Understanding Diabetes. Accu-Chek Guide. Understanding Diabetes. Experience what's possible

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1 Understanding Diabetes Accu-Chek Guide Understanding Diabetes Experience what's possible

2 Dear Reader, Diabetes is a condition that is as old as humankind itself. Although there is still no cure, the treatment of diabetes has made great advances since the beginning of the 20 th Century. These developments have not only improved control of the condition, but have increasingly enabled people with diabetes, their families and their caregivers to take an active part in managing diabetes. Being diagnosed with diabetes can be a life altering experience. Fortunately, with the right information, a well developed care plan and an optimistic attitude, it can be managed with ease. Your healthcare team also have an important role to play in helping you build your confidence in coping with diabetes, shaping your self-management programme and giving you the guidelines which will enable you to control your diabetes. This Accu-Chek guide will provide you with the basic information on diabetes and tips on how to manage it in order to live a normal and productive life. On the back of this brochure you will find more information on how to order further educational material and Accu-Chek product information related to diabetes management. Your Accu-Chek Team

3 Contents Topics Page What is diabetes? 1 Signs and symptoms of diabetes 2 Types of diabetes 3 Treating diabetes 6 Coping with diabetes 7 Managing your diabetes 8 - Eating well - Keeping active - Blood glucose monitoring - Monitoring your diabetes - A 1c test - Medication Complications of diabetes 14 Myths about diabetes 19 Experience what's possible

4 What is diabetes? Diabetes Mellitus is a life long physical condition in which there is too much sugar in your blood due to a lack of insulin or due to inappropriate action of insulin. To understand diabetes, it helps to know how your body uses food for fuel. Have you ever wondered why sugar is in your body in the first place? Why does eating sugar give some people more energy and leave others feeling poorly? When you understand the roles of sugar and insulin in your body, it is easier to answer those questions. Sugar is found in the foods that you eat. When you eat, your body turns food into glucose a type of sugar that moves through your bloodstream - enabling growth and providing energy to the cells that make up your muscles, nerves and other internal systems. Glucose cannot enter the cells without some help. An organ called the pancreas produces the hormone called insulin. The role of insulin is to move glucose from the bloodstream into the body cells, where it can be used as fuel. People diagnosed with diabetes have high blood sugar (glucose). This is because their pancreas does not make enough insulin or the insulin produced is not working effectively. As a result a build up of glucose in the blood occurs, which passes into the urine where it is eventually eliminated, leaving the body without its main source of fuel. With no fuel in your body s muscles and organs, you feel like you are running on empty. The extra sugar in the blood stream actually begins to damage the blood vessels and nerves in your body, leading to problems in the eyes, heart, kidneys, feet, legs and other areas. 1 Experience what's possible

5 Signs and symptoms of diabetes The signs and symptoms of diabetes include: Frequent urination Excessive thirst Sudden weight gain or loss Constant fatigue Blurry vision Slow healing cuts or bruises Numbness in hands and feet Erectile dysfunction Hunger Risk factors for diabetes: A family history of diabetes People that are overweight Diabetes during pregnancy Race / ethnicity Physical inactivity Age (>40 years) Impaired glucose tolerance 2

6 Types of diabetes Type 1 Type 1 diabetes is usually diagnosed in children or young adults, although it can occur at any age. Formerly known as juvenile diabetes or insulin-dependent diabetes, type 1 diabetes occurs when the body's immune system destroys the pancreas s beta cells the cells which produce the hormone insulin. As a result, the pancreas makes very little or no insulin of its own. Symptoms appear quite rapidly and the patient suffers from dramatic symptoms. A person with type 1 diabetes must take insulin injections every day to survive. Insulin dosages are carefully balanced with food and exercise programmes. Type 2 Type 2 diabetes represents more than 90-95% of all cases of diabetes. In type 2 diabetes, the pancreas may not make enough insulin or the body isn t able to use the insulin it does make. This is known as insulin resistance. Eventually, the pancreas may stop producing insulin altogether. People with type 2 diabetes often have other risk factors or characteristics: Family history of diabetes Previous history of gestational diabetes Obesity Members of certain ethnic groups: African-Americans, Mexican- Americans, Pacific Islanders and Pima Indians Traditionally affecting older people, type 2 diabetes was previously known as adult-onset diabetes. We now know that it can affect people at any age. As type 2 diabetes develops slowly over a period of time, many people aren t diagnosed until complications appear. In fact, the American Diabetes Association estimates that one-third of all people with diabetes may be undiagnosed. 3 Experience what's possible

7 What is gestational diabetes? Gestational diabetes is high blood glucose levels that develop at any time during pregnancy. It results in the inability to use the insulin that is present and usually disappears after the pregnancy is over. What is pre-diabetes? A new category of diabetes has been emerging recently called pre-diabetes. This occurs when a person has higher than normal blood sugar, but not high enough to be classified as diabetes. It's important, because it identifies when a person may be at a higher risk for type 2 diabetes, but may still be able to take steps to prevent the disease from occurring. Pre-diabetes includes two categories of high blood sugar: Impaired Glucose Tolerance (IGT) - a condition when blood sugar remains high for more than two hours after eating Impaired Fasting Glucose (IFG) - This occurs when a person has high blood sugar upon waking, as they haven't had anything to eat overnight 4

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9 Treating diabetes Although diabetes cannot be cured, it can be treated very successfully. Type 1 diabetes Type 1 diabetes is treated by insulin injections and diet, and regular exercise is recommended. Insulin is injected into the body. Insulin is a protein and would be destroyed by the digestive juices if taken in orally. Your doctor will advise you on how much insulin you should inject each day. Your aim will be to balance your insulin with your diet and exercise programme, to mimic the work of a normal pancreas as closely as possible. Type 2 diabetes Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. If diet and exercise are insufficient in lowering your glucose levels the doctor might prescribe diabetes tablets which can act in different ways. They may stimulate the pancreas to produce more insulin, or make the insulin you already have perform better, or they may slow down the speed at which the body absorbs glucose from the intestine. Type 2 diabetes is progressive. If your diabetes cannot be controlled through lifestyle changes, diet, exercise or tablets your doctor may recommend that you take insulin injections. 6

10 Coping with diabetes Being diagnosed with diabetes and living with diabetes can sometimes feel overwhelming - this is quite normal. Everybody reacts differently to the news that they have diabetes. One of the most difficult things to come to terms with is that diabetes is for life. In the weeks and months after being diagnosed with diabetes, emotions are often pushed to one side as you try to get to grips with new treatments and changing your lifestyle. Feelings of depression, inadequacy and "why me? are quite normal when you are told that you have diabetes. Over time it is likely that you will become more confident in your ability to cope with everyday activities and the initial turmoil you may have felt should start to fade. Coming to terms with diabetes takes time and nobody can tell you how long it will be before you overcome those initial feelings of feeling alone. It gets better but of course there will still be days when you feel depressed and upset. Your healthcare team is there to give you emotional support, reassurance and help in building your confidence in coping with diabetes. You can also get a lot of support and encouragement from other people with diabetes by joining a support group. Remember that while diabetes is a condition that needs to be controlled, it shouldn t control you. 7 Experience what's possible

11 Managing your diabetes Because diabetes is a chronic condition, caring for yourself is every bit as important as the treatment you receive from your doctor and healthcare team. For some people, managing their diabetes isn't a difficult thing to do. Much of diabetes management is identical to practices everyone should adopt in order to maintain a healthy lifestyle. For others, though, diabetes management can seem taxing or even overwhelming. This can be a natural reaction, especially when you're first diagnosed. However, as with many of life's challenges, a positive attitude is half the battle. By setting small goals and building on their successes, you'll find that in time, diabetes management becomes second nature. Ultimately, it is you who determines the state of your health. Taking responsibility involves many choices, including what you eat and how frequently you exercise. It also involves testing your blood sugar to make sure your blood sugar stays within acceptable levels, an important factor in reducing your risk of serious diabetes related complications. The goal of diabetes management is to bring your blood glucose levels into the normal range that is between 4-6 mmol/l. With the help of your doctor or other healthcare professionals, you will need to take care and manage your diabetes for the rest of your life. Eating well Everyone with diabetes should follow a healthy diet and lead a healthy lifestyle. Balancing your diet when you are diagnosed with diabetes can be challenging. Although the food choices you make and your eating habits are important in helping you manage your diabetes, you should be able to continue enjoying a wide variety of foods as part of healthy eating. You are sure to have lots of questions about your diet. Consult a dietician for advice on a healthy eating plan. Food and drink will raise your blood glucose levels. How much you eat and when you eat is important. 8

12 A few basic principles apply: Eat regular meals based on starchy foods like pasta, grains, bread, rice, and cereals Eat plenty of fruit, vegetables and pulses Eat less salt Try to minimise your alcohol intake Cut back on saturated (e.g. animal) fat KEY MESSAGE Join the Accu-Chek Diabetes Support Programme and receive the Accu-Chek Guide on Healthy Eating Keeping active Physical activity isn t always something we look forward to. Yet, along with a diet and medication it s central to the management of your diabetes. Don t worry, you don t have to run a marathon, climb a mountain or join a gym to enjoy the benefits. Half an hour of moderate activity on most days of the week is the latest recommendation for good health. Exercise lowers blood glucose levels. When you are active your body uses blood glucose faster. Exercise includes all physical activity such as housework, gardening and walking. Choose an activity that is going to become a regular part of your life - there is not much point if you feel like giving up at the end of the first week, so choosing something you enjoy and can easily fit into your week is important. 9 Experience what's possible

13 Blood glucose monitoring Self blood glucose monitoring is the main tool you have to check your diabetes control. It allows you along with your healthcare team, to judge how effective your therapy is and whether you need to adjust your food, weight, exercise or medication. Keeping a log in your Accu-Chek diary of your blood glucose results is vital. Routine blood glucose tests should be performed at certain times of the day. Consult with your healthcare professional on when you have to test your blood sugar. Your healthcare team may suggest testing blood sugar at one or more of the following times, depending on your individual needs: Upon waking Before each meal Before a bedtime snack One or two hours after a meal In the middle of the night Before exercising, to see if you need a snack Immediately after exercising (and during, if you're active for more than an hour) In the hours after exercising, as blood sugar can continue to drop after activity How to monitor blood sugar To test your blood sugar, all you need is a blood glucose meter, a test strip and a lancet device. 1. Wash and dry your hands - using warm water may help the blood flow 2. Follow the instructions included with your lancet device to get a drop of blood 3. Apply the drop to the strip as directed 4. View your test result within a few seconds 5. Discard the lancet properly 10

14 Maintaining your diabetes care routine It is important to monitor your diabetes regularly. The following tests should be taken: What test When Goal / Target A 1c Twice a year if stable < 7% ECG Capillary blood glucose value (finger prick) Lipogram (Blood Fat Analysis) Kidney Function Blood Creatinine Microalbumin Blood pressure Body Mass Index Waist Circumference Once a year Each visit (Daily) Once a year Once a year Once a year Each regular visit Each regular visit Each regular visit Normal Fasting 4-6 mmol/l 2 hour post-prandial 4-8 mmol/l - Total cholesterol < 5 mmol/l - LDL cholesterol < 3 mmol/l - HDL cholesterol > 1.2 mmol/l - Triglycerides < 1.5 mmol/l Male mol/l Female mol/l Negative < 130/80 mmhg (< 120/70 mmhg if protein in urine) < 25 kg/m 2 Male < 102cm Female < 88cm Annual examinations to include: Opthalmoscopy or fundus photography - (eye examination) Blood pressure measured in lying position and after standing for 2-3 minutes Comprehensive foot examination Patella and Achilles tendon reflexes Insulin injection site Reference: Revised SEMDSA for diagnosis and management of type 2 diabetes mellitus for primary healthcare in Experience what's possible

15 What is the A1c Test and why is it important? The A 1c (also known as glycated hemoglobin or HbA 1c ) measures your average blood sugar levels over a three-month period by taking a sample of haemoglobin A 1c molecules - a specific component of your red blood cells. Some blood sugar (or glucose) naturally attaches itself to these A 1c molecules considered "glycated". The more sugar in your blood, the higher the percentage of glycated A 1c molecules you'll have. Once a cell has glycated, it stays that way. And since each A 1c molecule has a lifespan of about four months, your A 1c sample will include cells that are a few days, a few weeks and a few months old. That's how the test result covers a span of about three months. The result of your A 1c Test gives you a good idea of how well your diabetes treatment plan is working. For people with diabetes the American Diabetes Association recommends a target level of 7% or below. KEY MESSAGE Have your A 1c Test done at your doctor at least twice a year Medication: Oral medications The first treatment for type 2 diabetes is often meal planning, weight loss and exercising. Sometimes these measures are not enough to bring blood glucose levels down. The next step is taking a medicine that lowers blood glucose levels. There are many different oral tablets available to help you control your diabetes. Some drugs stimulate the pancreas to release more insulin where others lower the blood glucose levels by primarily decreasing the amount of glucose produced by the liver. The drugs can even be used combined for controlling your diabetes. Type 2 diabetes is however a progressive disease which may require insulin therapy at a later stage. 12

16 Insulin Therapy Insulin is a hormone secreted by the pancreas that your body uses to keep the amount of glucose (sugar) in your blood at a steady level. Insulin used to treat diabetes is almost identical to the insulin your pancreas secretes. Insulin is produced in a laboratory using genetic engineering technology. The only way to use insulin is by injection. You cannot take insulin as a tablet, because it would be destroyed by the digestive juices in your stomach. There are four main types of insulin used to treat diabetes. They each work at different speeds. Depending on the type of injection device you use, the insulin will be packaged in vials (bottles), cartridges or pre-filled pens. The cartridges are used with pen injectors and the vials are used with syringes. Pre-filled pens are disposable pen injectors, which are pre-filled with insulin. Different types of insulin: Onset of Action Duration of Action Rapid Acting Insulin 5-20 minutes 3-5 hours Short Acting Insulin Within 30 minutes 3-8 hours Intermediate Acting Insulin 2-4 hours hours Long Acting Insulin 1-2 hours hours Pre-Mixed Within 30 minutes hours The kind of insulin that your doctor recommends will depend on how your body responds to the insulin, and how you want to use it. Your doctor or healthcare professional will help you to start on insulin with a dosing schedule that suits you and your lifestyle. It may take some time to get your dosing regime to fit your lifestyle. 13 Experience what's possible

17 Complications of diabetes What is hyperglycaemia? Hyperglycaemia is the medical term for elevated blood glucose levels. Causes of hyperglycaemia: Too much food or the wrong foods Too little or no exercise Too little diabetes medication or not taking diabetes medication as instructed Too much stress Infection or illness Warning signs of hyperglycaemia: High blood glucose Tiredness Increased appetite and thirst Frequent urination Blurred vision Headache It is important to treat hyperglycaemia as soon as you detect it. Failure to treat can cause a condition called ketoacidosis (diabetic coma). Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body cannot use glucose for fuel. So, your body breaks down fats to use for energy. When this happens, waste products called ketones are produced. The body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all ketones and they build up in your blood. You should check your urine for ketones when you experience the following symptoms: Shortness of breath Breath that smells fruity Nausea and vomiting Dry mouth KEY MESSAGE Ketoacidosis is dangerous and serious. Contact your healthcare provider right away when you have high blood sugar and ketones in your urine. 14

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19 What is hypoglycaemia? Hypoglycaemia is the medical term for low blood glucose levels. Causes of hypoglycaemia: Taking too much Insulin / oral medications Not eating enough food / missing a meal Too much exercise Stress Alcohol intake, especially without food Warning signs of hypoglycaemia: Sweatiness Nausea Blurred vision and shakiness Numb lips and tongue Fainting, cold, clammy skin and confusion Low blood glucose can happen quickly. The trick is to learn to recognise the symptoms of hypoglycaemia. If you feel a reaction coming on, you must react immediately. Test your blood sugar level Take sugar in the form of 5 glucose sweets (e.g. 5 Super C tablets) or 1 dessert spoon of honey or jam or 1/2 glass cola KEY MESSAGE Always have sugar at hand. See our comprehensive Accu-Chek guide for more information on highs and lows of blood glucose - how to master the risk. 16

20 Long term complications Living with diabetes can cause damage to your body over a period of time. High blood glucose can damage the large and small blood vessels and fine nerve endings. The good news is that with early detection and good care it can be prevented. Kidney disease (Nephropathy) Millions of blood vessels form part of the filtering system. High blood sugar levels and high blood pressure can damage those small blood vessels, resulting in inefficient filtering and the appearance of protein in your urine. This is called nephropathy. Nephropathy doesn't have any symptoms until it is advanced. Therefore, you should have your urine checked regularly for micro-albuminuria. Eye damage (Retinopathy) Diabetic retinopathy is one of the leading causes of blindness, and people with diabetes are at increased risk of other eye disorders, including cataracts and glaucoma. Regular eye checks are advised. Treatment before there is damage can prevent blindness. Nerve damage (Neuropathy) Damage to the peripheral nerves is one of the most common and distressing complications of diabetes. Peripheral neuropathy affects the nerves controlling touch and feeling. Vascular damage The main arteries become stiff, choked and stressed. The blood pressure increases and the heart becomes stressed and circulation in the hands and feet becomes poor. Test yourself regularly. Heart problems and strokes are the leading cause of death amongst people with diabetes. Foot care It is recommended that a person with diabetes visits a podiatrist every six months, if possible. Take good care of your feet and let the doctor examine them with each visit. Wash your feet daily, wear comfortable shoes and don't walk barefoot. 17 Experience what's possible

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22 Myths about diabetes Eating too much sugar causes diabetes Eating sugar does not cause diabetes. Diabetes is caused by a combination of genetic and environmental factors. However, eating a diet high in fat and sugar can cause you to become overweight. Being overweight increases your risk of developing type 2 diabetes. Type 2 is mild diabetes There is no such thing as mild or borderline diabetes. All diabetes is equally serious, and if not properly controlled can lead to serious complications. People with diabetes can t play sport People with diabetes are encouraged to exercise as part of a healthy lifestyle. Keeping active can help avoid complications associated with diabetes, such as heart disease. There may be some considerations to take into account with your diabetes before taking up a new exercise regime talk to your healthcare team for more information. People with diabetes eventually go blind Although diabetes can cause blindness, research has proven that you can reduce your chances of developing diabetes complications, such as damage to your eyes, if you: Control your blood glucose and blood pressure levels Keep active Maintain your ideal body weight Give up smoking 19 Experience what's possible

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24 Understanding Diabetes Order further Accu-Chek guides: Accu-Chek offers a complete programme of information for people with diabetes. We are pleased to provide you with further guides on Living with Diabetes. To order: Call our toll free Diabetes Care Line: 080-DIABETES (Dial: ) Important Information: Accu-Chek wants to emphasize that the information supplied in this guide, does not replace the opinion and recommendations of your healthcare team. References: 1. Revised Semdsa Guidelines, American Diabetes Association 3. Roche Product-Practise orientated on the spot diagnosis Roche Products (Pty) LTD Diagnostic Division PO Box 1927, Randburg Toll free: 080-Diabetes (Dial ) / NDG P