 and 5.9mmol/l and less than
7.8mmol/l one hour after eating.
You should be given ketone test
strips either for urine or blood, and
you should be given a glucagon kit
and shown how to use it. Make
sure some members of your family
are familiar with it, in case you
should experience a hypo which
you can’t treat yourself.
As well as your routine antenatal
appointments, you should have
contact with your diabetes
healthcare team every one to two
weeks during your pregnancy to
discuss your blood glucose levels.
This may be by phone or in person.
During labour
If your labour starts before 37
weeks you may be given steroids to
help your baby’s lungs to mature.
Steroids can raise your blood
glucose level, so you may have to
take extra insulin and monitor your
blood glucose closely.
Throughout your labour and the
birth you should try to monitor your
blood glucose hourly, aiming to
keep it between 4–7mmol/l.
You my be offered an intravenous
infusion (drip) of dextrose and
insulin to help to keep your levels
within your target range.
i You can find more information
in the NICE guidance for
diabetes in pregnancy at
http://guidance.nice.org.uk/
CG63/PublicInfo/pdf/English
Q& A
Will my baby be affected
by my diabetes once
its born?
Your baby should stay with
you unless there is a medical
reason why he or she needs
extra care. All babies’ blood
glucose levels drop after they
are born. so it is important
that you should start to feed
your baby as soon as
possible – certainly within 30
minutes of birth, and then
every two to three hours.
Your baby’s blood glucose
will be tested two to four
hours after birth, (unless there
are signs of hypoglycaemia)
the target being to keep it
above 2mmol/l.
Once I’ve given birth,
will my diabetes treatment
go back to how it was?
Unless you are breastfeeding
(which provides the best
nutrition for your baby, gives
protection against infections
and helps you to bond),
after you’ve delivered
your baby you will be able
to resume your prepregnancy medications.
pregnancy & labour
Living with diabetes
Specific antenatal care for women with diabetes
Appointment
Your heathcare professional should:
First appointment (joint
diabetes and antenatal
clinic)
Give you information, advice and support about your blood glucose levels.
Ask you questions about your health and diabetes.
Discuss your current medications.
Offer an eye examination (retinal screening) and a kidney test if these have not
been done in the last 12 months.
7–9 weeks
Check that you are pregnant and confirm the gestational age of your baby.
Booking appointment
(ideally by 10 weeks)
Offer information, education and advice about how diabetes will affect your
pregnancy, birth and early parenting (such as breastfeeding).
16 weeks
Offer you a repeat eye examination if you were found to have retinopathy at your
first antenatal appointment.
20 weeks
Offer you a test to check the development of your baby’s heart.
28 weeks
Offer you an ultrasound scan to check your baby’s growth.
Offer you a repeat eye examination if you did not have retinopathy at your
first antenatal appointment.
32 weeks
Offer you an ultrasound scan to check your baby’s growth.
36 weeks
Offer you an ultrasound scan to check your baby’s growth.
Give you information about:
• planning the birth, including timing and types of birth, pain relief and
anaesthesia and changes to your insulin during and after labour.
• looking after your baby following the birth, including starting breastfeeding and
the effects of breastfeeding on your blood glucose levels.
• contraception and your care after the birth.
Arrange for you to see an anaesthetist to prepare for the safe administration,
should it be necessary, during the birth.
38 weeks
Offer to induce your labour or offer a caesarian section if it is the best option for
you. Offer to start regular tests to check your baby’s health if you are waiting for
your labour to start.
Every week from
39 weeks to birth
Offer tests to check your baby’s wellbeing.
2013 Type 1 diabetes
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Living with diabetes
ILlness & infections
Feeling off
colour?
Falling ill is never fun, and having diabetes
means that you may need to consider a
few more things. So here are a few tips to
help you on your way to a speedy recovery
Y
our diabetes means that you
have to pay close attention to
any illness or infections you pick up
from time to time. Like any other
form of stress, illness can raise your
blood glucose levels. Typical things
that will upset your diabetes control
can include:
• colds, bronchitis and flu
• vomiting and diarrhoea
• urinary infections (eg, cystitis)
• skin infections (eg, boils, inflamed
cuts and skin ulcers).
Milky drinks and soup are a good
way of taking on carbohydrate
78
Type 1 diabetes 2013
Managing at home
When you are ill or have an infection
your blood glucose levels will rise
even if you’re not eating as much as
usual or are being sick. At these
times it is important to keep taking
your insulin. If you don’t, your blood
glucose levels will keep rising and
you will eventually develop diabetic
ketoacidosis (DKA). You should try to
drink plenty of unsweetened fluids
and to rest, exercise will make things
worse.
Your carbohydrate intake may
need to be taken in an easily
digested form. The following
carbohydrate-containing foods may
be useful alternatives to solid food
when you are feeling unwell:
• milky drinks
• soup
• ice-cream
• Complan/Build-up
• drinking chocolate
• ordinary squash or fizzy drinks.
It is important to monitor your blood
glucose levels and you may need
to increase the frequency of your
glucose monitoring while you are
unwell. Sometimes, high blood
glucose levels can be the reason
you are feeling unwell, rather than
your actual illness.
When to get medical help
You should seek medical advice if:
• you are unable to eat or drink
• you have persistent vomiting
or diarrhoea
• you become drowsy or confused.
You must also seek medical advice
if you are treated with insulin and:
• you have a blood glucose higher
than 25mmol/l despite increasing
your insulin
• you have persistent ketones
or large amounts of ketones
in the urine
• you have very low glucose levels.
Testing for ketones
If there is no glucose going into
the cells, your body will start to
burn its stores of fat as an
alternative source of energy,
producing an acidic by-product
called ketones. Checking your
urine with special test strips will
indicate the level of ketones you
had a few hours previously. These
strips are available on prescription
and you should always keep some
in-date ones at home.
ILlness & infections
Some blood glucose monitors
also measure ketones – this
test uses a different strip and
shows your current levels of
ketones. If either test shows
positive for ketones, seek
medical advice. If the test is
negative, you should retest
your blood glucose levels
after two hours to be sure
your blood glucose levels
have gone down. If they
haven’t, check again for
ketones. If you have high
blood glucose levels and any
signs of DKA (ketones in the
blood/urine, abdominal pain,
nausea/vomiting, rapid
breathing), you must contact
your diabetes healthcare
team immediately. If DKA is
left untreated it can lead to
unconsciousness. But, if
picked up early, it can easily
be treated with extra insulin
and fluid.
You may also be admitted
to hospital, if:
• a heart attack or intestinal
obstruction is suspected
• you are unable to swallow or
keep down fluids
• you have persistent
diarrhoea
• your blood glucose level
remains above 20mmol/l
despite attempts to get it
lower
• any clinical signs of your
condition worsening, eg
Kussmaul’s respiration
(deep, gasping breaths),
severe dehydration,
abdominal pain
• you live alone, have no
support and may be at
risk of slipping into
unconsciousness.
Managing your
diabetes in hospital
The responsibility for
managing your diabetes
should be shared between
you and the hospital staff.
Although they should be able
to provide you with diabetes
medication, if possible take
some with you to avoid delays
and take your own diabetes
equipment (insulin pens and
meters) because they won’t
supply this.
Once your condition has
stabilised, don’t assume
everyone treating you will
know you have diabetes –
it’s better to be over-cautious
and keep mentioning it.
Good diabetes control is
important to speed your
recovery. Stress and longer
periods of inactivity might
affect your blood glucose
levels, so test more often.
Even if you go to A&E
as an emergency, you may
have to wait to receive
treatment. In this situation,
you shouldn’t eat or drink
anything in case you need
surgery when you are seen.
As soon as you arrive,
tell a staff member that
you have diabetes and
may need to eat to avoid
going hypo. If you feel
that you do need to
eat or drink, check with
staff first.
i See ‘Your diabetes
care explained’, p24.
tops
tip
Living with diabetes
Diabetes
when you’re ill
1
2
3
Continue to take your insulin even
if you don’t feel like eating.
Test your blood glucose levels more
frequently.
If your blood glucose levels are
consistently above 15mmol/l, you
may have to increase your insulin
dose. Talk to your diabetes
healthcare team about how much.
4
If you don’t feel like eating, you are
feeling sick or can’t keep anything
down, replace meals with snacks
and drinks containing carbohydrate,
which will provide energy. Sip sugary
drinks or suck on glucose tablets.
5
Drink plenty of unsweetened fluids.
ACTION
POINTS
• If you are admitted to hospital,
make sure that everyone treating
you knows you have diabetes.
• Become familiar with the signs that
indicate you should seek medical
advice, and make sure that a close
friend, family member, or your carer
are also aware of these points.
2013 Type 1 diabetes
79
Living with diabetes
Work & discrimination
An even
playing field
Unfortunately you may
come across some
discrimination at work.
Here is some helpful
advice that should
help you deal with
the situation, should
it arise
Your employer should
work with you to make
adjustments to your role
T
hankfully, blanket bans on the
recruitment of people with
diabetes are almost a thing of the
past. The UK armed forces are
one of the very few employers who
list people with diabetes as being
ineligible to apply. Some jobs,
however, especially those involving
safety-critical work, will have
legitimate health requirements that
may exclude people with certain
medical conditions and on certain
medication, including diabetes.
Disability discrimination is a vast
area, but the Equality Act 2010
makes it unlawful for an employer
to discriminate against people
because of their disability.
Many people with diabetes
would not class themselves as
80
Type 1 diabetes 2013
disabled. Nevertheless, they can
fall within the scope of the Equality
Act 2010 and therefore benefit from
the Act’s protection. The Equality
Act applies to England, Wales
and Scotland and the Disability
Discrimination Act applies in
Northern Ireland.
The Act defines ‘disability’ as
a physical or mental impairment
that has a substantial and longterm adverse effect on a person’s
ability to carry out normal day-today activities. It is important to
remember that medical or other
treatment and aids, which relieve
or remove the effect of the
impairment, are ignored when
assessing whether the effect is
substantial and long-term.
The Act offers protection in a
number of different areas, of
which employment is one.
Unfortunately, people with
diabetes do sometimes face
discrimination in the workplace,
so the definition is there to
protect their rights.
The Act states that an employer
must not treat a disabled person
unfavourably and put them at a
disadvantage because of their
disability. This protection applies
to every stage of the employment
process; recruitment, terms and
conditions of employment,
opportunities for promotion,
training or any other benefit
and selection for redundancy
or dismissal.
Work & discrimination
Reasonable adjustments
The Equality Act states that
employers have to make
reasonable adjustments (changes
to the way they would normally do
things) to prevent someone being
placed at a disadvantage.
Reasonable adjustments can take
many different forms and for many
people, a few minor adjustments
may be all that is required.
Depending on the
circumstances, examples of
reasonable adjustments might be,
altering duties or working hours.
Although there is no legal
requirement to tell your employer
that you have diabetes, if there is
a health section on an application
form you should state that you
have diabetes.
If you are asked how diabetes
might affect your work, be honest.
You may need to ask for time off
for a clinic appointment or, you
may need to take time out to do
a blood test.
Keep positive
By being positive, honest and
showing how you cope with your
diabetes, your employer is fully in
the picture. If you then have
problems in managing your
diabetes, your employer should be
more aware and understanding
about the condition.
If you develop diabetes while in
employment, your employer may
offer to change aspects of your job,
for instance by altering your shift
patterns. If you’re no longer able to
Living with diabetes
meet the health requirements of
your job, your employer may offer
you a different job.
If you have any problems with
your employer’s response to your
diagnosis, you can contact the
Diabetes UK Advocacy Service
(see details in Further information
or visit www.diabetes.org.uk/
advocacy). You can also discuss
the matter with your union,
the Equality and Human Rights
Commission (EHRC), or your
local Citizens Advice Bureau
(CAB), see below.
i Equality and Human
Rights Commission
(EHRC)
www.equalityhumanrights.com
Citizens Advice Bureau (CAB)
www.citizensadvice.org.uk
Q& A
“
By being honest and showing
how you cope with your
diabetes, your employer is fully
in the picture
”
ACTION
POINTS
• Be honest with your employer, if they
don’t know that you have diabetes.
• If you feel you can’t cope with your
job in its present format, ask your
employer to make some reasonable
adjustments to your role.
Can I appeal if my current job changes or my
employment is terminated due to my diabetes?
If you find that you’re being moved to another job or
being discharged on medical grounds, you may wish to
appeal against the decision. Check your position with a
union rep, the local Citizens Advice Bureau (CAB) or the
Equality and Human Rights Commission (EHRC).
Can I appeal if I am turned down for a job after
an interview?
If you’ve been refused a job and you think it’s solely
because of your diabetes, it may be worth appealing
the decision. Again, get advice from your local
Citizens Advice Bureau (CAB), or the Equality and
Human Rights Commission (EHRC).Your diabetes
healthcare team should be able to provide you with a
supporting letter and the Diabetes UK Advocacy Service
can give you more general supporting information and
refer you on to other possible sources of support, if the
CAB or EHRC can’t help.
2013 Type 1 diabetes
81
Living with diabetes
DRIVING
The road
ahead
Diabetes doesn’t stop you
from driving. However extra
care has to be taken
Always check that you have a snack and
hypo treatments in the car before a journey
82
Type 1 diabetes 2013
DRIVING
I
f you drive and you are on insulin
you need to inform the Driver and
Vehicle Licensing Agency (DVLA).
You will be asked to fill in a medical
questionnaire and give the name
of the doctor who looks after your
diabetes. If your diabetes is well
controlled, with no complications
and good awareness of hypos,
you will normally be issued with a
new licence within eight weeks.
The licence will be valid for one,
two or three years and will need to
be renewed (free of charge). This
is so your fitness to drive can be
assessed on a regular basis – but
you won’t be charged anything for
the renewal.
You also need to let your
insurance company know that you
have diabetes. Most companies
won’t ask you for any further
information and won’t charge
you any more – but a few may ask
what may feel like unnecessary
questions, such as how much
insulin you take.
Even if they don’t ask about your
diabetes, do tell them you have it,
just in case you have an accident in
the future. You don’t want to find
any unknown small print if you
come to make a claim.
Group 2 licences
Since November 2011, people with
diabetes treated with insulin are
able to hold a licence to drive a
‘Group 2’ vehicle (HGV and PCV).
But you have to undergo an
independent medical assessment
every year to assess your fitness to
drive and your management of your
diabetes. You will need to monitor
your blood glucose regularly and
Living with diabetes
store the results on a memory
meter. For further details, see
www.diabetes.org.uk/driving or
contact the Diabetes UK Careline.
Hypos and driving
Having a hypo while driving can be
fatal, not only for the driver, but for
others as well. So it is essential you
always have some form of hypo
treatment and snacks with you in
the car. Even a mild hypo, because
of its effects on the brain, can
seriously impair your ability to drive.
Technically, you’re driving under
the influence of a drug – insulin
– and it’s an offence to drive while
hypo. So always check your blood
glucose levels before you start your
journey.
If you feel like you are going
hypo, stop driving as soon as
possible, remove the keys from the
ignition and leave the driver’s seat
before testing yourself. Either move
to the passenger seat or step out of
your vehicle, if it is safe to do so. If
you are on a motorbike or moped,
you must remove the keys from the
ignition and dismount.
If the test shows you are hypo,
treat it in the usual way and wait for
your blood glucose levels to rise
before continuing your journey. The
DVLA recommends that you wait
45 minutes after the blood glucose
levels have risen to above 4mmol/
before driving.
Remember, you should not test
blood glucose levels or treat a hypo
while in the driver’s seat – and you
must not start driving again until
you have dealt with the hypo.
i Visit www.diabetes.org.uk/
driving for more details.
ACTION
POINTS
• Check blood glucose levels
before driving. If below
5mmol/l have something
to eat and wait 45 minutes
before setting off.
• Always have hypo
treatments to hand.
• Don’t delay or miss a meal
or snack. Try not to drive
for more than two hours
without stopping to test
your blood glucose and
having a snack, if necessary.
• If you feel like you are going
hypo, stop driving as soon
as possible, remove keys
from the ignition, leave
the driving seat and test
yourself. You must not drive
until 45 minutes after your
blood glucose levels have
risen to 4mmol/l.
2013 Type 1 diabetes
83
Living with diabetes
Travel
your
“Planning
trip well in
Broad horizons
The world is your oyster and diabetes shouldn’t get
in your way. Here are some general points and tips
to help you have the trip of a lifetime
H
aving diabetes doesn’t mean
your globe trotting days
are behind you. Whether you’re
planning to take a chance with the
weather and holiday close to home
in the UK, or you’re heading for
more exotic climates, there’s no
reason to shelve your travel plans.
You will find that you have to plan
your trip carefully and add a few
extra items to your checklist.
Before you go
Planning your trip in advance will
give you time to get organised:
• Order plenty of supplies (see
essentials to pack, right) from
your GP. It’s a good idea to take
twice the quantity of medical
supplies you would normally use
for your diabetes. Most pharmacies
want at least 48 hours notice to
prepare your prescriptions and,
if you want to take extra supplies
with you in case of loss or damage,
then you must allow time to
arrange this.
84
Type 1 diabetes 2013
• Shop around for travel insurance
(see top tips for insurance, right).
A
• pply for a European Health
Insurance Card (EHIC). If you are
travelling to a European Union
member country – it will ensure that
you have easy access to healthcare
in that country. Visit www.ehic.org.
uk, call 0845 605 0707 or fill in a
form at the Post Office.
• Talk to your diabetes healthcare
team about how to manage your
diabetes while you’re away and
while you’re travelling, especially
if you’re crossing time zones.
• Ask your diabetes healthcare team
for a letter explaining that you have
diabetes and your treatment. You’ll
need this if you’re flying, so you
can carry sharp items (such as
pen needles) and insulin in your
hand luggage.
• Arrange to have any vaccinations
or malaria tablets you may need.
• Check that your accommodation
includes a fridge that you can
store insulin in.
advance will
give you plenty
of time to get
organised
”
A safe getaway
If you’re flying, here are a few things
to consider:
• Don’t store your diabetes
supplies in baggage that is going
to be checked-in at the airport
unless you absolutely have to –
the low temperate in the hold can
damage insulin and blood testing
strips. Instead, keep insulin and
equipment in your hand luggage,
and keep the insulin cool by using
an insulated bag (eg Frio) or
Thermos flask.
• If you have to store supplies in
your suitcase, pack the insulin in
a flask or bubble wrap and place
it in the centre of a suitcase.
• Don’t expect to have perfect
control while travelling.
Interruptions to your routine,
sitting for long periods and
unexpected delays can
cause blood glucose levels to
be higher or lower than usual.
• Carry plenty of snacks in your hand
luggage, particularly when there’s
Living with diabetes
Travel
no guarantee what time the in-flight
meal will be served or, as with low
budget airlines, you will have to buy
food or drink on the aircraft.
• Don’t feel like you have to order
the diabetic meal rather than
the standard one, ask for whatever
you prefer. Airline meals tend to be
low in carbohydrate, so the most
important point is to match your
insulin to your carbohydrate intake.
• Test your blood glucose levels
regularly, especially on a long flight.
• Make sure you keep your hypo
treatment close to hand.
While you’re away
• Keep insulin cool:
– If your accommodation doesn’t
include a fridge, store it in an
insulated bag or Thermos flask.
– Insulin that is in a device can be
kept at room temperature (under
25°C) for no longer than 28 days.
3
• A
hot climate and activities such
as swimming in the pool or sea
might cause your levels to drop
lower than usual. Likewise, different
foods or long periods lying around
doing nothing might cause them
to rise. Monitor your blood glucose
levels regularly and consider
whether you need to alter your
insulin dose.
• It’s tempting on holiday to forget
all about healthy eating, especially
if you are on a cruise or an allinclusive holiday where the food
supply is constant. Balance an
over-indulgent meal with some
healthy eating to try to avoid
straying too far from good
diabetes management. You
should be able to choose foods
from local menus and still eat a
balanced diet. Overseas travel is
also an ideal time to try
different foods.
Essentials to pack
• Insulin. Also take some spare
insulin as a precaution, in case
it gets misplaced or is not
available where you are
travelling to (it may be available
under a different brand, so
check before you go).
• Insulin injector pen/syringes
• Open needles
• BD Safe-clip (prescription
available) to store
used needles
• Finger pricking device
or lancets
• Blood glucose meter
• Glucose testing strips
• Ketone testing strips
• Ketone monitor (if you
use one)
• Hypo treatments (including
Glucogel and GlucaGen Hypo
Kit if you have these)
• Letter about your diabetes
• currency so you can buy
food and drink on arrival,
if necessary
• Travel insurance emergency
contact number
• European Health Insurance
Card (EHIC), if appropriate.
tops
tip
Insurance
1
Buy your insurance at
least two weeks before
your holiday.
2
Don’t just buy on price and
check the cover is what you
need (read the small print).
3
Choose an insurance
policy that covers illness
(including a stay in hospital),
emergency travel home and
any expenses caused by an
extended stay.
4
Be honest and declare all
pre-existing medical
conditions such as your
diabetes. If you don’t, it
could lead to difficulty if you
need to claim. Many insurers
exclude pre-existing medical
condition including diabetes
or raise the price when they
hear you have diabetes. You
can get a quote from
Diabetes UK Insurance
Services and use it as a
comparison.
By following these tips and
preparing carefully well in
advance there’s no reason why
you won’t have a fantastic trip!
i Diabetes UK Insurance Services
provides travel insurance Call
0800 731 7431 or visit www.
diabetes.org.uk/travel for details.
2013 Type 1 diabetes
85
Living with diabetes
religious holidays
Fasts &
Festivities
R
eligious holidays are an
important part of many people’s
lives. Most involve feasting and
some also precede this with a
period of fasting. So it is important
to understand how this may affect
your diabetes and what you can
do to manage your blood glucose
levels better, and reduce the
chance of any problems. Here we
take a look at how fasting features
as part of some religions.
Christianity
Fasting is not obligatory but the
major Christian festivals of
Christmas and Easter usually involve
not only eating more than usual but
also feature high-fat treats such as
nuts or chocolate, which you may
not normally include in your diet.
Having Type 1 diabetes doesn’t
mean that you have to miss out.
Being less active, over-indulging or
changing your routine will cause
your blood glucose levels to be
higher than usual, so talk to your
diabetes healthcare team about how
to increase your insulin to cope with
this. If you get back to your normal
routine once the holiday is over, your
long-term diabetes control or health
shouldn’t be affected.
Islam
Total fasting (no food or water)
between dawn and sunset in the
month of Ramadan is one of the
five pillars of Islam. Although people
86
Type 1 diabetes 2013
Fasts and feasts form significant parts of
the annual calendar for several religious
faiths, but care needs to be taken to ensure
that your diabetes control is not affected
with diabetes are exempt from this
requirement, many people with
Type 1 diabetes still wish to fast.
If you do choose to fast, then
you must talk to your diabetes
healthcare team before Ramadan
so that you can discuss how to
change your insulin regimen or
pump settings to minimise your
risk of hypos.
Before starting the fast, it might
be helpful to include more slowly
absorbed food (low GI – Glycaemic
index), such as rice, pitta bread,
chapattis and dhal, in your meal.
Fruits, vegetables and salad should
also be included. When you break
the fast, watch portion sizes and
limit the amount of sugary and fatty
foods you eat, such as Indian
sweets, cakes, samosas and puris.
Be careful to give yourself enough
insulin to cover the food you eat.
It is important to have plenty
of sugar-free drinks to avoid
dehydration, too.
Fasting increases the risk of
hypoglycaemia. so if you feel hypo
you must treat it in your usual way,
followed by some starchy food.
This breaking of the fast is permitted
– religious laws state nobody should
put their health at risk.
you
“When
break the
fast,watch your
portion sizes
”
to your
“Talk
diabetes
healthcare team
before fasting so
you can discuss
your insulin
regimen
”
Judaism
A number of fasting days are
observed in the Jewish faith. The
most prominent day of fasting is
Yom Kippur, known as The Day of
Atonement and the holiest day of
the Jewish calendar. The period of
fasting on this day starts at sunset
on the evening before Yom Kippur
and is broken after nightfall on the
following day.
Because of the potential
problems associated with fasting
for more than 24 hours, people with
diabetes may be allowed not to take
part in the fasting. Talk to your
diabetes healthcare team before
fasting, so that you can discuss
how to change your insulin regimen
to minimise your risk of hypos.
Once the fast is over, the
celebration may involve high-fat
and sugary foods, so blood glucose
levels may be affected for a short
period of time. Remember to adjust
your insulin dose accordingly.
religious holidays
Living with diabetes
Enjoy your religious
festivities
Sikhism
Sikhism condemns blind rituals,
such as fasting.
There are four major festivals in
the Sikh calendar where more
high-fat and sugary foods may be
eaten. A sweet-tasting food (Karah
Prasad) is blessed and served at
the Gurudwara (the Sikh place of
worship). It’s made from semolina
or wheat flour, sugar and ghee
(clarified butter), so it may have an
effect on your blood glucose level.
Depending on the amount you eat
you may need to adjust your insulin
dose accordingly. A Langar meal is
then shared from the free kitchen,
which is lacto-vegetarian.
Buddhism
Every month, most Buddhists have
special religious days, and many
Buddhists go to temples to
worship. Rather than fasting,
Buddhists will meditate.
Although there are no set dietary
laws in Buddhism, many Buddhists
are vegetarian as they follow the
teaching ‘do no harm’ and so apply
it to avoid killing animals.
Buddhist self-restraint in dietary
habits often means that even at
feasting times, your diabetes would
not be adversely affected.
Hinduism
Some Hindus practise the tradition
of fasting during special occasions,
such as holy days, new moon days
and festivals. Hindus fast in various
ways. Depending on the individual,
they may choose to not eat at all
during the fasting period, or to eat
only once, eat only fruits or restrict
themselves to a special diet of
simple foods.
Diwali (the festival of lights) is the
best known of the Hindu festivals.
It is a five-day festival and includes
the exchanging of gifts, which are
often sweets and dried fruits, and
preparing festive meals. As these
are usually high in fat and sugar,
blood glucose levels will be raised,
so care is needed to make sure
that you adjsut your insulin dose
accordingly and that you return
to a normal pattern of eating as
soon as possible.
ACTION
POINTS
• Be aware of how a period
of fasting can compromise
your diabetes control.
• Take care to get back
to your usual routine
as soon as you have
finished fasting.
2013 Type 1 diabetes
87
Living with diabetes
Alcohol, smoking & drugs
positive changes
Whether it’s a small change like cutting
down on the amount of alcohol you
consume each week or a bigger one like
quitting smoking, the benefits can be huge
W
e all need to take time out to
relax in a variety of different
ways. However, when it comes to
drinking, smoking or even using
illegal drugs, there are a few things
to bear in mind if you have been
diagnosed with Type 1 diabetes.
Alcohol
Having diabetes doesn’t mean that
you have to give up alcohol. The
same rules of sensible drinking apply
to someone with diabetes as for
someone without the condition,
which is no more than 2–3 units a
day for women or 3–4 units a day
for men. Also, ideally, try to have two
alcohol-free days each week.
Alcohol can interfere with the
mechanism of the liver, which
releases stored glucose when blood
glucose levels drop. Because you
are treated with insulin you are at
greater risk of having a hypo – and
88
Type 1 diabetes 2013
this increased risk continues for
some time after your last drink.
Alcohol also alters perception, so
you may miss the warning signs of a
hypo and not be able to react
appropriately when you need to.
To avoid the possibility of people
around you thinking that you’re just
drunk because you smell of alcohol
when in fact, you are having a hypo,
it’s a good idea to tell the friends you
are drinking with that you have
diabetes and how they should treat
a hypo. Also try to wear something
very obvious that indicates that you
have diabetes, such as an ID card,
a medical necklace or a bracelet
Visit https://shop.diabetes.org.uk for
diabetes ID.
Tips for a tipple
• Don’t ever drink on an empty
stomach. Eating starchy snacks,
such as crisps, while you are
drinking, will help reduce the risk
of hypos. You should also have a
starchy snack before going to bed.
This could be cereal or toast, or
even grab a pizza or chips on the
way home, and drinking plenty
of sugar-free fluids will help to
prevent dehydration.
• Don’t forget if you are on any other
medication besides insulin, to
check with your doctor that you can
still drink when you are taking it.
• The liver gets rid of alcohol at the
rate of about one unit per hour, but
this can vary. So if you drink more
than a few units in an evening, you
will have an increased risk of a
hypo during the night and also
part of the next day as the liver
continues to get rid of the alcohol.
• The next day try to have some
breakfast. Even if you don’t feel
like eating, it will help you get over
the night before and will help your
Alcohol, smoking & drugs
A rough guide to alcohol units
Units
Beer, Lager, cider
Pint2–3
Spirits (eg vodka, gin,
whisky)
Single pub measure (25ml)
Wine (red or white)
Standard glass (175ml) Large glass 250ml) 1
Up to 2.5
3 or more
Important: over the years the alcohol content of most
drinks has gone up – a drink can now contain more
units than you think.
blood glucose control.
• If you are suffering with the
typical hangover symptoms
of headache, nausea,
shaking and sweating,
check your blood glucose
level as you may actually be
having a hypo. No matter
how awful you feel, you
need to treat a hypo
straightaway.
• If you can’t face food or if
you are being sick, take as
much fluid as you can,
including some sugary fluids
such as a non-diet drink or
ordinary cola. Monitor your
blood glucose levels
regularly and never stop
taking your medication.
• You should be able to take
over-the-counter remedies
like paracetamol or
antacids. Ask your
pharmacist for individual
advice.
Smoking
Nearly one-sixth of people in
the UK smoke, and people
with diabetes are no
exception – the proportion of
smokers is exactly the same.
Having diabetes means
that you have a higher risk
of damaged blood vessels,
which can lead to certain
conditions, including heart
disease, stroke, problems
with the blood supply to
your legs, and kidney
damage. And smoking
greatly increases these
risks. Studies also show that
smoking increases the risk
of people with diabetes
developing nephropathy
(kidney disease) and
Living with diabetes
Feel the benefit
after quitting smoking
20 minutes: your blood pressure and pulse
rate return to normal.
8 hours: Nicotine and carbon monoxide
levels in blood reduce by half, oxygen levels
return to normal.
24 hours: Carbon monoxide has left
your body and the lungs start to clear
themselves of mucous.
48 hours: There is no nicotine in your body.
Your ability to taste and smell is greatly
improved.
72 hours: Your breathing will become
easier as your bronchial tubes begin to
relax and energy levels increase.
2–12 weeks: Your circulation will have
improved.
3–9 months: Any coughs, wheezing and
breathing problems will improve as your lung
function increases by up to 10 per cent.
5 years: Your risk of heart attack falls to
about half compared to a person who is still
smoking.
10 years: Your risk of lung cancer falls to
half that of a smoker and your risk of heart
attack falls to the same as someone who
has never smoked.
You can only give up if you want to. It’s no
good other people nagging a smoker to stop.
Different people have different needs and you
may prefer to have an individual session each
week with your practice nurse or you may
like to join a support group. There are a
variety of nicotine replacement treatments
available, and these are all free on the NHS.
Call Quit on 0800 002 200 or visit their
website at www.quit.org.uk for support and
practical advice.
2013 Type 1 diabetes
89
Living with diabetes
Alcohol, smoking & drugs
retinopathy (eye disease). We all
know that smoking is very bad for
us but that doesn’t make it any
easier to give up and if you’ve
already made lots of lifestyle
changes because of your diabetes,
smoking may be the one ‘pleasure’
you are determined to hold on to.
But quitting smoking is the
single most positive thing you
can do to improve your health
and reduce the risk of major
complications later in life.
For prolonged good health
stopping smoking is as important
as good blood glucose control,
healthy eating and being active.
Recreational drugs
Diabetes UK doesn’t advocate
the use of recreational drugs, but
if you’re using drugs of any kind,
even on a one-off basis, you
need to know about the effect
they can have. Even if you take
drugs in small doses, they’ll
reduce the control you have over
your muscles, lessen your reaction
time and affect your concentration,
so you might forget to eat or take
your diabetes medication.
There are many different
drugs around, some legal,
some illegal. Remember – there is
no such thing as a safe drug.
There are risks associated with
any drug you take, not just
affecting your diabetes.
Some drugs are illegal and there
are heavy penalties for possessing
and supplying them.
Drugs fall mainly into the
following categories:
• downers (or depressants)
• uppers (or stimulants)
• hallucinogenic.
Watch out for people offering you
‘legal highs’. These are substances
used to replicate the effects of illegal
drugs, such as cocaine, ecstasy or
amphetamines. Their chemical
ACTION
POINTS
• If you can, quit smoking. The benefits of
quitting are immense, while the costs of
smoking are numerous.
• Make sure you are aware of the amount
of units of alcohol it is safe to consume
each day and have at least two alcoholfree days a week.
• Alcohol can cause a hypo. Make sure
you and the people around you are
aware of this.
90
Type 1 diabetes 2013
structure is slightly different,
meaning they avoid being classified
as illegal under the Misuse of Drugs
Act 1971 but this doesn’t mean
that they are safe or approved for
people to use. It just means that
they’ve not been declared illegal
to use or possess. Some drugs
marketed as legal highs actually
contain some ingredients that are
illegal to possess.
There are many more drugs
around in many forms, so if you
have any questions about drugs
and you don’t want to talk to your
diabetes healthcare team, contact
‘Talk to Frank’ on 0800 776 600
(24 hrs a day, 365 days a year).
This is a free, confidential service
or you can visit the website at
www.talktofrank.com. Although
they don’t talk about diabetes
specifically, they give descriptions
of the effects of each drug, so
you can see the knock-on effect
on your condition.
you’re not
alone with
diabetes
bECome a m
em
Join us tod ber
ay
Diabetes UK is the leading charity that cares for, connects with and
campaigns on behalf of all people affected by and at risk of diabetes.
Over 300,000 supporters are the bedrock of the work we do at Diabetes UK to:
• Help people manage their diabetes effectively by providing information, advice and support.
• Campaign with people with diabetes and with healthcare professionals to improve the quality
of care across the UK’s health services.
• Fund pioneering research into care, cure and prevention for all types of diabetes.
Every supporter makes a difference to the lives of those affected by diabetes.
Join today. Call 0800 138 5605 and quote Begin1 or visit
www.diabetes.org.uk/Begin1
Living with diabetes
festivals
Mud, rain
& rock
‘n’ roll
Camping in a field and
listening to loud live music
shows no sign of going
out of fashion. So if
you’re going to brave the
elements, here are our
tips for staying safe
S
leep deprivation, dodgy food
and, of course, mud and rain
– but don’t let that put you off! The
plus points of a weekend away in
the fresh air with friends and great
music will always outweigh a few
negatives. But make sure you have
these points covered.
Be prepared:
• Visit the festival’s website and
download a map. Work out
where the first aid tent is – they
may not carry your particular sort
of insulin, but will be able to help
if you feel unwell.
• Get a letter from your doctor to
say you have diabetes and need
to carry needles and syringes as
some venues will need this.
The letter could also say that
you need to take food into the
festival as you have diabetes;
some festivals don’t let you
take in food, and it can be
very expensive to buy on site.
• Check you’ve got all your
diabetes equipment:
92
Type 1 diabetes 2013
Get a map of the site and familiarise yourself
with the location of the main facilities
– insulin and your delivery system
(pen/pump syringe)
– blood glucose monitoring kit
– hypo treatments
– snacks.
What to take:
• It may be a good idea to take
some disposable insulin pens
for the festival, even if you usually
use a pen with refills or a pump.
Your GP, practice nurse or
diabetes healthcare team will be
able to advise in case it fails.
• Remember to take your insulin.
You may want to put a reminder
on your phone to let you know
when to take your long-acting
insulin.
• Make sure you have ICE (In Case
of Emergency) on your phone
contacts list – put a number of
someone at the festival and
someone at home – paramedics
will look for this if you are too ill
to tell them who to contact.
• Charge your phone. Think about
solar power via a backpack or a
charger which uses standard
batteries for your phone. Ask
your local phone store, they’ll
be able to help.
• Keep your insulin cool - you
could use a Frio pack they work
by holding them under running
water so they are very useful:
www.friouk.com.
• Carry your diabetes kit and hypo
treatment with you when you are
moving around the festival site.
You may be a long walk from
your tent.
• Body art is best avoided,
especially if your diabetes is
not well controlled, as you’re
at more risk of skin infections.
festivals
Living with diabetes
tops
tip
Staying safe
1
2
Carry some kind of diabetes ID.
rink plenty of sugar-free fluids to
D
keep you well hydrated, and check
your blood glucose regularly.
3
Consider reducing your insulin dose
if you’re doing a lot of activity or if it’s
very hot.
4
5
6
7
M
ake sure you always have
something to treat a hypo with you.
Keep plenty of carbohydrate-based
snacks to hand.
Make sure your phone is charged.
K
eep to the recommended limits for
alcohol, that is two to three units per
day for women, and three to four units
for men. See p88.
8
Keep away from drugs, see p90.
NEW EVENTS FOR 2013
A range of fundraising challenges to suit
all abilities and tastes
Ride London 100
London2Brighton
100km walk
Thames Path
Trans Pennine Walk
Moonrider Series
For information contact
[email protected]
or call 020 7424 1000
www.diabetes.org.uk/events
A charity registered in England and Wales (215199) and in Scotland (SC039136). © Diabetes UK 2013
2013 Type 1 diabetes
93
Complications
Cardiovascular Disease
Looking
after your
Heart
People with diabetes have a higher risk of
cardiovascular disease, so it’s important
to look after yourself to reduce this risk
Y
our heart is an organ that
pumps oxygen and many
other substances via your blood
around your body. Blood vessels
carry blood to and from your
heart as well as to all parts of
your body. Damage to the heart
and blood vessels is collectively
known as cardiovasular disease
and people with diabetes have a
higher chance of developing it.
Cardiovascular problems
Your major blood vessels
consist of arteries which carry
blood away from your heart, and
veins which return it. Damage to
these vessels is referred to as
macrovascular disease.
Capillaries are the tiny vessels
where the exchange of oxygen
and carbon dioxide takes place
and when damage occurs to
these vessels it’s referred to
as microvascular disease.
When fatty materials, such
as cholesterol, form deposits on
the walls of the vessels (known
94
Type 1 diabetes 2013
as plaque), furring up the
artery and reducing the space
for blood to flow, this is
described as arteriosclerosis
or atherosclerosis. If the plaque
ruptures the artery walls, blood
cells (called platelets) try to repair
the damage, but this will cause
a clot to form.
Over time, the walls of blood
vessels lose their elasticity. This
can contribute to the development
of high blood pressure, or
hypertension, which will cause
more damage to the blood
vessels.
The force of the blood being
pumped from the heart can make
the clot break away from the artery
wall and travel through the system
until it reaches a section too
narrow to pass though. If this
happens the narrow section will
become partially or completely
blocked.
Blockage of an artery leads to
the part of the body it supplies
being starved of the oxygen and
nutrients it needs. This is the
cause of heart attack or strokes
(affecting the brain).
Narrowing of the blood vessels
can affect other parts of the body,
such as the arms or legs. This is
called peripheral vascular
disease (PVD). PVD may
produce an intermittent pain
known as intermittent
claudication (pain in the calf
muscle). If left untreated,
amputation of the limb may
eventually be necessary.
Blood vessels are damaged
by high blood glucose, high blood
pressure, smoking or high levels of
cholesterol. So it is important for
people with diabetes to manage
these levels by making lifestyle
changes such as eating a healthy
diet, taking part in regular activity,
reducing weight if you are
overweight and stopping smoking.
See ‘Action points’ for all the steps
you can take to stay healthy.
i For more on cardiovascular
disease, www.diabetes.org.uk/cvd
Cardiovascular Disease
Complications
ACTION
POINTS
Steps you can take to
to help prevent CVD
• If you smoke, ask
for help to stop.
• Eat a healthy, balanced
diet (see p36).
• Be more physically
active. Choose
something you enjoy.
• If you’re overweight, try
to get down to a healthy
weight. Any weight loss
will be of benefit (see p56).
• Take your medication
as prescribed.
• Get your blood glucose
levels, blood pressure
and blood cholesterol
checked at least once
a year and aim to keep
to the target agreed
with your healthcare
team (see p22).
• If you have any chest
Keeping active is an excellent
way to look after your heart
pain, intermittent pain
when walking, impotence
or signs of a stroke, such
as facial or arm weakness
or slurred speech, you
should contact a doctor
as soon as possible.
2013 Type 1 diabetes
95
Complications
Complications retinopathy
TESTIN
looking after
your eyeS
Keeping a close check on your eyes and
getting them examined every year are some
of the best ways of reducing the damage
that retinopathy can cause
T
o see, light must be able to
pass from the front of the
eye through to the retina, being
focused by the lens. The retina is
the light-sensitive layer of cells at
the back of your eye – the ‘seeing’
part of the eye. It converts light into
electrical signals. These signals are
sent to your brain through the optic
nerve and your brain interprets
them to produce the images that
you see. A delicate network of
blood vessels supplies the retina
with blood. When those blood
vessels become blocked, leaky
or grow haphazardly, the retina
becomes damaged and is unable
to work properly. Damage to
the retina is called retinopathy.
There are different types of
retinopathy: background
retinopathy, maculopathy
and proliferative retinopathy.
Background retinopathy This
will not affect your eyesight, but it
needs to be carefully monitored.
The capillaries (small blood vessels)
in the retina become blocked, they
may bulge slightly (microaneurysm)
96
Type 1 diabetes 2013
and may leak blood (haemorrhages)
or fluid (exudates).
Maculopathy describes when
the background retinopathy is at
or around the macula. The macula
is the most used area of the retina.
It provides our central vision and is
essential for clear, detailed vision.
If fluid leaks from the enlarged
blood vessels it can build up and
causes swelling (oedema).
This can lead to some loss of
vision, particularly for reading and
seeing fine details, and everything
may appear blurred, as if you are
looking through a layer of fluid not
quite as clear as water.
Proliferative retinopathy occurs
as background retinopathy develops
and large areas of the retina are
deprived of a proper blood supply.
This stimulates the growth of new
blood vessels to replace the blocked
ones. These growing blood vessels
are very delicate and bleed easily.
The bleeding causes scar tissue,
that starts to shrink and pull on the
retina – leading it to become
detached and possibly causing
vision loss or blindness. Once the
retinopathy has reached this stage it
will be treated with laser therapy.
Beams of bright laser light make tiny
burns to stop the leakage and to stop
the growth of new blood vessels.
Q& A
My vision hasn’t changed,
but my eye specialist
has told me I need laser
treatment. Is this correct?
Retinopathy frequently has
no symptoms until it is well
advanced. Your eye specialist
has probably caught your
retinopathy at an early stage
before you notice any visual
changes.
Will I be able to drive if
I have retinopathy?
You must tell the DVLA (DVA
in Northern Ireland) if you
develop retinopathy. For
more on driving, see p82.
retinopathy
Complications
macula
sclera
cornea
pupil
iris
vitreous\
humour
aqueous
humour
retina
optic
nerve
lens
ACTION
POINTS
Steps you can take to avoid retinopathy
Everyone over the age of 12 with diabetes
should have the retina of their eyes
photographed each year to check for
retinopathy so that treatment can be
given at the right time. This forms part of the
annual review. High blood glucose levels are the
main cause of retinopathy, but high blood fats
and high blood pressure also play a part. So to
help prevent any eye problems developing:
• Try to keep your blood glucose, blood fats
and blood pressure at your agreed target
(see p23 regarding target ranges). This is agreed
between you and your healthcare team.
• Tell your doctor if you notice any changes
to your vision (don’t wait until your next
screening appointment).
• Take your medication as prescribed.
• If you’re overweight, try to lose any excess weight.
• Eat a healthy, balanced diet.
• If you smoke, ask for help to stop.
• Attend your annual eye screening appointment.
2013 Type 1 diabetes
97
Complications
TESTIN
neuropathy
looking
after your
nerves
Keeping a close eye on your blood
glucose levels and having your feet
checked every year are steps you can
take to avoid neuropathy
N
erves carry messages
between the brain and
every part of our bodies,
making it possible to see,
hear, feel and move. Nerves
also carry signals that we’re
not aware of to parts of the body
such as the heart, causing it to
beat, and the lungs, so we can
breathe. Damage to the nerves is
called neuropathy.
Diabetes can cause neuropathy
as a result of high blood glucose
levels damaging the small blood
vessels which supply the nerves.
This prevents essential nutrients
reaching the nerves. The nerve
fibres are then damaged or
disappear. There are three
different types of nerves:
sensory, autonomic and motor.
98
Type 1 diabetes 2013
Sensory neuropathy affects the
nerves that carry messages of
touch, temperature, pain and other
sensations from the skin, bones
and muscles to the brain. It mainly
affects the nerves in the feet and
the legs, but people can also
develop this type of neuropathy
in their arms and hands.
Symptoms can include:
• tingling and numbness
• loss of ability to feel pain
• loss of ability to detect
changes in temperature
• loss of coordination – when you
lose your joint position sense
• burning or shooting pains –
these may be worse at night time.
The main danger of sensory
neuropathy for someone with
diabetes is loss of feeling in the
feet, especially if you don’t realise
that this has happened. This is
dangerous because you may not
notice minor injuries caused by:
• walking around barefoot
• sharp objects in shoes
• friction from badly fitting shoes
• burns from radiators or hot
water bottles.
If ignored, minor injuries may
develop into infections or ulcers.
People with diabetes are more likely
to be admitted to hospital with a
foot ulcer than with any other
diabetes complication.
Autonomic neuropathy affects
nerves that carry information to
your organs and glands. They help
neuropathy
Complications
important to have
“It’s
your feet checked at
least once a year
”
Q& A
Can neuropathy be treated?
The symptoms caused by neuropathy
can be treated, such as medication for
nausea and vomiting, or painkillers for
sensory neuropathy, but these symptoms
will be helped more by getting your blood
glucose levels on target.
Walking barefoot can lead to foot
damage if you have neuropathy
to control some functions
without you consciously
directing them, such as
stomach emptying, bowel
control, heart beating, and
sexual organs working.
Damage to these nerves
can result in:
• Gastroparesis – when food
can’t move through the
digestive system efficiently.
Symptoms of this can
include vomiting, bloating,
constipation or diarrhoea.
• Loss of bladder control,
leading to incontinence.
• Irregular heart beats.
• Problems with sweating,
either a reduced ability
to sweat and intolerance to
heat or sweating related to
eating food (gustatory).
• Impotence (inability to get or
keep an erection).
Motor neuropathy affects
the nerves which control
movement. Damage to these
nerves leads to weakness and
wasting of the muscles that
receive messages from the
affected nerves. This can lead
to problems such as
• muscle weakness which
could cause falls or problems
with simple tasks, such as
fastening buttons
• muscle wasting, where
muscle tissue is lost
due to lack of activity
• muscle twitching and
cramps.
What do I do if I become impotent?
Talk to your doctor, don’t hide away.
There are a number of treatments available
and if you also get your blood glucose well
controlled, your problem may be resolved
quite quickly.
ACTION
POINTS
Steps you can take
to avoid neuropathy
•Keep your blood glucose within
your target range (see p23).
•Have your feet checked at least
once a year.
•Tell your diabetes healthcare team if
you think you’re developing any signs
of neuropathy.
•If you think you’ve lost sensation in
your feet, protect them from injury
and check them every day. And talk
to your diabetes healthcare team.
2013 Type 1 diabetes
99
Complications
Nephropathy
looking
after your
kidneys
Keeping your blood glucose and
blood pressure levels on target
will help to keep your kidneys
in good working order
T
he kidneys are bean-shaped
organs about the size of a fist,
which sit at the back of your body
at the bottom of your ribcage. Most
people have two kidneys, but some
are born with only one or have one
removed for a variety of reasons
and live perfectly healthy lives, as
long as the remaining kidney is
functioning well.
What the kidneys do
Kidneys are very important as they
perform a number of vital functions.
After the body uses food for
energy and self-repair, the waste
is sent to the blood. The most
common waste products are urea
and creatinine, but there are many
other substances that need to be
eliminated. Using a system of tiny
blood vessels, the kidneys act as
very efficient filters for getting rid of
waste and toxic substances, and
returning vitamins, amino acids,
glucose, hormones and other vital
100 Type 1 diabetes
2013
substances into the bloodstream.
The waste products, along with
extra fluid that the body does not
need, are then converted into urine
and passed out of the body. In 24
hours, your kidneys filter around
150 litres of blood and produce
roughly 1.5 litres of urine.
The kidneys secrete a number of
hormones, which are important for
normal functioning of the body.
One hormone is rennin, which
keeps blood pressure normal. If
your blood pressure falls, rennin is
secreted by the kidneys to make
the small blood vessels narrower,
and so increase your blood
pressure. If your kidneys aren’t
functioning correctly, too much
rennin can be produced, which
leads to high blood pressure.
Blood pressure
Kidney failure causes high blood
pressure but also, high blood
pressure can cause kidney failure.
High blood pressure can damage
the blood vessels and if the blood
vessels in the kidneys are
damaged, they are unable to
remove the waste and extra fluid
from the body. The extra fluid left in
the blood vessels may then raise
the blood pressure even more, so it
is a dangerous cycle.
Another hormone is called
erythropoietin. This acts on the
bone marrow to increase the
production of red blood cells.
If your kidney function is reduced,
not enough hormone is produced
and the number of red blood cells
being produced will fall, resulting
in anaemia.
kidneys
“The
perform a
number of vital
functions
”
Nephropathy
Complications
Q& A
How will I know if
I have a problem?
There are usually no symptoms
at first, but if you notice your
ankles or fingers swelling you
should see your doctor
urgently. Your blood pressure
may rise and a kidney function
blood test would be done to
measure urea, creatinine,
estimated glomerular filtration
rate (eGFR) and electrolytes
(blood salts) . Any abnormal
or high levels of these would
indicate that your kidneys are
not working correctly. There
will be protein present on
urine testing.
Keeping active can help control your blood
pressure which in turn can prevent nephropathy
Calcium
Vitamin D is essential for a number
of bodily functions including the
absorption of calcium by the
intestine, the normal structure of
bones and effective muscle function.
Vitamin D from your diet needs to be
slightly altered by the kidney before it
can act within the body. If your
kidneys are not working properly you
may have low levels of blood calcium
resulting in muscle weakness and a
softening of the bones.
Nephropathy means damage
to or disease of a kidney.
Diabetes can cause damage to
the tiny blood vessels which supply
the kidneys if blood glucose levels
stay too high. The walls of these
blood vessels in the kidneys
become thickened or irregular,
which prevents them from filtering
waste products out of the blood
into the urine properly.
ACTION
POINTS
Steps you can take
to avoid nephropathy
The best way to prevent
nephropathy developing is:
• Keep your blood glucose
and blood pressure levels
within your target range
(see p23).
•Have your urine tested for
protein and a blood test
to measure kidney function
at least once a year.
•Take your medication
as required.
Is nephropathy treatable?
Prevention is the best way to
avoid kidney damage. Early
treatment includes keeping
your blood glucose and blood
pressure within your target
range, eating a healthy diet,
not smoking, and being
physically active. You may
also be prescribed
medications called ACE
inhibitors. If the kidney
damage progresses dialysis
and transplantation may be
options. In some cases of
kidney transplant, it is done
alongside a pancreas
transplant. Because the
new organ or cells are ‘foreign’
to the body, drugs must be
taken for life to stop the body
rejecting them.
2013 Type 1 diabetes 101
Further information
Diabetes UK
ABOUT Diabetes UK
Diabetes UK is the
leading UK charity that
cares for, connects with
and campaigns on behalf
of all people affected by
and at risk of diabetes.
GET in touch
Call us: 0845 123 2399
Email us: [email protected]
Website: www.diabetes.org.uk
need to talk?
Careline: 0845 120 2960
Monday–Friday, 9am–5pm
Join us
Become a member, or, if you’re a healthcare practitioner,
a professional member of Diabetes UK. You’ll receive
many benefits, including our magazines and updates
on the latest developments in diabetes treatment,
care and research. Visit www.diabetes.org.uk/join
Campaign with us
We work hard to make sure every person with diabetes,
whether Type 1 or Type 2, wherever they live in the UK,
gets the best treatment and services. Our Diabetes
Voices help us make a difference by working alongside
us to campaign and influence for change. Sign up at
www.diabetes.org.uk/Get_involved/Diabetes-Voices/Signup-for-Diabetes-Voices
Care Events for children,
young people and families
A Diabetes UK Care Event is packed
with fun activities and adventure. It also
offers a unique opportunity to be among
people who understand. For many
people, it is the first step to managing
their own diabetes.
Diabetes UK also runs events for the
whole family, committed to providing
families who have a child with diabetes
with support, information and the
opportunities to share experiences and
to discuss both emotional and practical
issues around living with diabetes. At the
same time, we offer safe and expert care
for children when they are taking part in
their own activities. For details, call
Diabetes UK on 020 7424 1000 or visit
www.diabetes.org.uk/careevents.
Ready
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All funds raised come to the charity.
Code 4222
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Carbs & Cals
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£5.95+p&p
Bearing the Diabetes UK
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This book contains more
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UMBRELLA
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Order these and other Diabetes UK items at shop.diabetes.org.uk
or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote G100
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