Diabetes is a disease in which your body cannot properly store and use fuel for energy. The fuel that your body needs is called glucose. Glucose comes from foods such as breads, cereals, pasta, rice, potatoes, fruits and some vegetables. To use glucose, your body needs insulin. Insulin is made by a gland in your body called the pancreas.

You have diabetes because either:

1. Your body makes too little or no insulin.
   This is called type 1 diabetes; or
2. Your body can't use the insulin it makes.
   This is called type 2 diabetes.

With little or no insulin, glucose builds up in your blood instead of being used for energy. This causes high blood glucose levels. When this happens, you may:

• Feel tired
• Be thirsty
• Urinate often
• Be hungry
• Be moody
  
  You may also:
• Lose weight
• Have blurry vision
• Get infections

How do I find out which type of diabetes I have?
Your doctor will tell you what type of diabetes you have and what you need to do. You can also ask your doctor to refer you to a Diabetes Education Centre. There, trained health professionals can teach you about diabetes and insulin.

Is diabetes serious?
Yes. Poor blood glucose management can lead to kidney failure, heart disease, impotence, blindness, and amputation.
The good news
By keeping your blood glucose levels in a target range determined by your doctor, you can live a long and healthy life.

If I have type 1 diabetes, what do I need to know?

You need to know

• Type 1 diabetes occurs when the body makes little or no insulin. It used to be called insulin-dependent or juvenile diabetes.
  

The cause of type 1 diabetes

• No one really knows what causes type 1 diabetes.
  

We do know that:

• There is nothing you could have done to prevent type 1 diabetes, even if you had been to see the doctor sooner.
• Your body's defence system may attack your insulin-making cells by mistake, but we don't know why.
• People usually find out they have it before the age of 30, most often in childhood or during their teens.
• It is not caused by eating too much sugar.

You might have a hard time believing and accepting that you or a family member has type 1 diabetes.

You may feel:

• Scared
• Shocked
• Angry
• Overwhelmed

This is normal and most people feel these emotions when they find out they have diabetes. You may also be feeling nervous at the thought of having to take insulin injections every day. The following pages will help you every step of the way.

What you can do to feel better

• Share your feelings with your family and friends. Tell them what you need from them to help you manage your diabetes well.
• Just because you have diabetes does not mean that you have to stop doing things you and your family enjoy.
• Learn as much as you can about your diabetes. The more you learn, the less fear you will have. Even if you have had diabetes for years, attend a Diabetes Education Centre session and join the Canadian Diabetes Association.

Keeping your blood sugar on the level

When insulin was first discovered and made available for people with diabetes, there was only one kind of short-acting insulin. This required several injections a day. As time went on, new insulin's were developed that lasted longer, requiring fewer injections, but requiring strict attention to timing of meals. Now, there are different types of insulin available, made from different sources. This gives more flexibility in the number and timing of injections, making it easier to maintain target blood glucose levels, based on your lifestyle. One to four injections a day may be suggested to you for optimal control of your blood glucose. Ask your health care team about the best insulin plan to meet your needs.

Insulin works differently in different people depending on factors such as: injection site, amount of insulin, etc. The following are general guidelines only.

TYPE	NAME	STARTS TO WORK IN	PEAK ACTION	DURATION
Rapid-acting insulin	Humalog®	5 - 15 minutes	˝ - 1 ˝ hours	3 ˝ - 4 ˝ hours
Short-acting insulin	Regular (R), or Toronto	30 - 40 minutes	2 - 4 hours	6 - 8 hours
Intermediate-acting insulin	NPH (N), Lente (L)	1 - 3 hours	2 - 12 hours	18 - 24 hours
Long-acting insulin	Ultralente (U)	4 - 6 hours	12 - 18 hours	24 - 28 hours
Premixed insulin (%R %N)	10/90, 20/80, 30/70, 40/60, 50/50	˝ - 1 hours	2 -12 hours	18 - 24 hours
Premixed insulin analog	Humalog® Mix25™	5 - 15 minutes	˝ - 12 hours	18 - 24 hours

What do I need to know about blood glucose levels?

Levels of glucose control for people with diabetes
(adults and adolescents)

	OPTIMAL (target goal but may be hard to achieve for some people)	SUBOPTIMAL (action may be required - not low enough to prevent complications)	INADEQUATE (action required - at increased risk for long-term complications)	'MY TARGET RANGE' (ask your doctor)
Glucose before meals	4 - 7 mmol/L	7.1 - 10 mmol/L	Over 10 mmol/L
Glucose 1 - 2 hrs after eating	5.0 - 11 mmol/L	11.1 - 14mmol/L	Over 14 mmol/L
HbA1c (depending on lab)	Less than 0.07%	0.07 - 0.084%	Over 0.084%

The above information serves only as a guide. You need to know what your own blood glucose target ranges are, so be certain to discuss this with your doctor.

How to test your blood glucose level
You can purchase a meter from your local pharmacy. Checking blood glucose requires obtaining a small drop of blood to place on a blood glucose strip. Talk to your diabetes educator or pharmacist about the various methods, and which one is right for you. When you decide, make sure you receive the proper training.

Ask about:

• The size of the drop of blood and the type of blood glucose strips to use
• How to clean you meter
• How to check if your meter is accurate
• How to code your meter

Why you should test your blood glucose level?

• Blood testing is a quick measurement of your blood glucose level at any point in time.
• Blood checking shows how your blood glucose levels are affected by your food intake, insulin, stress levels, illness and physical activity.
• Blood checking is a quick method to identify high and low blood glucose levels.
• Blood checking will help you, your doctor and diabetes health care team, to make the necessary changes in insulin, meal planning or exercise to achieve good blood glucose control.

What causes a low blood glucose level or hypoglycemia?
A low blood glucose level can occur when your blood glucose drops below a certain level (usually less than 4 mmol/L).

This is caused by:

• Not eating enough food
• Missing or delaying a meal
• Exercising without taking the necessary precautions
• Taking too much insulin
• Drinking alcohol.

Low blood glucose can happen quickly, so it is important to take care of it right away.

The warning signs of a low blood glucose level
Note the symptoms you are feeling, and this will help you to identify low blood glucose in the future.

You may feel:

• Hungry
• Shaky or light-headed
• Nervous or irritable
• Sweaty
• Weak
• Your heart beats at a faster rate
• Confused
• A numbness or tingling in your tongue or lips.

Other signs of low blood glucose levels
You may also:

• Have a headache
• Be unusually sleepy
• Experience mood changes

Remember: Some people do not have early warning signs of hypoglycemia. These individuals must check their blood glucose levels more often to avoid this condition. It is especially important for all people with diabetes to check before driving a car.

How to treat low blood glucose

• Check your blood glucose. If you do not have your meter with you treat the symptoms anyway. It is better to be safe.
• Eat or drink a form of sugar such as:
  • 3 B-D Glucose Tablets™ or 5 Dextrose Tablets™
  • 6 Life Savers TM
  • 3/4 cup (175mL) of juice or regular pop
  • 1 tablespoon (15mL) of honey.
• Wait 10 to 15 minutes, then test 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 half a sandwich or cheese and crackers (something with starch and protein).

Severe Low Blood Glucose:
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 MedicAlert® identification. Talk to your doctor or diabetes educator about prevention and emergency treatment for severe low blood glucose.

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

The signs of high blood glucose
You may be:

• Thirsty
• Urinating more often
• Tired

If you think your blood glucose is high, check your blood glucose levels
If you have type 2 diabetes, call or see your doctor. If you have type 1 diabetes, test your urine for ketones. Seek medical advice immediately if ketones are present.

What lifestyle changes do I need to make?

Eat healthy

• Eat three meals and a bedtime snack each day.
• Include a food from each of the food groups at each meal.
• If you are thirsty drink water or diet pop.
• If you are overweight, eat smaller portions. Reduce your intake of fat.
• Keep sweet and fatty foods to a minimum.

Keep active

• Talk to your diabetes health care team to learn how to adjust your insulin and food to prevent low blood glucose levels while exercising.
• Carry some form of sugar with you and extra food.
• Carry your meter with you. Be prepared to stop and test during exercise if you feel any symptoms.
• Wear a MedicAlert® identification.
• Carry a record of the names and amounts of insulin you use and any other medications you use regularly.
• Wear comfortable shoes and socks.
• Test your blood glucose before exercising. If lower than __________ mmol/L, (have your doctor determine this value for you) you may need extra food before you start.
• Stop exercising if you have pain or feel tired.
• Enjoy yourself.

Report your diabetes to the motor vehicle licensing office

• Most States and Territories require that a licensed driver immediately report any medical condition that may affect one's ability to operate a motor vehicle safely. Diabetes is one of those conditions