It s time to TALK Targets A guide to taking control of your type 2 diabetes The TALK Targets campaign was initiated and fully funded by Novo Nordisk.
By supporting you and your healthcare team, TALK Targets will allow you to: take control of your type 2 diabetes and high blood glucose talk to your healthcare team about managing your type 2 diabetes, and develop and agree a plan to help you meet your blood glucose targets. TALK Targets includes an acronym to help you remember the key steps to regaining control of your diabetes T A L K THINK Do you know what your blood glucose targets are? Are you meeting your personal targets? ASK your healthcare team if you can discuss any concerns you have if you are not meeting your blood glucose targets. LEARN what steps can be taken so you can meet your blood glucose targets, including lifestyle and treatment options. KEEP track of your blood glucose levels so you can easily spot high blood glucose and can take the necessary action. 2
This booklet is made up of three sections. 1 TALK ESSENTIALS page 4 Recap on important information about type 2 diabetes. 2 TALK TREATMENT page 12 An introduction to controlling your blood glucose levels with different treatment options. 3 TALK RECORDS page 14 Record sheets to help you keep a note of your blood glucose targets and make positive changes. It will be helpful to bring this booklet with you to future consultations so you can refer back to discussions and write down any questions you may have. Look out for words in bold these are explained in the glossary of terms on page 23 of this booklet. You can download an interactive version of this booklet and an educational video from www.talk-targets.co.uk If you have questions, ask your healthcare team. The information in this booklet is not intended to replace your healthcare team s advice or medical consultation. 3
1 TALK ESSENTIALS About type 2 diabetes As you probably remember, in type 2 diabetes, either the body does not make enough insulin, or the insulin that is produced can t be used properly. In some cases, it can be a combination of both. If you control your blood glucose levels properly you can reduce your risk of the following long-term illnesses. Heart disease Stroke Kidney disease Eye damage Nerve damage The main signs of high blood glucose levels are: You might also experience: Visiting the toilet more Increased thirst Weakness Feeling tired Weight loss Increased hunger Blurred vision Increased infection However, you may not experience any of these symptoms so it is important to stay on top of your diabetes with good blood glucose control, healthy eating habits and regular exercise. Doing this will help you reduce your risk of developing these other conditions. 4
Type 2 diabetes affects your whole body Knowing how diabetes affects you can help you look after your body and prevent complications. In this booklet we explain: how your body processes the foods you eat what happens when you have diabetes, and what happens when this system doesn t work properly. Different types of sugars Sugar comes from the food you eat and is also made in your liver. There are many types of sugar found in the blood. One particular type of sugar called glucose, which passes through your gut wall into your bloodstream, helps your body to detect that your blood glucose levels are rising. When you eat foods that contain carbohydrates (such as starchy foods for example like pasta or potatoes, sugary foods and drinks like chocolate or fizzy drinks, milk, some dairy products and fruit), they are broken down in the stomach into sugars. Glucose Hyperglycaemia Someone with type 2 diabetes will tend to have too much glucose in their blood (called hyperglycaemia). Glucose Hypoglycaemia You might also have heard of having too little glucose in your body. This is called hypoglycaemia. To stay healthy, your blood glucose level should not go too high or too low. Someone with type 2 diabetes will have trouble keeping the balance right. 5
Insulin If your blood glucose level rises, the pancreas, which is a gland that sits just underneath the stomach, starts to release insulin to make your blood glucose levels normal. Insulin is a hormone that is made by cells in your pancreas. The cells should make the right amount of insulin, at the right time, to keep your blood glucose levels normal. Insulin then lowers your blood glucose by helping to move it from your bloodstream into your cells. Some of the glucose is used by the cells for energy, and some is converted into stores of energy (glycogen or fat). For people with type 2 diabetes, a shortage of insulin can mean there isn t enough glucose moving into the cells to provide the energy the body needs. The longer you have diabetes, the less your body can produce or respond to insulin. This is what is meant by diabetes being a progressive disease. To find out more about insulin, the TALK Treatments section, which starts on page 12, gives more information on insulin and other treatments for type 2 diabetes. Insulin is made in the pancreas. Pancreas Liver Stomach Intestine 6
Glucagon-like peptide 1 (GLP-1) Insulin is not the only hormone that plays a role in controlling your blood glucose levels. Glucagon-like peptide 1 (GLP-1) is a hormone produced by a specific set of cells in the gut. When you eat, GLP-1 helps the body to control the amount of glucose in the blood. In people with type 2 diabetes, GLP-1 stops working normally. Brain Stomach GLP-1 works when you eat. It keeps food in the stomach for longer, making you feel full. It also works in your brain to help you feel fuller for longer. GLP-1 tells the pancreas to release insulin when your blood glucose level is high. Insulin Pancreas Insulin Liver Blood sugar Glucose is stored in the liver as glycogen. When this glucose is needed, it is released by a hormone, called glucagon, from the pancreas. In people with type 2 diabetes, the liver releases too much glucose at the wrong times. GLP-1 can help lower glucagon levels. To find out more about GLP-1, see the TALK Treatments section on page 12, where you will also find information on treatment. 7
Blood glucose targets Now that you understand how diabetes affects your body, it is important that you keep your diabetes under control and keep your blood glucose levels as normal as possible. In someone without diabetes, normal blood glucose levels are: 3.5 to 5.5 mmol/l before meals, and less than 8 mmol/l two hours after meals. Millimoles/mole (mmol/mol) is a measurement of sugar levels over time, for people with diabetes. At least once a year, your healthcare team should check your long-term diabetes control by taking a blood sample. The most common test is the HbA 1c test, which shows how your blood glucose levels have been for the past two to three months. It measures the amount of glucose that is being carried by the red blood cells in the body. Once this is measured your healthcare team will discuss the results with you and decide what your blood glucose target should be. 8
What is HbA 1c? The term HbA 1c refers to how much glucose is being carried by the red blood cells in the body. By measuring your HbA 1c, your healthcare team can get an overall picture of what your average blood glucose levels have been over a period of weeks or months. For people with diabetes this is important as the higher the HbA 1c, the greater the risk of developing diabetes-related complications. 9
HbA 1c targets For most adults with diabetes, the HbA 1c target is below 53 to 58 mmol/mol (7 to 7.5%). This target was set by the National Institute for Health and Care Excellence (NICE) because evidence shows that this can reduce the risk of developing complications. However, any reduction in HbA 1c levels (and so any improvement in control) is still considered to have beneficial effects on the onset and progression of these complications. Together with your healthcare team, you should find a target that is right for you. If you do not know your HbA 1c levels, or have not had an HbA 1c test for six to 12 months, you may want to go for a check-up. Even if you know what your levels are, you may still be experiencing slightly higher levels of blood glucose, so it is always good to talk to your healthcare team about any changes in your overall health. Take control with healthy eating and staying active To manage your type 2 diabetes most effectively, it is important to eat healthily and stay active, as suggested by your healthcare team. People with type 2 diabetes don t need to eat special foods, but by making smart decisions about what to eat, you can reach and stay at a weight that s good for your body. Healthy eating. It s important that you do the following. Eat a wide variety of healthy foods. Balance the number of calories you eat with your activity level. Choose foods rich in wholegrains, vegetables and fruits, fat-free or low-fat milk products. Eat fish and lean meats (such as chicken) and beans for protein. Space your eating throughout the day. It may also be beneficial to consult a dietician for a personal nutrition plan. 10
Stress management Stress has been proven to change blood sugar levels, which can be a problem for people with diabetes. So it is important to keep your stress levels low. Stay active Experts recommend staying active as an important part of managing diabetes. Regular activity can help to: prevent health problems keep your weight down make insulin work better to lower blood glucose, and give you more energy. Walking every day is one way to be more active. Some people start slowly by walking for 5 to 10 minutes a day, and increasing the time until they reach 30 minutes a day. Try having fun while staying active by mixing up your activities and picking things you enjoy. Below are some ideas of exercise you could try. Handy tips Walk somewhere you enjoy being, such as the park. Climb stairs whenever you can, even if it is just one flight. If you take public transport, try getting off one stop before you normally would. Ride a bike outdoors, or an exercise bike indoors. Take dancing lessons. Go bowling. Park further away from the shops. 11
2 TALK TREATMENTS Take control with the right treatment If you re not meeting your blood glucose targets, you might want to discuss treatments with your healthcare team. There are various treatment options available to you. Diabetes treatments aim to lower your blood glucose levels and keep your HbA 1c to below a target level agreed between you and your healthcare team. If your HbA 1c is above your target level, you may be advised to step up treatment (for example, increase a dose of medication or add on another treatment) to keep your blood glucose level at your agreed target. There are various treatments for type 2 diabetes and different ones suit different people. So it is important to discuss options with your healthcare team so that you reach a decision on the most suitable treatment. It is common to try several different medications before finding one that is right for you, and you may need a combination of medicines to control your blood glucose level. Metformin is usually the medicine that s first used to treat type 2 diabetes. It works by reducing the amount of glucose that your liver releases into your bloodstream. It also makes your body s cells respond to insulin better. Other treatments to lower blood glucose Some medicines work by helping insulin to work better on the body s cells. Metformin Thiazolidinediones (TZDs) Some medicines work by increasing the amount of insulin made by the pancreas. Sulfonylurea (SUs) And some mimic the actions of natural GLP-1 to increase the amount of insulin produced. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) Some medicines work by stopping an enzyme (or protein) from reducing the amount of insulin your body produces. Dipeptidyl peptidase 4 inhibitors (DPP-4is) And some work by allowing sugar to pass in your urine. SGLT-2 inhibitors 12
If you are introduced to GLP-1 RAs (listed opposite) they mimic the natural GLP-1 in the body (see page 7 in this booklet for more information). This medication can help you to: reduce your blood glucose levels lose weight without the risk of hypoglycaemia Insulin may work equally well for you too. It has been proven to lower blood glucose as it replaces the insulin your body is no longer producing. Benefits of this treatment are good blood glucose control, but you may also gain weight. It is important to regularly talk to your healthcare team about your individual goals and what you want from your treatment. The TALK Records sheets over the page will help you with this. 13
3 TALK RECORDS This section of the booklet will help you to: assess where you are with managing your diabetes keep track of important targets in managing your diabetes structure conversations with your healthcare team evaluate if you re ready for a change and then create an action plan. Tracking your targets This page will help you to track your important targets for managing your diabetes. You can also record your next appointment details here. Date...Total cholesterol... Blood pressure...weight... My target HbA 1c is...% or mmol/mol My current HbA 1c is...% or mmol/mol My next appointment is... Date...Total cholesterol... Blood pressure...weight... My target HbA 1c is...% or mmol/mol My current HbA 1c is...% or mmol/mol My next appointment is... Date...Total cholesterol... Blood pressure...weight... My target HbA 1c is...% or mmol/mol My current HbA 1c is...% or mmol/mol My next appointment is... 14
My situation Here you can make a note of any reasons why you think your HbA 1c levels might be high, and the changes you and your healthcare team have talked about making to lower them. Reasons why my HbA 1c levels are high Changes I can make to lower my HbA 1c levels 15
Readiness to change Date. Now that you are tracking your blood glucose levels, you may need to make a change. The question then is how do you know when you re ready to make a change? Take the following assessment below to find out. 1 Eating and drinking Put a mark on the line below to indicate how ready you are to start eating and drinking more healthily. Totally not ready to change 1 2 3 4 5 Completely ready to change 2 Physical activity Put a mark on the line below to indicate how ready you are to be more active. Totally not ready to change 1 2 3 4 5 Completely ready to change 3 Smoking Put a mark on the line below to indicate how ready you are to stop smoking. If you do not smoke, tick this box. Totally not ready to change 1 2 3 4 5 Completely ready to change 4 Stress management and self-care Put a mark on the line below to indicate how ready you are to move towards better self-care and stress management. Totally not ready to change 1 2 3 4 5 Completely ready to change 5 Change in treatment Put a mark on the line below to indicate how ready you are to move towards a change in treatment. Totally not ready to change 1 2 3 4 5 Completely ready to change What thing came out on top? What did you score a five for? If you feel ready, talk to your healthcare team and discuss the one change that you are willing to make. Each time you come back, try looking at these again. Is it the same as before or different? Are you ready to try to make another change? 16
My change plan Date. If you think that you need to make a change in how you are managing your diabetes, give details below and talk to your healthcare team. One thing I want to change The most important reasons why I want to make this change What I can do to start making positive changes 17
How other people can help me How I will know my plan is working Some things that could interfere with my plan What I will do if the plan isn t working 18
My treatment options Date. Consider the treatment options your healthcare team suggests to help you lower your HbA 1c levels and record the benefits and potential challenges below. Treatment options Benefits 19
Potential challenges Feelings and questions about these recommendations 20
My action plan Date. Write down your goals for managing your diabetes and the steps you have discussed with your healthcare team. 1 2 3 21
My achievements Date. List all your achievements here. 1 2 3 22
Glossary Calorie Energy that comes from food. Carbohydrate Carbohydrates are mainly sugars and starches that the body breaks down into glucose (a simple sugar that the body can use to feed its cells). Dietician An expert in nutrition who helps people plan the type and amount of foods to eat for special health needs. Dipeptidyl peptidase 4 inhibitors (DPP-4is) Tablets that help control blood glucose levels in type 2 diabetes. They regulate the levels of insulin the body produces after a meal. Glucagon-like peptide 1 (GLP-1) GLP-1 is a hormone that stimulates the release of insulin from the pancreas. GLP-1 receptor agonists GLP-1 receptor agonists act like natural GLP-1 (see above) in the body. Glucagon A hormone that raises the level of glucose in the blood by releasing stored glucose from the liver. Glycogen A stored form of glucose which builds up in response to insulin and is broken down into glucose in response to glucagon. Glucose A simple sugar found in the blood. It is the body s main source of energy and is also known as dextrose. HbA 1c test This is an important blood test to determine how well you are managing your diabetes. The test provides an average blood glucose measurement over a six to 12-week period and is used as well as glucose monitoring at home. Hyperglycaemia High blood glucose. This condition arises when the body does not have enough insulin or is not responding to insulin well enough. Hypoglycaemia Low blood glucose. Most cases arise when there is too much insulin and not enough glucose in your body. Insulin A hormone that helps the body use glucose for energy. Metformin A tablet that helps to stop the liver producing new glucose. It also helps insulin carry glucose into muscle cells more effectively. Progressive disease A disease or condition that is worsening, growing or spreading. Protein One of three main types of food. Cells need protein to grow and to mend themselves. Protein is found in many foods, like meat, fish, poultry, eggs, beans, and dairy products. Red blood cells The blood cells that carry oxygen. SGLT-2 inhibitors (SGLT-2is) A diabetes treatment that works by reducing the amount of glucose being absorbed in the kidneys so that it is passed out in urine, reducing the amount of glucose in your blood. Sulfonylurea (SUs) A treatment to manage type 2 diabetes by increasing the amount of insulin released from the pancreas. Thiazolidinediones (TZDs) Tablets to treat type 2 diabetes. They reduce the body s resistance to insulin. 23
The Apis bull logo is a registered trademark of Novo Nordisk A/S. UK/VT/0195/0483(1) Date of preparation: January 2016