DIABETES IN FIVE MINUTES A SURVIVAL GUIDE TO GOING HOME

DIABETES IN FIVE MINUTES A SURVIVAL GUIDE TO GOING HOME Information Leaflet Your Health. Our Priority.

of 7 These are brief reminders to help you at home. If in doubt please phone for advice Sugar Monitoring Always wash your hands before testing Aim for levels between 4 7 pre meals, 5 9 after meals Low if less than 4.0, 4 IS THE FLOOR! (see Hypos) High if above 10, consider extra Rapid if over 10 Check sugars before meals, 2 hours after meals and before bed ie about 5-6 times a day When you first go home you will need to check your sugars during the night, eg at 11pm- 12midnight and at around 3am. Write down all of your sugar levels in the diary provided so that you can see patterns developing at different times of the day. If less than 7 before bed/supper you need some extra supper e.g piece of toast or biscuit You will go home with an AccuCheck Aviva/Nano meter and some starter strips. There are lots of other glucose meters, please ask the diabetes team. Insulin Long Acting ( Levemir or Glargine ) is given at the same time every evening and keeps your blood sugar steady through 24 hours Rapid ( NovoRapid or Humalog ) is given with food to keep your blood sugars steady after meals / larger snacks Point needle upwards and do an `airshot` of 2 units before you inject (until insulin is seen at end of needle - clears air bubble ) Insulin should be kept in the pen at room temperature for a month. Spare cartridges are kept in the fridge and last until the expiry ( about six- twelve months ) Do not allow insulin to freeze eg in the back of the fridge or if next to a freezer pack. Insulin is a protein and will be damaged by freezing it won`t work! Keep it in the cardboard box. Keep moving your injection sites to avoid lumps we check your sites regularly in clinic! Sharps Disposal Use the SafeClip device to clip the needles off and then put all sharps (lancets and needle hubs) into a sharps bin. Return this to your GP surgery or chemist when full and get a new one. Keep out of reach of children. Eating Eat regularly, have some carbohydrate with each meal. Eat healthily eg low fat, more fibre (wholemeal) fresh fruit and veg. About half of a meal should be carbohydrate (bread, pasta, rice, potatoes, crackers, cereal ) Starchy foods are slow to raise your sugar and last longer Sugary foods will raise it quickly and are gone quickly! Don`t buy `diabetic` foods (expensive and unnecessary) Have SUGAR FREE drinks.

of 7 A `low GI` supper will help to keep your blood sugars steady overnight ( eg brown toast, cereal, crackers etc ) although not everyone seems to need it discuss with the diabetes team. Some people have a small amount of Rapid if they want a bigger supper. `Large` snacks (over 15g carbohydrate) may need a bolus of Rapid. Continue filling in the food diaries that the dietitian has given you on the ward, and bring these to your clinic appointment. What To Do If Your Blood Sugar Is Low- Hypos A Hypo is a low blood sugar (less than 4.0 four is the floor ) These can happen at any time but usually occur: during or after exercise, sometimes several hours after if prolonged exercise. if you accidently give too much insulin if you eat less carbohydrates than you thought, or than your body needs. They can be avoided by matching the amount of carbohydrates you eat, with the right amount of rapid insulin, having extra food with exercise, and by recognising when they are about to happen (feeling dizzy, shaky, wobbly, headache, hungry, looking pale and quiet or argumentative) and having something to eat. If you feel `low` check your blood sugar to make sure that you are hypo. If there isn t time just eat something! To get your sugar up quickly have something sugary FAST ACTING CARB 5g Carb (10kg child ) 10g Carb (30kg child ) 15g Carb ( 50 kg child ) Lucozade -Energy Full sugar cola, lemonade Ribena from carton Glucotab s Glucose tabletsdextros e Fresh Fruit juice Glucogel 25g tube ( 10g carb ) 25ml 50ml 50ml 1 tablet 1 ½ 100ml 0.5 tube tablets 50ml 100ml 100ml 2 tablets 3 tablets 200ml 1 tube 75ml 150ml 150ml 3 tablets 4 ½ tablets 300ml 1.5 tubes Then test blood sugar after 10-15 minutes, if above 4.0 - eat something more substantial afterwards to keep blood sugar up eg a biscuit, piece of bread, a small cereal bar. Always have emergency rations with you. eg a box at school, on a car journey, when out and about. Don`t rely on money to buy something the shop might be closed! If you are having a bad hypo, somebody else may have to give you something sugary. GlucoGel is thick sugary syrup which can be put around the inside of your gums or swallowed. Only to be given if you are still conscious. Occasionally hypos can cause someone to be very drowsy or unconscious. Call for Help.

of 7 Do Not Give Anything by Mouth If Someone Is Unconscious Call an ambulance, turn them on their side and give Glucagon by injection if you have it (If not the ambulance crew will). WHAT TO DO IF YOUR BLOOD SUGAR IS HIGH Did you wash your hands? Have you had a treat / something sugary? If yes, the level may well drop quickly by itself, wait and recheck in an hour. If you are higher than 14 mmol / L on 2 occasions over a few hours then consider checking for ketones. High sugars and ketones means you need extra rapid acting insulin. High sugars can cause increased thirst, passing more urine, tiredness and nausea. If your sugar is 10 or above before a meal add on a correction dose to the dose of rapid insulin you are giving for the meal you are about to eat. If blood sugars are greater than 10 away from a meal time then you may need some extra rapid acting insulin: Correction dose : as a general rule 1 unit of Rapid will bring your sugar down by 3 mmol/l eg if sugar 16 you would need 2 extra units to bring it to 10 This should not usually be given within 2 hours of a `usual` (meal time) dose of rapid acting insulin to avoid having too much insulin. Recheck your sugar in 1-2 hours. If you are unwell and /or vomiting you will need to come to the ward you may need a drip. Please phone the diabetes nurses, or if unavailable the ward to let them know. Brambles Ward 0161 419 2155 Exercise Exercise / sport / moving about is good for you we all should be doing something regularly eg 2-3 times every week Find an active hobby, swimming, dancing, football, even just a regular walk. Exercise tones your muscles and improves your metabolism (the way the body works), this can mean insulin works more effectively. Exercise can drop your blood sugar have something to eat before you start eg a biscuit or piece of fruit. You may want to check your sugar and may need extra carbohydrate at your next meal or for supper (the effects of exercise can last for several hours) Get Active- Have Fun- Don t Be A Couch Potato We Will Ask You/Encourage You About Exercise In Clinic Going To School School routines are generally good for young people with diabetes. Think about which friends you will tell and you will need to tell your class teacher and PE teacher. The diabetes nurse will arrange to go into school with you and go through basics. School staff can oversee sugar testing and insulin injections but this needs to be discussed and planned with the school. Many schools choose to support young children by administering their lunch time insulin injection, but they are not required to do so.

of 7 The school nurse will send you a school health care plan to complete. All the information you need to complete this is explained and agreed at the diabetes nurse s school visit. Excellent materials from Diabetes UK on their website www.diabetes.org.uk Support- Diabetes UK Diabetes UK is a national charity who gives excellent support for people with diabetes, their families and their diabetes team. They have a lot of information, regular magazines for all ages, fantastic holidays / camps, and lots of fund raising ideas, On the web at www.diabetes.org.uk -look for the My Life section for children & young people. Please ring Diabetes UK to order a free newly diagnosed child (and parent) pack - 0845 1202960. 10, Parkway, London, NW1 7AA The local support group is the Tadpoles for Stockport and PenPals for Buxton / High Peak see notice board in the clinic for details, or ask the team. Medic Alert Tag/ Bracelet These are a useful safety measure for people with diabetes who are getting more independent they come as watches / bracelets or pendants. Available from www.laurenshope.com ( US website ), www.medicalert.org.uk, or other sites DLA `Disability Living Allowance` is a government benefit that children & young people with diabetes are entitled to receive. Not a very helpful name for the benefit, but it does recognise the fact that you will have to attend clinic four times a year or more, buy bracelets / have extra support etc. Please ring 08456 123456 to request a DLA form (booklet) is sent to you, we will help you complete them. Please ask us to complete the Someone who knows the Child section before posting back. There is also guidance to complete these forms within the Diabetes UK pack mentioned earlier. Clinic Visits Every Tuesday afternoon on the ground floor of the Tree House. You will be able to see a doctor, diabetes nurse and dietitian. We normally weigh and measure you and take finger prick blood samples for HbA1c. This tells us how good your blood sugars have been over 3 months and is linked to your long term health. A good level is less than 48 mmol/mol At the beginning we will see you weekly, then monthly. We see all children with diabetes at least every 3 months, to provide support so that their diabetes (blood sugars) stays well controlled. We can manage after school appointments if you ask for them. if you cannot make it to the appointment please let us know, we can use your slot for someone else and rebook you. You should always know when your next clinic is.

of 7 You will receive an automated telephone reminder of your next clinic appointment during the week before. Please bring your blood sugar meters, sugar diary and food diary with you to clinic. Aim for a HbA1c of 48! Remember blood sugars 4 8 for HbA1c of 48!!! Useful Books Diabetes at your fingertips by Sonksen, Fox and Judd ISBN 1-85959-087-X Type 1 Diabetes in children, adolescents and young adults by Ragnar Hanas, FOURTH EDITION ISBN 978-1-85959-230-4 Diabetes ( Facts about series ) by Claire Llewellyn Pub by Chrysalis ISBN 1844582272 (for younger children) Growing up with diabetes what children want their parents to know. by Alicia McAuliffe Think Like a Pancreas by Gary Schiener ISBN-13: 978-1569244364 No Added Sugar - Growing up with Type 1 Diabetes by Fibi Ward Published by Hammersmith Press, 2009 ISBN: 9781905140268 Contact us When you first go home you will be speaking to the diabetes nurses on the phone every day. Please ring them with any questions, for advice and help you need with your diabetes. If you need advice out of office hours ring the ward for advice. Diabetes Nurses - Katie Beddows, Sarah Ghezaiel, Francine Lewis (office hours ) :0161 419 2103 / 07887 636580 Brambles Ward: (24 hours) 0161 419 2155 Dr Cooper, Dr Connell: (Secretary) 0161 419 2090 Dietitian : Cathy Head: 0161 419 2103

of 7 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number PAED60 Publication date October 2015 Review date October 2017 Department Children & Young Peoples Diabetes Team Location Stepping Hill Hospital