Diabetes Overview and Management

Diabetes

• Diabetes is a chronic condition impacting how the body processes blood sugar (glucose).
• Glucose is the primary energy source for cells.
• Pregnancy management with diabetes can be challenging due to hormonal changes affecting insulin sensitivity and glucose control.
• For pregnant women, insulin injections should be administered in the thigh, not the abdomen.

Types of Diabetes

Type 1 Diabetes

• An autoimmune condition where the immune system attacks and destroys insulin-producing cells in the pancreas.
• The body does not produce insulin, requiring insulin injections or pumps for management.

Type 2 Diabetes

• The body becomes resistant to insulin or doesn't produce enough.
• Often linked to lifestyle factors.
• Can be managed with diet, exercise, oral medications, and sometimes insulin.
• Can often be prevented or delayed.

Symptoms of Diabetes

• Increased thirst and hunger.
• Frequent urination.
• Fatigue.
• Unexplained weight loss (more common in type 1).
• Slow-healing wounds.
• Numbness or tingling in hands or feet.

Diagnosis of Diabetes

• Blood tests, including fasting blood glucose (FBG), A1C, and oral glucose tolerance tests.
• FBG measures blood glucose levels after an overnight fast (typically 8-12 hours without eating).
• Normal/target FBG range is 4-7 mmol.
• Hyperglycemic FBG is greater than 7 mmol.
• A1C measures average blood sugar levels over the past 3 months.

Glucose Tolerance

• Measures the body's ability to process glucose after a sugar load.
• Blood sugar levels are measured at intervals (e.g., 1 and 2 hours post-drink).
• Fasting blood glucose is measured before the glucose load.

Self-Monitoring of Blood Glucose (SMBG)

• Results are used to help change lifestyle habits (eating), adjust medications, and prevent issues (hypo/hyperglycemia).
• Barriers to SMBG include pain, cost, inconvenience, diabetes burnout, and feelings of judgment.

Hyperglycemia

• High blood sugar levels.
• Occurs when lifestyle factors (diet, activity, medication) aren't balanced or during illness or stress.
• Symptoms include shakiness, sweating, dizziness, hunger, and confusion.
• Management may involve adjusting medications, diet, and activity levels.

Hypoglycemia

• Low blood sugar levels.
• Most frequent in type 1 diabetics.
• Symptoms related to autonomic or neuroglycopenic systems (fight or flight responses) such as trembling, palpitations, sweating, hunger and/or anxiety.
• Management usually involves consuming fast-acting carbohydrates.

Nausea Management

• Consume fast-acting carbohydrates (15g).
• Use glucose tablets (4g of carbs per tablet).
• Use 15mL (3 teaspoons) of sugar/honey
• 6 lifesavers
• 150mL of juice
• Wait 15 mins before retesting.

Baqsimi Glucagon Nasal Powder

• Increases blood sugar rapidly by releasing glycogen from the liver.
• Takes less than 24 seconds to use.
• Safe for adults and children.

Glucagon Injection

• 1mg, Subcutaneous (SC) or Intramuscular (IM)
• Produces great increase within 1 hour.

Hypergylcemia Management

• Adjustments to adjust diet, medication, and physical activity
• Individuals with high blood sugar (>14mmol) need to consult with a healthcare professional.
• People with higher readings (20 mmol and above) should go to the emergency room.

Time in Range

• Shows the total time in a 24-hour period which a person's blood sugar level is within the target range (a helpful tool in diabetes self-management).
• Ranges for time in target are presented in percentages and millimoles per litre (mmol).

Sick Day Management

• If a person with diabetes experiences illness and can't maintain adequate fluid intake, they may temporarily adjust or hold medications to avoid complications or kidney function declines.

Ketones

• Ketones are produced when the body doesn't have enough carbohydrates for energy.
• Testing is recommended for people with type 1 diabetes during illness or high blood sugar periods.
• The Freestyle is a meter that gives ketone and glucose testing results.

Diabetic Ketoacidosis (DKA)

• A serious complication of diabetes that occurs when a body doesn't have enough insulin and starts breaking down fat for energy which produces ketones.
• This can lead to a dangerous increase in blood acidity.
• Symptoms include fruity-smelling breath (due to acetone)
• Treatment needs to occur in a hospital environment with insulin and fluids via intravenous (IV) administration. Recovery period may last several days.

Government Coverage of Diabetes Supplies

• Coverage regarding diabetes supplies and equipment may end at 18 years in Ontario
• Individuals above this age may require private health insurance or out-of-pocket payment.

Blood Glucose Monitoring

• Traditional finger prick glucometers.
• Continuous blood glucose monitoring (CGM).
• CGM readings may lag by 9 minutes compared with a finger-prick test.

Insulin

• Insulin is a hormone that controls blood glucose levels.
• Insulin is needed to move glucose from the bloodstream into cells.
• Different types of insulin exist with various durations of action (rapid, short, intermediate, and long-acting).
• Insulin classification methods include categorization by onset of action, peak of action, and duration of action.

Insulin Types

• Rapid acting insulin: covers blood sugar spikes from meals. Taken 5-15 minutes before eating.
• Short acting insulin: covers blood sugar increases from meals. Taken 30 minutes before eating.
• Intermediate acting insulin: Provides background insulin used between meals and overnight.
• Long acting insulin: Provides a steady basal coverage.

Insulin Supplies

• Insulin comes in various forms, such as vials, pre-filled pens, cartridges, and reusable pens.
• Most pre-filled insulin pens come in a box of 5; Each pen contains 3mL, with a 200U/mL dosage; One box typically lasts 45 days for patients who use 40 units daily.
• Specific examples of various insulin pens and cartridges mentioned include Tresiba, HumaPen, NovoPen, ClikSTAR, and KwikPen.

Injection Techniques

• No need to pinch skin.
• Hold needle for 5-10 seconds to allow full insulin delivery.
• Avoid injecting into the abdomen during pregnancy (use on thigh).
• Injection sites should also avoid areas where lumps or bumps are present.
• Use a new needle for each injection.