Type 1 Diabetes. Leaflet for Newly Diagnosed Children, Young People and their Families in East Cheshire

Transcription

1 Type 1 Diabetes Leaflet for Newly Diagnosed Children, Young People and their Families in East Cheshire Paediatric Specialist Diabetes Team Leaflet Ref: Published: 06/15 Review: 06/18 Page 1

2 Contents What is diabetes? Giving an insulin injection Doing a blood glucose test What can I eat? Introduction Your child has just been diagnosed with type 1 diabetes. This may be an upsetting and unsettled time for you all. The paediatric diabetes team, ward nurses and doctors are all here to support you. When you are ready to go home, you will be given contact numbers, so if you have any concerns, no matter what time, you will be able to speak to someone. There is a lot of new information to learn and we do not expect you to become experts overnight. It does take time to absorb all the new information, so if you are at all unsure about anything, please do not hesitate to ask us questions- even if you feel like you have asked lots of times already! We do not mind. Contact us on: Tel: Fax. No Ecn-tr.maccpdsn@nhs.net What is Diabetes? Type 1 Diabetes is a life-long condition in which the amount of glucose in the blood is abnormally high. This is because the body has stopped making insulin. Insulin is normally made by special cells in the pancreas and is a hormone which allows glucose into the body s cells. This glucose is used as fuel to give the cells energy. We get the glucose from the carbohydrates that we eat. Carbohydrates are present in certain types of food. We do not know why your child has developed diabetes, however we do know that: There is nothing that could have been done to prevent it occurring. It is not caused by eating too many sweets. It is not catching. Leaflet Ref: Published: 06/15 Review: 06/18 Page 2

3 How We Treat Diabetes The aim of treatment for type 1 diabetes is to mimic the work of the pancreas by providing the correct amount of insulin the body needs in order to allow the cells to use glucose as fuel. Consequently, diabetes treatment is focussed on monitoring your child s intake of food which provides glucose, monitoring the levels of glucose in their body and delivering the correct amount of insulin they need throughout the day and night. Giving an Insulin Injection You may be surprised at how quickly children and young people start to inject themselves. However, the process is really quite straightforward and once you have had some practice you will probably start to feel more confident. But if you find you need more support or advice the team are here to help! Timing of Injections Novo Rapid is the fast acting insulin which needs to be given 5-10 minutes before a meal or large snack. It lasts for approximately 3 ½ to 4 hours. Lantus or Levemir are the long lasting insulin and is given at the same time each day. We start with giving Lantus/Levemir at 8pm but this may be altered if required. It is not necessary to eat after injecting Lantus. Lantus lasts in the body for approximately 24 hours. Leaflet Ref: Published: 06/15 Review: 06/18 Page 3

4 Rotation of Injection Sites It is important to change the place of the injection each time it is given on the chosen site. If not, over a period of time, lumps and desensitisation may occur. Lumps are caused by the injected insulin building up a layer of fat; this affects the absorption of insulin. Lumps do disappear in time if the site is avoided, but preventing their appearance by regular rotation of sites is best. Different injection sites have different absorption rates: Abdomen (tummy) Quick Best for Novo Rapid Leg slow Best for Lantus/Levemir Buttock slow As different sites have different absorption rate it is useful to keep to the same site at the same time ensuring that the injection goes in a different place on each site! A good example of rotation would be to use the left side of the tummy for morning injections, right side of the tummy for evening injections, right leg for tea time injection, left leg for Lantus NB Lantus and Novo Rapid cannot be injected in the same site as this stops them working effectively, so it is really important to identify a separate site for the two insulins. Leaflet Ref: Published: 06/15 Review: 06/18 Page 4

5 The equipment Soap and water to wash hands Pen device 4mm needle Insulin Sharps bin Giving the injection 1. Wash your and your child s hands (Do not use baby wipes as these can affect the result) 2. Choose injection site The small very fine needle on the pen device needs to be inserted into fatty areas just underneath the skin. It is usually best to start with legs. Other sites are the bottom and tummy. 3. Check insulin Using pen device, ensure that the insulin is clear and in date. Insulin that you are currently using can only be kept at room temperature for 30 days. 4. Attach needle Attach a 4mm needle to the screw thread end of the pen until finger- tight ; remove needle guards, saving the outer white guard 5. Check for air Perform an air shot of 2 units with needle guard off. The nurses will show you how to do this. Insulin should be seen leaking from needle. (If not repeat until you see the insulin being expelled, if there is any resistance, change the needle and start again) 6. Dial With the dial on zero, dial the prescribed amount of insulin. Your pen device may be in ½ or 1 unit increments. 7. Inject Hold the area of skin to be injected with one hand and the pen in the other. Place the needle onto skin and gently push down at 90 degrees until all the needle is under the skin. Press and hold the plunger for a slow count of seconds. This allows for any drips of insulin to be delivered. Remove needle from skin at 90 degrees. There may be a small drop of clear insulin or blood drop left on skin surface. Wipe away but do not rub. This is normal, do not be concerned. Leaflet Ref: Published: 06/15 Review: 06/18 Page 5

6 8. Make Safe Replace white needle guard over needle and remove from pen by unscrewing. Place used needle into sharps container. Do not leave a used needle on pen device. NB Sharps bins are available from the GP and can be disposed of at local chemists. Storage of Insulin Insulin currently in use can be stored at room temperature, as long as it is out of direct sunlight. A cool cupboard would be a good place. This means that insulin is safe to use, for up to one month as long as it is not exposed to direct sunlight or temperatures above room temperature. Insulin not in use needs to be refrigerated. The vegetable drawer tends to be a good place. Place insulin into a clean clip lock box when storing. Insulin can be used straight from the fridge however as it is cold it can mean a more painful injection. NB. If insulin is frozen it will damage the insulin. Take care to make sure the insulin does not become frozen and discard the insulin if you have any concerns that it may have become frozen at some point. Obtaining More Insulin Supplies All your insulin supplies are obtained on repeat prescription from your GP. Your child is currently entitled to free prescriptions for life. (After 16 years they need to have a medical exemption certificate) You need to buy glucose tablets and sugary drinks for hypo treatments as these are not available on prescription. IMPORTANT!!! NEVER STOP GIVING THE INSULIN Leaflet Ref: Published: 06/15 Review: 06/18 Page 6

7 Blood Glucose Monitoring The way you monitor the levels of glucose in your child s blood is through testing it at regular intervals throughout the day. Normal blood glucose level A normal blood glucose level is between 4 7 mmols/litre (this is the UK standard measurement for blood glucose). Maintaining glucose levels at this target helps to ensure your child is healthy and also reduces the risk of related health problems in later life. It is not always easy to maintain blood glucose at the recommended level, but the whole team is here to help you with this. After diagnosis, it may take some time for the blood glucose to settle. The diabetes nurse will discuss this with you in detail. It will help if your child returns to normal daily activities as soon as they are able. When to do blood tests Blood should be tested before meals and before bed to help decide on insulin doses and to identify patterns of glucose levels. It is useful to have five readings a day, i.e. before breakfast, before lunch, before evening meal, before bed and around physical activity During illness frequent blood testing is required (2-4 hourly), as levels may be affected. Leaflet Ref: Published: 06/15 Review: 06/18 Page 7

8 How to perform a blood glucose test 1. Collect equipment Blood glucose machine Strips for machine Finger pricking device Lancet for finger pricking device 2. Prepare Prepare machine and finger pricking device according to manufacturer s instructions. Ensure the strips are in date. 3. Wash hands Wash hands in warm water to clean them and encourage good blood flow. Do not use baby wipes or other wipes containing alcohol or glycerine. 4. Prick finger Use a different finger each time. Before pricking finger encourage good blood flow by shaking hands downwards, opening and closing hand, massaging hands, pushing down palm to finger ends. Prick the sides of the finger as the tips tend to be more painful. Wait about five seconds, this allows for the capillaries to settle and help with blood flow. Massage fingers from palm to finger and then squeeze, release and repeat until there is a drop of blood. 5. Test Put the blood onto strip. Follow the meter instructions to obtain the result. Recording results It is useful to record results obtained in a diary. Diaries are available from the diabetes nurse specialists. If an abnormal result is obtained, but there is an obvious reason, use the comment section of the diary. You can also obtain software to download results onto your computer. The diabetes nurse specialists will give you information on how to do this. Always bring your glucose meter to appointments. The diabetes team will download the results to help you manage your diabetes. Leaflet Ref: Published: 06/15 Review: 06/18 Page 8

9 The First Dietary Steps Within a few days of diagnosis, the team will give you information and education about carbohydrate counting which is needed in order to work out insulin doses on a day to day basis. Until you are familiar with this, the following steps will contribute to getting glucose levels under control: Eat 3 regular meals and include a starchy carbohydrate food at each meal e.g. bread, potatoes, cereals, rice or pasta. For main courses, chose foods your child is familiar with. Include food from the main food groups i.e. meat/ fish/ poultry and vegetables as well as the starchy carbohydrate foods mentioned above. The amount of food eaten should be guided by your child s appetite, but it helps at first, if the amount of carbohydrate is similar from day to day. This means eating a similar amount of starchy food at lunch day to day, tea day to day etc. You do not have to restrict the amount eaten at meals if the blood sugars are high. Snacks are not usually necessary although your child is likely to be hungrier at first. Insulin doses for snacks will need to be considered- the Dietitian or Diabetes Nurse will advise you on this. Fresh fruit juices can be taken in small quantities with a meal e.g. 1 small glass a day with a meal. However they should not be used in large volumes to quench thirst between meals as this can contribute to raised blood sugars Sugar it is not necessary to avoid sugar completely but for general and dental health it is important to keep sugar intake (including hidden sugars) to moderate levels. It is also preferable to take any sugary food at a main meal time rather than between meals. Leaflet Ref: Published: 06/15 Review: 06/18 Page 9

10 The only sugary foods which are not recommended are sugary drinks such as ordinary squash or fizzy drinks (unless these are being used to treat a hypo see section on Hypoglycaemia) Suggested Changes: Leaflet Ref: Published: 06/15 Review: 06/18 Page 10

11 For further information on the references and sources used for this leaflet, please contact Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: Phone: Textphone: Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on East Cheshire NHS Trust operates a smoke-free policy (including e-cigarettes) For advice on stopping smoking please contact our Stop Smoking Service on East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. Leaflet Ref: Published: 06/15 Review: 06/18 Page 11