Diabetes
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Facts on DiabetesUnderstanding DiabetesDiabetes OverviewImportance Of Good Blood Sugar ControlMonitoring Your Blood SugarDiabetes TreatmentMaking The Most Of Your Healthcare VisitsDo You Have Type 2 Diabetes?Diabetes Health Care TeamGetting Help And Support
What Is Health and Wellness?
Health can be described as a balanced state of complete physical, mental, and social well-being. Being healthy does not only mean you are free from disease. Being healthy also means that you are educated and informed about all the sources of care available to you in your community. It means that you are educated about how and when to use your health care system, your physician, your pharmacist, or any other health care provider - allowing you to work together with your health care team to plan for your future health and wellness.
Taking Care Of Your Diabetes
Diabetes occurs when the body cannot produce or properly use insulin, a hormone that allows the body to use sugar, starches, and other foods as energy. It is not a single disease, but can occur in several forms, including, most commonly, type 1, type 2, and gestational diabetes. Together, these types of diabetes affect about 5% of Canadians 20 years of age and up, becoming more prevalent in older age groups. Up to one third of Canadians who have diabetes may not realize it - often there are no obvious symptoms - so the actual percentage may be much higher. Although at the present time there is no cure, knowing you have diabetes empowers you because it means you can take control of the condition and work to prevent or delay the many potential health challenges that diabetes can cause. Early diagnosis of diabetes can make a huge difference in your long-term health.
Here you will find the following:
Facts about diabetes
An overview of who is most at risk to develop diabetes, some of its warning signs, and how it is diagnosed
A discussion about why keeping your diabetes under control is essential
Steps you can take to manage your diabetes and prevent or delay its complications
Quick reference tables listing the most common diabetes medications and insulins
Where to go for more information or support
There is no single, simple treatment your doctor can prescribe to completely control your diabetes. While your diabetes care may include oral medications and/or insulin, it must also include positive lifestyle changes that only you can make for yourself. This Website will help you find the information and motivation you need to help keep your diabetes well-controlled - and to prevent or delay its many serious complications.
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True or False:"Diabetes is not a serious disease."
False. Diabetes is a leading cause of death in Canada. Uncontrolled diabetes can cause multiple, serious complications - including heart disease, stroke, kidney disease, blindness, and lower limb amputation. A national public health survey revealed that approximately 60% of people with diabetes have at least one complication and almost one in four have two or more diabetes-related health problems. Treatment of diabetes and its complications costs about $13.2 billion in Canada each year.
But there is good news. By taking charge of their health, people with diabetes can live long and active lives.
True or False:"People get diabetes from eating too much sugar."
False. People who are overweight or obese have a higher risk of developing diabetes, but the condition is caused by a combination of genetic and environmental factors. Avoiding sugar will not prevent or treat diabetes. In fact, foods with sugar in them are not completely off limits to people at risk of diabetes (or with diabetes), but like many other choices in a nutritious diet, they should be eaten in moderation. Eating too much sugar could provide too many calories, leading to weight gain.
True or False:"A person can have a mild case of diabetes."
False. You may hear people say they have mild or "borderline" diabetes,but it is important to realize that you either have diabetes or you do not. All cases of diabetes are equally serious and should be managed aggressively to prevent complications. The slightest increase in blood sugar (blood glucose) from normal target ranges, especially after meals, increases the risk of stroke and heart disease. Complications can occur in people whose blood sugar is very high, but they can also occur in people whose blood sugar is just above target levels - even if they do not experience any symptoms. Diabetes isn't a temporary condition. Once people are diagnosed, they will have to continue to manage their disease for the rest of their lives.
True or False:
"People with diabetes can't do the same types of work other people do."
False. For the vast majority of people, diabetes shouldn't place restrictions on their choice of work. But it does make sense to take a few precautions. If you have diabetes, be sure you wear your identification bracelet or card, let the appropriate people at work know, and teach your coworkers how to help should the need arise. Also, if you do physically demanding work or shift work, you may need to monitor your blood sugar levels more closely.
Shift work can present a special challenge, particularly for people using insulin, in trying to maintain consistent blood sugar control. See
http://www.diabetes.ca/section_about/
shiftwork.asp for valuable information and advice about staying healthy while working shifts.
If you work at a desk or seated job, you'll have to make an extra effort to fit exercise in, such as going for lunch-hour walks or taking the stairs instead of the elevator. And if your job involves driving, you will need to be familiar with the Canadian Diabetes Association's "2003 Guidelines for Diabetes and Private and Commercial Driving." See
http://www.diabetes.ca/section_about/aboutdriveguide.asp for more information.
Talk to your health care team about your work life. They can advise you in planning your diet, blood sugar monitoring, and medications to ensure you stay healthy - at home and at work.
What Is Diabetes?
Insulin is a hormone that is made in your pancreas, an organ in your abdomen. Insulin is needed to convert sugar, starches, and other foods you eat into energy. When the pancreas functions normally, it produces extra insulin in response to high blood sugar. This insulin allows cells to absorb the glucose they need out of the bloodstream, returning your blood to a normal sugar level. Diabetes occurs when your body either does not make enough insulin or is unable to use the insulin it does produce properly - causing your body to have potentially damaging high blood sugar levels. The two most common types of diabetes are type1 and type 2.
Type 1 diabetes has also been called insulin-dependent diabetes or juvenile-onset diabetes (because it is typically diagnosed in childhood, although it can occur in adolescents and adults as well). About 10% of people with diabetes have type 1. In the most common form of type 1 diabetes, insulin-producing cells in the pancreas are destroyed by the body's own immune system. The trigger that starts this process is currently unknown. Because the insulin-producing cells are either not present or not functioning, people with type 1 diabetes usually require many insulin injections per day or an insulin pump. They must also ensure that their lifestyle includes a healthy diet and enough physical activity.
What Is Pre-Diabetes?
You may have been told you have "pre-diabetes." What your health care provider is likely referring to are states where your blood sugar is higher than normal, but it is lower than the cut-off for the diagnosis of type 2 diabetes. There are two types of pre-diabetes: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).
Experiencing pre-diabetes does not mean that you will definitely go on to develop diabetes, but it does mean your body is not keeping blood sugar at the normal target levels. Pre-diabetes is a warning sign that you should become more conscious of your nutrition and lifestyle and make changes to help prevent or delay the onset of diabetes and reduce the risk of heart disease. Making changes at this stage is critical because long-term damage to your body, especially to your heart and blood vessels, could already be occurring during pre-diabetes.
Type 2 diabetes is sometimes called adult-onset diabetes or non-insulin-dependent diabetes (even though many people with type 2 require insulin injections). It is much more common than type 1, with about 90% of people with diabetes having type 2. In type 2 diabetes, the pancreas is unable to produce enough insulin or the body is unable to properly use the insulin that is produced. Type 2 diabetes is usually diagnosed in adults, but overweight or obese children and younger adults are also at risk. Treatment requires a healthy diet and physical activity and may also include oral medications and/or insulin injections.
Gestational diabetes affects a small number of women when they are pregnant. Treatment always includes a healthy and personalized diet and may also include insulin injections. Although it usually goes away once the baby is born, both the mother and baby may be at higher risk of developing type 2 diabetes later in life.
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Who Is at Risk of Diabetes?Risk factors for type 1 diabetes are less well understood than for type 2, but may include genetic, autoimmune, and environmental factors. While there is ongoing research into the triggers for type 1 diabetes, methods of prevention are not yet known.
In contrast, while there is no single cause of type 2 diabetes, many factors can put you at increased risk. By working to change the risk factors that you can (such as by losing weight), you can help prevent type 2 diabetes. Risk factors for type 2 diabetes include:
- Family history of diabetes
- High-risk ethnicity (Aboriginal, Hispanic, Asian, South Asian, or African descent)
- Age of 40 or more years
- High blood pressure
- High cholesterol
- Overweight or obese (especially if you carry extra weight around your waist)
- History of gestational diabetes
- Delivery of a large baby (more than 4 kg /9 lbs at birth)
- History of polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia
- History of pre-diabetes (IFG or IGT)
- Presence of complications associated with diabetes such as heart disease, kidney disease, eye disease, nerve damage, or erectile dysfunction
Recognizing Symptoms of Diabetes
The majority of people have no symptoms at first. And while there are many possible symptoms of diabetes, your health care provider will do blood tests to confirm a diagnosis. People with type 2 diabetes may experience some (or none) of the following symptoms:
- Frequent urination
- Excessive thirst
- Unexplained weight change
- Extreme hunger
- Sudden vision changes (such as blurred vision)
- Tingling or numbness in hands or feet
- Feeling very tired much of the time
- Sores that are slow to heal
- More infections than usual
- Trouble achieving or maintaining an erection
Diagnosing Diabetes
Standard tests can be used to measure your blood sugar. The Canadian Diabetes Association has published guidelines that state what sugar levels in the blood are normal and what levels result in a diagnosis of impaired fasting glucose, impaired glucose tolerance, or diabetes.
Casual (Random) Plasma Glucose - This blood test can be done at any time of the day without any eating or drinking restrictions. It may be used to diagnose diabetes if you are also experiencing symptoms of diabetes, such as frequent urination, excessive thirst, or unexplained weight loss. A casual plasma glucose of greater than or equal to 11.1 mmol/L along with symptoms indicates diabetes.
Fasting Plasma Glucose* - This blood test is done after you have had nothing to eat or drink except water for at least 8 hours (usually overnight). Fasting plasma glucose of greater than or equal to 7.0 mmol /L indicates diabetes.
Oral Glucose Tolerance Test* - This test is also performed after you have fasted for at least 8 hours. A starting blood sample is taken, and then you drink a special high-sugar drink. Your blood is tested again 2 hours after drinking it. In a person without diabetes, the glucose levels in the blood rise after the glucose drink, but then fall quickly back to normal. In people with diabetes, glucose levels rise higher than normal after drinking the glucose drink and come down to normal levels much slower. A blood sugar level of greater than or
equal to 11.1 mmol/L 2 hours after drinking the glucose drink indicates diabetes.
* For a definite diagnosis of diabetes to be made, a second test must confirm the findings on a separate day, except in situations where symptoms are severe.
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Importance of Good Blood Sugar ControlMany doctors used to take a "watch and wait" approach with diabetes, especially when the patient's blood glucose levels (the amount of sugar in the blood) were not severely elevated above normal. Now we understand that damage (to your kidneys, heart, eyes, and blood vessels throughout your body) can begin to occur from diabetes even when blood sugar levels are only slightly higher than normal. That is why it is very important to make changes to lower your blood sugar and improve your health from the moment you learn that you may be at risk for diabetes, have pre-diabetes, or have been diagnosed with diabetes.
Learning that you have diabetes can be scary. The great news is that by keeping your blood sugar levels in your target range, you can minimize or even prevent the damage that diabetes can cause over time to your body. There are a lot of steps you can take to help keep your blood sugar under control. Some of the most important include:
- Lifestyle changes (healthy diet, regular physical activity, weight loss, quitting smoking) – important for everyone
- Self-monitoring of your blood sugar and regular check-ups with your health care provider – important for everyone with diabetes
- Oral medications (pills) – if prescribed
- Insulin injections – if prescribed
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What Are Healthy Glucose Levels?Your blood glucose level is the amount of sugar in your blood at a given time. You should monitor and record your blood sugar level to understand how your lifestyle and medications are affecting you. This information will help you and your diabetes health care team to tailor your diet, physical activity, and medication to ensure you stay healthy. Your doctor or diabetes educator will tell you how often you should be checking your blood and at what time of day. Don't stop testing just because your levels look good. Diabetes is a changing disease, so regular monitoring is very important.
Blood glucose meters are available from most pharmacies to test your blood sugar at home. Your diabetes educator or pharmacist will help you choose the one that's best for you. Make sure that you receive the proper training and are confident you know how to use it before you take it home.
The Canadian Diabetes Association suggests the ranges in the table below, but target glucose ranges may not be the same for everybody. Your diabetes health care provider will tell you what your target blood glucose levels should be.
Target Glucose Ranges (mmol/L)
Pre-Meal 2 Hours Post-Meal
Target for Most People with Diabetes 4.0 – 7.0 5.0 – 10.0
Normal Range (target for people in whom it can be achieved safely) 4.0 – 6.0 5.0 – 8.0
Focusing on good eating habits, getting regular physical activity, and taking your medication as prescribed (if necessary) will help you maintain your blood sugar in your target range. When your blood glucose stays within your target range, it helps to delay or prevent complications of diabetes.
Monitoring Your Blood Sugar
Low Blood Sugar
If you eat less than usual, skip a meal, exercise more than usual, take too much of certain diabetes medications or insulin, or drink alcohol without eating properly, you could experience low blood glucose (also called hypoglycemia). Symptoms of low blood sugar can include:
- Shakiness or light-headedness
- Nervousness or irritability
- Confusion or disorientation
- Hunger
- Rapid heart rate
- Sweating, headaches
- Weakness
- Numbness or tingling
- Loss of consciousness or seizures
If you experience even one of these symptoms, you must act quickly. Take your blood sugar level if you have your glucose meter handy. If not, you should treat the symptoms anyway with one of these quick sugars. Treat low blood sugar by:
- Drinking 175 ml (3/4 cup) of juice or regular pop, or 3 teaspoons (3 packets) of sugar dissolved in water, or
- Eating 15 grams of glucose in the form of glucose tablets, 6 hard candies, or 1 tablespoon of honey
Note: You should always wear your identification bracelet or card in case you need help. Consult with your doctor if you are experiencing problems with low blood glucose.
High Blood Sugar
If you do not get enough physical activity, do not take enough medication (or insulin) to balance out the food you eat, or are sick or under stress, you may experience high blood glucose (also called hyperglycemia). With high blood glucose, you may:
- Feel thirsty
- Urinate more often than usual
- Feel tired
While high blood sugar is not the same type of short-term emergency that low blood sugar can be, it can cause long-term damage to your heart and throughout your body. That's why when you have high blood sugar, you need to see your doctor, dietitian, or diabetes educator about adjusting your medication, tailoring your meal plan, or increasing your physical activity. Speak to your health care team about how to handle these situations.
Understanding Your A1C
The A1C (formerly called HbA1C is a lab test that offers an excellent way to understand how well your blood sugar has been controlled over the past 3 months. Your A1C shows the "big picture" of your blood sugar levels - your average blood sugar over time rather than reflecting the day-to-day variations revealed by your glucose meter. In general, this measure should be taken every 3 months. The A1C target for most people with diabetes is less than or equal to 7%. For those in whom it can be achieved safely, the A1C target is less than or equal to 6%.
The A1C test cannot show the broad range of blood sugar readings (the highs and lows) that everyone experiences. That's why your self-monitoring blood sugar records, the laboratory glucose test, and the A1C test all work together to give a more complete picture of your diabetes control.
When you are diagnosed with diabetes, you may feel scared, shocked, overwhelmed, or even angry. You may also feel helpless. But the truth is, when it comes to controlling your diabetes, you are not at all helpless. There are many things you can do to help stay healthy and prevent or delay any complications of diabetes. You must take an active part in your own treatment plan.
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Positive Lifestyle ChangesLifestyle changes are an important part of managing your diabetes - and they are steps that only you can take for yourself. Your doctor, diabetes educator, or dietitian can give you assistance and tips, but only you can follow through.
- Eating well -Ask to be referred to a dietitian who will help you develop a flexible, nutritious, and appealing meal plan. If you are going to stick with it long term, it's important that your meal plan fits in with your culture and preferences and still includes your favourite foods in addition to being well-balanced, higher in fibre, and lower in fat, sugar, and salt.
- Limiting alcohol consumption -Do not have more than one or two drinks per day (fewer than 14 per week for men and fewer than 9 per week for women). Alcohol may cause low blood sugar, it may interact with your >medications, and may cause weight gain and other health-related problems.
- Attaining and maintaining a healthy weight -Ask your doctor or your dietitian about your BMI (body mass index: a number calculated based on your weight and height) and your waist circumference. Being overweight or obese carries a greater risk of developing future health problems, including complications of diabetes. Where on your body you carry your extra weight is also important. If you have a bigger waistline (102 cm/40 inches or greater for men or 88 cm / 35 inches or greater for women), you are also at higher risk for health problems.
- Being physically active - Regular physical activity can help you lower your blood sugar level, lose or maintain weight, lower your blood pressure, reduce medications or insulin, cope with stress, tone up your muscles, and keep your heart healthy. Walking is an excellent activity choice. A pedometer (step counter) can be a helpful tool to measure how many steps you currently take in a day and can help motivate you to increase this number. Just 150 minutes per week of moderate intensity exercise (such as brisk walking, dancing, or biking) spread out over 3 non-consecutive days can make a big difference in your health. If you combine that aerobic exercise with three sessions per week of resistance exercise (such as weightlifting), your health will benefit even more. Before starting any new exercise plan, talk to your doctor.
- Learning how to manage stress -Everyone faces stress sometimes in life, and it can affect your health. Stress can actually cause your blood sugar levels to be higher. Learning helpful ways of dealing with stress can make it easier to control your blood sugar.
- Quitting smoking - Like diabetes, smoking increases your risk of heart attacks and strokes. If you have diabetes and you smoke, you multiply your level of risk. Quitting smoking now can help you stay healthier, longer.
Diabetes Medications
Since the Canadian discovery of insulin in 1921, diabetes has become a highly controllable disease, with many additional types of medications becoming available. Because we now understand how important it is to get blood sugar under control quickly, your doctor may only give each agent a few months to work before adding another agent or strategy to your treatment regimen. Insulin is prescribed for people with type 1 diabetes, but it is also used in type 2 diabetes when healthy lifestyle and a combination of oral antihyperglycemic agents (blood-sugar-lowering pills) are not enough to keep blood sugar under control. Insulin is also used in gestational diabetes when lifestyle changes do not provide enough control.
There are various types of diabetes medications, all of which work differently to lower blood sugar levels.
Oral Antihyperglycemic Agents
Note: Oral diabetes medications are not recommended for women who are pregnant or trying to become pregnant. If you plan to become pregnant, talk to your health care provider about controlling your diabetes with diet and/or insulin.
Enzyme Blocker (Alpha-glucosidase Inhibitors)
Enzyme blockers modify the digestion of sugars and starches in the small intestine to reduce the peaks in blood sugar that occur during digestion. These drugs should be taken with the first bite of meals.
Biguanides
This type of medication works to reduce the overproduction of glucose by the liver. It also makes muscle tissue more sensitive to insulin, so blood sugar is more easily absorbed. It is often used in combination with other diabetes medications and sometimes also with insulin. Biguanides should be taken with food to minimize stomach upset and metallic taste.
Insulin Secretagogues (Sulfonylureas and Non-sulfonylureas)
Insulin secretagogues stimulate the pancreas to produce more insulin. One type of insulin secretagogue, called sulfonylurea, has been around for many years and includes many different brand names. All sulfonylureas have similar effects on blood sugar, but they may have differing side effects, frequency of dosing, and interactions with other drugs. A second type of insulin secretagogue, often called non-sulfonylurea, works to stimulate insulin production more rapidly and for a shorter period of time than the sulfonylureas. Non-sulfonylureas are taken just before each of your meals.
Insulin Sensitizers (Thiazolidinediones)
Insulin sensitizers are a new class of drugs that make the body more sensitive to the effects of the insulin it is already producing and enable it to use insulin more efficiently. These drugs may also work by decreasing the amount of sugar that is released by the liver. They can be taken with or without food.
Antiobesity Agent
This medication blocks about one-third of the fat in food from being digested. In combination with a lower calorie diet, it can lead to weight loss, which can enable better blood sugar control.
Insulin
The hormone insulin is required for the body to use the blood glucose it gets from food for energy. The pancreas in people with type 1 diabetes has stopped producing insulin. That's why people with type 1 diabetes always have to take insulin injections. Some people with type 2 diabetes also take insulin. In people with type 2 diabetes, insulin is sometimes used in combination with oral medications. Insulin is taken by injection, from once to several times a day. There are several types of insulin that differ in how they are made, how they work in the body, how quickly they act, and how long they last. As well, there are several delivery methods, including syringes, pens, and pumps. Your doctor will prescribe the type that will work best with your lifestyle.
Quick Reference to Oral Diabetes Medications
| Class of Medication |
Generic Name |
Brand Name |
Enzyme Blocker
(Alphaglucosidase Inhibitors) |
acarbose |
Prandase® |
Biguanide |
metformin |
Glucophage |
Sulfonylurea |
glyburide |
Diaßeta® Euglucon® |
|
gliclazide |
Diamicron® |
|
glimepiride |
Amaryl® |
Non-sulfonylurea |
repaglinide |
GlucoNorm® |
|
nateglinide |
Starlix® |
Insulin Sensitizer
(Thiazolidinediones) |
pioglitazone |
Actos® |
|
rosiglitazone |
Avandia® |
Combination |
rosiglitazone maleate
and metformin HCL |
Avandamet® |
Antiobesity Agent |
orlistat |
Xenical® |
Approved uses of listed medications were current at the time of publishing:
Quick Reference to Insulins
| Type |
Onset of Action |
Peak |
Duration of Action |
Trade Names |
| Rapid-action analogue (clear) |
10-15 min |
60-90 min |
4-5 hours |
Humalog® (insulin lispro),
NovoRapid® (insulin aspart) |
| Fast-acting (clear) |
30-60 min |
2-4 hours |
5-8 hours |
Humulin® -R,
Novolin® ge Toronto |
| Intermediate-acting (cloudy) |
1-3 hours |
5-8 hours |
up to 18 hours |
Humulin® -L,
Humulin® -N,
Novolin® ge NPH |
| Long-acting (cloudy) |
3-4 hours |
8-15 hours |
22-26 hours |
Humulin® -U |
| Extended long-acting analogue |
90 min |
|
24 hours |
Lantus®* (insulin glargine) |
| Premixed (cloudy)
A single vial or cartridge contains a fixed ratio of insulin (% rapid- or fast-acting to %
intermediate- acting insulin) |
|
|
|
Premixed (cloudy)
A single vial or cartridge contains a fixed ratio of insulin (% rapid- or fast-acting to %
intermediate- acting insulin) |
Approved uses of listed medications were current at the time of printing. *Approved, but not yet available, in Canada. Table adapted from the Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.
Preventing Heart Problems
The most common cause of death for people with diabetes is heart disease, but proper treatment and lifestyle changes can lessen your chances of developing it. That's why it is very important to reduce all risk factors, especially high blood pressure and high cholesterol. Talk to your doctor about taking a low-dose ASA (aspirin) daily to help protect your heart. Your doctor may also prescribe medications to help reduce high blood pressure and/or lower high cholesterol. Of course, lifestyle changes such as weight loss, a balanced diet, regular physical activity, and quitting smoking will help protect your heart as well.
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Diabetes Health Care VisitsYour health is a shared responsibility between you and your health care provider. You need to be an active participant in your own care, working together with your diabetes health care team to ensure that all aspects of your health are monitored and cared for. There are several tests and assessments that should be done on a regular basis for people who have diabetes. This table can help remind you (and your health care team) of what tests you should have and how often.
Diabetes Health Care Diary
| Test/Assessment |
How Often? |
Goal |
| Review your blood sugar diary |
Each visit |
Spot problems; improve control |
| A1C |
Every 3 months |
Less than or eqaul to 7% (0.07) |
| Blood pressure |
Each visit |
Less than or equal to 130/80 |
| Weight/BMI/Waist circumference |
Regularly |
Attain personal goal |
| Check your feet and hands |
Regularly |
Prevent ulcers and other injuries |
| Prevent ulcers and other injuries |
At least annually
(must be < 20% difference) |
Ensure meter is working properly |
| Lipids (blood fats) |
Every 1- 3 years, more often if needed |
LDL*
– High risk: Less than 2.5
– Moderate risk: Less than 3.5
TC:HDL**
– High risk: Less than 4
– Moderate risk: Less than 5 |
| Urine protein |
Annually |
Assess kidney function |
| Eye exam |
At diagnosis, then every 1-2 years |
Prevent retinopathy (eye damage) |
| Dental checkup |
Every 6 months |
Prevent infections |
| Flu shot |
Annually |
Reduce risk of complications from the flu |
| Pneumococcal vaccine |
One time + |
One time + |
* LDL = low density lipoprotein, also known as "bad" cholesterol
** TC:HDL = total cholesterol:high-density lipoprotein. This ratio compares the amount of HDL (also called "good" cholesterol) in your blood to the amount of cholesterol in your blood
+ A single repeat vaccination is recommended for patients who are older than 65 years and who were vaccinated more than 5 years ago
Notes
Write down any questions you have, so you'll remember to ask them during your appointment. Also be sure to write down and mention any unusual symptoms you've felt since your last visit, including blurred vision, numbness or tingling in your feet or hands, swelling in your hands, feet, face, or legs, cramping or pain in your legs, unusual weight change, sexual dysfunction, or anything else that is out of the ordinary for you. If you experience chest pain, shortness of breath, or numbness or weakness on one side of your body, call your doctor or go to the hospital immediately.
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Do you have type 2 diabetes? Reduce your risk of complications.
The Canadian Diabetes Association has lowered the recommended targets for your blood sugar levels. This quick and easy test will show you whether you need to be reassessed by your doctor to prevent or delay the onset of long-term complications.
1 |
I have type 2 diabetes and see my doctor only when I have a problem. |
Yes |
No |
|
2 |
I have been managing my type 2 diabetes using the same diet, medication and activity levels for several years. |
Yes |
No |
|
3 |
When I test my blood sugar levels at home, my pre-meal blood sugar levels are always high. |
Yes |
No |
Don't Test |
4 |
My A1C level is always higher than 7% (A1C is the test your doctor performs to measure your average blood sugar levels over the previous three months). |
Yes |
No |
I Don't Know |
5 |
When I test my blood sugar levels at home, there is no consistency in my test results. |
Yes |
No |
Don't Test |
6 |
My type 2 diabetes has led to other medical problems, such as symptoms of kidney disease, heart disease, stroke, vision damage or nerve damage. |
Yes |
|
|
If you answered 'Yes', 'Don't Know' or 'Don't Test' to any of these questions, ask your doctor how to achieve the new recommended blood sugar targets. Keeping blood sugar levels at the new targets have shown to help delay or prevent the complications arising from diabetes. (Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada)
There's a lot more to know about managing type 2 diabetes than just blood sugar levels. Find out how to manage your diabetes more effectively by visiting
http://www.diabetes.ca/managingdiabetes.
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Diabetes Health Care TeamBecause diabetes touches on so many aspects of a person's life, there are many health care specialties available to support people with diabetes. Don't forget that you are a key member of this team. Your team of health professionals might also include:
Family Doctor – Likely your main diabetes care provider, your family doctor will play an important ongoing role in diagnosing, monitoring, and helping you manage your diabetes. He or she may refer you to a diabetes care clinic or other specialists as necessary.
Endocrinologist – This type of doctor focuses on diseases of the endocrine system, which includes the pancreas, particularly the diagnosis and treatment of diabetes. Your family doctor may refer you to an endocrinologist for specialized care.
Dietitian (Nutritionist) – This person will help you design a meal plan that will both fit your lifestyle and preferences and help you maintain good blood sugar control.
Diabetes Educator – This professional, often a registered nurse or dietitian, has received special training in teaching people with diabetes how to provide the best self-care, including glucose self-monitoring, foot care, and so on. You may work with him or her one-on-one or be taught in a classroom setting.
Walk-in Clinics – A family doctor is the best option for helping you manage a chronic disease such as diabetes. However, if you do not have a family physician, walk-in medical clinics will be an important part of your diabetes care. You should be extra careful about keeping detailed personal records of your own health to ensure that the available doctor has the information he or she needs to help make good treatment decisions for you.
Occupational Health Nurse or Doctor – Some workplaces offer occupational health specialists, who can advise you or provide you with additional resources to help manage your diabetes and work.
Pharmacist – Your pharmacist may become an important part of your diabetes care team, especially if you take diabetes medications. Because pharmacists are experts in understanding how various medications work together, you should get all your prescriptions from the same pharmacy - and be sure to tell your pharmacist about any over-the-counter or herbal remedies you may be taking. Your pharmacist is also an excellent resource for your medication, blood sugar self-monitoring and general diabetes questions.
Psychologist/Psychiatrist/Social Worker – Mental health professionals can help with the personal and emotional aspects of living with diabetes. Stress can have major effects on your blood sugar levels as well, so learning how to better manage stress may also help you manage your diabetes.
Cardiologist – Most people with diabetes will eventually develop heart-related problems. A heart specialist may be able to help you prevent or manage heart disease.
Nephrologist – Because diabetes is the major cause of kidney disease, a kidney specialist may be a part of your diabetes care team.
Ophthalmologist /Optometrist – Regular eye care is critical for people with diabetes because they are prone to eye diseases that can lead to blindness.
Podiatrist /Chiropodist/Foot Care Nurses - These professionals specialize in the care of the feet and lower legs. Because diabetes can make you prone to poor blood flow and nerve damage, foot care to prevent ulcers and amputations is very important.
Alternative Therapies – Some people use alternative or complementary therapies – such as acupuncture, herbal medicines, or biofeedback – to help manage their diabetes or its complications. Some alternative therapies may have serious side-effects. To avoid potential problems, make sure to educate yourself, and ensure your primary care provider knows about all therapies, medicines, or supplements you are currently taking or considering for your diabetes.
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Getting Help and SupportNational Organizations
Canadian Diabetes Association
1-800-BANTING (226-8464)
Diabetes Québec
514-259-3422
1-800-361-3504
Useful Internet Sources of Information
Canadian Diabetes Association
http://www.diabetes.caDiabetes Québec
http://www.diabete.qc.caAmerican Diabetes Association
http://www.diabetes.orgNational Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health
http://www.niddk.nih.govOther
Ask your family doctor or pharmacist for local information and resources.
Your workplace may offer a wellness program or access to health care personnel for additional support.
Contact your local library or Community Information Service.
The pharmaceutical company that manufactures your medication may be able to provide more information. The telephone number can be found in your telephone directory, or your pharmacist can provide further help.
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