Download Type 1 Diabetes - Hampshire Hospitals

Type 1
Diabetes:
A guide for
patients and
carers
Dr Ed Hind - 2013
Hampshire Hospitals NHS Foundation Trust
Child Health Department
1
Contents
Page
1. Introduction
What is Diabetes? Why does it happen?
Why do diabetics need insulin?
3
2. Insulin
What types of insulin are there?
How to inject
6
3. Controlling the blood sugars
Testing your blood sugars
Adjusting your insulin doses
Correction doses of insulin
HbA1c
9
4. Hypos
What is a hypo? Why does it happen?
How to recognise hypos
How to treat hypos
13
5. Sick Day Rules
15
6. Ketones and Keto-Acidosis
What are ketones and why do they happen?
Why are ketones a problem?
16
7. Diet
Fast and slow carbohydrates
Timing of meals and snacks
Carbohydrate Counting
17
8. School
21
9. Exercise and Sport
22
10.Long Term Effects of high sugars
23
11.Getting Older
Transition
Alcohol
Driving
25
2
1. Introduction
In the UK, about 1 in every 400 children and young people have type 1
diabetes. In Basingstoke and the surrounding area, there are about 140.
The basic problem in type 1 diabetes is that the body is not able to control
the level of sugar in the bloodstream. The body needs sugar as fuel, but it
needs exactly the right amount of sugar – too little and it can‟t work
properly, too much and it causes damage.
What happens to sugar after you eat it?
In order to use sugar as fuel, it needs to journey from food to the cells.
Once eaten, food is broken down in the gut to form pure sugar, or
“glucose” (how long this takes depends on the type of food you have
eaten). The sugar is then absorbed from the gut into the bloodstream, and
the bloodstream takes the sugar to the body‟s vital organs like the
muscles and brain.
Then, to move sugar from the bloodstream into the cells of those organs,
it needs insulin. Insulin acts like a doorway to let the sugar into the cells.
Once inside the cells, the sugar undergoes a chemical reaction to create
energy.
If the body does not need to make energy at that time, the sugar is stored
up for later instead. This stored sugar can take the form of glycogen or
fat. Stored sugar can also be used to help the body to grow, by helping to
make muscle, bone and other organs.
What happens in diabetes, when you can’t make insulin?
In type 1 diabetes, the body cannot produce insulin. As a result, the sugar
cannot get from the bloodstream to the cells, so is stuck in the
bloodstream. Eventually it leaks out through the kidneys into the urine,
and because sugar is concentrated, it takes lots of water with it. This is
why you went to the toilet so much. Because you were weeing out so
much water, this made you very thirsty as well.
Because the sugar can‟t get in to the cells, the body tries to make energy
in other ways. It does this by breaking down other parts of the body, like
3
muscle and fat. This is why you lost weight. When the body uses fat to
make energy, it also makes ketones, which can make you very unwell.
Insulin also helps you get rid of ketones (see chapter 6 for more details).
Why did I get diabetes?
No-one really knows what causes diabetes. There is lots of research
going on into this, but the most likely explanation is that it is triggered off
by a virus infection. We also know that if there is someone in your
family with diabetes, you are slightly more likely to have it too.
We do know that type 1 diabetes does not happen because you eat too
much sugar. It is no-one‟s fault that you have diabetes, it is just down to
luck.
Why can’t people with diabetes make insulin?
The body‟s immune system gets confused and attacks the cells in the
pancreas that make insulin (the “beta cells”, also called “islet cells”), and
destroys them. This process happens over a few months, and you only
start to notice after about 80% of these cells have gone.
4
Why do I need insulin?
Normally, the pancreas would release a bit of insulin all day to keep your
sugar controlled, and when you eat, it releases an extra burst to cope with
the sugar from the meal. The pancreas releases exactly the right amount
of insulin to deal with the sugar you have eaten.
But in diabetes the pancreas can‟t produce insulin. This means that you
need to give insulin yourself to control your blood sugar.
Why does it have to be injections?
Unfortunately insulin only works if it is injected under the skin. If you
take it as a tablet, the stomach destroys it. People are working on other
ways to give insulin, but so far none of them work very well.
5
2. Insulin
Insulin comes in lots of different forms, which work in slightly different
ways. Most people with diabetes use a 24 hour insulin plus a short-acting
insulin before each meal.
Short-acting insulins (pre-meal, “bolus”)
Humulin S
This takes 20-30 minutes to start working, so needs to be given 20-30
minutes before a meal. It lasts between 4 and 6 hours, so people taking
this insulin also need a snack between meals, and should eat their meals
at least 4 hours apart.
Humalog/Novorapid
This works immediately, so can be given right before you eat (or even
just after, if you have not taken very long to eat your meal!). It lasts
about 2 hours, so only covers the meal. If you want a big snack between
meals, you may need an extra injection of this insulin.
These types of insulin are good for giving correction doses (see chapter
3), and for carbohydrate counting (chapter 7). Because they only last 2
hours, meal times can be more flexible.
Long-acting (24 hour, “basal”) insulins
Glargine (Lantus)
This gradually releases itself over 24 hours, so gives you a small amount
of insulin all day and night (“background insulin”). Most people give this
before bed, but as long as it is given within an hour of the time you gave
the last dose, the time of day it is given does not matter.
Levemir (Detemir)
Like glargine, this gradually releases itself over 24 hours, so gives you a
small amount of insulin all day and night (“background insulin”). Most
people give this before bed, but as long as it is given within an hour of the
time you gave the last dose, the time of day it is given does not matter.
Some people say that Levemir does not last all 24 hours at lower doses.
Some say it stings slightly less than glargine.
6
How to do your Insulin Injection
1. Make sure that you are confident about giving an injection before
going home:
2. Remove clothing to uncover the injection site
3. Take a gentle „pinch up‟ of the skin
4. Inject at an angle of 90 degrees to the skin
5. Administer the insulin
6. Keep the needle in place for 10 seconds after the insulin has been
given
It is important to inject your insulin in different places as shown in the
picture below. If you inject in the same site each time, the site may
become lumpy and the insulin will not be absorbed so well into the body.
7
Other ways of giving insulin
Mixed insulins
People with diabetes used to use a pre-mixed mixture of a short-acting
insulin and an intermediate-acting insulin, and give this twice daily. Less
people use these now because they were thought to be unpredictable and
inflexible, did not give as good control and made people more prone to
hypos. However, in some cases this type of insulin may still be used.
Insulin Pumps
These pumps deliver a small amount of insulin to you constantly
(“basal” insulin”), which you can vary at different times of the day. You
tell it to give you an extra shot (“bolus”) with food. It delivers the insulin
using a small plastic tube (a “cannula”) which you wear under your skin
and you replace every three days. The pump is about the size of an MP3
player and you wear it all the time.
These are thought to be a good way of giving insulin and are becoming
more popular. It takes a long time to learn how to use them ,and you do
need to be able to count carbohydrate (see chapter 7).
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3. Controlling Your Blood Sugars
Testing your blood sugar
The amount of insulin you need will change over time, as you grow, your
lifestyle changes and you stop making your own insulin. The only way
you can tell how much insulin you need each day is by checking your
blood sugar levels. Using these, you and the diabetes team can look for
patterns and adjust your insulin doses.
It is best to check your blood sugar at least four times a day, before each
dose of insulin. You should also check it if you feel low or unwell.
So many things affect the blood sugar – what you eat, exercise, how and
where you inject the insulin, the time of day, hormones, the outside
temperature, illness and more – that it is impossible to guess what your
blood sugar level will be.
The ideal blood sugar reading is between 4 and 7. If it is not in this
range, make sure you have remembered to wash and dry your hands!
If there seems to be no pattern to your blood sugars and they vary
between very high and very low, sometimes this can mean you are
injecting insulin into a lump, and the absorption of insulin is erratic.
Adjusting your insulin doses
In the first few weeks after you have been diagnosed with diabetes, we
would suggest that you adjust your insulin only after discussion with the
diabetes team. However, eventually you will feel confident to make your
own adjustments according to your blood sugar readings.
There will always be the odd unexplained high or low sugar. It is never a
good idea to adjust the insulin after one reading - it is much better to look
for a pattern over a few days or a week.
Adjusting Lantus and Levemir
The morning (before breakfast) blood glucose reading tells you whether
the 24 hour insulin (glargine/lantus and detemir/levemir) is at the correct
dose. If the morning blood glucose is usually low (below 4), the 24 hour
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insulin needs to be reduced. If it is usually too high (above 8), then the 24
hour insulin needs to be increased. It is best to adjust this insulin by 1 unit
at a time, then look for the effect over the next three or four days.
Remember that any increase in this insulin may take a few days to have
an effect.
Adjusting Pre-Meal Insulins
Each insulin dose affects the next blood sugar (the breakfast insulin
affects the lunchtime blood sugar, the lunchtime insulin dose affects the
teatime blood sugar, the teatime insulin affects the bedtime blood sugar).
So for instance, if a blood sugar reading at teatime is usually high, the
lunchtime insulin dose needs to be increased.
If you are carbohydrate counting and the pre-meal blood sugars are high
or low, it may be that you need to adjust the insulin to carbohydrate ratio.
For instance, if the blood sugar after breakfast or before lunch is high
most of the time and you currently give 1 unit to 10 grams, you may need
to try giving 1 unit to 8 grams instead. It may also be that you are
guessing the amount of carbohydrate wrongly.
High pre-breakfast blood sugar means basal
insulin dose too low
High blood sugar 2 hours after
lunch means lunch bolus too low
Breakfast
Lunch
Dinner
Bedtime
10
Correction Doses
If you are using a very short-acting insulin like Humalog or Novorapid,
you can give extra insulin to bring down your blood sugar if it is high.
We work out how much insulin to give using the “100 rule”:
100
Your total daily dose of insulin
=
The fall in blood sugar after
giving 1 unit of insulin
For instance, if your total daily dose of insulin is 30 units, when you give
1 unit of insulin your blood sugar should come down by about 3 points
(100/30). If your blood sugar is 16, and you want it to come down to
about 10, then give 2 extra units on top of what you would normally give.
It is best to aim for just above the normal range (about 8 or 9) so that you
do not overshoot. Allow two hours for the correction to work – if you
give more extra insulin before then, you may overshoot.
This rule is only a guide, and it may be that you will respond slightly
differently. If the sugar drops by more than you expected, then give less
insulin next time.
It is also worth remembering that the body is more sensitive to insulin at
night, so you will need less insulin to bring the sugar down.
11
HbA1c
When you come to clinic, you have a finger-prick test called an HbA1c.
This is a way of looking at how well your blood sugars have been
controlled over the last three months or so.
A high HbA1c suggests that the blood sugars have been high for a lot of
the time. We know that a high HbA1c makes you more likely to develop
complications from diabetes when you are older (see chapter 9), and
reducing the HbA1c also makes these complications less likely.
We like to aim for an HbA1c of less than 7.5%. Complications (see
chapter 9) become increasingly likely the higher it goes above this level.
Someone without diabetes would have an HbA1c of around 4.5 to 5%. If
yours was this low, it may make us worry that you must be having too
many hypos!
The way we look at HbA1c is about to change – this change is to bring
the UK in line with the rest of the world and will help make the HbA1c
results more accurate. For the next two years we will be told the results
in both formats, to give us all a chance to get used to the new numbers.
Current HbA1c (%)
5.0
6.0
6.5
7.5
8.0
10.0
New “IFCC” HbA1c (mmol/mol)
31
42
48
59
64
86
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4. Hypos
If you do not have diabetes, when your blood sugar is low your body
stops making insulin so that the sugar does not drop any further.
However, in diabetes, the insulin you have injected cannot be switched
off. Because of this, when your blood sugar is low, it might get lower,
and you will need to do something about it before this happens.
Lots of things can cause hypos:
 too little food
 too much insulin
 exercise
 stress
 studying very hard
How to recognise a hypo
When your blood sugar is low the body releases chemical messengers to
try to bring it up again (like adrenaline and cortisol – the “stress
response”). These messengers make you feel shaky and shivery, make
your heart beat fast and make you feel light-headed. You may just feel “a
bit weird”.
If the sugar goes even lower, the brain cannot work properly, and it may
make you drowsy or appear “out of it”. In very extreme conditions, it can
even make you have a seizure.
Signs of low blood sugar
Feeling Hungry or sick
Shakiness
Fast heartbeat
Feeling sweaty and “clammy”
Grumpiness
Blurred Vision
Feeling or acting oddly
Being more clumsy
Loss of concentration
Signs of very low blood sugar
Loss of Consciousness
Extreme tiredness
Seizures
Coma
If any of these signs happen, the first thing you should do is check your
blood sugar. The level at which you feel these symptoms can change,
13
and some of them can happen when the sugar is high. If you are in a
situation where testing is difficult or impossible, it is best to treat the low
sugar just in case.
If the blood sugar is low ( less than 4), then you are having a hypo and
you need to do something about it.
How to Treat a Hypo
In order to bring your blood sugar up you need to eat something sugary.
You need a fast-acting “pure” sugar.
Foods used to treat hypos
Glucose tablets (1 for under 5s, 2 for 5-12 year olds, 3 for over 12s)
Lucozade (not lucozade sport)
Carton of fruit juice (not toothkind or low sugar)
3-4 sweets (haribo, jelly babies, boiled sweets)
It is not a good idea to use foods like chocolate or ice cream to treat
hypos as they contain fat and so will be released very slowly.
After you feel better, if it is a long time till your next meal and you are on
a longer-acting insulin (like Humulin S) then you should also have some
carbohydrate, like a biscuit or a slice of toast.
It is important to keep some of these foods with you at all times in case
you go low.
How to treat a severe hypo
If your hypo is more severe then you may not be awake enough to eat. In
this case someone should give you Glucogel. They squeeze the contents
of a tube into your mouth between your cheek and your teeth, and then
rub the outside of your cheek. Glucogel contains fast sugar that is
absorbed straight into your bloodstream.
Very rarely, a low sugar can give you a seizure or make you unconscious.
If this happens someone needs to call 999. Some people have emergency
Glucagon (“the orange injection”) which they can inject into your muscle
as an emergency treatment to bring your sugar up.
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5. Sick Day Rules
When you are unwell, your body starts up the “stress response” to help
fight the infection. One side-effect of this is that it puts your blood sugar
up. So if you are sick, even if you are not eating anything, your sugars
can rise as well as fall.
If you are not able to eat properly, your body may try to make energy by
breaking down fat, and so make ketones. You need insulin to help you
control the level of ketones in the body. If you do not have enough
insulin your ketones may rise and make you very unwell (“keto-acidosis”
– see chapter 6).
The Golden Rules in illness are:
1.
2.
3.
4.
5.
Check blood sugars regularly, at least 4 times a day. If the
sugar is high, give correction doses; if it is low, give less, but…
Never, ever miss your insulin.
Check for ketones using the Optium Xceed meter.
If you can‟t eat, try to keep drinking sugary fluids.
If you can‟t keep anything down, or if your ketone levels are
high, or if your blood sugar is low and won‟t come up, you may
need to be in hospital.
All young people with type 1 diabetes have open access to Charlie‟s Day
Unit at Basingstoke and North Hampshire Hospital. The number is
01256 313697.
If you are not sure what to do, ring the diabetes team.
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6. Ketones and Keto-acidosis
What are ketones and why do they happen?
If the body cannot use sugar to make energy, it will convert fat into
energy instead. When it does this, it will also make ketones as a byproduct.
Everyone makes ketones if they are starving. If the blood sugar is low,
the body can‟t use sugar for fuel, so instead it uses fat, and you get
ketones. However, because you need insulin to control the ketone level,
diabetics can get dangerously high levels of ketones if they have not had
enough insulin.
In diabetes, if you have not got enough insulin in your body, sugar cannot
be taken into the body‟s cells. This fools the body into thinking it has not
got enough sugar – so it tries to make energy from fat, and makes
ketones. So even if your sugar is very high, you may have high ketones,
and may need extra insulin to bring the ketone level down.
Why are ketones a problem?
Ketones can make you feel sick and can make you vomit. Because they
are slightly acidic, if you have a very high ketone level you can be very
unwell. This is called “keto-acidosis”, and can only be treated in
hospital.
Keto-acidosis can happen when you first get diabetes, or if people with
diabetes miss their insulin. It can make you very poorly indeed, and
some people need very intensive treatment. Very rarely, people can die
from it.
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7. Diet
Diet is an important part of the treatment for diabetes but try to not to
worry too much about eating the right or wrong foods. It is more
important that you eat regularly, enjoy your food and you will soon begin
to feel better.
People used to think that having type 1 diabetes meant that you weren‟t
able to have treats anymore. Thankfully this is no longer true – people
with diabetes should be able to enjoy food just like anyone else. But it is
important to understand how different types of food affect the blood
sugar.
Here are some basic tips about diet in diabetes:
1. Don’t worry! People with diabetes do not need to eat a special diet.
The healthy diet recommended for people with diabetes is the same
healthy diet recommended for everyone.
2. Eat Regularly: Try to have 3 meals every day, with snacks if you are
on Humulin S or a mixed insulin.
3. Eat starchy carbohydrates at every meal: e.g. bread or cereal or
crackers or potatoes or rice or pasta. Eat your usual portions of these
foods.
4. Choose low sugar foods and drinks if possible:
Try to avoid
Sugar (all types)
X
Ordinary squash, fizzy drinks,
hot chocolate, milkshakes
Sweets, chocolates, sugary
biscuits, cakes
Sugary desserts e.g. ice-cream,
readymade custard, trifle,
mousse, whips, yogurt.
Choose these instead
√
Artificial sweetener e.g. canderel,
splenda,
No added sugar and diet varieties
fruit, toast, cereal, savoury crackers,
breadsticks, crisps, rice crackers,
digestives
No added sugar whip, diet/light
yogurts, sugar free jelly, fruit, custard
powder made with milk and sweetener.
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Meal Ideas
Breakfast


Bowl of cereal e.g. Weetabix or porridge or Cheerios or Shreddies.
Toast or crumpets with a thin spread of jam, marmalade or marmite.
Lunch or Light Meal




Soup with bread or a roll.
Baked beans on toast.
Pitta bread or tortilla wrap or a sandwich with salad and meat, cheese or fish.
Crackers or crispbreads with cheese and salad.
For dessert ideas see the table above.
If you have school meals there is no reason why you cannot continue to do so but
make sure that you have potatoes, rice, pasta or bread with your meal.
Evening or Main Meal







Grilled, baked fish or meat with vegetables and a jacket potato or rice or pasta.
Roast meat with vegetables and roast potatoes.
Chilli Con Carne or curry with rice and salad.
Lasagne or Spaghetti bolognaise with salad
Meat casserole with boiled potatoes and vegetables
Grilled fish fingers with mashed potato and peas.
Snacks if on Humulin S (or mixed insulins)
Mid-Morning
1 piece of fruit e.g. apple, orange, banana or plain biscuit e.g. digestive, fig roll,
garibaldi, rich tea or low fat crisps (limit to one packet per day).
Mid-Afternoon
2 Plain biscuits or 1 slice toast/crumpet with margarine and jam/marmalade or 1 scone
or 1 piece of fruit.
Bedtime
Glass of milk and a biscuit or a slice of toast or a small bowl of cereal
18
Fast and slow carbohydrates
Most foods contain some carbohydrate. Carbohydrate is made up of lots
of portions of glucose, and when eaten it is gradually broken down until it
becomes sugar, which is absorbed into the bloodstream.
How quickly the food affects the blood sugar depends on what sort of
carbohydrate you have eaten. Things with “pure” sugar in like sweets
and fruit juice will put your blood sugar up quickly. Starchy foods like
bread, pasta, cereals and potatoes take longer to be broken down, so the
blood sugar will rise more gradually.
In general, the more fibre a food contains, the slower it is released. High
fibre, slow-release foods are also known as “low glycaemic index (or
GI)” foods.
Faster rise in blood sugar happens if:
 Foods are prepared (such as mashing potatoes, grating carrots or
juicing fruit)
 Foods are cooked (especially if boiled)
 Food has high salt content (speeds up absorption into the
bloodstream)
Slower rise in blood sugar happens if:
 Food has a high fat content (delays stomach emptying)
 Food has a high fibre content
 Pieces of food are larger
 Foods are raw
Fatty foods are released very slowly. Most fatty foods also increase the
risk of heart disease, so should be eaten in moderation anyway.
Protein-based foods such as meat and fish contain little carbohydrate and
so do not affect blood sugar very much.
19
Timing of food and snacks
How often you eat depends on which sort of insulin you are on. If you
have a twice-daily mixed insulin or are using a longer-acting insulin like
Humulin S then you will need to eat meals at regular times each day
(roughly every four hours) and have regular snacks between meals (see
above).
If you are on a short acting insulin like Humalog or Novorapid, or use an
insulin pump, your meal times can be more flexible. You should not
need large snacks – a piece of fruit (roughly 10g carbohydrate or less) is
fine, but anything larger may need an extra injection of insulin. Many
children need a large snack with insulin when they come in from school.
Carbohydrate Counting
This is a method of working out exactly how much short-acting insulin
(Humalog/Novorapid) to give according to what you eat for the meal.
Put simply, you add up the amount of carbohydrate in your meal in grams
and give insulin accordingly (most give 1 unit of insulin per 10 grams of
carbohydrate).
It takes time to learn how to do this. Different foods contain different
amounts of carbohydrate – for example, a slice of toast (with nothing on
it) will be about 15g, an apple will be 10g, an egg-sized potato will be
10g.
Your dietician can discuss this and any other food related issues with you
in greater detail if you wish.
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8. School
Many parents worry about their child returning to school; please be
reassured that your child will be supported with their medical needs.
Pre-school/Nursery/Primary Schools:
A paediatric diabetes nurse will visit the school to discuss diabetes and
the impact this will have on the school day. You are very welcome to
attend this meeting.
Secondary/Sixth Form College:
We will telephone the school to inform them that your child has diabetes
and try to arrange a meeting with the First Aider/Tutor. We occasionally
hold „drop in‟ clinics at secondary schools. This does not replace your
hospital clinic appointment but is an opportunity for us to help support
your teenager either on a one to one or group basis. You will be informed
if this is going to happen.
With your help we will write a care plan to help the school staff care for
your child with diabetes.
It is essential that parents provide an „emergency box’ at school. This
should be kept in the office/medical room and in primary schools it is
very helpful to also have one in the classroom.
What to put in the emergency box:
Dextrose tablets
Sugary drink i.e. lucozade, full sugar ribena, full sugar coke
Small packet of plain biscuits
1 tube of dextrogel
37
Please take this box home every half term to ensure it is stocked and in
date.
Secondary school/college; your son or daughter should always carry
„emergency‟ items with them e.g. dextrose tablets.
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9. Exercise
People with diabetes need exercise just like anybody else. The more
exercise you do, the less insulin you will need, the better your control will
be and the healthier you are likely to be long-term.
Exercise can affect the blood sugars. Short bursts of intense exercise
(“anaerobic” exercise) like sprinting can put the blood sugar up, but it
can drop later. Longer exercise (“aerobic” exercise) like distance
running can make the blood sugar go down. This can happen during
exercise, immediately after or some time after you finish – sometimes it
can drop the blood sugar up to 24 hours later, and make you more
sensitive to insulin during that period.
Most types of sport cause the sugar to drop, although the only way to
know for sure how to affects you is to test your sugar before and after.
Most people need extra carbohydrate around exercise. The amount you
need will depend on the intensity of the exercise.
Some people have an extra snack before (something that will gradually
release itself, like a biscuit or fun-size chocolate bar).
Some people also need to “re-charge” their sugar stores after exercise to
stop themselves going lower later, and they do this by having a snack or a
larger meal after they finish.
Some people also have some sugar during prolonged exercise (like
lucozade, gradually sipped throughout the session).
How much of a snack you have, and when you have it, will depend on
lots of factors. It is a good idea to experiment with different snacks and
watching their effect by checking your blood sugars.
If you do prolonged exercise, it is very important to drink enough fluid as
well.
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10. Long Term Effects of Diabetes
Why is it so important to keep blood sugars under control? Why does it
seem as if the diabetes team and your family are obsessed by keeping
your blood sugar between 4 and 8?
There are two main reasons for this: firstly, there is a risk of ketone
production, ketoacidosis and serious illness (see chapter 6).
Secondly, if the blood sugar is high for a longer period of time, it can do
permanent damage to the organs of the body.
We know that each of these complications are more likely to happen if
the HbA1c is high, and even more likely if it stays high. We also know
that most of them can get better in the early stages if the HbA1c is
reduced.
As you get older, you will have regular tests to watch out for these
complications.
Eye problems (“Retinopathy”)
Damage to the eyes as a result of diabetes is the commonest cause of
blindness in the western world. High sugars damage the back of the eye
(the retina), as well as the lens. This can happen as early as late teens.
This is why we recommend that you have retinal screening once a year, to
pick up the early signs of this damage – because it is reversible if caught
early.
Kidney problems (“Nephropathy”)
High sugars cause damage to the kidneys, which control your blood
pressure and help clean the blood. If the damage is severe, people have to
have “dialysis” (which involves being connected to an artificial kidney
which cleans your blood for you), or even a kidney transplant.
Early signs of kidney damage can be picked up by doing a urine test and
measuring the blood pressure – we do this once a year once you are 12
years old. Again, if this is picked up early enough, it is reversible.
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Nerve Problems (“Neuropathy”)
High sugars can damage nerves, which may affect your ability to touch
things and move your body. The longest nerves get damaged first, which
is why we examine your feet once a year when you are in your teens.
If you injure your feet, you may not feel it, which means that damage can
get worse and healing may be delayed – this is why looking after your
feet is so important.
Heart Problems
As you get older, high sugars can cause damage to blood vessels,
including those around the heart. This damage (“atherosclerosis”) can
increase the chance of heart disease later in life. We watch for this by
regularly measuring blood pressure and cholesterol levels in teenagers
with diabetes.
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11. Getting Older
As you get closer to being an adult, there are several things which you
will have to think about. For instance, you will eventually leave home,
and so will need to look after yourself and your diabetes with less support
from your parents. This means you will need to:
 Do all of your blood tests and insulin injections yourself
 Understand how to adjust your insulin to help control your blood
sugar
 Understand what can have an effect on your blood sugars, such as
diet, exercise and illness
 Know how to recognise and deal with high and low blood sugars
 Know how to collect your prescriptions for insulin, pens, needles,
blood sugar testing strips and any other equipment you may have
 Know who to call and where to get help if things go wrong
 Organise your clinic appointments and remember them!
You may want to think about how you can begin to take more
responsibility for your diabetes – for instance, you may wish to come in
to the clinic by yourself, either for part or all of the appointment.
Being a teenager and growing up can be stressful enough without
diabetes! If you feel you want to talk to anyone about any difficulties you
may be having, please do ask us.
Otherwise, there is lots of information in the “My Life” section of the
Diabetes UK website (www.diabetes.org.uk/guide-to-diabetes/my-life/ ),
as well as blogs and forums.
Transition
Eventually, the Adult Diabetes Team will be looking after your diabetes
with you. The Adult Team is very much like ours – they have two
consultants, and several Specialist Nurses, as well as Dieticians and
Podiatrists.
The time when we transfer you to the adult team is up to you, to an extent
– it can happen any time between your sixteenth birthday and the time
you leave full-time education. Usually we would arrange a joint clinic
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appointment with both Dr Hind and the adult team, so that the transition
is smoother.
If you want to know about transition to the adult team, just ask, but we
would plan to start talking to you about it when you are about fifteen.
Alcohol
Of course, drinking alcohol is illegal under the age of 18, and can cause
ill health in later life.
It is important to know the effect of alcohol on blood sugar – many
alcoholic drinks contain sugar, so at first, the blood sugar rises. However,
in the next few hours it falls rapidly. So if you are going to drink, it is
very important to eat as well – that night and the next morning.
If you have a hypo when you are drunk, people may not realise, so your
friends need to know that your sugar may be low and you need help.
Driving
If you are about to learn how to drive you must inform the DVLA and
your insurance company that you have type 1 diabetes. If you tick the
relevant box on the application form you will be sent a questionnaire
(DIAB1).
The most important things are that you regularly test your blood sugars
and that you are able to recognise the early warning signs of a hypo and
treat it appropriately. The DVLA will usually contact your diabetes team
to find out if what you have put on the form is accurate.
When Driving:
 Always check your blood sugar before you set off
 Have a snack if your sugar is below 5 mmol/l
 Do not drive for more than 2 hours without stopping and checking
your blood sugar
 If you have a hypo while driving, pull over safely and stop the car
as soon as possible. Switch off the engine, remove the key and
move into the passenger seat before treating the hypo.
 After recovering from a hypo do not drive for at least 45 minutes.
www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDriver
s/
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Further reading
“Type 1 diabetes in children, adolescents and young adults”
Dr Ragnar Hanas - Class Health publishing
This is a well written, easy to navigate book covering all aspects of
having type 1 diabetes in much more detail than I could here – I would
highly recommend it. It‟s about £13 on Amazon.
“Diabetes Through the Looking Glass: Seeing diabetes from your
child's perspective: A Book for Parents of Children with Diabetes”
Dr Rachel Besser – Class Health Publishing, also £13 on Amazon.
Basingstoke Young Diabetics Group
Local support group who do a lot for our team, and for the young people
with diabetes and their families.
www.bydg.org.uk/index.php
Diabetes UK
National Charity for people with diabetes – the website has loads of
information about all types of diabetes, as well as special sections for
children and young people.
www.diabetes.org.uk/
Runsweet.com
Website designed for diabetics who do lots of sport, with lots of tips on
how to adjust your insulin and diet to control your sugar and maximise
your performance.
www.runsweet.com/
Juvenile Diabetes Research Foundation
Loads of info about Diabetes in young people, and news on the latest
research.
www.jdrf.org.uk
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