Post on 12-Apr-2018
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ContentsInformation 3
Anyquestions? 3
Glossaryofterms 3
WhydoIneedinsulin? 4
Whatdoesinsulindo? 5
Whyaretheredifferenttypesofinsulin? 5
HowdoItakeinsulin? 5
HowdoIusemyinsulinpen? 6
WheredoIinjectmyinsulin? 7
HowdoIstoremyinsulin? 7
HowoftendoIneedtoinjectinsulin? 8
WhendoIinjectinsulin? 8
Doesinsulinhaveanysideeffects? 8
DoIneedtochangewhatIeat? 9
Monitoringmybloodglucose 9
Mybloodglucosetests 10
Whatishypoglycaemiaandhyperglycaemia? 11
Whatdoesa‘hypo’feellike? 11
Whatcausesa‘hypo’? 11
WhatshouldIdoifIhavea‘hypo’(Bloodglucose<4mmol/L)? 12
Hyperglycaemia,orhighbloodglucose(>15mmol/L) 14
WhatshouldIdoifmybloodglucosestayshigh? 14
Notes: 15
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InformationToreceivethisinformationinChinese,Korean,SamoanorTongan,contacttheDiabetesServiceatNorthShoreorWaitakereHospitals(09)4868920extn2505.
Aninterpretercanbearrangedforclinicappointmentsifyouneedone.
Forhealthadvice24hours/daycontactHealthline0800611116orwww.healthline.co.nz
Forfurtherresources,visitHealthNavigatorwww.healthnavigator.org.nzorDiabetesNewZealandwww.diabetes.org.nz
Any questions?Thisbookletdoesnottellyoueverythingaboutyourmedicines.
Talktoyourdoctor,pharmacistornurseifyoudonotunderstandorwanttoknowmoreaboutyourmedicines
Glossary of termsCartridge Vialofinsulindesignedtofitintoinsulinpens
Confusion Gettingmixedupormuddled
Glucose Themaintypeofsugarintheblood
Hyperglycaemia Highbloodglucose
Hypoglycaemia Lowbloodglucose
Insulin Ahormonethatlowersbloodglucoselevels
Monitoring Checking(egmonitoringbloodglucoselevels)
Pre-filled pen Adisposablependevicetogiveinsulin
Prime Setup(egprimeinsulinpen)
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Why do I need insulin?Yourdoctorhassuggestedthatyoustartinsulinbecausethisisthenextstepinthetreatmentofyourdiabetes.
Inthepast,youmayhavebeenabletocontrolyourdiabeteswithhealthyeating,regularexerciseandtablets.Thesetreatmentsarestillimportantbutnowyouneedtoaddinsulintoyourtreatmentplan.
Itiscommonforpeoplewithtype2diabetestoeventuallyneedinsulintohelpcontroltheirdiabetesandstayhealthy.
Thisisbecause,overtime,thecellsinyourpancreasbegintoslowdownandstopmakingenoughinsulinforyourbody.
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What does insulin do?Insulinhelpsmoveglucosefromyourbloodintothecellsofyourbodytomakeenergy.Ifglucosecan’tgetintoyourcellsitwillstayinyourbloodandcauseyourbloodglucoseleveltorise.Thiswillslowlycausedamagetobloodvessels,nerves,youreyes,heartandkidneys.Youwillalsoloseenergy.
Thebestbloodglucoserangeforpeoplewithdiabetesisusuallybetween5-7mmol/L(beforemeals);askyourdoctoraboutthebestrangeforyou.
AbloodtestcalledHbA1Cwillalsobearrangedbyyourdoctortocheckyourdiabetescontrol.TheHbA1Cshowsyouraveragebloodglucoselevelover2-3months.AnHbA1Clevelof50-55isthetargetformostpeoplewithdiabetes.
Why are there different types of insulin?Sometypesofinsulinworkoverashortperiodoftime(rapidandshortacting)andothertypesworklonger(intermediateandlongacting).Somehaveamixtureofshortandlongactingabilityinthem(premixed).
• Yourdoctorandthediabetesteamwillhelpyoudecidewhichinsulinwillworkthebestforyou
• Theywillhelpyouchangeyourdosetokeepyourbloodglucoseasclosetothenormalrangeaspossible(5-7mmol/L beforemeals).
Itisimportantthatyouknowwhichtypeofinsulinyouareusing.
How do I take insulin?Insulincannotbeputintoatabletbecausetheacidinyourstomachwilldestroyit.Thisiswhyyouneedtoinjectinsulin.Insulincanbeinjectedusingasyringe,butmostpeopleuseinsulinpens.
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How do I use my insulin pen?
Mix Tomakesureinsulinisevenlymixed,
rotatepenupanddownatleast20times.
Prime Dialuptwounits.
Removeneedlecapwiththeneedlepointingupwards,pressplungercheckingtoseeifinsulinflowsfromthetipoftheneedle.Repeatprocess
untilinsulinappears.
Inject Dialupyourdoseandinject.
Afterpushingtheplungerin,countto10beforeremovingtheneedle.Withdrawneedleonthesameangleastheinjection
wasdonetopreventbruising.
Dispose
ALWAYSdisposeofyoursharpssafely.Pleaseaskyourdiabetesnursewhatyoushoulddo,eachregionhastheirownmeansofsharpsdisposal.
Remember• Changeneedleseveryday• Changeinsulincartridgeevery4weeksevenifthereisstillinsulininit• Avoidhotshowersandbathswithin30minutesofaninjectionto
decreasetheriskofasuddendropinbloodsugarlevel(ahypo)• Keeptheinsulinyouareusingatroomtemperature• Keepspareinsulinvialsorsparepensintherefrigerator
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Where do I inject my insulin?• Yourstomachisthebestplacetoinjectyourinsulin;itneedstobeinjected
intothelayeroffatjustundertheskin
• Itisimportantthateverytimeyouinjectyourselfyouchangewhereyoudoit,bymovingacrossyourstomacheachtime;thishelpstostopfattylumpsfromformingwhichwouldreducetheeffectofinsulin
• Yournurseordoctorwillshowyouhowtodothis
• Mostpeoplesaythatinjectinginsulinislesspainfulthanafinger-prick
How do I store my insulin?Yourunopenedinsulinshouldbekeptinthefridge.
Theinsulinyouareusingcanbekeptatroomtemperatureforone month,afterthatitmustbethrownaway.Duringsummer,whencarryinginsulinwithyou,orinthecar,keepitinachillybag.Heatanddirectsunlightcandamageinsulinanditmaynotwork.
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Do not useinsulinthathaschangedcolourorgonelumpyDo not useinsulinthathaspassedits‘expirydate’Do not freezeyourinsulinorleaveitanywheretoowarmorinthesunDo not useinsulincartridgesorpensthatarecrackedorleaking
How often do I need to inject insulin?Youmayneedtoinjectinsulinonceortwiceaday.Thetimeofyourinjectionwilldependonwhenyourbloodglucoselevelishighest.
When do I inject insulin?Mostpeoplefindtheirbloodglucoselevelsaretoo high when they wakeinthemorning(above7istoohigh).Thishappensbecauseyourbodymakesglucoseduringthenight,notbecauseofwhatyouatethenightbefore.Togetyourmorningbloodglucoselower,youwillneed to have insulin at bedtime.
Afewpeoplefindthattheirbloodglucoselevelsarehighest later in the day.Itmaybebesttostartinsulin in the morning.
• Yourdoctorornursewillhelpyoustartandchangeyourinsulindoses.
• Itwillusuallytakeseveralweekstogetyourdoseright.
• Youwillneedweeklycontactuntilyourbloodglucoselevelsarestable.
• Somepeoplemayneedtouseinsulin2ormoretimesadaytogetbetterbloodglucosecontrol.
Pleasetalktoyourdoctor,nurseorpharmacistifyouhaveanyproblemsorifyouareworriedaboutyourinsulin.
Does insulin have any side effects?Sideeffectsfrominsulinarenotverycommon.However,ifyoudonotbalanceyoureating,exercise,diabetestabletsandinsulin,yourbloodglucosemaydroptoolow.Thisiscalledhypoglycaemia(a‘hypo’).
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Onpage11wewilltellyouwhattodoifyouhavea‘hypo’.
Ifyouhaveanysideeffectsthatyouthinkmaybecausedbyyourinsulin,talktoyourdoctor.
Do I need to change what I eat?Healthyeatingwillstillbeanimportantpartofyourdiabetestreatment.Ifyoudonotfollowahealthyfoodplan,itwillbehardertocontrolyourbloodglucoselevels.
Youarealsolikelytoputonextraweightifyoueatmorefoodthanyourbodyneedsforenergy.Themoreweightyouhave,themoreinsulinyoumanyneed.
Itisimportantthatyouhaveregularmealscontainingcarbohydratesothatyoubalancewhatyoueatwithhowmuchinsulinyouinject.Somepeopleneedsnacksbetweenmeals,butifyouwanttocontrolyourweight,snacksmaynotbenecessary.Checkwithyourdoctorornurseforadvice.
Monitoring my blood glucoseYournurseorpharmacistwillshowyouhowtocheckyourownbloodglucoselevelsusingyourbloodglucosemeter.Checkingyourlevelsathomewillhelpyoutoseehowwellyourbodyrespondstoyourfoodplan,exercise,diabetestabletsandinsulin.Thegoalformostpeopleistokeepbloodglucoselevelsasclosetothenormalrangeaspossible(5-7mmol/Lbeforemeals).
Whenyoufirststartinsulinyouwillneedtotestyourbloodglucoseatleast3to4timesaday.Butonceyouhavefoundtheinsulindosethatbestsuitsyou,youcandolesstesting.Sometimespeoplealsoneedtotesttheirlevels2hoursaftermeals.Occasionallyyoumaybeaskedtotestovernight.
Ifyouareunwellitisimportantyoudomoretestingbecauseitcanchangeyourbloodglucoselevel.
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My blood glucose testsKeeparecordofyourglucoselevelsinatablelikethisone,oryoucanuseanApp.Thiswillshowhowwellyourdiabetesiscontrolledandifyouneedanychangestoyourtreatment.
Before breakfast
2 hours after
Before lunch
2 hours after
Before dinner
2 hours after
Bedtime 2am
You should think about wearing a MedicAlert® bracelet. Ifthereisanemergencythiswilltellotherpeoplethatyoutakeinsulin.
ContactMedicAlert®on0800840111orwww.medicalert.co.nz
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What is hypoglycaemia and hyperglycaemia?• Hypoglycaemia,ora‘hypo’or‘lowbloodglucose’iswhenyourblood
glucosefallsbelow 4mmol/L• Hyperglycaemiaor‘highbloodglucose’iswhenyourbloodglucoselevel
stayshigherthan15mmol/LPleasereadthefollowingpagesasitisimportanttoknowhowtotreata‘hypo’immediately.
What does a ‘hypo’ feel like?Youmayhavesome or all ofthesesymptoms:• Blurredvision• Pins&needlesonthelipsortongue• Hungry• Poundingheart• Lookpaleandhavesweatyskin• Headache• Light-headed• Dizziness• Tremblinghands• WeakandtremblingkneesSomepeoplefeelconfused,anxiousorirritableaswell.
What causes a ‘hypo’?• Amissedmealorsnack,latemealorsnackornoteatenenough
carbohydrate(starchy)foods• Moreexerciseorphysicalactivitythanusualwithouteatingextra
carbohydrates• Havingtoomuchinsulinortoomanydiabetestablets• Drinkingalcoholwithoutfood
Talktoyourdoctorornurseifyouhavea‘hypo’whilefirststartinginsulinorif‘hypos’arehappeningoften.
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What should I do if I have a ‘hypo’ (Blood glucose <4mmol/L)? Checkyourbloodglucoseifpossible.Ifyoufeelanyofthe‘hypo’symptoms,treatitrightaway.TakeONEofthefollowing‘sugary’foodsordrinktoraiseyourbloodglucosequickly:
3 teaspoonsofjamorhoneyorsugarinwater
OR HALF a glassofnormal(notdiet)
lemonadeorsugarydrink(egfizzydrinkorjuice)
OR 6-7 smalljellybeans
OR Useglucosetablets,gelorpowderfromyourpharmacy:
3-4glucosetabletsor1Hypofit®sachetor
2heapedteaspoonsofglucosepowderdissolvedinwater
THENIfyoustillfeel‘hypo’symptoms,testyourbloodglucoseagain.Ifityoudonothaveyourmeterwithyou,takeoneoftheaboveevery5-10minutesuntilyoufeelbetter,oruntilyourbloodglucoseisupto4mmol/Lifyouhaveyourmeter.
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When your blood glucose is up to 4mmol/L, have a meal if it is your usual meal time or have a snack such as:
• Athinsliceofbread or
• Aglassofmilk or
• 2-3crackerbiscuits or
• Asmallcontainerofyoghurt or
• Awholepieceofrawfruit(eganapple)
Be preparedYoushouldalwayscarrysomethingsugarywithyouincaseyouhavea‘hypo’.
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Hyperglycaemia, or high blood glucose (>15mmol/L)Ifyouhaveeatentoomuchsweetorstarchyfoodyourbloodglucosemaygettoohigh.Thisiswhenyourbloodglucoselevelstaysover15mmol/L.
Signsthatyourbloodglucoseistoohighare:
• Youaremorethirsty
• Youaregoingtothetoiletalottopasswater
• Youfeelmoretired
• Youhaveblurredvision
Somepeoplemayhavenosymptomsandonlynoticethattheirbloodglucoseistoohighbycheckingtheirbloodglucoselevels.
Yourbloodglucosemayalsobetoohighwhen:
• Youareunwellorhaveaninfection
• Youchangetheamountofexerciseyoudo
• Yourdoseofinsulinistoolow,oryoumissaninjection
What should I do if my blood glucose stays high?Ifyourbloodglucosefallsafterafewhoursyouusuallydon’tneedtoworry.Butifitstayshigh(over15mmol/L)after2or3days,youmayneedmoreinsulin.
• Checkyourbloodglucoselevelmoreoften.
• Seeyourdoctorornurseforadvice.