What you need to know

Starting insulin treatment for people with type 2 diabetes

2

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

3

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)

4

Why do I need insulin?Yourdoctorhassuggestedthatyoustartinsulinbecausethisisthenextstepinthetreatmentofyourdiabetes.

Inthepast,youmayhavebeenabletocontrolyourdiabeteswithhealthyeating,regularexerciseandtablets.Thesetreatmentsarestillimportantbutnowyouneedtoaddinsulintoyourtreatmentplan.

Itiscommonforpeoplewithtype2diabetestoeventuallyneedinsulintohelpcontroltheirdiabetesandstayhealthy.

Thisisbecause,overtime,thecellsinyourpancreasbegintoslowdownandstopmakingenoughinsulinforyourbody.

5

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.

6

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

7

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.

8

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’).

9

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.

10

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

11

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.

12

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.

13

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’.

14

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.

15

Notes:

Classificationnumber076801005(Reviewdate:July2018)