What is diabetes?

Type 1 diabetes is usually diagnosed during the childhood and teen years and occurs when the pancreas is unable to produce insulin. Insulin is a hormone that controls the amount of glucose (sugar) in the blood. Your body produces glucose from the food you eat to give your body energy, but needs insulin to use it. Approximately 10 per cent of people with diabetes have type 1 diabetes. The cause of type 1 diabetes remains unknown; however, we do know it is not preventable, and it is not caused by eating too much sugar. Anyone with type 1 diabetes must take insulin.

The remaining 90 per cent have type 2 diabetes, which occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 diabetes usually develops in adulthood, although increasing numbers of children in high-risk populations are being diagnosed. People with type 2 diabetes may manage their condition with lifestyle changes like healthy eating and being physically active. They may also take diabetes medications or insulin. For more information about managing type 2 diabetes, refer to the “Staying Healthy - Managing Type 2 Diabetes” fact sheet in this kit.

Gestational diabetes is a temporary condition that occurs during pregnancy. It affects approximately 3.7 per cent of all pregnancies and eight to 18 per cent of all pregnancies in the Aboriginal population. If a pregnant woman is diagnosed with gestational diabetes, both she and her child have an increased risk of developing diabetes in the future.

Is diabetes preventable?

Scientists believe that changing your lifestyle can help prevent or delay the onset of type 2 diabetes. Healthy eating, weight control and physical activity are important prevention steps.

What are the signs and symptoms of diabetes?*

• Unusual thirst

• Frequent urination

• Weight change (either gain or loss)

• Extreme fatigue or lack of energy

• Blurred vision

• Frequent or recurring infections

• Cuts and bruises that are slow to heal

• Tingling or numbness in the hands or feet

• Trouble getting or maintaining an erection * Keep in mind that many people with type 2 diabetes display none of these symptoms. Talk to your family health care provider about whether you are at risk.

DiabetesAn Introduction

You are not alone. In Ontario, there are over 800,000 people living with diabetes.

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Diabetes.

Diabetes - An Introduction

What are the risk factors for diabetes?

If you are 40 years of age or over, you are at risk for type 2 diabetes and should be tested at least every three years. You should be tested earlier/more often if you:

• Are a member of one of the following high-risk groups: Aboriginal, Hispanic, Asian, South Asian or African descent

• Are overweight – especially if you carry most of your weight around your middle

• Have a parent, brother or sister with diabetes

• Have any health complications associated with diabetes, such as eye, nerve or kidney problems

• Gave birth to a baby weighing more than 4 kg (9 lbs)

• Had gestational diabetes while you were pregnant

• Have a history of impaired glucose tolerance, impaired fasting glucose or prediabetes

• Have high blood pressure

• Have high cholesterol or other high levels of fats in the blood

• Ha ve been diagnosed with any of the following conditions:

Polycystic ovary syndrome

Acanthosis nigricans (darkened patches of skin)

Schizophrenia

Is diabetes serious?

If not treated or properly managed, diabetes can result in a variety of complications, including:

• Heart disease and stroke

• Kidney disease

• Eye disease

• Erectile dysfunction (impotence)

• Nerve damage

Good diabetes management can help to prevent or delay these complications – talk to your health care provider.

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What is type 2 diabetes?

To use the energy that comes from food, your body needs insulin. Type 2 diabetes is a condition in which your pancreas does not produce enough insulin, or your body does not properly use the insulin it makes. If you have type 2 diabetes, glucose builds up in your blood instead of being used for energy.

Get the support you need

You may have a hard time accepting that you or a family member has type 2 diabetes. It is not unusual to feel scared, shocked, overwhelmed, or even angry. Talk to others who have diabetes: A positive and realistic attitude can help you manage your condition.

In addition, your diabetes health care team can answer all of your questions about how to manage your diabetes. Your team might include a health care provider (your family doctor or a diabetes specialist) and diabetes educators (nurse and dietitian) as well as a:

• Pharmacist

• Social worker

• Psychologist

• Foot care specialist

• Endocrinologist

• Eye care specialist

CThe good news

You can live a long and healthy life by keeping your blood glucose levels (the amount of sugar in your blood) in the target range set by your family health care provider. There are many things you can do to stay healthy and manage your diabetes.

AB

Do you know your ABCs?

Talk to your family health care provider about what targets are healthy for you, and how to achieve and maintain them over time.

A1C* Recommended Targets: 7.0 per cent or below (for most people with diabetes) My Goals

Blood Pressure Recommended Targets: Below 130/80 mm Hg My Goals

Cholesterol Recommended Targets: LDL: 2.0 mmol/L or lower Total cholesterol to HDL ratio: below 4 My Goals

* Measure of blood glucose levels over time. A1C targets for pregnant women and children 12 years of age and under are different.

Staying HealthyManaging Type 2 Diabetes

Remember: The most important member of your health care team is you.

Remember, lowering your blood glucose and blood pressure – even a little – will help you to become healthier and stay that way.

Staying Healthy - Managing Type 2 Diabetes

Things to work on!Blood glucoseYou and your health care team should set goals for your blood glucose levels. It is important to recognize that you may need to add pills and/or insulin to your lifestyle changes (meal planning and increased activity) to achieve your blood glucose targets. Ask about a blood glucose meter to help track your blood glucose levels. For more information, refer to the “Managing Blood Glucose Levels” fact sheet in this kit and watch the “Managing Your Blood Glucose” video.

Physical activityPhysical activity helps control blood glucose levels, results in weight loss and helps reduce stress. Do at least 150 minutes (e.g., 30 minutes, five days a week) of moderate to vigorously intense aerobic exercise per week. You may need to start with as little as five to 10 minutes per day of brisk walking. In addition, resistance exercise (such as weight training) should be performed three times per week. If you are just getting started, check with your family health care provider first. For more information, refer to the “Physical Activity” fact sheet in this kit and watch the “Managing Your Fitness” video.

Healthy eatingWhat, when and how much you eat all play an important role in regulating blood glucose levels. Follow a balanced meal plan. Ask your family health care provider to refer you to a registered dietitian to learn about healthy eating, and follow Eating Well with Canada’s Food Guide. For more information, refer to the “Healthy Eating: The Basics” fact sheet in this kit and watch the “Managing Your Nutrition” video.

Weight managementMaintaining a healthy weight is especially important in managing type 2 diabetes. Doing so will help you control your blood glucose, blood pressure and blood fat levels. For more information, refer to the “Maintaining a Healthy Weight” fact sheet in this kit and watch the “Managing Your Weight” video.

MedicationIn some cases, type 2 diabetes can be managed with physical activity and healthy eating. However, oral medications and/or insulin are often prescribed – take them as directed by your family health care provider. For more information, refer to the “Using Insulin” fact sheet in this kit and watch the “Medication” video.

Lifestyle managementStress can impact your blood glucose levels. Learning to manage your day-to-day stress may help you maintain better control. For more information on dealing with stress, watch the “Managing Your Stress” video in this kit.

Quit smokingSmoking and diabetes are a dangerous mix. If you are serious about quitting, your family health care provider or health care team can help. Keep trying; your health is worth it.

Type 2 diabetes is a progressive, life-long condition; over time, it may be more difficult to keep your blood glucose levels in your target range. Your health care team can help by working with you to adjust your food plan, activity and medications.

Monitoring your blood glucose is important. Review your home glucose monitoring record with your family health care provider regularly. And make sure that your meter is providing accurate results by checking against the results of a blood test at the lab at least once a year.

Things to be aware ofBlood pressureHigh blood pressure can lead to eye disease, heart disease, stroke and kidney disease. You may need to change your eating and exercise habits and/or take pills to keep your blood pressure below 130/80 mm Hg.

CholesterolHigh cholesterol and other fats in the blood can lead to heart disease and stroke. You may need to change your eating and exercise habits and/or take pills to keep your blood fats at healthy levels. For more information, refer to the “Managing Your Cholesterol” fact sheet in this kit and watch the “Blood Pressure and Cholesterol” video.

Eye diseaseYou need to be seen by an eye care specialist who will dilate your pupils and check for signs of eye disease. Your regular family health care provider cannot do this special test in his or her office. Ask for a referral to an eye care specialist.

Foot careTake off your shoes and socks at every visit (even if your family health care provider or health care team forget to ask you). Ingrown toenails, cuts and sores on the feet can lead to serious infections. Learn about proper foot care. For more information, refer to the “Foot Care” fact sheet in this kit and watch the “Managing Your Feet” video.

Depression and anxietyThese are common feelings in people with diabetes and can negatively affect your diabetes control. Speak to your family health care provider or health care team if you feel you might have depression or anxiety.

Kidney diseaseThe earlier you catch signs of kidney disease, the better. You must have your urine tested regularly for early signs of kidney disease. Your family health care provider may prescribe pills to delay more damage to your kidneys.

Nerve damageTell your family health care provider or health care team if your hands or feet ever feel numb or have “pins and needles.”

Problems with erectionTrouble getting and maintaining an erection is a very common problem in men with diabetes. Do not be shy about talking to your family health care provider or health care team.

Staying Healthy - Managing Type 2 Diabetes

Keep on top of your diabetes managementBe an informed patient: Stay healthy by asking the right questions. Talk to your family health care provider about these important tests for basic diabetes care. You may need some tests more often than indicated. Target blood glucose and blood pressure levels may differ, depending on your health.

When? What test?

At diagnosis • Kidney test: urine test performed at the lab

• Eye examination: through dilated pupils by an eye care specialist

• Nerve damage test: using a 10-g monofilament or 128-Hz tuning fork

• Cholesterol and other blood fat tests: a blood test

Approximately every 3 months * More often if treatment

is initiated.

• A1C blood test* (goal: 7.0 per cent or below for most people with diabetes)

• Blood pressure (goal: below 130/80 mm Hg)

• Review of home blood glucose monitoring record

Every 6 to 12 months • Kidney check

• Foot exam at least once a year and right away for an ingrown toenail or any cut or sore that doesn’t heal

• Meter check against the results

Every 1 to 2 years • Eye examination by an eye specialist every 1 to 2 years (if eye disease is not present), more often if eye disease is present

Every 1 to 3 years • Cholesterol and other blood fats tests

Regularly/Periodically • Questions about erection problems

• Questions about depression and/or anxiety

• Questions about healthy eating and physical activity

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Staying Healthy with Diabetes.

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Ask your family health care provider to refer you to a registered dietitian. You may also visit ontario.ca/eatright, or call 1-877-510-510-2 to speak to an EatRight Ontario registered dietitian about developing a menu plan that is right for you. Meanwhile, here are some tips to help you get started.

Tips ReasonEat three meals per day at regular times and space meals no more than six hours apart. You may benefit from a healthy snack.

Eating at regular times helps your body control blood glucose levels.

Limit sugars and sweets such as sugar, regular pop, desserts, candies, jam and honey.

The more sugar you eat, the higher your blood glucose will be. Artificial sweeteners can be a better option.

Limit the amount of high-fat foods you eat such as fried foods, chips and pastries.

High-fat foods may cause you to gain weight. A healthy weight helps with blood glucose control and is healthier for your heart.

Choose starchy foods such as whole-grain breads and cereals, rice, noodles, or potatoes at every meal.

Starchy foods are broken down into glucose, which your body needs for energy.

Eat more high-fibre foods (whole-grain breads and cereals, lentils, dried beans and peas, brown rice, vegetables and fruits).

Foods high in fibre may help you feel full and may lower blood glucose and cholesterol levels. Vegetables are very high in nutrients and low in calories.

Talk to your family health care provider about whether you can include alcohol in your meal plan and how much is safe.

Alcohol can affect blood glucose levels and cause you to gain weight.

If you are thirsty, drink water. Drinking regular pop and fruit juice will raise your blood glucose level.

Be physically active. Regular physical activity will improve your blood glucose control.

It’s natural to have questions about what food to eat. A registered dietitian can help you include your favourite foods in a personalized meal plan. You can also speak to an EatRight Ontario registered dietitian free of charge at 1-877-510-510-2 or visit EatRight Ontario at ontario.ca/eatright

Healthy EatingThe Basics

Healthy eating is an important part of managing diabetes.

Healthy Eating - The Basics

For smaller appetites For bigger appetites

Breakfast:

Cold cereal (1/2 cup, 125 mL)

Whole-grain toast (1 slice)

1 orange

Low-fat milk+ (1 cup, 250 mL)

Peanut butter (2 tbsp, 30 mL)

Tea or coffee

Lunch:

1 sandwich

2 slices of whole-grain bread or 6” pita

meat, chicken or fish (2 oz, 60 g)

non-hydrogenated margarine (1 tsp, 5 mL)

Carrot sticks

Low-fat plain yogurt (3/4 cup, 175 mL)

Tea or coffee

Dinner:

1 medium potato or rice (2/3 cup, 150 mL)

Vegetables

Non-hydrogenated margarine (1 tsp, 5 mL)

Lean meat, chicken or fish (2 oz, 60 g)

Cantaloupe (1 cup, 250 mL)

Low-fat milk+ (1 cup, 250 mL)

Tea or coffee

Evening Snack:

Low-fat cheese (1 oz, 30 g)

Whole-grain crackers (4)

Breakfast:

Cold cereal (1/2 cup, 125 mL)

Whole-grain toast (2 slices)

1 orange

Low-fat milk+ (1 cup, 250 mL)

Low-fat cheese (2 oz, 60 g)

Tea or coffee

Lunch:

Soup (1 cup, 250 mL)

1 sandwich

2 slices of whole-grain bread or 6” pita

lean meat, chicken or fish (3 oz, 90 g)

tomato slices

non-hydrogenated margarine (1 tsp, 5 mL)

Carrot sticks

Low-fat plain yogurt (3/4 cup, 175 mL)

Tea or coffee

Afternoon Snack:

1 medium apple or small banana

Dinner:

1 large potato or cooked noodles (1 1/2 cup, 375 mL)

Vegetables

Green salad with low-fat salad dressing

Lean meat, chicken or fish (4 oz, 120 g)

1 medium pear

Low-fat milk+ (1 cup, 250 mL)

Tea or coffee

Evening Snack:

Peanut butter (4 tbsp, 60 mL)

Whole-grain crackers (4)

Low-fat milk+ (1 cup, 250 mL)

+ If you are lactose intolerant, try a fortified soy beverage.

FRUITS*/GRAINS and STARCHES*:Choose an amount the size of your fist for each

of grains and starches, and fruit.

MEAT and ALTERNATIvES*:Choose an amount up to the size of

the palm of your hand and the thickness of your little finger.

FATS*:Limit fat to an amount the size of the

tip of your thumb.

MILK and ALTERNATIvES*:

Drink up to 250 mL (8 oz) of low-fat milk+ with a meal.

* Food group names taken from Beyond the Basics: Meal Planning

for Healthy Eating, Diabetes Prevention and Management

© Canadian Diabetes Association, 2005. Please refer to this resource

for more details on meal planning.

vEGETABLES*:Choose as much as you can hold in both hands.

Making sense of portion sizes

Keep your eye on portion sizes – in addition to what you eat, how much you eat is a very important factor. Have portion sizes that will help you reach or maintain a healthy body weight. The following tool can give you an idea of what appropriate portion sizes are.

Sample Meal Plans

Be sure to eat breakfast. It provides a good start to your day.

Read the nutrition facts and look at the label on food packaging to make healthy food choices.

Serving size

Compare the serving size on the package to the amount that you eat.

% daily value tells you how much of a particular nutrient is found in one serving. Compare similar products. Choose foods with a lower % daily value of fat and a higher % daily value of fibre.

Fat

• Choose foods with a lower fat content

• Choose foods with little or no saturated fat

• Choose foods with no trans fat

Cholesterol

• Choose foods with little or no cholesterol

• Aim for less than 200 mg of cholesterol per day

Fibre

• Choose foods high in fibre

• Aim for 25 g to 35 g or more of fibre per day

Read the ingredient list on food packages. Avoid foods containing these fats:

• Hydrogenated or partially hydrogenated oil, shortening

• Tropical fats/oils such as coconut, palm, palm kernel

For more information on food labels, visit healthyeatingisinstore.ca. For more information on eating healthy, watch the “Managing Your Nutrition” video, which is part of this kit.

MEAT and ALTERNATIvES (fish, lean meat, chicken, beans, lentils)

GRAINS and STARCHES

(potato, rice, corn, pasta)

vEGETABLES (at least 2 kinds)

• Have foods from at least three out of the four key food groups from Eating Well with Canada’s Food Guide at each meal:

Vegetables and Fruit

Grain Products

Milk and Alternatives

Meat and Alternatives

• Include fish, lean meats, low-fat cheeses, eggs or vegetarian protein choices (tofu, legumes, lentils) as part of your meal.

• Have a glass of milk and a piece of fruit to complete your meal.

MILK

FRUIT

A Balanced Diet

Healthy Eating - The Basics

Make lower-fat choices (e.g., use skim milk, lower-fat cheese, and lean ground beef, trim fat on meat, chicken etc., and only use small amounts of added fat such as oil and/or salad dressing).

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Sugars and sweetened foods may be eaten in moderation by people with diabetes. Their effect on blood glucose levels will vary. Talk to your dietitian about how to fit sweeteners and sweetened foods into your diet.

Tip for portion control: Use a luncheon plate instead of a dinner plate. Research shows that people who are presented with larger containers of food eat more than those eating from smaller containers.

Tips for eating away from home

• Stop eating when you are full; take extra food home

• Skip or share appetizers or snacks

• Ask for sauces on the side and use sparingly

• Order from the menu instead of going to the buffet

• Balance the choice that you feel is less healthy with a healthier choice (e.g., fried chicken with baked potato instead of French fries)

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Just the Basics © 2009.

Why is physical activity so important?The health benefits of regular exercise include weight loss, stronger bones, improved blood pressure control, lower rates of heart disease and cancer as well as increased energy levels. If you have type 2 diabetes, regular exercise has special advantages: improving your body’s sensitivity to insulin and helping you manage your blood glucose levels.

What kind of activity is best?Aerobic exercises (such as brisk walking, running, swimming, dancing, playing hockey and skiing) work your heart and lungs and carry oxygen to your muscles.

Resistance exercises (such as weight training) increase muscle strength and add to the benefits of aerobic exercise. If you decide to begin resistance exercise, you should first get some instruction from a qualified exercise specialist and start slowly.

How much is enough?Your goal should be to complete at least 150 minutes of moderate to vigorously intense aerobic exercise each week (e.g., 30 minutes, five days a week).

You may have to start slowly, with as little as five to 10 minutes of exercise per day, gradually building up to your goal. The good news, though, is that multiple, shorter exercise sessions of at least 10 minutes each are probably as useful as a single longer session of the same intensity.

If you are able and when you are ready, try adding resistance exercises like lifting weights three times a week.

Start off slowly. Small amounts of exercise, like walking five to 10 minutes a day, can make a difference.

Safety first• If you have been inactive for some time,

talk to your family health care provider before starting any exercise program that is more demanding than brisk walking.

• Make sure you wear comfortable, proper-fitting shoes.

• Wear your MedicAlert® bracelet or necklace.

• Listen to your body. Speak to your family health care provider if you are very short of breath or have chest pain.

• Monitor your blood glucose before, during and many hours after your activity to see how the exercise affects your blood glucose levels.

• Carry some form of fast-acting carbohydrate with you in case you need to treat low blood glucose (hypoglycemia) – for example, glucose tablets (preferred) or Life Savers®.

Physical Activity

Both aerobic and resistance exercise are important for people living with diabetes.

Physical ActivityKeep going!

Habits can be hard to change, so be prepared with a plan in case you stop feeling as motivated or inspired:

• Do something you like! It is hard to stick to an activity that is not fun. It may take you a few tries before you find the activity that is right for you.

• Have a support network. Ask your family, friends and co-workers to help you stay motivated by joining you for a walk or a workout at the gym.

• Set small, attainable goals and celebrate in a healthy way when you reach them.

• Talk to friends who have included physical activity into their daily routines and ask them how they got started.

• Buy a pair of walking shoes.

• Make yourself a list of the reasons why you might want to introduce physical activity into your life.

Plan on being active!

Try filling out this chart and check off each activity as it’s completed, to kick-start the first few weeks of your new habit! As your body adjusts, make sure you’re increasing the intensity and building up to 30 minutes a day – and more! For more information on getting active, watch the “Managing Your Fitness” video, which is part of this kit.

Increase your physical activity

• Build time for physical activity into your daily routine.

• Try to be active most days of the week.

• Walk whenever you can, instead of taking the car.

• Start slowly and gradually increase the amount of effort; for instance, start with strolling and move on to brisk walking.

• Make family times active; try swimming or skating together instead of watching TV or a movie.

• Try new activities; learn to dance, play basketball, or ride a bike.

• Enjoy your improved sense of health and well-being!

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Example Morning walk

Walk after dinner

Play hockey with boys

Ride bike to the library instead of driving

Family swim

Bowling night

Rake leaves

Week 1

Week 2

Week 3

Your goal should be to complete at least 150 minutes of moderate to vigorously intense aerobic exercise each week (e.g., 30 minutes, five days a week).

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Content taken from the Canadian Diabetes Association’s consumer fact sheet, Physical Activity and Diabetes © 2009.

Healthy eating and physical activity are key lifestyle factors in managing your weight.

Maintaining a healthy weight is very important in managing type 2 diabetes. Doing so will help you control your blood glucose, blood pressure and blood fat levels. A healthy weight can help to reduce the risk of complications such as heart disease and stroke and simply makes you feel better, with more energy!

Maintaining a Healthy Weight

How do I know if I’m at a healthy weight?

There are many ways to determine if you’re at a healthy weight. Ask your health care team about your body mass index (BMI), waist measurement and weight goals.

Body Mass Index (BMI) compares a person’s weight to their height. For most adults aged 18 to 64, a BMI of 25 or higher is overweight. This doesn’t include women who are pregnant or breastfeeding, very muscular adults, or adults with a very lean build.

You can calculate your BMI using this formula:

BMI = weight (kg) [height (m) x height (m)]

For example, if you weigh 69 kg and are 1.73 m tall, you have a BMI of approximately 23, which is a normal weight.

Waist Circumference (WC) is also important. Too much fat around the waist (apple shape) is linked to health problems such as heart disease and high blood pressure. WC goals differ depending on ethnic background and gender. In general, a healthy WC for men is less than 40 in (102 cm), and for women it is less than 35 in (88 cm).

Lifestyle tips for a healthy weight

The key to reaching and staying at a healthy weight is to make lifestyle changes you can live with. Set realistic goals. Make one or two small changes at a time. When these changes are part of your daily routine, add new ones.

Maintaining a Healthy Weight

Goal Tips Changes I will make

Build exercise into your day

Exercise helps muscles use glucose and burn calories. Do aerobic exercises such as brisk walking, skiing, or biking for at least 150 minutes each week (e.g., 30 minutes, five days a week). If you can, increase the amount of time and intensity gradually. Add resistance exercises like lifting weights three times a week. Check with your family health care provider before starting.

Eat only when hungry

Ask yourself if you are really hungry. Avoid eating out of habit, boredom or for emotional reasons. Try to figure out what it is that you really need.

Create a healthy eating environment

Serve foods in the kitchen rather than at the table. Eat at the table rather than in front of the TV or computer. Eat slowly. It takes your brain about 20 minutes to realize that your stomach is full.

Eat regular, balanced meals

Eating three meals a day reduces overeating. Start with a healthy breakfast. Meals should be spaced four to six hours apart and include foods from each of the food groups.

Choose appropriate portions

Too much food, healthy or not, leads to weight gain. If you can, check your portions with measuring cups or scales. Talk to a dietitian about how much food is right for you.

Eat fibre-rich foods

High-fibre foods may help keep you feeling full longer. Whole grains, vegetables, fruits and legumes (dried beans and lentils) are high in fibre.

Choose healthy beverages and snacks

Satisfy thirst with water. Pop, sweetened hot or cold drinks, juice and alcohol can add many unwanted calories. Small snacks can help control hunger. Keep pre-cut vegetables and washed fruit handy for easy snacking. Avoid fried, salty and sugary snacks.

Weight management challenges and possible solutions

Planning ahead means having solutions to deal with weight management challenges.

Each person’s body has its own size and shape. Feel good about yourself and the lifestyle changes you make. Remember to think long-term, but make changes gradually.

Challenges I might face Possible solutions

• I don’t know how to start.

• I don’t feel ready to change.

• I get discouraged and give up.

• When I lose weight, I have trouble keeping it off.

• I think my health condition prevents me from making lifestyle changes.

• Meet with a family health care provider to:

discuss your situation and readiness to change;

set realistic goals and develop a personal plan; and

help you with your challenges.

• My family and friends sometimes sabotage my efforts.

• Discuss your goals with friends and family. Suggest how they can help. Look for support and/or resources in your community.

• I make unhealthy choices when stressed, bored or emotional.

• I don’t know what or how much to eat.

• I don’t have time to be active and/or to eat well.

• Plan ahead (e.g., make weekly menus and grocery lists, schedule time for exercise).

• Keep track of things that affect your choices.

• I feel deprived when I follow a “diet”.

• It’s hard to eat healthy and/or keep active when away from home.

• Keeping active and eating well is too expensive.

• Others:

• Learn about eating sensible portions and balanced meals and snacks. Avoid fad diets. For more information, refer to the “Healthy Eating: The Basics” fact sheet in this kit.

• Save money: Shop with a list to get only what you need for nutritious meals, avoiding impulse buys. Buy fruits and vegetables economically – fresh when in season, frozen when they aren’t. You don’t need to join a gym to stay active; brisk walks will help you achieve the same results.

• Others:

Maintaining a Healthy Weight

Special considerations for people with diabetes

People with diabetes must balance a healthy weight with blood glucose levels that fall within target range. Talk to your health care team about what is right for you.

• Weight loss and lifestyle changes can affect blood glucose control. Find out how by testing your blood glucose level at recommended times and tracking your progress. Diabetes medications may need to be reviewed.

• Try not to let the fear of low blood glucose prevent you from being physically active and/or eating smaller servings.

• Some diabetes medications may affect weight.

• Some complications such as high blood pressure, foot ulcers or eye damage may change the types of exercises you can do.

• If lifestyle changes do not lead to appropriate weight loss, talk to your health care team about other options.

For more information on maintaining a healthy weight, watch the “Managing Your Weight” video, which is part of this kit.

My weight management numbers

My BMI:

My target BMI:

My waist measurement:

My target waist measurement:

My current weight:

My 5 to 10 per cent weight loss:

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Managing Weight and Diabetes.

You are at a higher risk if you carry most of your weight around the abdomen. If you are overweight, losing 5 to 10 per cent of your current body weight at a rate of 2 to 4 lbs (1 to 2 kg) per month is a healthy goal. For someone who weighs 200 lbs (90 kg), 5 to 10 per cent is 10 to 20 lbs (4.5 to 9 kg).

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Not necessarily.

As a general rule, there is no need to stop drinking alcohol because you have diabetes. Most people who are managing their diabetes well can safely drink alcohol in moderation: as a general rule, no more than two standard drinks per day with a maximum of up to 14 standard drinks a week for men and up to nine standard drinks for women a week. However, you should speak with your health care team first, especially if any of the following apply to you:

  •   You have health complications of diabetes such as pancreas  or eye disease, high blood pressure or triglycerides, liver problems, nerve damage or stroke.

  •  You have trouble preventing and treating low blood glucose.

You should not drink alcohol if you:

  •  Are pregnant or trying to get pregnant;

  •  Are breastfeeding;

  •  Have a personal or family history of drinking problems;

  •   Are planning to drive or engage in other activities that require attention or skill;

  •   Are taking certain medications. Ask your pharmacist about your medications and possible interactions with alcohol.

Be aware of the risks for people with diabetes

• For people using insulin: Delayed hypoglycemia (low blood glucose) can occur up to 24 hours after drinking alcohol.

• For people with type 1 diabetes: There is a risk of morning hypoglycemia if alcohol is consumed two to three hours after the previous evening’s meal.

When drinking alcohol, make sure you know how to prevent and treat low blood glucose.

Remember that for anyone, alcohol can:

•  Affect judgment

•   Provide extra calories that can make weight loss  or weight management a challenge

•  Increase blood pressure and triglycerides

•   Contribute to sexual difficulties and inflammation of the pancreas

•   Damage your brain, nerves and your liver over time

•   Dehydrate the body, which is very dangerous in someone with high blood glucose

•   Increase the risk of various cancers over time

•  Increase the risk of depression or aggression

•  Worsen eye disease

Alcohol and Diabetes

Does having diabetes mean that you can’t drink alcohol?

If you consume more than two standard drinks on any one  day (weekly up to nine standard drinks for women and up to 14 standard drinks for men), you are strongly advised to reduce the amount of alcohol you drink. Heavy alcohol use can make blood glucose control more difficult and increases other health risks, like cancer.

For people taking insulin and some medications: Reduce the risk of low blood glucose caused by drinking alcohol by taking the steps outlined on the back of this sheet.

For more information on alcohol and diabetes, watch the “Managing Your Lifestyle” video in this kit. Also, people with diabetes should discuss alcohol use with their diabetes health care providers.

Alcohol and Diabetes

Carbohydrate and calorie content in some common alcoholic beverages and mixes (amounts listed are a general guide only)

BEFORE Drinking Alcohol •   Eat regular meals, take your medication(s), and 

check your blood glucose levels frequently (keep  your blood glucose meter with you).

  •   Always have a treatment for low blood glucose with you (such as three glucose tablets or ¾ cup regular pop or six Life Savers®).

  •   Wherever you are, make sure the person with you knows your signs and symptoms of low blood glucose, and how to treat it.

  •   Be aware that glucagon, a treatment for low blood glucose, will not work while alcohol is in the body so make sure that someone knows to call an ambulance if you faint.

  •   Wear diabetes identification such as a MedicAlert® bracelet or necklace.

WHILE Drinking Alcohol •   Eat carbohydrate-rich foods when drinking alcohol.

  •   Eat extra carbohydrate-rich foods when  physically active.

  •   Always pour your own drinks. Use less alcohol  and dilute your drinks with sugar-free mixes.

  •   Drink slowly. Make your second drink  without alcohol.

AFTER Drinking Alcohol •   Tell a responsible person that you have been 

drinking. They should look for low blood  glucose symptoms.

  •   Check your blood glucose before going to bed. Eat a carbohydrate snack if your blood glucose  is lower than usual.

  •   Set an alarm or have a responsible person wake you up throughout the night and early morning – a delayed low blood glucose can occur anytime up to 24 hours after drinking alcohol.

  •   Get up on time the next day for any food, medication or insulin you normally take. Missed medication or insulin can lead to high blood glucose, ketones and diabetic ketoacidosis (DKA).

For more information, visit Low-Risk Drinking Guidelines  at www.lrdg.net

What is a “standard drink”?

One standard drink (13.6 g of alcohol):Beer: 360 mL (12 fl.oz) of regular strength beer (5% alcohol)Spirits: 45 mL (1.5 fl.oz) of spirits (40% alcohol)Wine: 150 mL (5 fl.oz) of wine (12% alcohol)

Note: If you are counting carbohydrates, do not take insulin  for the carbohydrate content of alcoholic drinks.

Reference: Canadian Nutrient File, 2005 *Actual labels **Manufacturer †USDA, 2004 (Release 17)

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Alcohol and Diabetes.

Beverage Standard serving size

Energy (kcal)

Carbohydrate content (g)

Beer:

regular

light

non-alcoholic*

low-carb*

360 mL (12 fl. oz)

360 mL (12 fl. oz)

360 mL (12 fl. oz)

360 mL (12 fl. oz)

140

100

50-75

90-97

10

5

11-15

2.5

Spirits/Hard liquor 45 mL (1.5 fl. oz) 98 0

Liqueurs and Cordials 45 mL (1.5 fl. oz) 163-190 17-21

Wine:

regular

dessert

non-alcoholic

150 mL (5 fl. oz)

150 mL (5 fl. oz)

150 mL (5 fl. oz)

102-108

231-243

9

1-2.5

17-21

1.6

Cooler:

regular**

light**

360 mL (12 fl. oz)

360 mL (12 fl. oz)

310

210

48

26

Mixes:

Sugar-free pop

Regular pop

Club soda

Tonic water

Orange juice

Tomato juice

Tomato + clam juice†

240 mL (8 fl. oz)

240 mL (8 fl. oz)

240 mL (8 fl. oz)

240 mL (8 fl. oz)

240 mL (8 fl. oz)

240 mL (8 fl. oz)

240 mL (8 fl. oz)

2

84-120

0

84

110

41

116

0.2

22-31

0

22

25

9

26

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Have you had your cholesterol tested lately?

People with diabetes have an increased risk of heart attack and stroke even if their LDL-cholesterol (“bad” cholesterol) is “normal”. They have an even higher risk if their LDL-cholesterol is above normal.

If you have diabetes, you should have your cholesterol tested every one to three years: more frequently if you are taking cholesterol-lowering medications.

Talk to your family health care provider and other members of your health care team about how to keep your LDL-cholesterol within your target range. Most adults with diabetes need medications (such as a statin) in addition to weight management, healthy eating and regular physical activity.

All about cholesterol: definitions

Cholesterol: a fat substance that is naturally present in your blood and cells. There are two main types of cholesterol: LDL and HDL.

• LDL (low-density lipoprotein): often called “bad” cholesterol because higher levels of LDL can increase the risk of cardiovascular disease.

• HDL (high-density lipoprotein): often called “good” cholesterol because higher levels of HDL can reduce the risk of cardiovascular disease.

Total cholesterol to HDL ratio: a measure of cardiovascular risk calculated by dividing your total cholesterol level by your HDL-cholesterol level.

Triglyceride: a form of fat that the body makes from sugar, alcohol or other food sources.

Cardiovascular disease: damage to the heart and blood vessels. One cause of this disease is narrowing of the blood vessels due to fat deposits on the vessel walls, which limits blood flow.

People who smoke or have a family history of heart disease or stroke are at even higher risk.

Talk to your family health care provider and health care team about ways to improve your cholesterol and lower your risk!

Heart disease is very common among people with type 2 diabetes. Coronary artery disease is the most common form of heart disease. It develops when the arteries that supply the heart or brain with blood become narrowed or blocked by fatty deposits, potentially causing heart attack or stroke. In fact, up to 80 per cent of people with diabetes will die as a result of a heart attack or stroke.

People with diabetes often have a number of risk factors for heart disease, including the following:

• High blood glucose

• Being overweight (especially in the abdomen)

• Inactive lifestyles

• High blood pressure

• High cholesterol

Managing Your Cholesterol

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Cholesterol and Diabetes.

Managing Your Cholesterol

Are you doing all that you can to lower your LDL cholesterol?

Yes No

I am taking my cholesterol medication(s) as prescribed by my family health care provider

My weight is in the healthy range

My waist measurement is in the healthy range

I choose low-fat foods and avoid saturated and trans fat

I limit cholesterol-containing foods

I make high-fibre choices (such as whole grains)

I eat enough vegetable and fruit servings every day

I am physically active on a regular basis

Have you met your LDL target goal? Are you ready to do more for your cardiovascular health?

Your next step: lower your total cholesterol to HDL ratio and triglyceride level. The recommended total cholesterol to HDL ratio goal is less than 4.0. Ask your family health care provider for your ratio.

One way to lower your ratio is to raise your HDL. You may increase your HDL by choosing small amounts of the following unsaturated fat sources instead of saturated and trans fats:

• Vegetable oils: canola, olive, peanut

• Olives, avocados

• Soft non-hydrogenated margarine

• Nuts and seeds such as peanuts, almonds, ground flax

If your triglyceride level is very high, your family health care provider may suggest you lower it by taking medication and making healthier lifestyle choices. The following can help improve your triglyceride level:

• Limit the amount of alcohol you drink

• Achieve and maintain excellent blood glucose control

• Achieve and maintain a healthy weight

• Limit added sugar and low-fibre foods such as regular pop, candy, sugar-sweetened cereals

For more information about cholesterol and diabetes, watch the video “Blood Pressure and Cholesterol” in this kit.

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Eye Health and Diabetes

Eye disease is a common complication of diabetes, which can lead to blindness. If you have diabetes, you are at increased risk of developing eye disease. However, there are measures you can take to help keep your eyes healthy.

Reduce your risk of eye disease

Undergoing eye exams every year is very important for people with diabetes. Eye exams give you an indication of how diabetes is affecting your overall health. Controlling blood sugar, blood pressure and cholesterol will also help prevent or delay the development of eye disease. Be sure to:

• Work with your family doctor to control your blood sugars, blood pressure and cholesterol

• Avoid smoking

• Maintain a healthy weight through diet and exercise

• Have an eye exam with an optometrist or ophthalmologist every year.

Eye disease caused by diabetes

In North America, eye disease due to diabetes is the leading cause of preventable blindness in people between 30 to 69 years of age. Diabetes can cause damage to the blood vessels in the retina, the light sensitive tissue at the back of the eye. Rapid changes in blood sugar levels can also cause sugar to leak into the lens of the eye, causing swelling and blurred vision.

Eye Exam Facts

• In Ontario, the cost of eye examinations by an optometrist or an ophthalmologist for people with diabetes is covered through OHIP, regardless of age.

• You can see an optometrist without a referral.

• People with diabetes should have an eye exam every year, or as recommended by an eye doctor.

Normal eye Severe eye disease due to diabetes

Early eye damage can occur without pain, redness or blurred vision. Therefore, people with diabetes need to have their eyes examined regularly by an optometrist or ophthalmologist to ensure changes are detected early. When caught early, eye disease can be treated with medications or laser surgery to prevent further permanent damage. If left untreated, the disease can lead to blindness.

What can you expect from your screening eye examination?

With regular eye examinations, your optometrist or ophthalmologist can diagnose diabetic eye disease at an early stage. Treatment at this stage can often prevent vision loss. Looking at the blood vessels in the eye also gives an indication of how diabetes is affecting other parts of the body. During the exam, your optometrist or ophthalmologist will assess your overall eye health, including a detailed look at the inside of your eye. Changes inside the retina can offer an early warning sign of damage to the heart, kidneys, and elsewhere in the body.

Your optometrist or ophthalmologist will dilate your pupils with eye drops to get a good look at the back of your eye. Dilation can cause blurry vision for several hours, so someone should be available to drive you home from your exam.

In Ontario, the cost of eye examinations by an optometrist or an ophthalmologist for people with diabetes is covered through OHIP, regardless of age. You do not need a referral to see an optometrist for an eye exam. Your eye care provider, either an optometrist or ophthalmologist, will usually report to your family doctor on the health of your eyes.

Optometrists and Ophthalmologists – What’s the diff erence?

Most people with diabetes can be monitored by either an optometrist or an ophthalmologist. Ophthalmologists are medical doctors who specialize in the diagnosis, medical and surgical treatment of all types of eye disorders. Optometrists are primary eye care doctors who perform comprehensive eye exams, diagnose and medically treat common eye disease and disorders. People who are monitored by an optometrist are referred to an ophthalmologist once the eye disease becomes severe enough that it requires treatment.

Eye Health and Diabetes

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The human eye

Developed in collaboration with

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Daily foot care

As always, prevention is the best medicine. A good daily foot care regimen will help keep your feet healthy.

Start by putting together a foot care kit containing nail clippers, a nail file, lotion, a pumice stone and a non-breakable hand mirror. Having everything you need in one place makes it easier to follow this foot care routine every day:

1. Wash your feet in warm (not hot) water, using a mild soap. Don’t soak your feet, as this can dry your skin.

2. While your feet are still wet, use a pumice stone to keep calluses under control.

3. Dry your feet carefully, especially between your toes.

4. Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.

5. Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.

6. Trim your toenails straight across and file any sharp edges. Don’t cut your nails too short.

7. Apply an unscented lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don’t put lotion between your toes, as the excessive moisture may cause infection.

8. Wear fresh, clean socks and well-fitting shoes every day. Whenever possible, wear white socks – if you have a cut or sore, the blood or pus will be easy to see.

Diabetes and your feet

Foot problems are very common in people with diabetes and can lead to serious complications.

Diabetes affects the circulation and immune systems, which makes it harder for the body to heal itself. Over time, diabetes can damage sensory nerves (this is known as “neuropathy”), especially in the hands and feet. As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.

Foot Care

Shake out your shoes or wear them on your hands before you wear them on your feet, because you don’t know what’s in there.

Foot Care

Diabetes foot care dos and don’ts

When to see your family health care provider

  •   If you have any swelling, warmth, redness or pain in your legs or feet, see your family health care provider right away.

  •   If you have any corns (thick or hard skin on toes), calluses (thick skin on bottom of feet), ingrown toenails, warts or slivers, have them treated by your family health care provider or a foot care specialist (such as a podiatrist, chiropodist or experienced foot care nurse). Do not try to treat them yourself.

  •   Have your bare feet checked by your family health care provider at least once a year. In addition, ask your family health care provider to screen you for neuropathy and loss of circulation at least once a year.

  •   Take your socks off at every  diabetes-related visit to your family health care provider and ask him or her to inspect your feet.

For more information on how to take care of your feet, watch the “Managing Your Feet” video in this kit.

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Foot Care: A step toward good health © 2008

Do wear well-fitting shoes. They should be supportive, have low heels (less than 5 cm high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professionally fit your shoes.

Do wear socks at night if your feet get cold.

Do elevate your feet when you are sitting.

Do wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs.

Do exercise regularly to improve circulation.

Do inspect your feet daily and in particular, feel for skin temperature differences between your feet.

Don’t wear high heels, pointed-toe shoes, sandals (open-toe or open-heel) or worn-out shoes.

Don’t wear anything tight around your legs, such as tight socks or knee-highs.

Don’t ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors.

Don’t put hot water bottles or heating pads on your feet.

Don’t cross your legs for long periods of time.

Don’t smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation.

Don’t have pedicures by non- health care professionals.

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Why should you check your blood glucose levels?Checking your blood glucose levels will:

• Provide a quick measurement of your blood glucose level at a given time.

• Determine if you have a high or low blood glucose level at a given time.

• Show you how your lifestyle and medication affect your blood glucose levels.

• Help you and your diabetes health care team to make changes to your lifestyle and medication that will improve your blood glucose levels.

Canadian Diabetes Association blood glucose targets for people with diabetes*

A1C Fasting blood glucose

Blood glucose two hours after the start of a meal

Target for most patients with diabetes

≤7.0% 4.0 to 7.0 mmol/L

5.0 to 10 mmol/L. 5.0 to 8.0 mmol/L if A1C targets are not being met

* These targets are for most adults with diabetes and serve as a guide. They do not apply to children 12 years of age or under, or pregnant women. Talk to your family health care provider about your blood glucose target ranges.

Ask your diabetes educator about:

• the size of the drop of blood needed;

• the type of blood glucose strips to use;

• how to clean the meter;

• how to check if the meter is accurate; and

• how to code your meter.

What is blood glucose?Blood glucose is the amount of glucose (sugar) in your blood at a given time.

How do you monitor your blood glucose levels?A blood glucose meter is used to monitor your blood glucose levels at home. These meters can be purchased at most pharmacies. Talk with your diabetes educator or pharmacist about which model is right for you. Once you purchase a meter, ensure you receive the proper training before you begin to use it.

Managing Blood Glucose Levels

If you have diabetes, you should try to keep your blood glucose levels as close to your target range as possible. This will help to delay or prevent complications of diabetes.

Managing Blood Glucose Levels

Managing your blood glucose when you’re illWhen you are sick, your blood glucose levels may fluctuate and be unpredictable. During these times, it is a good idea to check your blood glucose levels every two to four hours. It is also very important that you continue to take your diabetes medication. If you have a cold or flu and are considering using a cold remedy or cough syrup, ask your pharmacist to help you make a good choice. Since many cold remedies and cough syrups contain sugar, try to pick sugar-free products.

When you are sick, it is VERY IMPORTANT that you:

• Drink plenty of sugar-free fluids or water; try to avoid coffee, tea and colas as they contain caffeine, which may cause you to lose more fluids.

• Replace solid food with fluids that contain glucose, if you can’t eat according to your usual meal plan;

• Try to consume 15 grams of carbohydrate every hour;

• Call your family health care provider or go to an emergency room if you vomit and/or have had diarrhea two times or more in four hours; and

• If you are on insulin, continue taking it while you are sick.

Check with your health care providers about guidelines for insulin adjustment during an illness.

How do I treat a low blood glucose?

If you are experiencing the signs of a low blood glucose level, check your blood glucose immediately. If you don’t have your meter with you, treat the symptoms anyway. It is better to be safe.

Eat or drink a fast-acting carbohydrate (15 grams):

• 15 g of glucose in the form of glucose tablets (preferred choice)

• 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water

• 175 mL (3/4 cup) of juice or regular soft drink

• 6 Life Savers® (1 = 2.5 g of carbohydrate)

• 15 mL (1 tablespoon) of honey

Wait 10 to 15 minutes, then check your blood glucose again. If it is still low:

• Treat again

• If your next meal is more than one hour away, or you are going to be active, eat a snack, such as a half-sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source).

For more information on blood glucose levels, watch the video “Managing Your Blood Glucose” in this kit.

Lows and highs: blood glucose levels outside of your target range

What is low blood glucose?When the amount of blood glucose (sugar in your blood) has dropped below your target range (less than 4 mmol/L), it is called low blood glucose or hypoglycemia.

What are the signs of a low blood glucose level?You may feel:

• Shaky, light-headed, nauseous

• Nervous, irritable, anxious

• Confused, unable to concentrate

• Hungry

• Your heart rate is faster

• Sweaty, headachy

• Weak, drowsy

• A numbness or tingling in your tongue or lips

What causes a low blood glucose level (hypoglycemia)?

Low blood glucose may be caused by:

• More physical activity than usual

• Not eating on time

• Eating less than you should have

• Taking too much medication

• Drinking alcohol

Low blood glucose can happen quickly, so it is important to take care of it right away. If your blood glucose drops very low, you may:

• Become confused and disoriented

• Lose consciousness

• Have a seizure

You will need assistance from another person. Make sure you always wear your MedicAlert® identification, and talk to your family health care provider or diabetes educator about prevention and emergency treatment for severe low blood glucose.

Managing Blood Glucose Levels

What is high blood glucose and what are some of the signs? When your blood glucose level is above your target range (see chart on the first page of this fact sheet), you may:

• Be thirsty

• Urinate more often

• Be tired

What causes high blood glucose (hyperglycemia)?High blood glucose can result when food, activity and medications are not balanced. High blood glucose may happen when you are sick or under stress.

What do I do if I have high blood glucose?Maintaining healthy eating habits and an active lifestyle, and taking medication, if necessary, will help you keep your blood glucose levels within their target range. If your blood glucose levels are high, talk to your family health care provider about:

• Adjusting your medication and/or insulin

• Adjusting your meal plan

• Increasing your physical activity

Content taken from the Canadian Diabetes Association’s consumer fact sheets, Managing Blood Glucose and Lows and Highs: Blood Glucose Levels © 2008.

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What is insulin?

Insulin is a hormone produced by the pancreas to control the amount of glucose (sugar) in the blood. In people who have diabetes, the pancreas does not produce any or enough insulin, or is unable to effectively use the insulin it does produce. As a result, glucose builds up in the bloodstream, potentially leading to serious health problems such as blindness, heart disease, kidney problems, amputation, nerve damage and erectile dysfunction.

Insulin and type 1 diabetes

People with type 1 diabetes do not naturally produce any insulin. As a result, they need to take insulin every day.

Insulin and type 2 diabetes

People with type 2 diabetes may be able to keep their blood glucose levels within their target range through healthy eating, physical activity and by taking diabetes medication.

However, many people with type 2 diabetes will need to use insulin to properly manage blood glucose levels at some point. The most important thing is to manage your diabetes and prevent complications. The good news is that modern injection devices, such as insulin pens, are simple to use and virtually painless.To work, insulin must be injected under

the skin but not directly into the blood. Insulin is absorbed from different parts of your body at different rates and can also be affected by the amount of physical activity you are doing. Different injection devices may require specific injection sites. Talk to your family health care provider or diabetes educator about a pattern for your injections.

Types of insulin

Many different types of insulins are available, offering more flexibility in the number and timing of injections you may need and making it easier for you to maintain your target blood glucose levels. You may need one or more injections a day to better manage your blood glucose levels.

Insulins differ by their duration of action (how long they work), their onset of action (how quickly they start working) and when their action peaks (when they are most effective). By understanding how your insulin works, you can time your meals, snacks and activity levels accordingly.

Using Insulin

Your family health care provider or diabetes educator will help you with any questions you have about your insulin, including how to mix or inject two different kinds.

The importance of monitoring your blood glucose levels

Monitor your blood glucose levels regularly.

Regular monitoring is the best way to know that your blood glucose levels are in your target range. Regular checks also give you important information about how your blood glucose levels vary during the day, how much insulin you need and whether you’re on track in managing your diabetes.

Using Insulin

What insulin plan is right for you?

When prescribing an insulin plan, your family health care provider will consider several factors, including your treatment goals, age, lifestyle, meal plan, general health, risk and awareness of low blood glucose (hypoglycemia), and motivation. Social and financial factors may also be considered. There is no “one size fits all” plan.

Your health care team will talk with you about the best insulin plan to meet your needs. Remember, it will take time to fine-tune your insulin regimen, which may change over time depending on life events (such as a major illness) and changes in your lifestyle (such as a new exercise plan).

Talk to your family health care provider or diabetes educator if you have any questions or concerns about your insulin schedule, or if you aren’t sure how to handle certain situations, such as adjusting your insulin when travelling.

How do I use insulin?

Insulin can be administered by syringe, pen or pump – according to your personal preference.

• Insulin pens combine a very fine needle and insulin cartridge in a single unit, making it easier to give multiple injections. Some people carry two or more pens if they use more than one kind of insulin at different times of the day. If you need to use two types of insulin at the same time, you will need two separate pens and will need to give yourself two injections. One of the main benefits of insulin pens is their portability.

• Jet injectors have no needles at all. These devices release a tiny stream of insulin, which is forced through the skin by pressure. Some people find that bruising occurs at the injection site.

• Syringes today are smaller than ever and have finer needles with special coatings so injecting causes little discomfort. If you need to use two types of insulin at the same time, you can mix the insulin and give yourself only one injection, or you may be prescribed a mixed insulin.

• Insulin pumps are a safe, effective way to deliver intensive insulin therapy. The device involves a small catheter, which is inserted under the skin, and a pump, which is about the size of a pager, that is worn outside the body. The pump has a reservoir and can be programmed to deliver small amounts of insulin on a schedule that you determine. To deliver extra doses of insulin (at meal times, for example), you simply press a button on the device.

Talk to your family health care provider or diabetes educator about which device is right for you. For more information on using insulin, watch the “Medication” video, which is part of this kit.

Types of insulin (approved for use in Canada)

Insulin type (appearance)

Action Brand names ( generic name in brackets)

Dosing schedule

Rapid-acting analogue (clear)

Onset: 10-15 minutes

Peak: 60-90 minutes

Duration: 3-5 hours

Apidra® (insulin glulisine)

Humalog® (insulin lispro)

NovoRapid® (insulin aspart)

Usually taken right before eating, or to lower high blood glucose

Short-acting (clear) Onset: 30 minutes

Peak: 2-3 hours

Duration: 6.5 hours

Humulin®-R

Novolin®ge Toronto

Taken about 30 minutes before eating, or to lower high blood glucose

Intermediate-acting (cloudy)

Onset: 1-3 hours

Peak: 5-8 hours

Duration: up to 18 hours

Humulin®-N

Novolin®ge NPH

Often taken at bedtime, or twice a day (morning and bedtime)

Long-acting analogue (clear and colourless)

Onset: 90 minutes

Peak: none

Duration: up to 24 hours (Lantus 24 hours, Levemir 16-24 hours)

Lantus® (insulin glargine)

Levemir® (insulin detemir)

Usually taken once or twice a day

Premixed (cloudy) A single vial or cartridge contains a fixed ratio of insulin (the numbers refer to the percentage of rapid- or fast-acting insulin versus the percentage of intermediate-acting insulin)

Premixed regular insulin

NPH

Humulin® (30/70)

Novolin®ge (30/70, 40/60, 50/50)

Premixed insulin analogues

Humalog® Mix25 and Mix50

NovoMix 30

Depends on the combination

Adapted from the Canadian Diabetes Association’s consumer fact sheet, Insulin: Things you should know © 2008.

Using Insulin

Insulin tips

• Keep a written record of the name(s) and amounts of the insulin(s) you use, what times during the day you should inject your insulin, how long the insulin works and when it is most effective.

• Keep unopened insulin at refrigerated temperatures of 2°C to 10°C (35°F to 50°F). Once opened, insulin has a shelf life of 28 days. Unopened vials are good until the expiry date – be sure to check the expiry date on a vial before you use it.

• Make sure your insulin does not freeze or get too hot (not over 37°C or 98.6°F).

Content taken from the Canadian Diabetes Association’s consumer fact sheet, Insulin: Things you should know © 2008

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Health CoverageHelpful Options for People with Diabetes

Eye care services

Coverage provider: Ontario Health Insurance Plan (OHIP)

Who qualifies? For what services?

Patients 65 years of age and older and patients 19 years of age and younger.

One routine eye examination every 12 months and any required follow-up assessments.

Patients age 20 to 64 with any of the following conditions: diabetes, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease and strabismus.

Major eye examination by an optometrist or physician every 12 months and any necessary follow-up assessments.

Patients of all ages. Medically necessary eye care services provided by physicians.

Contact:

• ServiceOntario: 1-800-268-1154 (toll-free in Ontario only). In Toronto: 416-314-5518

• Visit www.health.gov.on.ca/english/public/pub/ohip/eyecare.html

People with diabetes can face high medical costs for supplies, medication and medical devices. To help ease the burden, a number of options are available to those who qualify.

Health Coverage - Helpful Options for People with Diabetes

Prescription drugs and supplies

Coverage provider: Ministry of Health and Long-Term Care, Ontario Drug Benefit Plan (ODB)

Who qualifies? For what supplies?

Patients on a provincial social assistance program and those who are 65 years of age or older.

Diabetes supplies including most types of insulin, and oral medications (hypoglycemics), and blood testing strips.

Note: If you are 65 years of age or older, are using the ODB and have an annual income of $16,018 or more (or a combined income of $24,175 or more for a couple), you will have to pay an annual deductible of $100 up front. After that, you will pay up to $6.11 per prescription. If your annual income is under $16,018 or $24,175 for a couple, no up-front payment will be required and you will pay a $2 prescription fee.

Products listed on the ODB Formulary for diabetes are:

• Oral antidiabetic agents • Insulins • Testing strips

Contact:

• Your local social services agency to find out if you qualify for this coverage. Contact your regional office to find out about your local social services agency: www.mcss.gov.on.ca/mcss/english/ministry/regionaloffices

• Your pharmacist

• Visit www.health.gov.on.ca/english/providers/program/drugs/odbf_mn.html

Coverage provider: Ministry of Health and Long-Term Care, Trillium Drug Program

Who qualifies? For what supplies?

Patients whose drug costs are high compared to their annual income. You will need to make an up-front payment, broken up into four parts over the year, to access the program. This payment is based on a review of your household income.

Diabetes supplies including most types of insulin, and oral medications (hypoglycemics), and blood testing strips.

Contact:

• 1-800-575-5386

  • Visit www.health.gov.on.ca/english/public/pub/drugs/trillium.html

Coverage provider: Ministry of Health and Long-Term Care, Assistive Devices Program (ADP)

Who qualifies? For what supplies?

Patients 65 years of age or older who use insulin by injection on a daily basis.

Annual grant of $170, paid once per year, for the purchase of needles and syringes used to inject insulin.

Children, youth and adults with type 1 diabetes who meet the program’s medical eligibility criteria. You must be assessed and followed up by an ADP-registered Diabetes Education Program.

Patients who continue to qualify will have to show that they meet the eligibility criteria.

  •   100 per cent of the cost of an insulin pump listed with  the program, which must be sold to the patient at the ADP-approved price of $6,300.

  •   Funding for insulin pumps can be renewed every five years, if the pump is no longer in good working order.

  •   An annual grant of $2,400 for related supplies, paid out  in four equal payments ($600 each) directly to the patient or their legal agent. The grant must be used to buy supplies needed to make the pump work and must be renewed on a yearly basis.

Contact:

• Assistive Devices Program: 1-800-268-6021 (toll-free in Ontario only). In Toronto: 416-327-8804

Coverage provider: Ministry of Health and Long-Term Care, Assistive Devices Program (ADP), administered by the Canadian Diabetes Association

Who qualifies? For what supplies?

Eligible patients who use insulin or have gestational diabetes.

  •   75 per cent of the cost of a blood glucose monitor up to $75, or 75 per cent of the cost of a talking blood glucose monitor up to $300. Patients can access this funding once every five years.

  •   75 per cent of the cost of lancets and testing strips up to $820 annually.

Contact:

Canadian Diabetes Association: 1-800-361-0796

Health Coverage - Helpful Options for People with Diabetes

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Dietitians

Registered dietitians working in Diabetes Education Centres in acute care and community care settings are covered by OHIP. Private insurance coverage may cover the cost of visiting a registered dietitian in private practice. To determine if you have coverage for the services of a registered dietitian working in private practice, contact your insurance provider. To locate a Diabetes Education Centre or a registered dietitian working in private practice, call the number or visit the website listed below.

Contact:

• A registered dietitian working in private practice by calling 1-877-510-510-2

• Visit www.ontario.ca/eatright

Foot Care

Coverage provider: Ontario Health Insurance Plan (OHIP)

Who qualifies? For what supplies?

Residents of Ontario

Assessments personally performed by physicians for all aspects of diabetes care, including assessment of feet. OHIP does not pay for services such as the clipping or trimming of toenails.

Contact:

  • ServiceOntario: 1-800-268-1154 (toll-free in Ontario only). In Toronto: 416-314-5518

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Learn how to manage your disease from the experts.

You’ve recently been diagnosed with diabetes, but you’re far from alone. In fact, there are approximately one million Ontarians living with diabetes and that number is expected to grow.

While a diagnosis of diabetes may come as a surprise, you can take comfort in knowing that good diabetes self-management can help you lead a full, healthy life. That’s where a Diabetes Education Program (DEP) can help you.

DEPs usually include a nurse and a dietitian – and may also include a social worker, clinical psychologist, foot care specialist, pharmacist and/or physiotherapist as needed.

They will work together and support you with your diabetes by providing guidance on healthy eating, weight management, exercise, blood glucose monitoring and ongoing motivation to stand up and fight this disease.

Each year, over 80,000 Ontarians like you are diagnosed with diabetes.

Management of the disease is crucial for your health and well-being.

That’s where Diabetes Education Programs can help.

These professionals will develop a special management plan for you to help you understand how to relieve diabetes symptoms and prevent

or treat complications. By attending a Diabetes Education Program and following the guidance provided, you will be more in control of your disease and enjoy a better quality of life.

To find a Diabetes Education Program in your community, use the online search directory at ontario.ca/diabetes

Please be advised that some Diabetes Education Programs may require a referral from your primary health care provider.

Remember, good quality care requires regular visits to a primary care provider who helps you manage the disease and supports you on an ongoing basis.

If you don’t currently have a primary health care provider, Health Care Connect can help. To sign up, call 1-800-445-1822 or visit ontario.ca/healthcareconnect

Diabetes Education Programs are part of the Ontario Diabetes Strategy, which was launched by the Ontario Government in November 2009. The strategy’s goal is to help people living with diabetes and to meet the needs of those who are high at risk of developing it.

To learn more about the strategy, please visit ontario.ca/diabetes

We’re here to help you live well with diabetes.