What is diabetes? After eating, most food is turned into glucose, the body’s main source of energy. As sugar enters the bloodstream, the amount of sugar in the blood rises, and that rise will signal the pancreas to send the hormone “insulin” into the bloodstream. Insulin is produced by the pancreas, an organ that lies behind the stomach. It helps sugar to enter the cells to be immediately used for energy or stored for later use. When you have diabetes, the food you eat cannot be used for energy because your body is not making enough of insulin or the insulin you have is not working properly. Therefore, sugar stays trapped in the bloodstream, raising the amount of sugar in your blood to abnormally high levels. Diabetes can, and must, be treated. High blood sugar levels can cause serious health problems. Talk to your doctor or health clinic for more information. What are the most common types of diabetes? Type 1 diabetes About 1 in 10 people with diabetes have Type 1. It usually occurs in children, adolescents or young adults. The body makes little or no insulin; therefore, sugar stays in the bloodstream, and you don’t have enough energy to keep you healthy. People with type 1 diabetes will need insulin shots daily. Type 2 diabetes Type 2 diabetes is more common in adults, but the number of children and young people with type 2 diabetes is growing. With type 2 diabetes, your body makes some insulin, but not enough. Or, the insulin your body makes does not work right. Eating healthy foods, in the right amounts, and being physically active can help people lowering their blood sugar How often should you screen for diabetes? The American Diabetes Association (ADA) recommends that adults age 45 and older get screened for type 2 diabetes every three years by their health care provider. You may need earlier or more frequent diabetes screening if you are overweight AND have one or more of the following risk factors: Family history of diabetes (a parent or sibling with the disease) African-American, Hispanic-American, Native-American, Asian-American, or Pacific Islander ancestry History of blood glucose problems History of gestational diabetes (diabetes during pregnancy) or a baby weighing over nine pounds (or 4 kilograms) High blood pressure Cholesterol problems Polycystic ovary syndrome (PCOS) History of vascular disease How is diabetes diagnosed? Fasting blood sugar (blood sample is taken after 8 to 12 hours without food) of 126 mg/dL (7 mmol/L) or greater OR random blood sugar of 200 mg/dL (11.1 mmol/L) or greater in patient with classic symptoms of high blood sugar OR 2-hour blood sugar of 200 mg/dL (11.1 mmol/L) or greater during an oral glucose tolerance test (OGTT) OR HbA1c level is 6.5% or greater Note: In the absence of unequivocal high blood sugar, result should be confirmed by repeated testing What are the goal and normal value for diabetes? A normal fasting blood sugar range for a person who does not have diabetes is less than 100 mg/dL (5.5 mmol/L). A target blood sugar range is a range that people with diabetes should try to achieve. The ADA recommends the following targets for most non-pregnant adults with diabetes. Level for people without diabetesADA goal for people with diabetesBlood sugar before mealsLESS than 100 mg/dL (5.5 mmol/L)70-130 mg/dL (3.9-7.2 mmol/L)Blood sugar after mealsLESS than 110 mg/dL (6.1 mmol/L)LESS than 180 mg/dL (10 mmol/L)HbA1C4-6%LESS than 7% in most cases What are the common signs and symptoms of diabetes? Increased thirst Frequent urination Fatigue Blurred vision Frequent infections Increased hunger Unexplained weight loss Non-healing wounds Tingling or numbness of the hands and feet Sexual dysfunction What are some serious complications of uncontrolled diabetes? Retinopathy: damage to the retina in the back of the eye Prevention is KEY Have an annual eye exam Maintain good blood sugar and blood pressure control Call your eye doctor immediately if you have sudden eyesight changes such as black spot, flashing lights, or cobwebs in your eye Nephropathy: damages to small blood vessels in the kidneys that cause them to leak excess protein into the urine and decrease their ability to filter Prevention included testing for microalbumin or protein in the urine annually Maintain good sugar level and blood pressure under control Take blood pressure pills to protect kidney Neuropathy: damages to the nerves that cause them to not work properly Signs and symptoms: numbness, tingling, or pain in your hands and feet, erectile dysfunction. Goal is to maintain good blood sugar level in control Prescription medications that treat neuropathy include gabapentin or pregabalin Erectile dysfunction medicines are available. Talk to your doctor about that Foot care: Examine your feet everyday and look for breaks in skin, blisters, calluses, and red or infected areas Apply lotion on top and bottom of feet, but not between toes Trim toe nails straight across Wear socks all the time, even at home to protect your feet Get your feet examined by a specialist at least once a year Heart and blood vessels diseases: including heart attack and stroke Maintain good blood sugar and blood pressure level Get a lipid profile test at least once a year Stop smoking Exercise regularly Eat a balanced diet Take daily aspirin as recommended by your doctor How do you manage episodes of overly low blood sugar? Sign/Symptoms: Weakness Shakiness Sweating Fast heartbeat Irritability/anxiety Blurred vision Hunger Headache Management: Rule of 15 When symptoms occur, make sure that you check your blood sugar level. If it comes out less than 70 mg/dL (3.9 mmol/L) Eat or drink 15 grams of fast acting sugar: 4 glucose tablets, half a cup of juice or regular soda, 5 to 6 hard candies. Check blood sugar level again after 15 minutes. If it’s still low, eat another 15 grams of fast sugar. If the blood sugar level is still low after 15 minutes, call the emergency. Note: If the person is unconscious or unable to swallow, use glucagon emergency kit where available, otherwise call the emergency immediately. How do you manage episodes of overly high blood sugar? Sign/Symptoms: Extreme thirst Frequent urination Drowsiness Dry skin Slow-healing wound Blurred vision Hunger Management: When symptoms occur, make sure that you check your blood sugar level more frequently (e.g., every couple of hours). Drink fluids – at least 8 ounces (240 mL) every hour. Maintain adequate carbohydrate intake. Continue prescribed medications. Call your doctor or go to the emergency right away: If your blood sugar is more than 240 mg/dL (13 mmol/L) twice in a row (during 2-6 hours) OR if your blood sugar is more than 240 mg/dL (13 mmol/L) and your urine ketones tests show moderate or large amounts of ketones (for type 1 diabetes). If you have severe fever, confusion, shortness of breath or fruity odor on breath. If you have severe nausea, vomiting or diarrhea for over 4-6 hours. If you are severely dehydrated. DO NOT WAIT TO GO TO THE EMERGENCY! What are some medications used to treat diabetes? Note: NOT all the medications listed below are available in Vietnam and some medications also exist in combination with another drug. Check with your doctor or pharmacist for more information. Oral medications Brand nameGeneric nameWhen to takeHow it worksSide EffectsGlucophage® Glucophage XR® MetforminWith mealsKeep the liver from releasing excess glucose (sugar) Tell your doctor if you have liver or kidney problem Hold medication if having procedure where dye is injected into your body Nausea, diarrhea, bad taste Diamicron MR®GliclazideWith mealsEnhance pancreas to produce more insulinLow blood sugar Weight gain Amaryl®Glimepiride15 minutes before mealsGlucotrol® Glucotrol XL® Glipizide30 minutes before mealDiabeta®Glyburide30 minutes before mealPrandin®Repaglinide5 – 30 minutes before mealsStarlix®Nateglinide5 – 30 minutes before mealsPioglite® Actos® PioglitazoneWith or without mealsHelp the body make better use of insulin. May take up to 6 weeks to work. Need liver function test before starting therapy and periodically thereafter. Possible swelling of the feet and hands, weight gain, liver dysfunction Avandia®RosiglitazoneWith or without mealsGlucobay®AcarboseWith first bite of food in each main mealSlow down sugar absorption in the intestineNausea, diarrhea, flatulence MiglitolWith first bite of food in each main meal Invokana®CanagliflozinBefore first meal of the dayIncrease sugar release through urine Use caution in patients with kidney disease, low blood pressure, or high potassium level Yeast infections, urinary tract infections, increased urinationFarxiga®DapagliflozinBefore first meal of the dayJanuvia®SitagliptinWith or without mealsSlow breakdown of gut hormone which increases insulin production and release, and decreases glucagon secretionHeadache, upper respiratory symptomsOnglyza®SaxaliptinWith or without mealsGalvus®VildagliptinWith or without mealsTrajenta®LinagliptinWith or without mealsNesina®AlogliptinWith or without mealsCycloset®BromocriptineTake with food in the morningIncrease dopamine receptor activity in brainNausea, headache, low blood pressure, constipation Injectable medications Non-insulin products Brand nameGeneric nameWhen to takeHow it worksSide EffectsByetta® Bydureon® ExenatideUp to 60 minutes before breakfast and evening mealStimulate insulin secretion when blood sugar is rising Slow glucose release in liver Give a feeling of fullness Nausea, weight loss Victoza®LiraglutideWith or without mealsSymlinPen®PramlintideBefore meals with at least 30 grams of carbohydratesHelp insulin lower blood sugar after mealsNausea, low blood sugar Insulin products InsulinOnsetPeakDurationNoteRapid-acting insulinLispro (Humalog®) Aspart (Novorapid®) Glulisine (Apidra®) <15 minutes0.5 -3 hours3 – 5 hoursIf mixing with NPH, rapid-acting insulin should be drawn first. Mixture need to be used immediatelyShort-acting insulinRegular (Actrapid®)0.5 – 1 hour2 -4 hours4-8 hours Intermediate-acting insulinNPH (Insulatard®)2-4 hours4-10 hours10-12 hoursShould look uniformly cloudy or milkyLong-acting insulinGlargine (Lantus®)4-6 hoursSame action throughout the day20-24 hoursDo not mix with other insulinLevemir (Detemir®)2-3 hours6-8 hoursDose dependent: from 6 to 20 hours Premixed insulinMixtard® 300.5 hour2-12 hours18-24 hours30% regular + 70% NPHNovomix® 3010-20 minutes1-4 hour18-24 hours30% aspart + 70% aspart protamineHumalog Mix 75/2515-30 minutes1.6-5 hours14-24 hours25% lispro + 75% lispro protamineHumalog Mix 50/5015-30 minutes0.8-4.8 hours14-24 hours50% lispro + 50% lispro protamine General information on insulin: Insulin is synthetically made today in laboratories. It is referred to as human insulin. Always store UNopened pen or vial in the refrigerator (2-8oC). Do NOT freeze. Most insulin last around 28 days after opening at room temperature (~25oC). Insulin detemir lasts 42 days after opening. Check with your pharmacist for more information. Never inject cold insulin. Wait until pen warms up to room temperature Always check the expiration date of the insulin and make sure the insulin has no foreign particles in it. Always wash hands with soap and water before an injection Injection Sites: insulin is injected into fatty tissues in the abdomen (1), on both sides of the thighs (2), upper hip, or the back of the upper arms (3). Rotate sites every few days for best absorption and avoid fat tissue built-up. Always use a new needle for each injection and never share needles or pen with another person. Insulin injection technique How do you adjust your lifestyle when you have diabetes? STOP SMOKING! EXERCISE! ADA recommends at least 150 minutes of aerobic exercise each week. You can break this up into 30-minute sessions 5 days a week. Exercising every day is ideal. Examples of aerobic exercises are jogging, brisk walking, biking, rowing, and swimming. Consult your doctor if you want to add resistance training to your workout. Lifting weights builds muscle, and help control your blood sugar and your weight. A combination of aerobic exercise and resistance training provides the greatest benefits for people with diabetes. LOSE WEIGHT! Maintaining a healthy weight helps your body make better use of insulin. The combination of weight loss and exercise is the best way to improve blood sugar control. Healthy eating means that you are not eating too little or too much calories. The most important thing is balancing what to eat. Every person has an individualized balance. The sources of calories that human body absorbs are carbohydrates, protein, and fat. Make sure you eat foods from each of these food groups. Most of the carbohydrates you eat enter your blood within a couple of hours. Protein and fat are slower to digest and do not affect blood sugar as quickly as carbohydrates do. Carbohydrates Carbohydrates are the main source of energy of the body. They also affect blood sugar the most. The body needs at least 130 gram of carbohydrate per day for basic function. Sources of carbohydrates: Bread, pancakes, muffin, hamburger bun, cereals, pasta, rice Starchy vegetables: corn, pea, potato, pumpkin Dairy: milk, yogurt Sweets: jam and jelly, syrup, honey, cookies, ice cream, cake. Fat The main goal is to reduce saturated fat, trans fat, and increase fiber and unsaturated fat. The body needs around 40 – 70 grams of fat in a day Saturated fats raise total cholesterol and low-density lipoprotein (LDL – bad cholesterol), which increase the risks for cardiovascular diseases Sources: cream, cheese, butter, lard, and fatty meats Unsaturated fats mainly come from plants and include both monounsaturated and polyunsaturated fats. Both are high in total fat and have as many calories as saturated fats, but they are healthier options compared to saturated or trans fats. Sources: avocado, most nuts, peanut butter, vegetable oil Your dietician may also suggest omega-3 fatty acids for you. Sources: fish such as salmon or mackerel, fish oil, soybeans, flax seed (ground) Protein Protein provides nutrients for building cells, tissue, bones and muscles. The body needs around 60 – 90 grams of protein in a day. Sources: meat, seafood, eggs, nuts, seeds, beans, tofu Meat can have a lot of fat. Buy lean meats or remove fat from meat before cooking. TIPS ON HEALTHY EATING: ADA states that alcohol can be part of your diabetes plan only if your blood sugar is in good control. The general guidelines are 1-2 servings with a meal only. Spread carbohydrate through out the day. Eat some carbohydrates at each meal, but don’t eat too much at one time. Protein, fat, and fiber don’t raise your blood sugar as rapidly as carbohydrates. 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