An Introduction to Diabetes Care

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.

Please remember to consult with your diabetes care team before making any changes to your diabetes care.  Information provided is for your consideration only and is not meant to be taken as medical advice in any way.

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.  We will explain the differences between all five below.

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.

Read why we feel that sugar did not cause your diabetes.

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. 

Why is it important to check blood glucose levels?

To properly manage your diabetes care, it is important to know what your blood glucose levels are.  If they are too high or too low, it can lead to disastrous long-term and short-term complications.

Read more about what you need to know about checking your blood glucose levels.

When should you check blood glucose levels?

When you should check your blood glucose levels depends on if you have Type 1 Diabetes or not and how active you are. Current Diabetes Canada Clinical Practice guidelines suggest checking blood glucose levels at least four times per day. 

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 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.

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.
• When your blood glucose is falling, testing with a fingertip sample may identify a hypoglycemic (low blood sugar) level sooner than a test with an arm sample.
• Use arm samples only for testing prior to, or more than 2 hours after, meals, insulin dosing or physical exercise.
• 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

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.

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.

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.

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