Health Society of South Africa

DIABETES (TYPE I)
Balancing insulin, diet and exercise puts you in control

Learning to Live With Diabetes

Diabetes is a disease that keeps your body from turning the food you eat into energy. Now that you know you have diabetes, you may be feeling scared, angry or helpless. You may even be wondering whether you can lead a normal life. Most people have these concerns at first. You don't have to face these questions alone. Your doctor is there to help - and so are the diabetes educator, dietitian and other members of your health care team. Together, they'll show you what you need to do to take care of yourself.

You Can Take Charge
You have Type I diabetes, which is also called insulin-dependent diabetes. It usually starts before you're 20, but it can happen later. There isn't a cure for diabetes, but you can live an enjoyable, active life. How? By controlling your blood glucose (a type of sugar in your blood). Here are some of the basics you need to learn:

What diabetes is and how it changes the way your body gets its energy.
How to check your blood glucose to be sure you maintain a level that's right for you.
How to control your blood glucose by taking insulin, eating right and exercising regularly.
How to take care of yourself - especially your feet and eyes, and what to do when you're ill.

How Your Body Gets Its Energy

Your body needs energy to make it run. It gets this energy by changing the food you eat into fuel (glucose). The energy you get from this fuel allows you to think, talk, walk and even blink.

What Happens When You Eat
Your body is made up of millions of cells. These cells burn fuel to make energy, a process called metabolism. But the cells need help in order to use fuel effectively.

Food changes into glucose. During digestion, your body changes most foods you eat into a fuel called glucose. Then, glucose enters your blood and travels to your cells.

The pancreas makes insulin. Also during digestion, your body tells the pancreas (an organ behind your stomach) to make a chemical called insulin. Insulin, like glucose, enters your blood and travels to your cells.

Insulin lets glucose into the cells. Glucose and insulin meet at your cells. Insulin acts as a key, unlocking the cells to let the glucose enter. Your cells can then burn the glucose to give you energy.

Diabetes Changes What Happens When You Eat
When you have Type I diabetes, your pancreas can't make insulin. Without insulin, glucose can't enter your cells.

Food still changes into glucose. With diabetes, your body still changes most foods into glucose. Glucose enters your blood and travels to the cells.

Your pancreas doesn't make insulin. Since your pancreas doesn't make insulin, there's nothing to unlock the cells so glucose can enter. Glucose remains in your blood instead. That's how your blood glucose gets too high.

Your body looks for new fuel. Without glucose, your cells try to get energy from stored fat. But fats leave a waste product called ketones. Ketones build up and cause a dangerous condition called ketoacidosis.

Controlling Your Blood Glucose

Controlling your blood glucose at a level that's right for you is done by balancing insulin, your meal plan and exercise. When any of these three things are out of balance, your blood glucose goes out of balance. Your body may react by telling you something is wrong.

When Glucose is Too Low
Too little glucose in your body is called hypoglycaemia. It can happen suddenly if you eat too little or exercise too much. You may feel symptoms quickly. And if you don't take action, you may pass out. Your health care team should give your family special instructions about what to do if this occurs.

What you may notice
You may suddenly feel very hungry or weak, have a headache, feel shaky or dizzy, feel sweaty, feel nervous or act confused.

What to do
Eat quick-acting sugar (such as 1/2 cup orange juice, 2 hard candies or 6 jelly beans).
If you don't feel better in 15 minutes, repeat.
Check your blood glucose level.
Call your doctor or health care team if you still don't feel better.

When Glucose is Too High
Too much glucose in your blood is called hyperglycaemia. This can happen if you eat too much, take too little insulin, exercise less or are ill or under stress. If you don't take action, hyperglycaemia may lead to ketoacidosis and you may pass out.

What you may notice
You may become very thirsty or need to urinate often. More serious signs of hyperglycaemia are feeling sick to your stomach, having blurry vision, breathing rapidly or feeling weak or dizzy.

What to do
Check your blood glucose level and check your urine for ketones.
If your blood glucose is too high, drink a sugar-free, non-caffeine liquid. Follow your sick-day plan for taking extra insulin.
Call your doctor or health care team if your blood glucose level doesn't go down, if ketones remain in your urine or if you don't feel better within a few hours.

Is Your Blood Glucose in Balance?
Your health care team will tell you what level of blood glucose is right for you. To be sure your glucose and insulin are in balance, check your blood glucose regularly.

Testing your blood glucose level
The easiest and best way to check your blood glucose level is to test your blood. You can test it anywhere. There are three steps:

Draw a drop of blood, put it on a test strip, and put the strip in the meter.
Read the meter.
Record the results.

Your health care team will show you how and tell you when to test your blood glucose.

Testing your urine for ketones
You may need to test your urine for ketones to make sure your body isn't trying to get energy from fats. Test your urine for ketones when:

Your blood glucose is above 250mg/dL (milligrams per deciliter).
You are ill or under stress.
You have an upset stomach, diarrhoea (loose stool), or are vomiting.
Your blood glucose level remains higher than your normal level.

If your urine shows ketones, call your doctor or health care team.

Balancing Your Glucose with Insulin

Taking insulin is the first step to keeping your blood glucose in balance. How often you take your insulin depends on the kind of insulin your doctor recommends.

Kinds of Insulin
Most insulin is made in a laboratory and is called human insulin, because it's just like the insulin that's made in the body. Some kinds of insulin work fast and other kinds work slowly and last longer.

Fast-acting (Regular) insulin:
Begins working 20-30 minutes after taken.
Strongest (peak) action is 2-4 hours after taken.
Continues working for 6-8 hours.

Intermediate-acting (NPH, Lente) insulin:
Begins working 2 hours after taken.
Strongest action is 8-10 hours after taken.
Continues working for 18-24 hours.

Long-acting (Ultralente) insulin:
Begins working 4-6 hours after taken.
Strongest action is 12-16 hours after taken.
Continues working up to 36 hours.

Taking Insulin
Insulin is taken by injection. You can't take insulin by mouth because the acids in your stomach would destroy it. Your health care team will show you how to give yourself insulin injections. Here are some things to remember:

Try to take your injections at the same time each day.
Throw away used needles and syringes in a heavy plastic jug with a screw cap.
Eat 20-30 minutes after your injection.

Storing Insulin
Never freeze insulin or let it get above 30° C. And never use it after the expiration date on the bottle.

Store open bottles
At room temperature (15°-30°C).
In a dark place.

Store unopened bottles in the door of the refrigerator so they stay cool but don't freeze.

Help from Your Health Care Team
A diabetes educator will help you learn how to give yourself insulin injections. There are times when you may need to change the kind or amount of insulin you take, so keep in touch with your health care team.

Balancing Your Glucose by Eating Right

Eating right is the second step to keeping your blood glucose in balance. A food specialist (dietitian) will help you with a meal plan that's right for you. You don't have to give up all the foods you like. But you'll need to eat on a regular schedule and follow some guidelines.

Eat Plenty of Carbohydrates
Carbohydrates are your body's main source of glucose. Your dietitian will probably recommend that 55 to 60 percent of your calories come from carbohydrates. There are two types of carbohydrate: complex and simple.

Complex carbohydrates
Your meal plan will call for lots of complex carbohydrates. They turn to glucose slowly in your body. Foods high in complex carbohydrates include: whole-grain breads and cereals, pasta, potatoes, rice, bulgur and starchy vegetables like squash, peas and dried beans.

Simple carbohydrates
Your meal plan may call for some simple carbohydrates. But don't eat a lot of them, because they have few nutrients, they have lots of calories, and they make your blood glucose go up quickly. Candy, cookies, cake, pie, jam and jelly contain simple carbohydrates.

What About Alcohol?
Ask your health care team whether you can have alcohol. If they say you can drink alcohol, always eat food at the same time. This helps prevent hypoglycaemia.

Eat Less Fat
Fats give you lots of calories in very little food. They can also cause heart disease. Your dietitian will probably recommend that less than 30 percent of your daily calories come from fats.

Low-fat foods
Choose fish, lean meat and chicken and turkey without the skin. Roast, broil or bake your food - don't fry it. Use margarine or canola, safflower, sunflower, peanut, soybean or olive oil. Drink nonfat or low-fat milk.

High-fat foods
Butter, cream, whole milk, bacon, bakery goods and most cheeses are high in fat. Eat less of these high-fat foods.

Eat Plenty of Fibre
Your meal plan probably calls for foods that are high in fibre. High-fibre foods take longer to break down in your body. They can help lower your blood glucose. They also soften your stool.

High-fibre foods
Brown rice, peas, dried beans, vegetables and whole fruits, whole-grain breads and cereals and nuts are all high in fibre.

Low-fibre foods
Bread and noodles made from white flour. White rice, cornflakes, fruit juices and dairy foods are low in fibre.

Help from Your Health Care Team
A dietitian can help you develop a meal plan that balances food with insulin and exercise. Your meal plan will include the right number of calories and the right amounts of foods that are healthy for you and that you enjoy eating.

Balancing Your Glucose with Exercise

Exercise is the third step to keeping your blood glucose in balance. Daily exercise helps lower your blood glucose. Your blood glucose can continue to fall for several hours after you stop exercising. Check with your health care team before you start an exercise programme. You may need to begin slowly.

Your Exercise Programme
Every person's exercise programme is different. Your programme will depend on what shape you are in and what you like to do. Most exercise programmes include 4 steps.

1. Stretching. Loosen up by walking for a few minutes. Then, take about 5 minutes to stretch all the muscles in your body. Otherwise, you'll get sore or hurt during exercise. Don't bounce while you stretch.

2. Warming up. Begin any exercise slowly. This lets your heart rate go up gradually. Walking or jogging slowly for 5 minutes is a good way to warm up.

3. Aerobic exercise. Aerobic exercise gets your heart beating fast and you lungs working hard. Brisk walking, jogging, biking and swimming are all aerobic exercises. Gradually work up to 20-30 minutes a day.

4. Cooling down. Your heartbeat needs to come down slowly. Walk or jog slowly for 5-10 minutes, just as you did when you warmed up. Stretch your muscles again, too.

Exercise Tips
Exercise every day at the same time. Once you have worked up to your full programme, exercise the same length of time and at the same pace each time. Don't exercise just before bedtime, as this may cause hypoglycaemia.

Inject your insulin into areas around muscles you won't use when you exercise, such as your stomach. If you don't, your insulin may be used up too fast.

Eat 1-2 hours before, so your blood glucose will be at its highest point while you exercise.

Always carry quick sugar, such as glucose tablets or hard candy, with you. Eat it if you start feeling faint. You could be heading for hypoglycaemia.

Always wear identification that says you have diabetes - just in case you faint or have any other emergency. Carry change for a phone call. It's a good idea to exercise with a partner, too.

Ask your doctor when to check your blood glucose. It's not safe to exercise if your blood glucose is above 250 or below 100 mg/dl, if you're ill, or if there are ketones in your urine.

Help from Your Health Care Team
A diabetes educator or exercise specialist can help you decide on an exercise programme that will work for you. It depends on what shape you're in and what you like to do. Be sure to choose activities you enjoy.

Taking Care of Yourself

If you have had high blood glucose levels for manly years, it's possible to develop other problems, too. Following a few simple steps for taking care of yourself can help you catch these problems early and keep you feeling your best.

Foot Care
Over time, you may find that cuts and sores on your feet may not heal as fast as they should. They can become problems quickly. If trouble develops, your doctor may refer you to a podiatrist (a foot doctor). Here are some tips for keeping your feet healthy:

Check your feet for cuts, blisters and sores every day.
Wash your feet daily in warm (not hot) water. Don't soak them. Test the water temperature with your elbow, not your feet.
Cut your toenails straight across, not too close to your skin.
Always wear shoes and change your socks daily.
Keep your feet warm, but not hot or cold. Don't use a heating pad.

Eye Care
Gradually, high blood glucose may cause blood vessels in your eyes to break. Finding and treating these problems early can save your eyesight. Your doctor may have you see an ophthalmologist (an eye specialist) regularly.

Sick-Day Care
An illness, injury or infection can throw your blood glucose level out of balance. Work out a sick-day plan with your health care team before you get ill. Here are some guidelines:

Take your normal level of carbohydrates. If you can't eat, sip fruit juices, soft drinks with sugar or soup. Eat gelatin or ice cream.
Adjust your insulin as outlined in your sick-day plan. You need insulin even if you can't eat your normal meals.
Drink liquids every hour.
Test your blood glucose and urine every four hours. Call your doctor if your blood glucose is more than 250mg/dl or if you have ketones in your urine.
Ask someone to check in on you several times a day.
Let your doctor know if you have a fever or diarrhoea, are vomiting or if you are ill longer than two days.

Resources For More Help
Call your health care team whenever you have questions. But don't forget about these other resources, too. Ask your health care team about local support groups, education programmes and community services.

Looking Ahead

Although there's no cure for diabetes, you can keep your blood glucose under control and lead an active, full life. Taking you insulin, following your meal plan, exercising regularly and checking your blood glucose all help you stay in better health. Your health care team plays a part, too. They'll teach you how to care for yourself and keep track of your progress.