Types of Diabetes Symptoms of Diabetes Early Symptoms of Diabetes Diabetes Treatment Diabetes Diet Insulin Pump

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Types of Diabetes
Symptoms of Diabetes
Early Symptoms of Diabetes
Diabetes Treatment
Diabetes Diet
Insulin Pump
Diabetes explained
Diabetes explained
Diabetes is a chronic condition marked by high blood glucose (sugar) levels. Our
bodies rely on blood glucose for energy.
Blood glucose levels are normally regulated by a hormone called insulin, which is
made by the pancreas.
Insulin stimulates the body’s cells to use glucose as energy. When a person has
diabetes, the pancreas doesn’t make enough insulin, or the cells don’t respond to the
hormone.
Latest research has shown that in the Australian population aged 25 years or older,
7.5 per cent have diabetes. The risk of diabetes increases with age, from 2.5 per
cent in people aged between 35-45 years to 23.6 per cent in those over 75.
Aboriginal people have one of the highest rates of Type 2 diabetes in the world.
There are two main types of diabetes

Type 1 (insulin dependent diabetes mellitus):
Is caused by an autoimmune destruction of insulin-making cells in the pancreas,

which means insulin is no longer made.
Is one of the most common childhood diseases in developed nations.
Can occur at any age.
Type 2 (non-insulin dependent diabetes mellitus) is:
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Caused by either inadequate levels of insulin or insulin that doesn’t work effectively
in the body.
Most common after the age of 40, although the age of onset can be earlier.
Often, but not always, associated with obesity, particularly around the abdomen or
upper body.
Found in families, but no specific genes have been found.
Responsible for 85 to 90 per cent of all diabetes in developed countries.
Symptoms of high blood glucose
When there are high levels of glucose in the blood, the body loses its main source of
energy, even though the blood contains large amounts of glucose. The build-up of
glucose in the blood can cause distressing symptoms and actual harm to the body’s
cells. Symptoms include:
Extreme tiredness
Excessive thirst
Blurred vision
Increased risk of infections.
Get help immediately if these symptoms occur
Occasionally, the onset of diabetes - particularly Type 1 - can be abrupt. It can lead
to a condition called 'keto acidosis', which is a medical emergency. The symptoms of
this condition are loss of appetite, weight loss, vomiting, excessive passing of urine,
altered consciousness and, finally, coma. Seek medical help immediately if these
symptoms occur.
Untreated diabetes can cause long term damage

If untreated, high blood glucose levels can be life threatening. The damage to the
body’s cells can cause:
Kidney damage
Eye damage
Nerve damage to feet and other parts of the body
Heart disease and circulation problems in the legs
Stroke
Impotence.
Types of help available
There is no cure for diabetes, but the symptoms can be controlled. The treatment
depends on the type of diabetes. The aim of all treatment is to control blood glucose
levels, blood pressure, weight and blood fat levels. Treatments can include:
A low fat, high carbohydrate diet.
Regular exercise.
Avoiding cigarettes.
Insulin injections or tablets to control blood glucose levels.
Where to get help
Your doctor
Your local community health centre
Diabetes Australia Victoria Tel. 1300 136 588
International Diabetes Institute Tel. (03) 9258 5000
Juvenile Diabetes Research Foundation Tel. (03) 9696 3866
Things to remember
People with diabetes have high blood glucose levels, caused by a problem with the
hormone insulin.
Diabetes is a common chronic condition.
There is no cure, but the symptoms can be controlled with diet, exercise and
medication.
Diabetes tests
Diabetes - diagnostic tests
The main diagnostic test for diabetes is taking a blood test to measure glucose,
either when you have been fasting or at other times of the day. Diagnostic tests are
also used routinely during pregnancy to identify gestational diabetes.
High blood sugar levels harm the body

The hormone insulin helps to move blood sugars (glucose) into cells and convert
glucose into energy. Diabetes is a condition characterised by abnormally high levels
of glucose in the blood. This occurs because either not enough insulin is made or the
cells don’t respond to the hormone.
Untreated, high glucose levels can cause serious damage to many parts of the body,
including:
Kidney damage
Eye damage
Nerve damage to the feet and other parts of the body
Stroke
Impotence.
Accuracy of test results
Depending on the test used, the level of blood glucose can be affected by many
factors including:
Eating or drinking
Taking medications that are known to raise blood sugar levels, such as oral
contraceptives, some diuretics (water pills) and corticosteroids
A recent injury, physical illness or surgery that may temporarily alter blood sugar
levels.
Test procedures
Most diabetes tests require blood samples. Generally, a band is tightened around
your upper arm to slow blood flow and cause the veins below the band to stand out.
The intended injection site is swabbed with alcohol. The hypodermic needle is
inserted into the vein and the blood is directed into a collection tube. The band may
be removed from your arm while the blood is being taken.
You may need more than one collection tube, depending on the test. After the blood
is taken, you are asked to press a cotton ball or gauze against the injection site.
Once bleeding has stopped, the injection site is covered with a sticking plaster.
Types of tests
Tests to diagnose diabetes include:
Fasting blood glucose test – blood glucose levels are checked after fasting for
between 12 and 14 hours. You can drink water during this time, but should strictly
avoid any other beverage. Patients with diabetes may be asked to delay their
diabetes medication or insulin dose until the test is completed.
Random blood glucose test – blood glucose levels are checked at various times
during the day, and it doesn’t matter when you last ate. Blood glucose levels tend to
stay constant in a person who doesn’t have diabetes.
Oral glucose tolerance test – a high-glucose drink is given. Blood samples are
checked at regular intervals for two hours.
The most common test for diagnosis of diabetes is the fasting blood glucose test.
Glucose tolerance tests are used when the results of the fasting blood glucose are
borderline. They are also used to diagnose diabetes in pregnancy (gestational
diabetes).
Immediately after the procedure

The fasting blood glucose test will confirm that the person has diabetes if it shows
that the level of glucose in their blood is higher than normal when they are fasting.
Sometimes the test result of the fasting blood glucose test is borderline. If this is the
case, a glucose tolerance test may be performed. This test will confirm diabetes if
the person’s blood sugar levels stay high for a long time after the tests.
If a person doesn’t have diabetes, the results of the glucose tolerance test will show
that their blood sugar levels fall within the normal range.
Possible complications
Possible complications of diabetes testing include:
Some people feel faint or nauseous at the sight of blood or needles
Bleeding and bruising at the injection site
Infection of the skin at the injection site
Multiple injection sites if collecting the blood is difficult
A reaction following the oral glucose tolerance test if the patient has diabetes
mellitus or hypoglycaemia (low blood sugar levels) – medications may be needed.
Taking care of yourself at home
Be guided by your doctor, but generally there are no special instructions to follow
after having a diabetes test.
Long-term outlook
Gestational diabetes is a temporary condition that usually resolves by itself once the
baby is born. Regular monitoring throughout the pregnancy is recommended.
There is no cure for diabetes mellitus, but the condition can be managed. Treatment
depends on the type of diabetes (type 1 or type 2), but the general aim is to control
blood sugar levels and keep them within the normal range. Treatment options may
include:
Low fat, high carbohydrate diet
Regular exercise
Insulin injections or tablets
Other medications as required.
Other blood glucose tests
A person with diabetes may regularly check their blood sugar levels at home using
glucose test strips. This is a monitoring test, not a diagnostic test.
Where to get help

Your doctor
Things to remember
There are various tests your doctor may wish to perform if you have symptoms of
diabetes, including a random blood sugar test, a fasting blood sugar test or an oral
glucose tolerance test.
Factors that can affect the accuracy of test results include failure to follow pre-test
instructions, recent injury or illness, and certain medications including oral
contraceptives, corticosteroids and antidepressants.
Insulin pump
An insulin pump is a medical device used for administering insulin in the treatment of
diabetes mellitus. The device includes:
the pump itself (including controls, processing module, and batteries)

a disposable reservoir for insulin (inside the pump)
a disposable infusion set, including a cannula for subcutaneuos insertion (under the
skin) and a tubing system to interface the insulin reservoir to the cannula.
An insulin pump is an alternative to multiple daily injections of insulin by syringe or
an insulin pen and allows for intensive insulin therapy when used in conjunction with
blood glucose monitoring and carb counting.
Contents [hide]
1 Dosing
1.1 Bolus Shaping
1.2 Basal Rate Patterns
1.3 Temporary Basal Rates
2 Advantages
3 Disadvantages
4 Acceptability
5 Recent developments
6 Current insulin pump manufacturers
7 Future developments
8 Bibliography
9 External links
[edit] Dosing
Insulin pump therapy, also known as continuous subcutaneous insulin infusion,

allows the pump user to replace the use of slow-acting insulin for basal insulin needs
with a continuous infusion of rapid-acting insulin.
The insulin pump delivers a single type of fast-acting insulin in two ways:
a bolus dose that is pumped to cover food eaten or to correct a high blood glucose
level.
a basal dose that is pumped continuously at an adjustable basal rate to deliver
insulin needed between meals and at night.
[edit] Bolus Shaping

An insulin pump user has the ability to influence the profile of the rapid-acting insulin
by shaping the bolus. While each user must experiment with bolus shapes to
determine what is best for any given food, they can improve control of blood sugar
by adapting the bolus shape to their needs.
A standard bolus is an infusion of insulin pumped completely at the onset of the

bolus. It is most similar to an injection. By pumping with a "spike" shape, the
expected action of insulin is the fastest possible for that type of insulin. The standard
bolus is most appropriate when eating high carb low protein low fat meals because it
will return blood sugar to normal levels as fast as possible.
An extended bolus is a slow infusion of insulin spread out over time. By pumping
with a "square wave" shape, the bolus avoids a high initial dose of insulin that may
enter the blood and cause low blood sugar before digestion can facilitate sugar
entering the blood. The extended bolus also extends the action of insulin well beyond
that of the insulin alone. The extended bolus is appropriate when covering high fat
high protein meals such as steak, which will be raising blood sugar for many hours
past the onset of the bolus. The extended bolus is also useful for those with slow
digestion (such as with Celiac disease).
A combination bolus is the combination of a standard bolus spike with an extended

bolus square wave. This shape provides a large dose of insulin up front, and then
also extends the tail of the insulin action. The combination bolus is appropriate for
high carb high fat meals such as pizza, pasta with heavy cream sauce, and chocolate
cake.
A super bolus is a method of increasing the spike of the standard bolus. Since the
action of the bolus insulin will be for several hours, the basal insulin could be stopped
or reduced during this time. This facilitates the "borrowing" of the basal insulin and
including it into the bolus spike to deliver the same total insulin with faster action
than spike plus basal rate.
[edit] Basal Rate Patterns

The pattern for delivering basal insulin throughout the day can also be customized
with a pattern to suit the pump user.
A reduction of basal at night to prevent low blood sugar.

A pre-dawn increase to prevent high blood sugar due to the dawn effect.
In a proactive plan before exercise times.
[edit] Temporary Basal Rates

Since the basal insulin is provided as a rapid-acting insulin, the basal insulin can be
immediately increased or decreased as needed with a temporary basal rate.
Examples when this is helpful include:
During illness or stress, when basal demand increases due to insulin resistance.
During a long car drive, when more insulin is needed due to inactivity.
During and after exercise, when the body needs less insulin.
[edit] Advantages
The use of rapid-acting insulin for basal needs offers relative freedom from a
structured meal and exercise regimen previously needed to control blood sugar with
slow-acting insulin.
Many pumpers feel that bolusing insulin from a pump is more convenient and
discrete compared to injection.
Insulin pumps also make it possible to deliver more precise amounts of insulin than
can be injected using a syringe. This supports tighter control over blood sugar and
Hemoglobin A1c levels, reducing the chance of long-term complications associated
with diabetes. This is predicted to result in a long term cost savings relative to
multiple daily injections.[1]
[edit] Disadvantages
Insulin pumps, cartridges, and infusion sets are more expensive than syringes used
for insulin injection.
Since the insulin pump needs to be worn most of the time, pump users need
strategies to participate in activities that may damage the pump, such as rough
sports and activities in the water. Some users may find that wearing the pump all the
time (together with the infusion set tubing) is uncomfortable or unwieldy.
A disadvantage of giving up slow-acting insulin is that the user may suffer an episode
of diabetic ketoacidosis if the pump user does not receive sufficient fast acting insulin
for many hours. This can happen if the pump battery is discharged, or if the insulin
runs empty, or the tubing becomes loose and insulin leaks rather than being injected.
Therefore pump users typically monitor their blood sugars more frequently to
evaluate the effectiveness of insulin delivery, and this should safeguard against
occurrences of ketoacidosis.
[edit] Acceptability
Use of insulin pumps is increasing throughout the world because:
it provides an easier means to deliver multiple insulin injections for those using
intensive insulin therapy. This is especially true for children and others who are
uncomfortable with needles (although the pump user still has to inject an infusion set
every few days, and poke fingers for blood glucose tests many time a day).
acceptance among doctors and insurance companies due to the benefits contributing
to reducing the incidence of long-term complications. It's also interesting to note that
because of differences in health insurance and public funding, the US has about
150,000 pump users. In the UK, NICE have now ruled that if a diabetic patient's
doctor agrees that they should be using an insulin pump, they should apply to the
NHS and they will fund it. Therefore numbers are increasing but are still less than the
USA, there are around 1100 pump users in the UK by comparison.
improvements in blood glucose monitoring. New meters require smaller drops of
blood, and the corresponding lancet poke in the fingers is smaller and less painful.
These meters also support alternate site testing for the most routine tests for
practically painless testing. This compensates for the need for pump users to test
blood sugar more frequently.
techniques learned to adapt their pump use to sports, exercise, and water sports.
Expert help is becoming common in user groups and books. The pump can be
effectively combined with partial basal insulin from the pump and partial basal insulin
from a long-acting insulin such as Lantus and Levemir. This is becoming known as
the Untethered Regemin.
[edit] Recent developments

New insulin pumps are becoming "smart" as new features are added to their design.
These simplify the tasks involved in delivering an insulin bolus.
insulin on board: Based on the time and quantity of the last bolus, the pump
software keeps track of the insulin remaining in the bloodstream and displays it on
the screen. This supports the process of performing a new bolus before the effects of
the last bolus are complete, and thereby helps prevent the user from
overcompensating for high blood sugar with unnecessary correction boluses.
bolus wizards: Pump software helps by calculating the dose for the next insulin
bolus. The user enters the grams of carbohydrates to be consumed, and the bolus
wizard calculates the number of units of insulin needed. It adjusts for the most
recent blood glucose level and the insulin on board, and then suggests the best
insulin dose to the user to approve and bolus.
custom alarms: The pump can monitor for activities during specific times of day and
then alarm the user if an expected activity did not occur. Examples include a missed
lunch bolus, a missed blood glucose test at 10am, a new blood glucose test 15
minutes after a low blood glucose test, etc. The alarms can be customized to support
each user.
touch bolus: For persons with visual impairments, this button on the pump can be
used to bolus for insulin without using the display. This works with a system of beeps
to confirm the bolus parameters to the pump user.
interface to personal computers: New pumps interface to personal computers for
managing and documenting pumps delivery programs and to upload data from the
pump. This simplifies record keeping and can be interfaced with diabetes
management software.
integration with blood glucose meters: Blood glucose data can be manually entered
into the pump for supporting the bolus wizard for calculation of the next insulin
bolus. Some pumps are supporting an interface from the insulin pump to a blood
glucose meter.
The Cozmo pump works with the CozMonitor (using Freestyle test strips) attached to
the back of the pump. The pump receives glucose readings from this attached meter
via infrared (IR).
The Medtronic Minimed Paradigm 512 insulin pump allows for radio frequency (RF)
communication to the pump. This was previously used to read blood glucose data
from a blood glucose meter called the Paradigm Link, and now can interface with a
continuous blood glucose sensor.
The Insulet Myomnipod has a separate electronic display with a built-in meter that
uses Freestyle test strips.
A remote control: allows a discrete bolus when the pump is concealed or
inaccessible.
tubeless pod: one pump can be attached directly to the skin by its infusion set,
eliminating the tube from the pump.
[edit] Current insulin pump manufacturers

http://www.animascorp.com/
http://www.minimed.com/
http://www.disetronic-usa.com/
http://www.cozmore.com/
http://www.niprodiabetes.com/home.html
http://www.myomnipod.com/
[edit] Future developments

When insulin pump technology is combined with a continuous blood glucose

monitoring system, the technology seems promising for real-time control of the
blood sugar level. Currently there are no mature algorithms to automatically control
the insulin delivery based on feedback of the blood glucose level. When the loop is
closed, the system may function as an artificial pancreas.
Insulin pumps are being used for infusing pramlintide (brand name Simlin, or
synthetic amylin) with insulin for improved post-prandial glycemic control compared
to insulin alone.
An insulin pump that can be surgically implanted inside the body will be available
soon by Medtronic. It is the approximate size of a hockey puck, and communicates
via RF to an external control. It is refilled by injection through the skin, and holds
approximately 2 weeks of insulin.
Diabetes - possible complications
Diabetes is a condition in which there is too much glucose, a type of sugar, in the
blood. A hormone called insulin, which is made in the pancreas, controls Blood
glucose levels.
When a person has diabetes, the pancreas either can’t make insulin, or the insulin it
makes isn’t enough and doesn’t work properly. If the insulin can’t do its job, glucose
builds up in the blood. Over time, high blood glucose levels can damage the body’s
organs. However, the good news is that the risk of most diabetes-related
complications can be reduced.
The most common complications

The most common complications of diabetes include:
Damage to the large blood vessels of the heart, brain and legs (macrovascular
complications).
Damage to the small blood vessels causing problems in the eyes, kidneys, feet and
nerves (microvascular complications).
Other parts of the body can also be affected by diabetes including the digestive
system, skin and immune system. Although this is not considered a complication as
such, people with diabetes may have more thyroid problems than people without
diabetes.
The risk of cardiovascular disease is increased

Cardiovascular disease, which includes blood vessel disease, heart attack and stroke,
is the leading cause of death in Australia. The risk is greater for people with diabetes.
People with diabetes often have increased cholesterol and blood pressure levels,
which, combined with increased blood glucose levels, increase the risk of
cardiovascular disease. Smoking, having a family history of cardiovascular disease
and being inactive also increase the risk.
Large blood vessel damage - reducing the risk

Damage to the large blood vessels can be reduced or even prevented. Strategies
include:
Have regular check ups - see your doctor regularly.
Don’t smoke - if you smoke, stop now. Speak to your doctor or call the Quit line for
guidance and support.
Lose weight if you are overweight - even a small weight loss, especially round the
abdomen, helps reduce your blood pressure, blood glucose and cholesterol levels.
Be as active as possible - do at least 30 minutes of moderate physical activity on
most, if not all, days of the week.
Eat healthy food - follow a healthy eating plan. It may help to consult a dietitian.
Test your blood - test glucose levels as recommended. Aim to keep your blood
glucose levels as normal as possible
Regular medical check ups are very important
See your doctor regularly and make sure you are checked for each of the following:
Cholesterol and triglycerides - have a test at least once a year. Aim for total
cholesterol of less than 4.0 mmol/L and triglycerides of less than 2.0 mmol/L
Blood pressure - every time you visit your doctor. Try to keep you blood pressure
under 130/80.
Blood glucose levels - have a HbA1c (glycated-haemoglobin) test every three to six
months. This test shows an average of your blood glucose levels over the last 10 to
12 weeks. The goal for HbA1c is less than 7 per cent.
Medication - ask your doctor if you should be taking low dose aspirin, as this can
help reduce your risk of heart attack.
Eye damage - reducing the risk
Damage to the blood vessels at the back of the eyes (retinopathy) can occur without
you being aware of it. Vision may seem unchanged until the problem is severe.
However, retinopathy can be detected in the early stages by having your eyes
checked regularly and action can be taken to prevent further damage.
Macular oedema is another problem that can occur with diabetes as a result of
damage to blood vessels in the eyes. Cataracts and glaucoma can occur in anyone
but are more common in people with diabetes.
To reduce the risks:

Have regular eye checks - everyone with diabetes should have a professional eye
examination when they are first diagnosed and then at least every two years after
that (children usually start this screening at puberty). If retinopathy or other
abnormality is found, eye tests will be required ever year, or more frequently, if
advised by your eye care professional.
Manage your health - keep blood glucose levels, HbA1c and blood pressure within the
recommended ranges.
Seek help quickly - if you notice any changes in your vision, notify your doctor or eye
specialist immediately.
Kidney damage - reducing the risk
People with diabetes are at risk of kidney disease (nephropathy) due to changes in
the small blood vessels of the kidney. Kidney disease is painless in the early stages
and does not cause symptoms until it’s advanced.
Kidney damage can be diagnosed early by detecting microalbumin (very small

amounts of protein). Screening is very important. If damage is identified early, the
progression of nephropathy can be slowed or prevented with appropriate treatment.
Medications called ACE inhibitors and angiotension receptor antagonists help to
protect the kidney from further damage. These tablets can also be used to treat high
blood pressure.
To reduce the risks of kidney disease:

Have your urine checked - everyone with diabetes should have a urine check for
microalbumin at least once a year
Monitor your glucose levels - keep your HbA1c under 7%
Manage your blood pressure - keep your blood pressure less than 130/80 and
cholesterol less than 4.0 mmol/L. If you already have kidney disease, keep your
blood pressure under 125/75
Reduce infection risk - see your doctor immediately if you think you have a bladder
infection. Symptoms may include feeling the need to urinate more often, a burning
sensation when passing urine, loss of bladder control, cloudy or sometimes bloody
urine. Blood glucose levels will often be high when an infection is present.
Nerve damage - reducing the risk
Nerve damage (neuropathy) is usually caused by high blood glucose levels but it is
also occasionally caused by other disorders, or drinking large amounts of alcohol.
Damage can occur to the sensory (‘feeling’) nerves of the legs, arms, hands, chest
and stomach, and to the nerves that control the actions of body organs.
Ways to reduce the risk of nerve damage include:

Keep your blood glucose and HbA1c within recommended ranges.
Tell your doctor about any tingling, pain or numbness in your feet or hands.
Protect your feet from injury and inspect them every day.
Treat foot injuries promptly and don’t delay seeking attention from your doctor or
podiatrist for foot problems.
Have a foot check by your podiatrist, doctor or diabetes educator at least once a year
to detect changes in nerves as early as possible.
If you have erectile problems, speak to your doctor. Eighty per cent of erectile
dysfunction (impotence) is physical and treatments are available.
If you drink alcohol, have no more than two standards drinks per day for men, and
one for women. Have two alcohol-free days per week
Tell your doctor about any digestive complaints and see a dietitian who may be able
to help you with your eating plan.
Skin problems - reducing the risk
The most common problem for people with diabetes is very dry skin, caused by
damage to the small blood vessels and nerves. To reduce the risk you could:
Keep your blood glucose levels and HbA1c within recommended ranges to reduce the
risk of skin infections.
Avoid overheating - don’t let your house get too hot, especially in winter when the
heaters are on. If possible, increase the humidity.
Protect your skin by wearing gloves when you use household cleaners and solvents.
Avoid very hot baths and showers, and use non-scented soaps.
Use a cream or lotion on your skin after bathing, preferably one that is perfume-free.
Check your feet every day. If you have dry, rough or cracked skin on your feet, see
your podiatrist or doctor.
See your doctor if your skin is very dry or irritated.
Don’t smoke.
Teeth and gum problems - reducing the risk
People with diabetes can have a higher risk of tooth decay and gum infections when
their blood glucose levels are high. Tooth and gum infections can increase your risk
of heart disease. To reduce the risk you can:
Keep your blood glucose levels within recommended ranges.
Visit your dentist regularly, tell them you have diabetes and they will show you how
to care for your teeth and gums.
Drink water if you have a dry mouth. Sugarless gum can help increase saliva
production.
Don’t smoke.
Reducing the risk of infections
The immune system helps to prevent and fight infection. High blood glucose levels
slow down the action of infection-fighting white blood cells. This makes it more
difficult for the immune system to do its job. To help your immune system you can
try to:
Keep your blood glucose levels within the recommended ranges.
Get plenty of rest.
Wash your hands often.
Protect yourself against infection - everyone with diabetes should have a yearly
influenza (flu) injection. Ask your doctor about a pneumonia injection.
Don’t smoke.
Low thyroid hormone levels
Although diabetes doesn’t directly cause thyroid problems, studies show an increased
risk of hypothyroidism (low thyroid levels) in people with type1and type 2 diabetes,
especially in women over 40 years. Your doctor may recommend a test for thyroid
function (TSH) every five years.
Where to get help

Your doctor
Dietitian
Podiatrist
Eye specialist
Diabetes educator
Quit - Victorian Smoking and Health Program Tel. 131 848
Diabetes Australia -Victoria Tel. (03) 9667 1778 or country callers 1300 136 588
Things to remember
Diabetes-related complications include damage to large and small blood vessels,
which can lead to heart attack and stroke, and problems with the kidneys, eyes, feet
and nerves.
The risk of most diabetes-related complications can be reduced.
One of the most important risk reduction strategies is to have regular screening to
detect complications early and to keep your blood pressure, blood glucose levels,
HbA1c and cholesterol within recommended ranges.
It’s very important that you don’t smoke if you have diabetes as it increases the
likelihood of complications.
Mellitus
Gestational diabetes mellitus (GDM)
GDM, or carbohydrate intolerance, is first diagnosed during pregnancy through an
oral glucose tolerance test. Between 5.5 and 8.8% of pregnant women develop GDM
in Australia. Risk factors for GDM include a family history of diabetes, increasing
maternal age, obesity and being a member of a community or ethnic group with a
high risk of developing type 2 diabetes. While the carbohydrate intolerance usually
returns to normal after the birth, the mother has a significant risk of developing
permanent diabetes while the baby is more likely to develop obesity and impaired
glucose tolerance and/or diabetes later in life. Self-care and dietary changes are
essential in treatment.
Diabetes and coma

Diabetes and coma
Diabetes mellitus is a condition characterised by high blood glucose (sugar) levels.

Uncontrolled diabetes may lead to coma or unconsciousness. The three types of
coma associated with diabetes include ketoacidotic coma, hyperosmolar coma and
hypoglycaemic coma.
Ketoacidotic coma
Ketoacidotic coma is more common in people with Type 1 diabetes, which is also
known as juvenile diabetes or insulin dependent diabetes mellitus (IDDM). This type
of coma is triggered by the build-up of chemicals called ketones. Ketones are
strongly acid and cause the blood to become too acidic. Ketones are by-products of
fat breakdown; they can build up excessively when there is insufficient insulin in the
body. When there is not enough insulin circulating, the body cannot use glucose for
energy. Instead, fat is broken down, which is then converted to ketones in the liver.
Common causes of ketoacidosis include a missed dose of insulin or an acute
infection. Symptoms of ketoacidosis are:
Extreme thirst
Lethargy
Frequent urination (due to high blood glucose levels)
Nausea
Vomiting
Abdominal pain
Progressive drowsiness
Deep, rapid breathing
A fruity or acetone smell on the breath may also be present.
Tests will reveal that large amounts of ketones are present in the blood and urine.
Hyperosmolar coma
A hyperosmolar coma is caused by severe dehydration and very high blood glucose
levels (hyperglycaemia). Events that may lead to high blood glucose levels include:
Forgotten diabetes medications or insulin
An infection or illness, such as the flu or pneumonia
Increased intake of sugary foods or fluids.
Those at most risk of this type of coma are people with Type 2 diabetes, who have an
infection or acute illness and have reduced their intake of fluids or are taking diuretic
medication or steroids.
The kidneys respond to high levels of blood glucose by doing their best to excrete it,
along with a great deal of water. The person experiencing diabetic hyperosmolarity
will be very thirsty but they can’t drink enough water to replace the lost fluids. They
will become dehydrated and urgently need intravenous fluids. Without this kind of
treatment, they may lapse into hyperosmolar coma. Hyperosmolar coma develops
slowly over several days, so if the high blood glucose levels are detected and treated
early, coma can be prevented.
Hypoglycaemic coma
Hypoglycaemia, or low blood glucose levels (below 3.5 mmol/L), may occur if a
person on diabetes medication or insulin:
Takes an extra or an increased dose
Exercises strenuously without eating extra food or reducing their insulin intake
Misses a meal or snack
Drinks too much alcohol or drinks alcohol without eating food.
If the blood glucose level falls very low, the person may become unconscious
(hypoglycaemic coma) and seizures may occur. Symptoms of hypoglycaemia include:
Trembling
Palpitations
Weakness
Sweating
Intense hunger
Confusion, altered behaviour, drowsiness or coma may occur if the blood glucose
becomes very low.
Prolonged or frequent coma should be avoided and hypoglycaemia treated quickly.
First aid
First aid for someone who has lapsed into a diabetic coma includes:
Call 000 for an ambulance immediately.
Don’t try to give them anything to eat or drink, as they may choke.
Turn them onto their side to prevent obstruction to breathing.
Follow any instructions given to you by the operator until the ambulance officers
arrive.
Don’t try to give them an insulin injection.
Diagnosis methods
A coma is a medical emergency. A quick diagnosis can be life saving. The cause of a
diabetic coma is diagnosed using a number of tests, including:
Medical history
Physical examination
Blood tests, including glucose and ketones
Urine tests.
Treatment options
Treatment options for diabetes-related coma include:
Ketoacidotic coma - intravenous fluids, insulin, and administration of potassium and
sodium.
Hyperosmolar coma - plenty of intravenous fluids, insulin, potassium and sodium
given as soon as possible.
Hypoglycaemic coma - administration of the hormone glucagon to reverse the effects
of insulin, or glucose given intravenously.
Where to get help
Your doctor
Diabetes specialist
Emergencydepartment of the nearest hospital
Always call an ambulance in an emergency Tel. 000
Things to remember
The three types of coma associated with diabetes include ketoacidotic coma,
hyperosmolar coma and hypoglycaemic coma.
Diabetic coma is a medical emergency and needs prompt medical treatment.
Uncontrolled blood glucose levels may lead to hyper or hypoglycaemia.
Low or persistently high blood glucose levels means diabetes treatment needs to be
adjusted. Speak to your doctor or health professional.
Diabetes and diagnostics

Diabetes - diagnostic tests
The main diagnostic test for diabetes is taking a blood test to measure glucose,
either when you have been fasting or at other times of the day. Diagnostic tests are
also used routinely during pregnancy to identify gestational diabetes.
High blood sugar levels harm the body

The hormone insulin helps to move blood sugars (glucose) into cells and convert
glucose into energy. Diabetes is a condition characterised by abnormally high levels
of glucose in the blood. This occurs because either not enough insulin is made or the
cells don’t respond to the hormone.
Untreated, high glucose levels can cause serious damage to many parts of the body,
including:
Kidney damage
Eye damage
Nerve damage to the feet and other parts of the body
Stroke
Impotence.
Accuracy of test results
Depending on the test used, the level of blood glucose can be affected by many
factors including:
Eating or drinking
Taking medications that are known to raise blood sugar levels, such as oral
contraceptives, some diuretics (water pills) and corticosteroids
A recent injury, physical illness or surgery that may temporarily alter blood sugar
levels.
Test procedures
Most diabetes tests require blood samples. Generally, a band is tightened around
your upper arm to slow blood flow and cause the veins below the band to stand out.
The intended injection site is swabbed with alcohol. The hypodermic needle is
inserted into the vein and the blood is directed into a collection tube. The band may
be removed from your arm while the blood is being taken.
You may need more than one collection tube, depending on the test. After the blood
is taken, you are asked to press a cotton ball or gauze against the injection site.
Once bleeding has stopped, the injection site is covered with a sticking plaster.
Types of tests
Tests to diagnose diabetes include:

Fasting blood glucose test – blood glucose levels are checked after fasting for
between 12 and 14 hours. You can drink water during this time, but should strictly
avoid any other beverage. Patients with diabetes may be asked to delay their
diabetes medication or insulin dose until the test is completed.
Random blood glucose test – blood glucose levels are checked at various times
during the day, and it doesn’t matter when you last ate. Blood glucose levels tend to
stay constant in a person who doesn’t have diabetes.
Oral glucose tolerance test – a high-glucose drink is given. Blood samples are
checked at regular intervals for two hours.
The most common test for diagnosis of diabetes is the fasting blood glucose test.
Glucose tolerance tests are used when the results of the fasting blood glucose are
borderline. They are also used to diagnose diabetes in pregnancy (gestational
diabetes).
Immediately after the procedure

The fasting blood glucose test will confirm that the person has diabetes if it shows
that the level of glucose in their blood is higher than normal when they are fasting.
Sometimes the test result of the fasting blood glucose test is borderline. If this is the
case, a glucose tolerance test may be performed. This test will confirm diabetes if
the person’s blood sugar levels stay high for a long time after the tests.
If a person doesn’t have diabetes, the results of the glucose tolerance test will show
that their blood sugar levels fall within the normal range.
Possible complications of diabetes testing include:
Some people feel faint or nauseous at the sight of blood or needles
Bleeding and bruising at the injection site
Infection of the skin at the injection site
Multiple injection sites if collecting the blood is difficult
A reaction following the oral glucose tolerance test if the patient has diabetes
mellitus or hypoglycaemia (low blood sugar levels) – medications may be needed.
Taking care of yourself at home
Long-term outlook
Gestational diabetes is a temporary condition that usually resolves by itself once the
baby is born. Regular monitoring throughout the pregnancy is recommended.
There is no cure for diabetes mellitus, but the condition can be managed. Treatment
depends on the type of diabetes (type 1 or type 2), but the general aim is to control
blood sugar levels and keep them within the normal range. Treatment options may
include:
Low fat, high carbohydrate diet
Regular exercise
Insulin injections or tablets
Other medications as required.
Other blood glucose tests
A person with diabetes may regularly check their blood sugar levels at home using
glucose test strips. This is a monitoring test, not a diagnostic test.
Where to get help

Your doctor
Things to remember
There are various tests your doctor may wish to perform if you have symptoms of
diabetes, including a random blood sugar test, a fasting blood sugar test or an oral
glucose tolerance test.
Factors that can affect the accuracy of test results include failure to follow pre-test
instructions, recent injury or illness, and certain medications including oral
contraceptives, corticosteroids and antidepressants.
Diabetes and healty eating

Diabetes and healthy eating
Healthy eating, combined with regular physical activity and weight control, is
important to manage diabetes.
People with diabetes should eat mainly high fibre carbohydrate foods such as
wholegrain breads and cereals and vegetables and fruit. They should also reduce
their intake of fat, especially saturated fat. Limiting the serving size of your meals is
often required to maintain a healthy body weight. It’s also a good idea to see a
dietitian who can help develop a healthy eating plan.
Healthy eating helps a person with diabetes to:
Maintain general good health

Control blood glucose levels
Achieve normal blood lipid (fat) levels
Maintain a healthy blood pressure
Maintain a healthy body weight
Prevent the complications of diabetes.
No special diets required
Healthy eating for people with diabetes is no different than for everyone else. People
with diabetes do not need to prepare separate meals or buy special foods, so relax
and enjoy healthy eating with the rest of your family.
Physical activity
Along with healthy eating, physical activity is important. Be as active as possible. Try
to do at least 30 minutes of moderate intensity physical activity most days, and
make the most of other opportunities to be active.
Basic eating guidelines

Follow this simple healthy eating plan if you have diabetes:
Eat regular meals throughout the day. You need to have breakfast, lunch, and dinner.
Limit the serving size of your meals and snacks. Too much food will lead to an
increase in body weight.
Choose a food containing some carbohydrate at each meal – for example, one cup of
pasta, rice or cereal, two slices of bread or a medium potato.
For most people the total carbohydrate content of a meal needs to be between 30 to
50 grams.
Between meals, limit the carbohydrate content of a snack to 20 grams. For example
one piece of fruit, a small tub of yoghurt, a small slice of cake or one biscuit.
Make sure breads, biscuits and cereals contain at least 3 grams of fibre per 100
grams.
Select a variety of healthy foods from the different food groups. Include cereals, fruit
and vegetables, low fat dairy products and lean meat.
Fill up on low kilojoule foods such as salad vegetables.
Avoid saturated fats that are found in animal foods like full fat milk, ice creams,
butter and cheese as well as palm oil and coconut products, processed meat and
snacks and takeaway foods.
Consume small amounts of unsaturated fats like olive, canola or sunflower oil, mono
or polyunsaturated margarines, oily fish, avocado and seeds and nuts.
Baked items like cakes and biscuits should be eaten only occasionally and in small
serves, even when they are low in fat.
Avoid lollies, chocolates and sweet soft drinks.
Don’t add salt when you cook or at the table, and reduce the use of high salt foods.
Limit alcohol to four standard drinks per day for men and two standard drinks per
day for women. Have at least two alcohol free days per week.
Counting the carbohydrate in your eating plan
The amount of carbohydrate in meals has a great impact on blood glucose levels. By
eating regular meals and spreading carbohydrate foods evenly throughout the day,
you can maintain energy levels without causing large rises in blood glucose levels.
Most people are advised to have some carbohydrate at each meal. This could include
having either a cup of rice, noodles or cereal, two slices of bread, a bread roll or a
medium potato. A table with the carbohydrate content of most foods is available
from the Diabetes Australia website.
If you take insulin or diabetes medication, you may also need to eat snacks between
meals. Check with your diabetes educator or dietitian.
Glycaemic index
Some foods release glucose into the bloodstream more quickly than others. Foods
that produce a slower rise in blood glucose levels are described as having a low
glycaemic index (GI).
Healthy foods that have a low GI include cereals and breads high in fibre, spaghetti,
fruit and legumes and dairy products. Rice and potato have a higher GI but are still
healthy choices that can be eaten in moderation.
Some packaged foods promoted as ‘low GI’ may be high in fat and energy - for
example ice cream. Always check the list of ingredients and the energy (calorie or
kilojoule) content of packaged foods.
The GI values of foods are only an average taken from ten healthy people, who can
show large variations. Therefore people with diabetes are advised to test their blood
glucose levels to determine the effect of various foods on their own blood glucose
levels.
Sugar and a healthy eating plan

People with diabetes who follow a healthy eating plan can include some sugar in their
diet. However the sugar should be eaten in nutritious foods, such as breakfast
cereals or low fat dairy products, rather than in sweets or soft drinks.
You can use artificial sweeteners to replace some sugar if it helps to reduce your
total energy intake and control weight.
Eat less fat – especially saturated fat

All fats are high in energy (kilojoules). Eating too much fat can lead to weight gain,
unstable blood glucose levels and higher blood fat levels.
The type of fat you eat is also important. People with diabetes have a greater risk of
developing heart disease so try to eat less saturated fat.
Foods high in saturated fat include meat fat, full fat dairy foods, cream, solid cooking
fats (such as butter, lard, copha and ghee), oils such as palm and coconut, and
products that contain these fats (for example fried foods, some cakes and biscuits
and convenience foods).
When you do eat fats, choose mainly:

Polyunsaturated fats and oils – found in polyunsaturated margarines (check the
label); sunflower, safflower, soybean, corn, cottonseed, grapeseed and sesame oils;
oily fish such as herring, mackerel, sardine, salmon and tuna; nuts and seeds.
Monounsaturated fats and oils – such as canola or olive oil margarines; canola and
olive oil; avocados, nuts and seeds.
Eat moderate amounts of protein
The body uses protein for growth and repair. Protein foods often contain fat.
Most people only require one to two small serves of meat or other protein foods each
day. The best protein foods to choose are those that are low in fat, such as:
Half a cup of peas, beans and lentils.
90 to 120 grams of fish and seafood, lean meat and poultry without the skin.
Three daily serves of low fat or skim milk dairy foods such as 250 mls of milk, 40
grams of cheese and 200 grams of yoghurt.
Sample meal plan
Choose foods you like and which satisfy you, and include carbohydrate foods in each
meal or snack to help manage blood glucose levels. You can eat your main meal at
lunch or dinner.
Breakfast
Choose from:
One cup of high fibre breakfast cereal with low fat milk and one piece of fruit; or,
Two slices of bread or toast – preferably wholegrain, wholemeal or high fibre white –
with thinly spread margarine, peanut butter, jam, Vegemite, baked beans, grilled
tomato or sardines. Plus 100 mls of fruit juice.
Light meal
Soup (preferably one with vegetables and legumes).
One sandwich made with bread, one roll or six dry biscuits – preferably wholegrain or
wholemeal – with thinly spread margarine or avocado.
Lots of salad vegetables.
90 to 120 grams of lean meat, skinless poultry or seafood; or two eggs; or 40 grams
of fat reduced cheese; or a half a cup of legumes (such as beans or lentils).
One piece of fruit.
Water, tea or coffee.
Main meal
One cup of cooked rice or pasta or one medium potato.
Lots of other vegetables.

90 to 120 grams of lean meat, skinless poultry, seafood; or half a cup of legumes
(such as beans or lentils).
One fruit or one small tub of yoghurt.
Talk to a dietitian
People with diabetes should discuss their food habits with a dietitian, so that
appropriate dietary recommendations can be tailored to each individual.
Where to get help

Your doctor
An accredited practicing dietitian – to find a local dietitian, contact the Dietitians
Association of Australia Tel. 1800 812 942.
Diabetes educator
Diabetes Australia – Victoria Tel. 1300 136 588
International Diabetes Institute Tel. (03) 9258 5000.
Things to remember
People with diabetes do not need a special diet.
Limit serving sizes to maintain or achieve a healthy weight.
Meals should be based on high fibre carbohydrates and be low in total and saturated
fat, sugar and salt.
Diabetes diet
diabetes diet
Diabetes Diet
The proper diet is critical to diabetes treatment. It can help someone with diabetes:
Achieve and maintain desirable weight. Many people with diabetes can control their
blood glucose by losing weight and keeping it off.
Maintain normal blood glucose levels.
Prevent heart and blood vessel diseases, conditions that tend to occur in people with
diabetes.
A doctor will usually prescribe diet as part of diabetes treatment. A dietitian or
nutritionist can recommend a diet that is healthy, but also interesting and easy to
follow. No one has to be limited to a preprinted, standard diet. Someone with
diabetes can get assistance in the following ways:
A doctor can recommend a local nutritionist or dietitian.
The local American Diabetes Association, American Heart Association, and American
Dietetic Association can provide names of qualified dietitians or nutritionists and
information about diet planning.
Local diabetes centers at large medical clinics, hospitals, or medical universities

usually have dietitians and nutritionists on staff.
The guidelines for diabetes diet planning include the following:
Many experts, including the American Diabetes Association, recommend that 50 to

60 percent of daily calories come from carbohydrates, 12 to 20 percent from protein,
and no more than 30 percent from fat.
Spacing meals throughout the day, instead of eating heavy meals once or twice a
day, can help a person avoid extremely high or low blood glucose levels.
With few exceptions, the best way to lose weight is gradually: one or two pounds a
week. Strict diets must never be undertaken without the supervision of a doctor.
People with diabetes have twice the risk of developing heart disease as those without
diabetes, and high blood cholesterol levels raise the risk of heart disease. Losing
weight and reducing intake of saturated fats and cholesterol, in favor of unsaturated
and monounsaturated fats, can help lower blood cholesterol.
For example, meats and dairy products are major sources of saturated fats, which
should be avoided; most vegetable oils are high in unsaturated fats, which are fine in
limited amounts; and olive oil is a good source of monounsaturated fat, the
healthiest type of fat. Liver and other organ meats and egg yolks are particularly
high in cholesterol. A doctor or nutritionist can advise someone on this aspect of diet.
Studies show that foods with fiber, such as fruits, vegetables, peas, beans, and
whole-grain breads and cereals may help lower blood glucose. However, it seems
that a person must eat much more fiber than the average American now consumes
to get this benefit. A doctor or nutritionist can advise someone about adding fiber to
a diet.
Exchange lists are useful in planning a diabetes diet. They place foods with similar
nutrients and calories into groups. With the help of a nutritionist, the person plans
the number of servings from each exchange list that he or she should eat throughout
the day. Diets that use exchange lists offer more choices than preprinted diets. More
information on exchange lists is available from nutritionists and from the American
Diabetes Association
Continuing research may lead to new approaches to diabetes diets. Because one goal
of a diabetes diet is to maintain normal blood glucose levels, it would be helpful to
have reliable information on the effects of foods on blood glucose. For example,
foods that are rich in carbohydrates, like breads, cereals, fruits, and vegetables
break down into glucose during digestion, causing blood glucose to rise. However,
scientists don't know how each of these carbohydrates affect blood glucose levels.
Research is also under way to learn whether foods with sugar raise blood glucose
higher than foods with starch. Experts do know that cooked foods raise blood glucose
higher than raw, unpeeled foods. A person with diabetes can ask a doctor or
nutritionist about using this kind of information in diet planning.
Points to Remember
A diabetes diet should do three things; achieve ideal weight, maintain normal blood
glucose levels, and limit foods that contribute to hear disease.
A nutritionist or dietitian can help plan a diabetes diet.

Juvelline diabetes type 1
Type 1 diabetes (previously known as insulin-dependent diabetes)

Type 1 diabetes is an auto-immune disease where the body's immune system
destroys the insulin-producing beta cells in the pancreas. This type of diabetes, also
known as juvenile-onset diabetes, accounts for 10-15% of all people with the
disease. It can appear at any age, although commonly under 40, and is triggered by
environmental factors such as viruses, diet or chemicals in people genetically
predisposed. To live, people with type 1 diabetes must inject themselves with insulin
several times a day and follow a careful diet and exercise plan.
--
Diabetes Type 1 - juvenile diabetes
Around one in every 700 Australian children has diabetes, which makes it one of the
most common serious diseases amongst children. Diabetes is a disorder of the
endocrine system, characterised by the body’s inability to use blood sugar (glucose).
There are two main types of diabetes: juvenile-onset and mature-onset. Juvenile
diabetes can affect anyone of any age, but is more common in people under 30 years
and tends to develop in childhood, hence its name. Other names for juvenile diabetes
include diabetes and insulin dependent diabetes mellitus (IDDM).
Estimates vary, but approximately one in every five to 10 Australians with diabetes
has IDDM. In fact, the incidence of IDDM in Australia is very high compared to other
countries.
In order to use glucose for energy, the hormone insulin needs to be secreted by the
pancreas, a gland of the endocrine system located in the abdomen. A person with
IDDM is unable to produce insulin, after the insulin-producing cells in the pancreas
are destroyed by the body’s own immune system. Currently treatment includes
closely monitoring the blood sugar levels, modifying the diet and taking daily
injections of insulin until a cure is found.
Symptoms
The symptoms of diabetes include:
Excessive thirst
Frequent urination
Hunger
Weight loss
Fatigue
Visual disturbances, such as blurred vision
Itching skin, particularly around the genitals
Nausea and vomiting.
The role of the pancreas
The digestive system breaks down carbohydrates into glucose. This simple sugar is
then transported to each cell via the bloodstream. The pancreas secretes the
hormone insulin, which allows the glucose to migrate from the blood into the cells.
Once inside a cell, the glucose is ‘burned’, along with oxygen, to produce energy. The
pancreas of a person with IDDM doesn’t make any insulin at all. Without insulin, the
glucose remains in the bloodstream at high levels. The body recognises the dilemma
and tries to provide the cells with other sources of fuel, such as stored fats.
Extensive fat burning can release by-products called ketones, which are dangerous in
high amounts.
The cause is unknown

The exact cause of IDDM is unknown and there is no cure. It is thought that some
kind of viral infection or other environmental factor induces the immune system to
attack the insulin-producing cells of the pancreas in genetically susceptible
individuals. The onset tends to be sudden.
Complications of untreated diabetes

Untreated diabetes can severely damage many systems, organs and tissues of the
body. Complications include:
Kidney damage.
Increased likelihood of infections such as thrush.
Damage to the eyes (diabetic retinopathy).
Poor blood circulation in the legs and feet - potentially leading to lower limb
amputation.
Damage to the nerves of the feet.
Significantly increased likelihood of heart disease and stroke.
Sexual impotence.
Diagnosis and treatment
Diabetes is diagnosed with blood tests to check the glucose levels. There is no cure
for IDDM, but the condition can be successfully managed. Treatment options include:
Self-monitoring of blood sugar levels by regularly testing droplets of blood in a
glucose meter, or comparing the colour of a test strip to a colour chart.
Self-testing of urine to check for high levels of ketones, using a test strip.
Taking insulin injections daily.
Increasing the amount of ‘slow’ carbohydrates in the diet, such as beans and fruit,
which take longer to be absorbed by the body.
Regular exercise.
Maintaining regular checks for diabetes complications.
Hypoglycaemia
If a person with IDDM skips a meal, exercises heavily or takes too much insulin, their
blood sugar levels may plummet. This leads to a ‘hypo’ (hypoglycaemia). The
symptoms include dizziness, sweating, hunger, headache and change in mood. This
can be remedied with a quick boost of sugar (such as jellybeans or glucose tablets),
then something more substantial like fruit. A person with IDDM should ideally have
lollies on hand at all times, just in case.
Where to get help

Your doctor
Juvenile Diabetes Research Foundation Tel. (03) 9696 3866
Things to remember
Other names for juvenile diabetes include diabetes and insulin dependent diabetes
mellitus (IDDM).
IDDM can occur at any age, but tends to develop in childhood.
Around one in every 700 Australian children has diabetes.
There is no cure, but the disorder can be successfully managed with medication,
dietary modifications and exercise.

Healthy eating, combined with regular physical activity and weight control, is
important to manage diabetes.
People with diabetes should eat mainly high fibre carbohydrate foods such as
wholegrain breads and cereals and vegetables and fruit. They should also reduce
their intake of fat, especially saturated fat. Limiting the serving size of your meals is
often required to maintain a healthy body weight. It’s also a good idea to see a
dietitian who can help develop a healthy eating plan.
Healthy eating helps a person with diabetes to:
Maintain general good health

Control blood glucose levels
Achieve normal blood lipid (fat) levels
Maintain a healthy blood pressure
Maintain a healthy body weight
Prevent the complications of diabetes.
No special diets required
Healthy eating for people with diabetes is no different than for everyone else. People
with diabetes do not need to prepare separate meals or buy special foods, so relax
and enjoy healthy eating with the rest of your family.
Physical activity
Along with healthy eating, physical activity is important. Be as active as possible. Try
to do at least 30 minutes of moderate intensity physical activity most days, and
make the most of other opportunities to be active.
Basic eating guidelines

Follow this simple healthy eating plan if you have diabetes:
Eat regular meals throughout the day. You need to have breakfast, lunch, and dinner.
Limit the serving size of your meals and snacks. Too much food will lead to an
increase in body weight.
Choose a food containing some carbohydrate at each meal – for example, one cup of
pasta, rice or cereal, two slices of bread or a medium potato.
For most people the total carbohydrate content of a meal needs to be between 30 to
50 grams.
Between meals, limit the carbohydrate content of a snack to 20 grams. For example
one piece of fruit, a small tub of yoghurt, a small slice of cake or one biscuit.
Make sure breads, biscuits and cereals contain at least 3 grams of fibre per 100
grams.
Select a variety of healthy foods from the different food groups. Include cereals, fruit
and vegetables, low fat dairy products and lean meat.
Fill up on low kilojoule foods such as salad vegetables.
Avoid saturated fats that are found in animal foods like full fat milk, ice creams,
butter and cheese as well as palm oil and coconut products, processed meat and
snacks and takeaway foods.
Consume small amounts of unsaturated fats like olive, canola or sunflower oil, mono
or polyunsaturated margarines, oily fish, avocado and seeds and nuts.
Baked items like cakes and biscuits should be eaten only occasionally and in small
serves, even when they are low in fat.
Avoid lollies, chocolates and sweet soft drinks.
Don’t add salt when you cook or at the table, and reduce the use of high salt foods.
Limit alcohol to four standard drinks per day for men and two standard drinks per
day for women. Have at least two alcohol free days per week.
Counting the carbohydrate in your eating plan
The amount of carbohydrate in meals has a great impact on blood glucose levels. By
eating regular meals and spreading carbohydrate foods evenly throughout the day,
you can maintain energy levels without causing large rises in blood glucose levels.
Most people are advised to have some carbohydrate at each meal. This could include
having either a cup of rice, noodles or cereal, two slices of bread, a bread roll or a
medium potato. A table with the carbohydrate content of most foods is available
from the Diabetes Australia website.
If you take insulin or diabetes medication, you may also need to eat snacks between
meals. Check with your diabetes educator or dietitian.
Glycaemic index
Some foods release glucose into the bloodstream more quickly than others. Foods
that produce a slower rise in blood glucose levels are described as having a low
glycaemic index (GI).
Healthy foods that have a low GI include cereals and breads high in fibre, spaghetti,
fruit and legumes and dairy products. Rice and potato have a higher GI but are still
healthy choices that can be eaten in moderation.
Some packaged foods promoted as ‘low GI’ may be high in fat and energy - for
example ice cream. Always check the list of ingredients and the energy (calorie or
kilojoule) content of packaged foods.
The GI values of foods are only an average taken from ten healthy people, who can
show large variations. Therefore people with diabetes are advised to test their blood
glucose levels to determine the effect of various foods on their own blood glucose
levels.
Sugar and a healthy eating plan

People with diabetes who follow a healthy eating plan can include some sugar in their
diet. However the sugar should be eaten in nutritious foods, such as breakfast
cereals or low fat dairy products, rather than in sweets or soft drinks.
You can use artificial sweeteners to replace some sugar if it helps to reduce your
total energy intake and control weight.
Eat less fat – especially saturated fat

All fats are high in energy (kilojoules). Eating too much fat can lead to weight gain,
unstable blood glucose levels and higher blood fat levels.
The type of fat you eat is also important. People with diabetes have a greater risk of
developing heart disease so try to eat less saturated fat.
Foods high in saturated fat include meat fat, full fat dairy foods, cream, solid cooking
fats (such as butter, lard, copha and ghee), oils such as palm and coconut, and
products that contain these fats (for example fried foods, some cakes and biscuits
and convenience foods).
When you do eat fats, choose mainly:

Polyunsaturated fats and oils – found in polyunsaturated margarines (check the
label); sunflower, safflower, soybean, corn, cottonseed, grapeseed and sesame oils;
oily fish such as herring, mackerel, sardine, salmon and tuna; nuts and seeds.
Monounsaturated fats and oils – such as canola or olive oil margarines; canola and
olive oil; avocados, nuts and seeds.
Eat moderate amounts of protein
The body uses protein for growth and repair. Protein foods often contain fat.
Most people only require one to two small serves of meat or other protein foods each
day. The best protein foods to choose are those that are low in fat, such as:
Half a cup of peas, beans and lentils.
90 to 120 grams of fish and seafood, lean meat and poultry without the skin.
Three daily serves of low fat or skim milk dairy foods such as 250 mls of milk, 40
grams of cheese and 200 grams of yoghurt.
Sample meal plan
Choose foods you like and which satisfy you, and include carbohydrate foods in each
meal or snack to help manage blood glucose levels. You can eat your main meal at
lunch or dinner.
Breakfast
Choose from:
One cup of high fibre breakfast cereal with low fat milk and one piece of fruit; or,
Two slices of bread or toast – preferably wholegrain, wholemeal or high fibre white –
with thinly spread margarine, peanut butter, jam, Vegemite, baked beans, grilled
tomato or sardines. Plus 100 mls of fruit juice.
Light meal
Soup (preferably one with vegetables and legumes).
One sandwich made with bread, one roll or six dry biscuits – preferably wholegrain or
wholemeal – with thinly spread margarine or avocado.
Lots of salad vegetables.
90 to 120 grams of lean meat, skinless poultry or seafood; or two eggs; or 40 grams
of fat reduced cheese; or a half a cup of legumes (such as beans or lentils).
One piece of fruit.
Main meal
One cup of cooked rice or pasta or one medium potato.
Lots of other vegetables.
90 to 120 grams of lean meat, skinless poultry, seafood; or half a cup of legumes
(such as beans or lentils).
One fruit or one small tub of yoghurt.
Talk to a dietitian
People with diabetes should discuss their food habits with a dietitian, so that
appropriate dietary recommendations can be tailored to each individual.
Where to get help

Your doctor
An accredited practicing dietitian – to find a local dietitian, contact the Dietitians
Association of Australia Tel. 1800 812 942.
Diabetes educator
Diabetes Australia – Victoria Tel. 1300 136 588
Things to remember
People with diabetes do not need a special diet.
Limit serving sizes to maintain or achieve a healthy weight.
Meals should be based on high fibre carbohydrates and be low in total and saturated
fat, sugar and salt.
Diabetes type 2
Diabetes Type 2
Type 2 diabetes is sometimes described as a ‘lifestyle disease’ because it is more

common in people who do insufficient physical activity and are overweight or obese.
It is strongly associated with high blood pressure, high cholesterol and an ‘apple’
body shape, where excess weight is carried around the waist.
In diabetes there is too much glucose, a type of sugar, in the blood. The two main
types of diabetes are type 1 and type 2.
Type 2 diabetes is by far the most common form of diabetes. It affects 85 to 90 per
cent of all people with diabetes. While it usually affects mature adults, younger
people are also now being diagnosed in greater numbers as rates of overweight and
obesity increase. Type 2 diabetes used to be called non-insulin dependent diabetes or
mature onset diabetes.
The cause of type 1 diabetes is unknown, but research suggests it occurs when
something in the environment such as a viral infection triggers the immune system
to destroy the insulin-making cells in the pancreas. There is presently no
preventative measure or cure for type 1 diabetes.
The causes of type 2 diabetes are known and in some cases it can be prevented.
However there is no cure for type 2 diabetes.
Symptoms
Type 2 diabetes often has no symptoms. About half of those who have type 2
diabetes have not yet been diagnosed. Even if symptoms are present, they are often
not recognised or are attributed to other reasons such as being busy or ‘getting
older’.
In many cases blood glucose levels can be very high by the time symptoms are
noticed and medical treatment is sought. Common symptoms include:
Being more thirsty than usual

Passing more urine
Feeling tired and lethargic

Slow-healing wounds
Itching and skin infections
Blurred vision
Mood swings.
Glucose metabolism explained
The body uses glucose as its main source of energy. Glucose comes from foods that
contain carbohydrates such as potatoes, bread, pasta and rice, fruit and milk. After
food is digested, the glucose is released and absorbed into the bloodstream.
The glucose in the bloodstream needs to move into body tissues so that cells can use
it for energy. Excess glucose is also stored in the liver or converted to fat and stored
in other body tissues.
Insulin is a hormone made by the pancreas, which is a gland located just below the
stomach. Insulin opens the doors (the glucose channels) that let glucose move from
the blood into the body cells. This is part of a process known as glucose metabolism.
In diabetes, one of two things occurs.

The pancreas can’t make insulin (type 1 diabetes) or;
The cells don’t respond to the insulin properly (insulin resistance) and the pancreas
produces inadequate insulin for the body’s increased needs (type 2 diabetes).
If the insulin can’t do its job, the glucose channels can’t open properly and glucose
builds up in the blood. High blood glucose levels cause the health problems linked to
diabetes, often referred to as complications.
Risk factors for type 2 diabetes

While there is no single cause of type 2 diabetes, there are well-known risk factors.
Those most at risk of developing type 2 diabetes include:

People with pre-diabetes.
Aboriginal and Torres Strait Islander people aged 35 and over.
People aged 35 and over who are Pacific Islanders, from the Indian subcontinent or
of Chinese origin.
People aged 45 and over who are obese or overweight, have high blood pressure or
have a first-degree relative with type 2 diabetes.
People with cardiovascular disease such as heart attack, angina, stroke, or narrowed
blood vessels.
Women with polycystic ovarian syndrome who are obese.
Women who have had gestational diabetes.
People aged 55 or over.
Lifestyle factors that increase the risk of developing type 2 diabetes include:
Being overweight or obese.
Low levels of physical activity.
Unhealthy eating habits, such as regularly choosing high fat, high sugar, high salt or
low fibre foods.
High blood pressure.
High blood cholesterol.
Cigarette smoking.
People at risk need to have a laboratory blood glucose test (not using a portable
blood glucose meter) performed by their doctor to check if they have diabetes. This
test is preferably done after fasting.
Pre-diabetes
Pre-diabetes is a condition in which the blood glucose level is higher than normal but
not high enough to be called diabetes. Pre-diabetic conditions include impaired
fasting glucose and impaired glucose tolerance. It is important that people with these
conditions reduce their risk of developing diabetes by increasing their physical
activity and seeing a dietitian to develop a healthy eating plan and assist them to
lose weight.
Gestational diabetes
Gestational diabetes is diabetes that occurs in, and is diagnosed during, pregnancy.
It usually goes away after the baby is born, but the mother and child are at
increased risk of type 2 diabetes later in life.
Type 2 diabetes management options

The aim of diabetes treatment is to maintain blood glucose levels within the normal
range, which is between 3.5 and 6 mmol/L before meals and 3.5 and 8mmol/L two
hours after meals. This will help prevent possible long-term problems that can affect
the heart, blood vessels, eyes, kidneys and nerves. Keeping your blood pressure and
cholesterol within the recommended range is also very important to help prevent
these long term problems.
Healthy eating, achieving and maintaining a healthy weight and doing regular
physical activity are also important. Sometimes tablets and then insulin may also be
needed.
Your health care team

A lifelong condition like diabetes is best managed with the support of a diabetes
health care team. You are the most important member of your diabetes team. Other
members are your doctor, diabetes educator, dietitian and podiatrist. Depending on
your needs, the team may also include medical specialists, exercise physiologists and
counsellors.
Self-care basics
Suggestions to manage your diabetes include:
Link up with the diabetes team in your area. Your doctor may need to refer you, but
this isn’t always necessary. Call Diabetes Australia-Vic to find health professionals in
your local area.
Test your blood glucose levels regularly.
Use any medication strictly as prescribed.
Be physically active as often as you can.
Have a healthy eating plan.
Keep a positive mental attitude and seek advice if anxious or depressed.
Seek medical advice if unwell.
Consider joining a support group.
Where to get help
Your doctor
Diabetes educator
Dietitian
Podiatrist
Diabetes Australia – Vic Tel. (03) 9667 1777 or 1300 136 588
Things to remember
Type 2 diabetes is strongly associated with being overweight and physically inactive.
Type 2 diabetes may be prevented but it cannot be cured.

Lifelong management should include regular exercise, healthy eating, loss of excess
body weight and, where appropriate, use of prescribed medications.
Early symptoms
Diabetes: How Do I Know If I Have It?
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What is diabetes?
Diabetes is a disease that occurs when your body doesn't make enough of a hormone
called insulin, or if your body doesn't use insulin the right way. If left untreated, it
may result in blindness, heart attacks, strokes, kidney failure and amputations. Only
half of the people who have diabetes have been diagnosed, because in the early
stages of diabetes there are few symptoms, or the symptoms may be the same as
symptoms of other health conditions.
Return to top
What are the symptoms of diabetes?

Early symptoms of diabetes may include the following:
Extreme thirst
Extreme hunger
Frequent urination
Sores or bruises that heal slowly
Dry, itchy skin
Unexplained weight loss
Blurry vision that changes from day to day
Unusual tiredness or drowsiness
Tingling or numbness in the hands or feet
Frequent or recurring skin, gum, bladder or vaginal yeast infections
If you are regularly experiencing 1 or more of these symptoms, call your family
doctor right away.
Return to top
Who is at risk for diabetes?

The early stages of diabetes have very few symptoms, so you may not know you
have the disease. But damage may already be happening to your eyes, your kidneys
and your cardiovascular system even before you notice symptoms. You are at risk for
having diabetes if:
You're older than 45 years of age

You're overweight
You don't exercise regularly
Your parent, brother or sister has diabetes
You gave birth to a baby that weighed more than 9 pounds or you had gestational
diabetes while you were pregnant
You're African American, Hispanic American/Latino, Native American, Asian American
or Pacific Islander
If you have 1 or more of these risk factors, your doctor may want you to be tested
for diabetes. You might also be tested at a younger age and more often if you have
risk factors. Talk to your doctor about your risk of developing diabetes and about a
plan for regular testing.
Return to top
How will I be tested for diabetes?

Testing (also called "screening") is usually done with a fasting blood test. You'll be
tested in the morning, so you shouldn't eat anything after dinner the night before. A
normal blood sugar test result is below 110 mg per dL. A test result higher than 125
mg per dL suggests diabetes. However, you should have 2 tests that are higher than
125 mg per dL, on 2 different days, before a diagnosis of diabetes is made. Test
results from 110 mg per dL to 125 mg per dL suggest that you have a higher risk of
diabetes.
Return to top
Why is it important for diabetes to be diagnosed early?

Many people have diabetes for about 5 years before they show symptoms . By that
time, some people already have eye, kidney, gum or nerve damage caused by
diabetes. There's no cure for diabetes, but there are ways for you to stay healthy
and reduce the risk of complications. If you exercise, watch your diet, control your
weight and take the medicine your doctor may prescribe, you can make a big
difference in reducing or preventing the damage that diabetes can do. The earlier
you know you have diabetes, the sooner you can make these important lifestyle
changes.
----
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Early Symptoms May Not Look Like Diabetes
Condition Can't Be Ignored, Can Be Treated
Jonathan Lloyd, Staff writer
Email This Story | Print This Story
Dan Rehmann thought a change in the weather made his mouth dry in the middle of
the night.
All About Diabetes | Testing | Diabetes Section
"I thought it would go away," Rehmann said. "The dry mouth continued for a couple
of weeks. Then, I began getting up in the middle of the night having to urinate, and I
also had excessive thirst and blurred vision. I would drink almost a half-gallon of
water in about 10 minutes."
Rehmann, 33, scheduled a physical and described his symptoms to a doctor, who
conducted tests for diabetes. Four hours later, a clinic staff member called and urged
him to go to the nearest emergency room.
His blood sugar level had climbed to 563. A normal fasting blood sugar level is 80 to
110. The numbers indicate the milligrams of glucose per deciliter of blood.
"Most of the staff were pretty surprised, as was I," Rehmann, who has no family
history of diabetes, said.
Rehmann became one of more than 14 million people in the U.S. who have been
diagnosed with diabetes, a condition characterized by the hallmark of consistently
high blood sugar levels.
Blood sugar refers to the amount of glucose, which supplies the body with energy, in
the blood. The pancreas makes the hormone insulin, which helps the sugar get into
the cells to provide that energy. When insulin is low, absent or the body resists it, the
sugar remains in the blood, causing increased thirst and urination. It may also
damage blood vessels, leading to many complications.
A blood sugar level that is too low is called hypoglycemia, also a dangerous
condition. Symptoms include fatigue, confusion, irritability and loss of consciousness.
When the blood sugar level gets too high, it is called hyperglycemia. This condition
can lead to long-term health problems involving eyes, kidneys and nerves.
Doctors conducted tests and determined that Rehmann had not suffered any heart
problems or other complications. He was diagnosed with type 2 diabetes, which is
not considered as dangerous as type 1 diabetes.
In many cases of type 1 diabetes, the pancreas may not produce any insulin.
Although some of these cases used to be called juvenile onset diabetes, type 1
diabetes can affect adults and children. Type 1 diabetes often involves more severe
symptoms than type 2 diabetes, though experts stress that both conditions require
attentive treatment.
Type 2 diabetes is the more common form, accounting for 90 percent of all cases. It
also has been called non-insulin dependant diabetes and adult-onset diabetes, but it
is becoming more prevalent among children as obesity rates increase.
"Regrettably, both can happen at all ages," said Dr. Larry Deeb, president of
medicine and science with the American Diabetes Association. "Obesity is
everywhere, including younger kids. A lack of activity is everywhere, including
younger kids. Fat is insulin-resistant."
Type 2 diabetes may develop when cells become insulin-resistant, meaning they do
not respond to normal levels of the substance. Glucose builds up in the blood and
does not get to the cells to provide energy, and the pancreas often loses the ability
to produce insulin.
Symptoms of type 2 diabetes often develop so gradually that some people might not
notice them until after a doctor points out the symptoms. The American Diabetes
Association reports that 6.2 million people with diabetes are undiagnosed.
"It's already ticking the clock and causing damage to your kidney and eyes," Deeb
said. "We need to diagnose it and get it treated to prevent that damage. The only
way to know is to see a doctor and get tested. Not knowing doesn't do your health
any good. You don't feel bad until it's too late."
Treatments
Type 1 diabetes is treated with insulin, which can be delivered by a syringe, an

insulin pen, jet injectors and pumps.
There are different methods to treat type 2 diabetes and reduce the risk of long-term
problems. Treatments -- including diet and exercise plans, insulin, and oral
medications that make the body less resistant to insulin -- can help a diabetic patient
manage the disease.
"We used to talk about starting diabetes treatment in type 2 with diet and exercise,"
Deeb said. "If that didn't work, they'd go on drugs. Now, the idea is to just start
drugs right away. It's an admission that we're just not motivating enough people to
exercise as they need to, and to eat correctly.”
"Diet and exercise, when applied vigorously, can help control diabetes. We know we
can prevent diabetes with diet and exercise. But for a lot of people, that's hard to
do."
Rehmann's initial stage of treatment included a medication used to reduce blood

sugar.
"Through exercise and diet, I no longer need to take it," Rehmann said. "I really cut
back on pasta, refined carbs -- sugar and flour -- and no longer drink any soda."
About one year after his diagnosis, Rehmann's A1c test was 6.1 percent. Deeb said
that a diabetic actively participating in the treatment plan should not be satisfied
with a result above 7 percent.
The test provides the average blood sugar level over a three-month period.
"One of the major failures in American medicine is that too few people have diabetes
well-controlled," Deeb said. "You should insist that it is treated until that A1c gets
down. You should not be complacent with an A1c that is not below 7. At 10.2,
everything's not fine. You have to push, but it is manageable."
A treatment plan should be discussed with a doctor. Serious complications can result
if diabetes is not treated. Those complications include heart disease and stroke, high
blood pressure, blindness, kidney disease, nervous system disease, amputations,
dental disease, and complications linked to pregnancy.
"Many times, if diabetics manage the disease properly, they will end up leading
better, healthier lives than people who eat whatever they want," Rehmann added.
"It's a very manageable disease, but also a very serous one if ignored."
Immunization and diabetes

Immunisation and diabetes
The human body needs blood glucose (sugar) for energy. Blood glucose levels are
regulated by the hormone insulin, which is made by the pancreas. Diabetes is a
condition characterised by high blood glucose levels. Type 1 diabetes, or insulin
dependent diabetes mellitus (IDDM), is caused by an autoimmune destruction of
insulin-making cells in the pancreas. It is one of the most common childhood
diseases in developed nations. Some researchers have speculated that IDDM may be
linked with certain vaccinations such as measles-mumps-rubella (MMR), Haemophilus
influenzae type b (Hib), and the pertussis component of diphtheria,tetanus,pertussis
(DTP). This theory has caused widespread concern in the medical community and
panic amongst some parents. However, further studies undertaken around the world
have found no evidence that vaccinations can cause or influence the development of
diabetes.
The diabetes theory

The researchers, such as Dr Classen, proposed that some childhood vaccinations
may trigger an abnormal immune system response in vulnerable children, ultimately
causing the body to attack and destroy the insulin-making cells of the pancreas.
Trials showed that giving animals (such as mice) certain vaccines could either
increase or decrease their risk of developing diabetes, depending on the age of the
animal when the vaccinations were given.
Problems with the methodology

Commentators point out that the Classen experiments used the anthrax vaccine,
which is hardly ever administered to humans. Animals and humans are very different
in biology, which means something that affects an animal may not affect a human,
and vice versa. Dr Classen’s theory that vaccinations can cause diabetes was further
based on the fact that diabetes type 1 is common in Western nations where
immunisation is widespread, but relatively uncommon in developing nations where
immunisation rates are low. Critics argue that this reasoning is flawed because it
doesn’t take into account any other genetic or environmental factors.
Other studies have failed to find a link

Researchers around the world who have investigated the issue have found no
evidence that supports the theory linking immunisation and diabetes. Graves (1999)
and co-workers prospectively studied children from families with a member with type
1 diabetes. They looked for the development of autoimmunity to the insulin-
producing cells of the pancreas. No association was found between such
autoimmunity and being vaccinated - this includes hepatitis B, Hib, polio, or
diphtheria and tetanus toxoids and pertussis (whooping cough).
Later, a large population-based case-control study (De Stefano, from the Centers for
Disease Control and Prevention, and others), published in Pediatrics (December
2001), found no increased risk of type 1 diabetes associated with any of the routinely
recommended childhood vaccines. However, there is concern that parents may
choose not to have their children vaccinated. If vaccination levels fall too low, disease
epidemics may flourish.
No need to alter vaccination schedules

There have been suggestions that babies should receive their vaccinations later in life
to reduce the ‘risk’ of adverse reactions such as diabetes. However, the proposed link
between diabetes and childhood immunisation has been investigated by researchers
worldwide and refuted. There is no need to alter current immunisation schedules.
Delaying vaccination is dangerous because it leaves young children vulnerable to

catching serious diseases.
Possible triggers of diabetes under investigation

The exact cause of type 1 diabetes mellitus is unknown, but a range of genetic and
environmental factors is thought to contribute. Current factors under investigation
include:
Infection - the incidence of diabetes seems linked to the seasons, with increased
rates in late autumn and early winter. This suggests to some researchers that the
development of diabetes may include a viral component.
Milk - some studies have found that breastfed babies have a reduced risk of
diabetes, while babies fed cows milk may have an increased risk.
Nitrates - some studies have shown that drinking water containing high amounts of
nitrates is a risk factor.
Where to get help
Your doctor
Immunisation program, Department of Human Services Victoria Tel. 1300 882 008
Juvenile Diabetes Foundation Tel. (03) 9696 3866
Things to remember
Type 1 diabetes, or insulin dependent diabetes mellitus (IDDM), is caused by an
autoimmune destruction of insulin-making cells in the pancreas.
Some researchers have speculated that IDDM may be linked with certain
vaccinations such as measles-mumps-rubella (MMR), Haemophilus influenzae type B
(Hib), and the pertussis component of diphtheria,tetanus,pertussis (DTP).
Further studies undertaken around the world have found no evidence that childhood
vaccinations can cause or influence the development of diabetes.
Insuline choices
Diabetes - insulin choices
Insulin is classified according to how long it works in the body. There are five
different types of insulin, ranging from short to long acting. Some insulins are clear
in appearance, while others are cloudy.
Often people need varying amounts of both a short and longer acting insulin.
However, everyone is different and will respond differently to the insulin they take in
the management of diabetes.
Methods of taking insulin by mouth are still in development. The first inhaled insulin
has recently been approved for use in the USA and Europe. Clinical trials of inhaled
insulin are still being conducted in Australia. Insulin cannot be taken in tablet form as
the stomach would digest it.
Many different devices are available to inject insulin. Discuss the options with your
doctor or diabetes educator.
Types of insulin
The five types of insulin include:
Rapid onset-fast acting insulin

Short acting insulin
Intermediate acting insulin
Mixed insulin
Long acting insulin.
Rapid onset-fast acting insulin
Rapid onset-fast acting insulin always looks clear. It is fast acting and starts to work
within one to 20 minutes. It peaks about one hour later and lasts from three to five
hours. When you use this type of insulin, you must eat immediately after you inject.
The two rapid onset-fast acting insulin types currently available are:
NovoRapid (Insulin Aspart)
Humalog (Lispro).
Short acting insulin
Short acting insulins always look clear. They begin to lower blood glucose levels
within half an hour, so you need to have your injection half an hour before eating.
Short acting insulin has a peak effect at two to four hours, and lasts for between six
and eight hours. Short acting insulin types currently available include:
Actrapid
Humulin
Hypurin Neutral (bovine - highly purified beef insulin).
Intermediate acting insulin
Intermediate acting insulins always look cloudy. They have either protamine or zinc
added to delay their action. These insulins begin to work about 90 minutes after you
inject, peak at four to 12 hours, and last for 16 to 24 hours.
Intermediate acting insulins currently available include:

With protamine added – Protaphane, Humulin NPH and Hypurin Isophane (bovine).
Mixed insulin
Mixed insulin always looks cloudy. It contains a pre-mixed combination of either a
rapid onset-fast acting or a short acting insulin and intermediate acting insulin. This
makes it easier because two types of insulin can be given in one injection.
If the insulin is ‘30/70’ then it contains 30 per cent of quick acting and 70 per cent of
intermediate acting insulin. ‘50/50’ means 50 per cent of each.
Before injecting a mixed or other cloudy insulin, you must gently roll the vial or pen
between the palms of your hands and/or rock it slowly to make sure the different
strengths of insulin are evenly distributed.
The mixed insulins currently available include:

With rapid acting insulin – NovoMix 30 (30% Rapid 70% Intermediate), and Humalog
Mix 25 (25% Rapid 75% Intermediate NPH).
Other mixed insulins – Mixtard 30/70, Mixtard 20/80, Mixtard 50/50, Humulin 30/70
and Humulin 20/80.
Long acting insulin
There are two kinds of long acting insulin, which both have a clear appearance.
They are:
Lantus (Glargine) – has no pronounced peak action, which means the insulin is
released into your bloodstream at a relatively constant rate.
One injection can last the full 24 hours.
Levemir (Detemir) - has a relatively flat action, can last up to 24 hours and may be
given once or twice during the day.
Insulin injection devices
There are many different devices available to inject insulin. The main choices
include:
Insulin syringes
Insulin delivery pens
Insulin pumps.
Insulin syringes
Points to consider include:
Insulin syringes are to be used with 10ml insulin vials.
Syringes are manufactured in 30 unit (0.3ml), 50 unit (0.5ml) and 100 unit (1.0ml)
measures. The size of syringe will depend on the insulin dose, for example, it is
easier to measure a 10 unit dose in a 30 unit syringe, and 55 units in a 100 unit
syringe.
Needles on the syringes are available in different lengths ranging from 8mm to
13mm. Your doctor or diabetes educator will help you decide which syringe is right
for you.
Use each syringe once only.
Syringes are free for people registered with the National Diabetes Service Scheme
(NDSS).
Insulin delivery devices

‘Pen’ devices come in all shapes and sizes. An insulin cartridge (3ml, containing 300
units of insulin) fits into the device. When finished, a new cartridge is inserted.
However, some pen devices are pre-filled with insulin and the whole device is
disposable. Your doctor or diabetes educator will advise the right type for your
needs.
Durable devices include NovoPen 3, NovoPen Demi, Innovo and HumaPen.
Pre-filled disposable devices include Innolet, FlexPen and Novolet.
Many people find pen devices easier and more convenient than syringes.
Those who have difficulties with their sight or arthritis may find the Innolet pre-filled
device easier to use. Discuss this with your doctor or diabetes educator.
Pen needles vary in length (5mm, 6mm, 8mm or 12mm). They also vary in thickness
or gauge (28G, 29G, 30G or 31G). The higher the number, the finer the needle.
It is recommended that the pen needle be changed with each injection.
Pen needles are free for people registered with the National Diabetes Service Scheme
(NDSS).
Insulin pumps
The insulin pump is a small programmable device, about the size of a pager that
holds a reservoir of insulin. The pump is programmed to deliver insulin into the body
through thin plastic tubing known as the infusion set or giving set.
The pump is worn outside the body, in a pouch or on your belt. The infusion set has
a fine needle or flexible cannula that is inserted just below the skin (usually on the
abdomen) where it stays in place for two to three days.
Only short or rapid acting insulin can be used in the pump. Whenever food is eaten,
the pump is programmed to deliver a surge of insulin into the body similar to the
way the pancreas does in people without diabetes. Between meals, a small and
steady rate of insulin is delivered.
The insulin pump isn’t suitable for everyone. If you’re considering using one, you
must discuss it first with your diabetes health care team.
Storage of insulin
Unopened insulin vials or pen cartridges can be kept in the fridge. Do not allow it to
freeze. Once opened, insulin may be kept at a temperature less than 30 degrees for
30 days and then must be thrown away.
Always check the expiry date and appearance of insulin before use. Insulin is
destroyed by heat and so must not be left in a car or anywhere where temperatures
exceed 30 degrees centigrade.
Disposal of used syringes

Used syringes, pen needles and lancets must be disposed of in an Australian Safety
Standards-approved sharps container which is puncture proof and has a secure lid.
These containers are usually yellow in colour and are available through pharmacies,
councils and Diabetes Australia - Vic.
Procedures to dispose of sharps containers vary between States. Contact Diabetes

Australia – Vic, your State Department of Health or local council for information.
Where to get help

Your doctor
Diabetes educator
Diabetes Australia – Victoria Tel. (03) 9667 1777, country callers 1300 136 588
Things to remember
There are five different types of insulin, ranging from short to long acting.
Insulin injection devices include insulin syringes, insulin delivery devices and insulin
pump.
Syringes and pen needles are free for people registered with the National Diabetes
Service Scheme (NDSS).
Diabetes type 2
Type 2 diabetes (previously known as non-insulin dependent diabetes)
Type 2 diabetes is the most common form of diabetes, affecting 85-90% of all people
with the disease. This type of diabetes, also known as late-onset diabetes, is
characterised by insulin resistance and relative insulin deficiency. The disease is
strongly genetic in origin but lifestyle factors such as excess weight, inactivity, high
blood pressure and poor diet are major risk factors for its development. Symptoms
may not show for many years and, by the time they appear, significant problems
may have developed. People with type 2 diabetes are twice as likely to suffer
cardiovascular disease. Type 2 diabetes may be treated by dietary changes, exercise
and/or tablets. Insulin injections may later be required.
Diabetes insipidus
Diabetes insipidus
Diabetes insipidus is characterised by extreme thirst and the passing of vast amounts
of urine. It is caused by insufficient vasopressin, a hormone produced by the brain
that instructs the kidneys to retain water. Without enough vasopressin, too much
water is lost from the body in urine, which prompts the affected person to drink large
amounts of fluids in an attempt to maintain their fluid levels. In severe cases, a
person may pass up to 30 litres of urine per day. Without treatment, diabetes
insipidus can cause dehydration and, eventually, coma due to concentration of salts
in the blood, particularly sodium.
The name of this condition is a little misleading, since diabetes insipidus has nothing
to do with diabetes mellitus (a condition characterised by high blood sugar levels),
apart from the symptoms of thirst and passing large volumes of urine. The word
diabetes means 'to go through' - describing the excessive urination. Insipidus means
the urine is tasteless, whereas mellitus suggests it is sweet from its sugar content.
This terminology dates back to a time when physicians literally dipped a finger in the
patient's urine and tested its taste. Not a diagnostic method much in use today!
Symptoms
The symptoms of diabetes insipidus include:
Extreme thirst that can't be quenched (polydipsia)

Excessive amounts of urine (polyuria)
Colourless urine instead of pale yellow
Waking frequently through the night to urinate
Dry skin
Constipation
Weak muscles
Bedwetting.
Too much water is lost in the urine
The kidneys are organs of excretion. They filter the blood to remove wastes (such as
urea) and regulate the amount of salts and water in the bloodstream. The hormone
vasopressin is made by a structure in the brain called the hypothalamus. Vasopressin
controls the amount of water excreted by the kidneys. Diabetes insipidus can be
caused by two flaws in this process: the hypothalamus isn't making enough
vasopressin or the kidneys aren't responding to the hormone. Either way, the result
is the loss of too much water in the urine, leading to the characteristic symptom of
excessive thirst.
There are various forms of diabetes insipidus

The forms of diabetes insipidus are categorised by cause and include:
Neurogenic - the brain doesn't produce enough of the hormone vasopressin. Some of
the events that could cause this form of diabetes insipidus include head injury,
infection (such as meningitis), brain tumour, ruptured aneurysm or brain surgery. In
about half of cases, the cause remains unknown (idiopathic neurogenic diabetes
insipidus).
Nephrogenic - the kidneys aren't sensitive to vasopressin and fail to respond. This
comparatively rare form of diabetes insidipus is caused by an inherited disorder that
affects the tubules, the tiny structures inside the kidneys that absorb water. Men are
more prone to this condition than women.
Without medical treatment, the possible complications of diabetes insipidus include:
Chronic dehydration
Low body temperature

Accelerated heart rate
Weight loss
Fatigue
Frequent headaches
Low blood pressure (hypotension)
Kidney damage
Brain damage.
Diagnosis methods
Diabetes insipidus is diagnosed using a number of tests including:
Medical history
Physical examination
Urine analysis
Blood tests - to measure electrolyte levels
Water deprivation test (to see how much urine is passed)
Magnetic resonance imaging (MRI) scan of the brain
Computerised tomography (CT) scans.
Treatment options
Treatment for diabetes insipidis (DI) depends on the cause. For DI that is associated
with decreased vasopressin production, replacement of vasopressin is required. This
is usually given by sniffing a small amount of vasopressin that can be absorbed
through the lining of the nose. For DI that is associated with reduced or absent
response to vasopressin, adequate replacement of fluids is necessary.
Options include:
Drink plenty of fluids.
Switch to a low salt diet.
Medications like hydrochlorothiazide may help.
Some forms of DI, such as those that occur following head injury or neurosurgery or
during pregnancy, resolve with time.
Where to get help

Your doctor
Things to remember
Diabetes insipidus is characterised by extreme thirst and the passing of large
amounts of urine.
It is caused by the lack of sufficient vasopressin, a hormone produced by the brain
that instructs the kidneys to retain water.
Treatment options include vasopressin replacement.

Types of Diabetes Symptoms of Diabetes Early Symptoms of Diabetes Diabetes Treatment Diabetes Diet Insulin Pump

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html for early symptoms

Early Symptoms of Diabetes

There are two main types of diabetes

Is caused by an autoimmune destruction of insulin-making cells in the pancreas,

Untreated diabetes can cause long term damage

High blood sugar levels harm the body

Immediately after the procedure

Where to get help

the pump itself (including controls, processing module, and batteries)

Insulin pump therapy, also known as continuous subcutaneous insulin infusion,

[edit] Bolus Shaping

A standard bolus is an infusion of insulin pumped completely at the onset of the

A combination bolus is the combination of a standard bolus spike with an extended

[edit] Basal Rate Patterns

A reduction of basal at night to prevent low blood sugar.

[edit] Temporary Basal Rates

[edit] Recent developments

[edit] Current insulin pump manufacturers

[edit] Future developments

When insulin pump technology is combined with a continuous blood glucose

The most common complications

The risk of cardiovascular disease is increased

Large blood vessel damage - reducing the risk

To reduce the risks:

Kidney damage can be diagnosed early by detecting microalbumin (very small

To reduce the risks of kidney disease:

Ways to reduce the risk of nerve damage include:

Where to get help

Diabetes and coma

Diabetes mellitus is a condition characterised by high blood glucose (sugar) levels.

Diabetes and diagnostics

High blood sugar levels harm the body

Tests to diagnose diabetes include:

Immediately after the procedure

Where to get help

Diabetes and healty eating

Healthy eating helps a person with diabetes to:

Maintain general good health

Basic eating guidelines

Sugar and a healthy eating plan

Eat less fat – especially saturated fat

When you do eat fats, choose mainly:

Lots of other vegetables.

Where to get help

Maintain normal blood glucose levels.

A doctor can recommend a local nutritionist or dietitian.

Local diabetes centers at large medical clinics, hospitals, or medical universities

Many experts, including the American Diabetes Association, recommend that 50 to

A nutritionist or dietitian can help plan a diabetes diet.

Juvelline diabetes type 1

Type 1 diabetes (previously known as insulin-dependent diabetes)

Diabetes Type 1 - juvenile diabetes

The cause is unknown

Complications of untreated diabetes

Where to get help

Diabetes and healthy eating

Healthy eating helps a person with diabetes to:

Maintain general good health

Basic eating guidelines

Sugar and a healthy eating plan

Eat less fat – especially saturated fat