Why do I need to take insulin?

Transcription

1 Why do I need to take insulin? Staying in control At Novo Nordisk, we are changing diabetes. In our approach to developing treatments, in our commitment to operate profitably and ethically and in our search for a cure.

2 With you all the way is a patient support programme created by Novo Nordisk, providing practical information on diabetes and its management for children and young adults with diabetes. This material has been reviewed by a panel of experts: Lead Diabetes Specialist Nurse Nicola Lewis, UK Paediatric Endocrinologists Prof Thomas Danne, Germany and Dr Nandu Thalange, UK This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes. Why do I need to take insulin every day? 1

3 It is important that you take insulin every day to maintain control of your diabetes. 1 As your pancreas is no longer able to make insulin, your body is unable to transport glucose from the blood to other cells in the body that need it for energy. 1 Taking insulin, either by injection or by using a pump, helps to regulate your blood glucose levels. 1 If you are receiving injections, you will need to inject insulin several times a day. Some people have a fixed insulin dose with meals and some vary the amount of insulin according to carbohydrate intake (usually called carb counting ). Whether you have a regular fixed dose, or you count carbs, you should also adjust your insulin dose according to your blood glucose level and physical activity. Your insulin needs will change as you grow and develop, so you will have your insulin regimen reassessed regularly. 2 2

4 Sometimes you may forget to take your insulin at the normal time. This will cause your blood glucose to increase. ALEKSEY EVSTRATOV, Russia Aleksey has type 1 diabetes You should discuss with your doctor or nurse what to do if you forget a dose, so you have a plan in place. When your blood glucose is too high, you may notice some of the following signs and symptoms: 1 Feeling hungry Feeling very thirsty Feeling tired or exhausted Frequent urination Blurred vision 3 What if I forget to take my insulin?

5 Diabetic ketoacidosis (DKA) If hyperglycaemia is left untreated, it may lead to a life-threatening condition called diabetic ketoacidosis (DKA). DKA happens when there is a lack of insulin circulating in the blood, which causes the body to start breaking down fats for energy, producing chemicals called ketones. DKA can be confirmed by testing ketone levels in your blood or urine using testing strips. You should check for ketones if your blood glucose is high, particularly if you are unwell. If you have any of the signs of DKA, tell your parents or teacher immediately or contact your doctor/ nurse directly as you may need to go to hospital. DKA is a medical emergency it is important to take it seriously. Signs of DKA include: 1 Nausea and vomiting Stomach pain Fruity odour on your breath ( ketones ) often described as similar to nail polish remover Rapid breathing Dehydration (e.g. dry tongue, passing urine less frequently) Increased blood glucose levels 4

6 What will happen if I stop taking insulin? Some days you may feel like you want to skip injections, but you should be aware that skipping insulin can have serious consequences. Without adequate insulin your blood glucose levels will increase. High blood glucose (hyperglycaemia) can make you feel unwell and can lead to DKA and other problems like infections, as well as increasing your chance of long-term complications. Risk of long-term problems Poor glucose control over time can increase the risk of long-term complications. 3 Prolonged high blood glucose levels have been shown to increase the risk of problems with your feet, eyes, kidneys, nervous system or heart. 1 Good control will prevent you developing complications for many years. These tests urine and blood tests, eye checks and foot examinations give important early warning signs of problems at a stage when they can be treated. Remember, with good control you can live a normal, healthy life. Taking control of diabetes It is important to learn how to manage your diabetes and how to balance your food intake, insulin dosing and physical activity. 4 Maintaining good glucose control can help to prevent complications in the future. 3 Your doctor or nurse will look out for signs of complications at your routine check-ups. 5

7 You are given a higher glucose target at bedtime to reduce your risk of hypoglycaemia at night. However, it is also important that your blood glucose levels are not too high at bedtime. If you are aiming for a blood glucose level over 10 mmol/l (180 mg/dl) because you are worried about hypoglycaemia, you should talk to your diabetes care team they can advise you on how to stay in control. Don t worry if you don t reach these goals straight away. It can take a long time to get your diabetes under control, and your insulin needs will change during your teenage years. Once you have finished growing (girls around 15 and boys around 17), you may need less insulin. Goals Long-term goals that you should be aiming for are: 5 Before a meal levels should be between 4.0 and 8.0 mmol/l ( mg/dl) 2 hours after a meal levels should be no more than 10.0 mmol/l (180 mg/dl). One way to help you hit your glucose target after meals is to make sure you are injecting on time ideally, just before you eat At bedtime levels should be between 7.0 mmol/l and 10.0 mmol/l ( mg/dl) Lars Myhrer, Norway Lars has type 1 diabetes Talk to your doctor or nurse about your progress and what you can do to get closer to these goals. 6

8 Staying in control of your diabetes 7 Learning to manage your diabetes will help you to balance your blood glucose levels and can help to avoid hypoglycaemia and hyperglycaemia. Your doctor or nurse will teach you how to manage your diabetes.

9 Tips 6 Check your blood glucose regularly This will help to track your blood glucose levels and make adjustments if necessary People who test themselves four or more times a day usually have better blood glucose control than people who test less frequently Keep a record of your progress to help you manage your insulin, and pick out times which are a problem, such as after exercise or before your evening meal. Your diabetes care team can look at the patterns of glucose results and help you get your insulin doses right Learn how to recognise signs of hypoglycaemia and hyperglycaemia Know what you need to do if they happen Try to exercise regularly and adjust your insulin or have a snack when exercising This can help to prevent hypoglycaemia Stick to your meal plans Don t skip meals as this can lead to hypoglycaemia Don t skip insulin doses This can lead to hyperglycaemia and diabetic ketoacidosis 8

10 Hypoglycaemia is not a pleasant experience and you may worry about it happening in front of other people. However, keeping blood glucose levels too high is dangerous in the long-run as it increases your risk of infection, diabetic ketoacidosis and long-term complications. Should I aim for higher blood glucose levels to avoid hypoglycaemia? 9 If you have any questions or concerns, speak to your doctor or nurse.

11 Sude IĞdır, Turkey Sude has type 1 diabetes References 1. NIH Medline Plus Library. Type 1 diabetes. Available at: medlineplus/ency/article/ htm Accessed October Silverstein J et al. Care of children and adolescents with type 1 diabetes. Diabetes Care 2005; 28(1): Rewers MP et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): Smart C et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): Diabetes UK. Children and diabetes. Available at: Accessed October NIH Medline Plus Library. Managing your blood sugar. Available at: gov/medlineplus/ency/patientinstructions/ htm Accessed October Novo Nordisk website. Available at: Accessed October

12 About Novo Nordisk This information was developed by Novo Nordisk, a global healthcare company specialising in the care of people with diabetes. Novo Nordisk was started up almost 90 years ago by a Danish couple with a passion for changing diabetes. August Krogh was a professor at the University of Copenhagen and Nobel Prize winner and his wife Marie, a doctor and researcher into metabolic diseases, suffered from type 2 diabetes. They learned of insulin being developed in Canada and were determined to ensure access to insulin for everyone with diabetes, hence in 1923 Novo Nordisk was born. Since then Novo Nordisk has grown to become a world leader in the provision of diabetes products and support for patients of all ages. 7 We fully understand the challenges that children with diabetes face and are working together with parents, schools and healthcare professionals to improve the care of children with diabetes, as they grow up and develop. For more information about Novo Nordisk, please visit: This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes. APROM ID#4599; approval date: December Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S. Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark