When you are first diagnosed with diabetes, the terms and technologies associated with your diabetes care can be overwhelming. You are suddenly expected to learn an entirely new language. Words like glucose, blood glucose monitoring, self-monitoring, insulin, and glucagon are thrown at you.
We want to make things a bit easier for you. Here is a basic introduction to some of the terms you will need to know to manage your diabetes care.
What are the types of diabetes?
There are three main types of diabetes—type 1 diabetes, type 2 diabetes, and gestational diabetes. LADA and MODY are considered subtypes of diabetes.
None of them are the good kind of diabetes or the bad kind. Each type of diabetes has its own challenges as we will explain.
Type 1 diabetes
Type 1 diabetes is also known as insulin-dependent diabetes. It was previously called juvenile-onset diabetes because it often, but not always, begins in childhood. It is an autoimmune condition that occurs when your body attacks your pancreas with antibodies. The organ is damaged and doesn’t make insulin.
Type 2 Diabetes
In the case of Type 2 diabetes, it begins as insulin resistance. Your body is unable to use it’s insulin efficiently. This stimulates your pancreas to produce more insulin until it can no longer keep up with demand. Insulin production then decreases, which leads to high blood sugar.
Gestational diabetes
Gestational diabetes is due to insulin-blocking hormones produced during pregnancy. This type of diabetes only occurs during pregnancy.
Latent Autoimmune diabetes of adulthood
Latent Autoimmune Diabetes of Adulthood or LADA is a form of type 1 diabetes that develops later into adulthood. Unlike Type 1 diabetes in children which tends to happen quite quickly, LADA can take years to develop. It is often mistaken for Type 2 diabetes in older adults. A diagnosis of LADA can be achieved by examining the presence of elevated levels of pancreatic autoantibodies amongst patients who have recently been diagnosed with diabetes but do not require insulin. According to Diabetes UK, a GAD Antibody test can measure the presence of these autoantibodies.
Maturity Onset diabetes of the Young
Maturity Onset Diabetes of the Young, or MODY is more likely to be inherited than other types of diabetes. It has a strong genetic risk factor. It shares some type 2 diabetes symptoms but is not linked to obesity. Many patients with MODY are young and not necessarily overweight. This type of diabetes tends to occur in people before the age of 25. It may or may not require the use of insulin.
Blood Glucose Monitoring
Blood glucose monitoring can be done using the tips of the fingers, Alternate Site Testing (AST) on such places as the sides of the hands, the forearm and the leg, or by using a continuous or flash glucose monitor. Whenever your readings do not seem to reflect how you feel, always rely on the fingertip for most reliable results.
What does “blood glucose monitoring” monitor?
Glucose is a type of sugar. The body forms glucose when it breaks down the food we eat into a useable form of energy. Glucose is the body’s main source of energy. Measuring the amount of glucose found in your blood helps to show how the body is breaking down food into energy. It also can show how the liver is working.
Blood glucose monitoring may be done:
- Fasting blood sugar: done after you have not eaten for 12-14 hours and is often used in a clinical setting to diagnose diabetes.
- Postprandial checks: are done within 2 hours after a meal.
- Random checks: are done at various times throughout the day to manage unexpected highs or lows.
How often should I check my readings?
To properly manage your diabetes care, it is important to know what your blood glucose levels are. According to Diabetes Canada’s Clinical Practice Guidelines, people with type 1 diabetes and those with type 2 who are on insulin, should at minimum be checking their blood glucose levels at least three times per day. “More frequent testing before meals, two hours after meals, as well as overnight is often required to provide information to reduce the risk of hypoglycemia and well as night-time lows.”
Most people living with type 1 diabetes who wish to maintain tight control are checking their blood glucose at least 8-16 times per day. They will want to monitor their range after food, before and after exercise, as well as during illness and times of stress. This information allows them to make changes to doses as well as to correct high or low blood sugars throughout the day and night.
When should you check blood glucose levels?
Many doctors suggest checking before each meal, before, after and during strenuous physical activity, and before bed. Some people like to check at least once throughout the night to ensure that night-time basal insulins are working properly.
Consult with your diabetes team to see how often you should check your blood glucose levels.
What do the numbers on the meters mean?
Under certain conditions, blood glucose check results obtained using samples taken from your arm or displayed on a continuous glucose or flash monitor may differ significantly from fingertip samples. Always follow the results of the fingerstick.
The conditions in which these differences are most likely to occur are when your blood glucose is changing rapidly such as following a meal, an insulin dose or associated with physical exercise.
When blood glucose is changing rapidly, fingertip samples show these changes more quickly than arm samples.
Checks performed within two hours after a meal, an insulin dose or physical exercise, or whenever you feel that your glucose levels may be changing rapidly, should be done from the fingertip.
You should also use fingerstick check whenever you have a concern about hypoglycemia (insulin reactions) such as when driving a car, particularly if you suffer from hypoglycemic unawareness (lack of symptoms to indicate an insulin reaction), as arm testing may fail to detect hypoglycemia.
Alternate Site Blood Checks
Alternate Site Checking involves taking a blood sample on the side of the hand and arm using the Freestyle Mini™ glucometer.
Postprandial Readings
A postprandial reading is that reading taken 1 hour after a meal. Ideally, for children under 5 years old the reading should be under 13.7 mmol/L (250mg/dl). For children 5-11 years old, the reading should be under 12.5 mmol/L(225 mg/dl) and adults would aim to keep it under 11.1 mmol/L(200 mg/dl). It is felt that high postprandial numbers may account for higher A1c readings. High postprandial readings may also lead to kidney disease 9 years earlier than in those with lower
readings.
For the most up-to-date guidelines on ideal blood glucose readings, please check the latest Clinical Practice Guidelines like those released by Diabetes Canada.
For many people, postprandial ideals are hardest to achieve after breakfast. One way to avoid this “spike” is to look at adjusting the time at which one boluses. If the bg levels are low before breakfast and you are having a low Glycemic Index meal, you may wish to bolus within 15 minutes of the meal. If you have a high bg level and a high glycemic index meal, one would try to bolus 15-20 minutes before the meal. For normal to moderate glycemic index meals, one would one to bolus about 5 minutes before the meal.
*From Gary Scheiner’s Strike the Spike
Another option is of course to try John Walsh’s “super bolus“. This incorporates some of the basal rate into the initial bolus.
Download the symptoms of high and low blood sugar levels here.
Ketone Testing
Ketones occur when the body breaks down fat for energy instead of getting energy from the carbohydrates found in your diet. If your diet does not contain enough carbohydrates to supply the body with sugar(glucose) for energy or if your body cannot use blood sugar (glucose) properly, stored fat is broken down and ketones are made.
This can be very dangerous for people who have diabetes. The most accurate method of testing to see if the body is “spilling ketones” is to use a home blood ketone meter such as the Precision Xtra ™ or Freestyle Neo. A urine test will also detect ketones but it is less accurate than a blood test.
Read What you should know about ketones.
Get a free copy of our ketone chart
What is the difference between fingerstick glucose monitoring and using a Continuous Glucose Monitor?
Fingerstick glucometers are portable devices that read glucose levels from a blood sample. The blood is placed on a tiny test strip. Test strips are discarded after a single-use. Meters store a limited number of glucose results in their memory. The results can be downloaded into a computer.
A Continuous Glucose Monitor (CGM) requires a glucose sensor (a tiny electrode) that is inserted by the person with diabetes under their skin (subcutaneous tissue). It continuously records glucose levels around the clock.
The sensor is worn for approximately seven days (the actual life of a sensor depends on the manufacturer) before it is discarded and replaced by the patient. Glucose readings are transmitted to a monitor, smart device or insulin pump where the values are displayed. Trend reports and charts can be viewed after data is downloaded to a computer.
A Flash Monitoring System is similar to a continuous glucose monitor but readings are only received when the “wand” or reader, is passed over the sensor.
When using a glucometer, flash monitor, or a CGM, you may see a difference in your readings. There is often a lag between the CGM or flash system and a glucometer. Updated algorithms in devices like the Dexcom G6, work to bridge that gap however.
Methods of insulin delivery
For people who no longer produce insulin, like those living with Type One Diabetes, there are two methods of insulin delivery available to them–insulin injections or the use of an insulin pump.
Insulin injections are taken once a day or for more intensive management, multiple times throughout the day to manually mimic the actions of the pancreas. A combination of long and short/rapid-acting insulins are used to achieve this.
Insulin pumps are small, computerized devices that deliver specific amounts of insulin to the wearer through tubing. This is not an artificial pancreas but an insulin delivery method.
For a complete listing and detailed information on adding an insulin pump to your diabetes care routine, please see our Insulin Pump page.
Types of Insulin Available in North America
Insulin types currently available in Canada include:
- Novorapid®
- Fiasp®
- Admelog®
- Humalog®
- Lyumjev®
- Apidra®
- Humulin R®
- Novolin ge Toronto®
- Entuzity®
- Tresiba®
- Levemir®
- Humulin N ®
- Novolin ge NPH®
- Lantus®
- Basaglar®
- Toujeo®
- Humulin® Mix25
- Humulin® 30/70
- Novolin® ge 30/70
- Novolin® ge 40/60
- Novolin® ge 50/50
- NovoMix® 30
Insulin types currently available in the USA include:
- Humalog®
- Lyumjev®
- Apidra®
- Fiasp®
- Novolog®
- Afrezza
- Velosulin
- Novolin
- Humulin R®
- Tresiba®
- Levemir®
- Humulin N ®
- Novolin ge NPH®
- Lantus®
- Basaglar®
- Toujeo®
- Humulin® Mix25
- Humulin® 30/70
- Novolin® ge 30/70
- Novolog® ge 40/60
- Novolog® ge 50/50
- Novolog Mix® 70/30
- NovologMix® 30
Insulins vary from rapid acting acting insulin that begins to work within 10 minutes of injection and can last for 3-5 hours, to long lasting insulin with little to no peak that can last as long as 36 hours. Consult your diabetes team to learn which insulin is best suited for your needs.
Rapid Acting Insulin
Rapid acting insulin begins to work within approximately 15 minutes of injection. It is will peak in one to two hours, but last up to four hours.
There are three different types of rapid acting insulin insulin aspart (Fiasp, NovoLog/NovoRapid) Insulin glulisine (Apidra), and insulin lispro (Admelog, Humalog, Lyumjev). They act the most like insulin produced by the human pancreas. It is usually used for the start of meals, to bring down hyperglycemia, and as the insulin used in insulin pumps.
Intermediate Insulin
NPH or intermediate insulin takes 1-2 hours to kick in and will reach its peak in 4-6 hours. This type of insulin is absorbed at a more slower rate and will last longer than a rapid insulin. The duration of action for these type of insulins can be over 12 hours.
Long Acting Insulin
Long acting insulin is used as a background insulin. It begins to work with 90 to 120 minutes. The insulin plateaus over the next few hours and then remains working at relatively flat level for 12-24 hours if it is an insulin detemir or 24 hours for insulin glargine.
What is an A1c
A1C (or HbA1c) measures how much glucose is stuck to your haemoglobin. Haemoglobin is a protein inside your red blood cells. It is the part of the red blood cell that carries oxygen from your lungs to the rest of your body. Haemoglobin also carries glucose, because glucose can stick to all kinds of proteins in your body.
Once glucose sticks to haemoglobin, it is stuck there for the life of the red blood cell, about three or four months. The more glucose there is in your blood, the more will end up stuck to the haemoglobin. Your A1C reading tells you what your average blood glucose level has been over the last two or three months. If you have lots of glucose in your blood and your average blood glucose has been high for the past few months, then your A1C will be high. Diabetes Canada’s Clinical Practice Guidelines recommend that anyone living with diabetes have their A1c checked every 6 months.
Please remember that these are guidelines. Consult with your diabetes care team to determine where your ideal A1c should be.
You can read more about things that you should know about your hbA1c in this article.
What is the goal for Time in Range?
Time in Range refers to the amount of time that your blood glucose values stay within parameters set by your diabetes team. The exact goals for Time in Range are usually established by your doctor but international guidelines have suggested that being able to stay between 3.8mmol (70mg/dL) and 10mmol (180mg/dL) for 70% of the time over a 14-day period is optimal.
Learn more about time in range by clicking the link below.
How to prevent complications
Diabetes complications are both real and scary. Many feel that they are to blame if they develop any issues because of their diabetes. While poor care can contribute to some issues, diabetes is a disease and disease can wreak havoc on the body.
You can do a few things that help reduce your risk of complications. Make sure to
- have regular eye exams
- get routine urine screening
- take care of your feet and learn proper foot care
- keep in touch with your diabetes team and attend regular check-ups.
What you need to know about urine screening
High blood glucose levels require the kidneys to filter too much blood. This extra work is hard on the filters. After many years of such a strain, the kidneys can start to leak and useful protein is lost in your urine. This is why it is important to have your urine checked on a regular basis.
People with type 2 diabetes are usually checked for kidney disease upon diagnosis. For those with type 1 diabetes, there may be a baseline taken at diagnosis but regular checks usually don’t begin until 5 years after diagnosis. Children with type 1 diabetes will have their urine randomly checked but regular screening does not normally happen until during puberty or 5 years after diagnosis.
According to Diabetes Canada, if you have diabetes and show a result of 2.0 ( 30mg/dl) or higher, you could have some kidney damage. If your urine shows an elevated amount in the random sample done with your bloodwork, your diabetes team may request that you do a 24-hour urine collection. This will give them a much better idea of whether or not there is any real damage or the first result was an anomaly.
What are the symptoms of high urine?
For most people there are no symptoms at all which is why it is important to have your kidney function checked regularly if you have diabetes. In some cases, a person can experience a buildup of fluids. They may be having issues sleeping, have a poor appetite, upset stomach, feel weak, and have difficulty concentrating.
How to treat kidney damage?
According to the UK’s National Health Services, the treatments will depend on the severity of the condition.
Small amounts of protein in your urine is called microalbuminuria. Treatment for microalbuminuria can range from lifestyle change to medications that are associated with high blood pressure and high cholesterol.
Larger amounts of protein are called macroalbuminuria. This can be much more serious. If the issue is not caught until you have reached the large stage, end stage renal disease may soon follow. Treatment for this could be dialysis or even a kidney transplant.
How to prevent kidney damage?
The best way to prevent kidney damage is to maintain tight control.
Chronic high blood glucose levels do more than just narrow and clog the blood vessels in your kidneys. It can damage the nerves that carry messages between your brain and your bladder. The damaged nerves may no longer tell you when your bladder is full and the subsequent pressure from a full bladder can damage your kidneys.
High blood glucose levels also create a breeding ground for urinary tract infections. Sometimes the urinary tract infection can spread to the kidneys causing damage there as well.
How to protect your eyes
You don’t have to have poor control to develop retinopathy or other complications so make sure that you do schedule regular eye checkups for yourself or your loved one with diabetes.
High blood sugars can harm the small vessels of the eye and create vision problems. Good glucose control does not, however, guarantee that you can’t have sight issues.
Since people with diabetes are more likely to have
- Cataracts
- Age-Related Macular Degeneration (AMD)
- Glaucoma
- Diabetic Macular Edema (DME)
- And of course, Diabetic Retinopathy
Again, this is why it is vital that to have a regular eye exam. If your blood glucose is high or low at the time of your eye exam, it will impact your vision. Make sure that your clinician does not write you out a prescription for glasses when out of range. Come back another time to get a true gauge of your proper eyesight.
Glucagon
Glucagon is a hormone that raises the level of glucose in the blood. The alpha cells of the pancreas, in areas called the islets of Langerhans, make glucagon when the body needs to put more sugar into the blood.
Everyone who uses insulin should have a glucagon emergency kit on hand at all times to counteract severe hypoglycemia that causes loss of consciousness, or if sugar cannot be given. The glucagon kit should be stored where all the family members know where to find it. Storage temperatures should be under 90 degrees F (28 degrees C).
Glucagon, like insulin, must be injected. Within the glucagon kit is a syringe pre-filled with a liquid and a vial of powdered glucagon. You prepare the glucagon for injection immediately before use by following the instructions that are included with the glucagon kit.
In general, small children (under 20 kg, or 44 pounds) are given 1/2 cc (half the syringe), while older children and adults are given 1cc (the entire syringe). In kids, some authorities advise using 1/2 cc to start with, then giving the other 1/2 about 20 minutes later if needed. This method can lessen the rebound hyperglycemia that usually ensues after use of glucagon.
There is no danger of overdose. The injection is given in a large muscle, such as the buttocks, thigh or arm. (The needle on the syringe is usually larger than those on insulin syringes.) *from http://www.childrenwithdiabetes.com/d_0n_022.htm
What do you do when Glucagon expires?
The importance of medical ID for people with diabetes
If you are living with type 1 or type 2 diabetes, it is also important to have some sort of medical ID. These can be anything from necklaces and bracelets to medical tattoos. A medical ID will speak for you in an emergency if you are not able to speak for yourself.
Lauren’s Hope, an organization offering medical jewelry has a great article further explaining why it is important to wear something that will identify you as having diabetes.
Handling the emotional side of diabetes care
Living with diabetes is more than just the highs and lows of blood glucose levels. It is a 24/7 job that takes no holidays. The stress of life with type one and type two diabetes is very real. It is therefore very important to also take care of your mental health as when managing with your diabetes care.
- Take time out for you
- Learn how to take life four hours at a time
- Reach out for help when you need it
- Take a diabetes day
- Journal your frustrations
- Contact a mental health professional if it becomes too much for you to handle on your own.
