Type 1 diabetes What you need to know
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Type 1 diabetes
What
you
need
to
know
The National Diabetes Service Scheme (NDSS) is an initiative of the Australian Government administered
by Diabetes Australia. The NDSS Agent in Queensland is Diabetes Australia – Queensland.
Contents
A guide
Chapter 1 – Diabetes
• What is diabetes?
• Type 1 diabetes
to type 1 • Other types of diabetes
Chapter 2 – Lifestyle
diabetes
• Eating well
• Carbohydrates and blood
glucose levels
• Adding sugar
Type 1 Diabetes: What You Need To Know is designed to
provide the latest and most useful information for people with
• Let’s eat out
type 1 diabetes, their family members and carers. Whether you • Exercise
have just recently been diagnosed or have been managing
• Weight management
type 1 diabetes for some time, this booklet provides facts,
figures, tips and useful advice to help you live a healthier life. • Alcohol
Managing type 1 diabetes is not easy. It is a considerable • Smoking
personal challenge and may seem daunting at first. When • Recreational drugs
you have mastered the early challenges of managing type 1
diabetes, there is a great ongoing benefit to be had in keeping
Chapter 3 – Monitoring and care
up to date with the latest knowledge and treatments. This
booklet is designed to be helpful to people facing both these • Blood glucose monitoring
challenges. • Insulin
The booklet is produced by Diabetes Australia – Queensland, • Insulin pumps
an organisation dedicated to providing support and education
to people with diabetes. It contains resources, information and • Hypoglycaemia
advice on how to get the best out of your health care team as • Emergency
well as information on a variety of topics such as exercise, living
• Sick days
and eating well and what to do if it all goes wrong.
• Complications
Coping with hypos, health emergencies, travel, driving, insulin,
discrimination issues and even making decisions on when and • Pregnancy
what to eat are all part of coping with type 1 diabetes. • Monitoring
The better informed you are, the better prepared you will be for • Your diabetes health care team
making the right decisions. If you have had diabetes for some
time, this booklet may be a good refresher. It is also a resource
Chapter 4 – Living with diabetes
you may like to share with family members and friends who
want to know more. • Coping
Type 1 diabetes affects different people in different ways. • Driving
A management plan is very personal and every individual has • Discrimination
their own response and different needs to be taken
• Insurance
Diabetes: What you need to know
into account.
Diabetes Australia – Queensland is here to guide and support • Travelling
you, whether you are taking your first steps, or just the latest of
many steps, along the path to maximising your health potential. Chapter 5 – Support
If you have any queries or issues you would like to discuss after • Diabetes Australia – Queensland
reading this booklet, ring Diabetes Australia – Queensland’s call • NDSS
centre on 1300 136 588. You can make this call from anywhere
in Queensland for the cost of a local call. • Medicare
If you have direct concerns about your treatment or health, • Fact sheets
contact your diabetes health care team to discuss the problem. • Websites
2
CHAPTER ONE
What is diabetes?
Diabetes is the term used to describe a common medical condition in which the body fails to process
blood sugar, or glucose, in the normal way. There are three main kinds of diabetes: type 1, type 2
and gestational. This booklet is mainly about type 1 diabetes. More than 123,000 people in Australia
have type 1 diabetes and more are being diagnosed all the time. Understanding the different kinds of
diabetes can help you understand the symptoms and treatment available.
Type 1 diabetes
What is ...
Insulin - the hormone produced by
the pancreas that allows glucose to
enter the body’s cells to be used as
fuel. Insulin is like a key that unlocks Type 1 diabetes is a life-long • Unquenchable thirst
the door to cells allowing glucose to autoimmune disease that usually
• Insatiable hunger, often for
enter and do its job. occurs in childhood but can occur
sweet foods
later in life. Type 1 diabetes occurs
Glucose - a type of sugar that comes
when the immune system damages • Extreme tiredness
from carbohydrates in your food.
the pancreas and it no longer
• Unexplained weight loss
Carbohydrates - one of the basic produces insulin. This means there is
building blocks of food. Carbohydrates no key to let glucose into the cells so it • Genital itching or regular episodes
are energy rich and found in many can provide fuel for the body. of thrush
different kinds of food and drink
The onset of type 1 diabetes can • Slow healing of cuts and wounds
including those that taste sweet
be abrupt and the symptoms are
such as fizzy drinks, cake, pastry, • Blurred vision
obvious. Between 10 and 15 per cent
chocolate, lollies, ice-cream, custard,
of all cases of diabetes are diagnosed • Mood changes
fruit and juice. Carbohydrates are also
as type 1 but it is still one of the most
found in food that doesn’t necessarily
taste sweet such as bread, cereals,
common chronic childhood diseases Type 1.5: Latent
legumes, milk, yoghurt and starchy
and becoming more common in Autoimmune
vegetables such as potato, sweet
young adults. Diabetes of
potato and corn. Adulthood
Causes Latent Autoimmune Diabetes of
If you have diabetes, your body
The cause of type 1 diabetes and Adulthood (LADA) is also called ‘type
cannot make proper use of the
how to prevent it is still unknown. The 1.5’. LADA is a slow-developing form
carbohydrates broken down from
most likely explanation is that the body of type 1 diabetes that is sometimes
food. The sugar produced from the
has an abnormal reaction to the cells mistaken for type 2 diabetes.
carbohydrates builds up in the blood
triggered by a virus or other infection.
as glucose, when it should be inside About 10% of adults diagnosed
We do know that it’s more common in
Diabetes: What you need to know
the cells being used for energy. with type 2 diabetes may have
people under 30.
The pancreas - A small organ LADA. People with LADA are not
near the stomach that normally Symptoms usually overweight but, as with type
produces insulin. When you have 1 diabetes, they may have a family
The symptoms of type 1 diabetes
type 1 diabetes, the pancreas does history of another autoimmune
come on suddenly, so the disease is
not produce insulin, so you need to disease like coeliac disease.
more likely to be diagnosed quickly.
replace the hormone every day People with LADA usually progress
with insulin injections or via an The main symptoms of
on to requiring insulin fairly quickly
insulin pump. undiagnosed diabetes include:
after being diagnosed with diabetes.
• Passing urine more often than usual,
especially at night
3
Chapter 1: Diabetes
Other types Fact sheets
Diabetes Australia –
of diabetes Queensland
www.diabetesqld.org.au
1300 136 588
Diabetes Australia – National
www.diabetesaustralia.com.au
websites
NDSS
Type 2 diabetes • High blood pressure and high
blood cholesterol levels
www.ndss.com.au
1300 136 588
Type 2 diabetes is the more common
form of the disease – 85% to 90% of • Use of some medications, such Queensland Health
all people with diabetes have type 2 as steroids www.health.qld.gov.au
diabetes. In type 2 diabetes, the body (07) 3234 0111
• Polycystic ovarian syndrome
still produces some insulin, although it Australian Indigenous
may not produce enough, or it may not
work well enough, to keep the blood
Gestational HealthInfoNet
glucose levels within a healthy range.
diabetes (Edith Cowan University)
www.healthinfonet.ecu.edu.au/
Diabetes occurs in 3 to 8 per cent of
In type 2 diabetes this is called ‘insulin chronic-conditions/diabetes
Australian women during pregnancy
resistance’. It means the insulin is not and usually goes away after the baby Diabetes Australia –
working well, so the pancreas makes is born. Women continue to produce Multilingual Resources
more in an attempt to keep up, but insulin normally but the hormones http://www.diabetesaustralia.com.
eventually becomes exhausted. In the produced during pregnancy mean au/NDSS-Content/Resources/
meantime, the blood glucose levels their bodies are temporarily less Multilingual
begin to rise. responsive to insulin and they cannot Sweet – Diabetes Transition to
Type 2 diabetes can occur at any age, maintain normal blood glucose levels. Adult Care Program
but is more common among those who This kind of diabetes may require www.sweet.org.au
are overweight, carry excess kilograms insulin but can be managed with
around the waist and are older than 40. lifestyle changes. Kids Helpline
It is a progressive disease managed www.kidshelp.com.au
Of the women who develop 1800 551 800
with healthy eating, exercise and gestational diabetes, about 17 per
medication. cent go on to develop type 2 diabetes Lifeline
The risk factors for type 2 diabetes within 10 years, and up to 50 per cent www.lifeline.org.au
include: will develop type 2 diabetes within 13 11 14
30 years. Royal Flying Doctor Service
• Increasing age
Good management after pregnancy (RFDS)
Diabetes: What you need to know
• Family history of type 2 diabetes www.flyingdoctor.org.au
helps reduce the risk of developing
• Excess weight or obesity type 2 diabetes later in life. (Call 000 for emergencies)
• Lack of exercise Women most at risk from gestational SANE
diabetes are overweight or obese, www.sane.org
• Diabetes during pregnancy 1800 18 SANE (7263)
have a family history of diabetes, have
• Certain ethnic backgrounds – polycystic ovarian syndrome, or have Vision Australia
Indigenous Australians and people of Aboriginal or Torres Strait Islander www.visionaustralia.org.au
Middle Eastern or Pacific family backgrounds. 1300 847 466
Island descent
4
CHAPTER TWO
Lifestyle
Some tips on Eat more fibre. Fibre helps control
blood glucose levels, cholesterol and
healthy eating weight. It also keeps the digestive
Choose the right food. Choose a system healthy. Good sources of
broad variety of foods from the five fibre can be found in wholegrain
food groups: breads, cereals, rice, bread, fruit, vegetables and legumes.
pasta, and noodles; fruit, vegetables
and legumes; low-fat dairy; lean meat, Try this:
People with diabetes are fish, poultry and nuts; and, small • Reduce your intake of saturated
the same as everyone else amounts of healthy fats. The Australian fat and trans fats – these are
Guide to Healthy Eating is a useful found in whole fat dairy products,
when it comes to eating a
resource for nutritional advice. fatty meat and butter and in
healthy diet. It is important tropical oils such as coconut
Watch your portions. Match your
for us all to eat a balanced energy intake with your energy output and palm oil. Replace them with
diet that is high in fibre, low (physical activity). Eating too much, healthier polyunsaturated and
monounsaturated fats found in
in saturated fat and contains even of healthy foods, can increase
insulin resistance and raise blood oily fish, avocado, vegetable oils,
low glycaemic index (low GI) nuts and seeds
glucose levels.
carbohydrates to provide
Eat regularly throughout the day. • Aim for at least two portions of
the body with necessary fuel oily fish a week
Start your day with breakfast and
and micronutrients. There don’t skip meals. Depending on your • Eat two serves of fruit and at least
Diabetes: What you need to know
is no need for people with insulin regimen, you may need to snack five serves of vegetables a day
diabetes to have special or between meals – discuss this with your and include beans and lentils
separate meals. If you need dietitian or diabetes educator.
• Limit salt intake and replace with
help deciding which foods Include carbohydrates at each herbs, spices, onion, chilli and
to eat, how much to eat meal. Carbohydrates are nutrients that capsicum
are an important fuel source for your
and how often to eat, talk body. You need to match your insulin
• Avoid or limit alcohol intake (no
to an Accredited Practising more than two standard drinks on
to the amount of carbohydrate you
any one day)
Dietitian for advice. have consumed.
5
Chapter 2: Lifestyle
Carbohydrates and blood
glucose levels
Digested carbohydrates are broken To work out the amount of Foods with a low GI raise blood
down into glucose – the body’s main carbohydrates you eat, you glucose levels more slowly than
source of fuel. Balancing diet, exercise can use: foods with a high GI and provide a
and insulin intake will help manage your longer-lasting source of energy so
• The carbohydrate ‘exchange’ or
blood glucose levels. Regular blood you feel fuller for longer. Eating too
‘serve’ lists (one carbohydrate
glucose testing will help you find the much of any carbohydrate will still
‘exchange’ contains 15g of total
right balance. raise your blood glucose level. High
carbohydrates)
GI carbohydrates increase blood
How to manage • Food labels glucose levels quickly, which is useful
blood glucose • Carbohydrate counters
when treating a hypo, but eating
levels Why GI matters
low GI carbohydrates is generally
recommended.
Timing
The glycaemic index (GI) ranks the You should discuss your plan for
Different types of insulin have different effect carbohydrates have on your treating a hypo with your diabetes
actions. Each type varies in when it blood glucose levels. health care team.
begins to work, reaches its peak and
runs out. Good diabetes management Healthy carbohydrate choices
is about matching insulin intake with *Italics = lower GI
the carbohydrates eaten. If your
Wholegrain/wholemeal Burgen® Breads, 9-grain Multigrain®, PerforMAX®
carbohydrate meal plan is regular and
bread/bread rolls
consistent, it is easier to manage blood
glucose levels. High fibre breakfast cereals Rolled oats, All-Bran®, Guardian® or untoasted
muesli
The amount – too little or too much
Pasta, rice and grains Basmati, Moolgiri or Doongara, barley, bulgur and
If you eat more carbohydrates couscous
Diabetes: What you need to know
than usual and don’t increase your Legumes Baked beans, kidney beans, chick peas, lentils,
physical activity or your insulin, your three bean mix
blood glucose level can rise too high
Milk products or dairy Low fat milk, soy drinks (calcium fortified), custard
(hyperglycaemia). If you don’t eat
alternatives and yoghurt
enough carbohydrates or skip a meal,
your blood glucose level can drop too Vegetables Potatoes, sweet potatoes and sweet corn have
low (hypoglycaemia or hypo). There is high levels of carbohydrates
no ‘one size fits all’ solution: It depends Fruit Most fruit is low GI – apples, oranges, pears,
on your age, body size and physical peaches, bananas. Eating lots of watermelon and
activity levels. lychees can increase BGLs quickly.
6
Chapter 2: Lifestyle
Sugar
A little bit is ok
Small amounts of sugar are OK, but
high-energy foods like chocolate,
cakes and lollies should be limited.
Using an alternative sweetener is an
option, but read the label carefully
because there are two different types
of sweeteners (nutritive and non-
nutritive sweeteners). Foods that
contain an alternative sweetener,
such as sugar-free chocolate, can
still be high in fat (particularly saturated
fat) and should not be eaten in
large amounts.
Sweetened products can add variety
to a low saturated fat, high fibre eating
plan. Check the effect of sweeteners
on your blood glucose level by testing
before eating and again two hours
later. You can repeat the test to make
sure the results really are due to that
specific food.
Non-nutritive sweeteners
(also known as artificial or intense
sweeteners). These are kilojoule-free
and do not affect blood glucose levels.
They include acesulphame K, alitame,
aspartame and sucralose, saccharine,
cyclamates and stevia.
Heat can change the taste of non-
Eating out
nutritive sweeteners, so add them
after you have finished cooking.
Splenda, Equal, Spoonful and
neotame are the only ones that can
be added during cooking or baking,
without affecting the taste. Eating out is one of life’s pleasures and you can still enjoy this experience while
looking after your health.
Low joule foods and drinks that
contain non-nutritive sweeteners (soft Meals chosen should:
drinks, cordials and jellies) can add
• Be lower in fat (especially saturated fat like butter)
variety without raising your blood
glucose levels. • Contain breads and cereals (preferably wholegrain), vegetables (including legumes)
and fruit
Nutritive sweeteners. These include
fructose, sorbitol, maltodextrin and • Have low amounts of added sugar
xylitol. They are not kilojoule-free,
Diabetes: What you need to know
have different effects on blood Insulin and eating out
glucose levels and may be labelled as
You have less control over when your food arrives when you eat out, so to
‘carbohydrate modified’.
avoid hypos take your insulin as the meal arrives. Choose meals with enough
carbohydrates and ask for extra bread, rice, potato, fruit or fruit juice if you need
more. Alternatively, you may need to reduce your dose of insulin.
If it’s a special occasion and you are having a bigger meal with more carbohydrates
than usual, you may wish to increase your insulin dose before the meal. Discuss this
with your diabetes health care team if you are not confident in making this decision
for yourself.
7
Chapter 2: Lifestyle
Physical
activity
Checklist to
get into action
Work out what activity
you will do and how
long you will do it for
Monitor your blood
glucose level before,
during and after
exercise
Exercise can help control diabetes and prevent long-term
Consider whether
complications. Becoming more active does not mean you
extra carbohydrates
or a reduction in have to sweat it out at the gym – it can be as simple as
insulin is needed walking for 30 minutes a day. Find something you enjoy
and keep it up. Incidental activity is also a
Carry your blood
good way to keep active so vacuuming,
glucose testing kit,
walking up the stairs or stretching at
diabetes identification,
hypo treatment and your desk all counts.
drinks
Footwear – is it Insulin and Listen to
comfortable and will physical activity your body
Regular exercise helps make insulin Keeping your blood glucose level stable
it protect your feet
more effective, so you may need a during exercise means you have to
during the activity? lower dose. Your diabetes health balance insulin and carbohydrates.
Diabetes: What you need to know
care team can advise you on changes Your blood glucose level will continue to
Check your feet
that may need to be made to your drop and will trigger a hypo if you
after every activity normal regimen. Check your blood don’t restock.
and if you develop glucose level before, during, and after
Blood glucose levels may rise for a short
problems, see a a training session.
time after intense exercise. This can be
podiatrist You may need to increase your portions due to the amount, type or duration of
of carbohydrates, as well as reduce the activity, your blood glucose level
Drink plenty of water your insulin dose during the training before the exercise, food intake or the
and replace lost fluids period to help prevent hypos. kind of treatment you are using.
8
Chapter 2: Lifestyle
Weight management
Following a long-term, balanced eating plan and adding regular physical
activity into your life are great ways to manage your weight. It is important to
get help from your diabetes health care team to work out the combination of
treatment, eating plan and activity that best suits your needs and lifestyle.
Managing your Being overweight also puts pressure
on joints – such as your hips, knees
No quick fix
weight and back, which makes physical If you are looking to lose weight, don’t
It’s not just the scales that reflect activity more difficult. rush to follow the latest fad diet. The
your weight – it is also the size of best way to improve your health is to
your waist. Health professionals Body Mass Index make small, sustainable changes to your
eating behaviour and physical activity.
recommend that men have a girth
below 94cm and women below
(BMI)
If you are thinking about using meal
80cm – although different ethnic The best way to determine whether
replacement programs, talk to your doctor
groups have different recommended you are in a healthy weight range is to
first. They are generally low-energy,
measurements. measure your BMI. This is calculated by
high-protein and low-carbohydrate plans
dividing your body weight in kilograms
You can work out your true waist that can put stress on your body if not
by your height in metres squared.
measurement by finding the halfway managed with medical supervision. Your
point between your lowest rib and the body is already working hard to control
Body Mass Index Weight
top of your hip. If you find it difficult to your blood glucose, blood pressure and
(BMI) (kg / m2) Status
measure yourself, ask for help. cholesterol so it pays to seek the
Below 18.50 Underweight right advice.
People with a high waist measurement
are more likely to have high blood 18.50 – 24.99 Normal There are potential side-effects to
pressure, high cholesterol, sleep 25 – 29.99 Overweight using meal replacements, such as
apnoea and dementia, as well as hypoglycaemia, and the medications you
30 Obese take may need adjustment.
some cancers.
It takes time
Diabetes: What you need to know
9
Chapter 2: Lifestyle
Losing weight is all about having
realistic expectations. It takes time
component to maintain healthy blood
glucose levels.
Complementary
to put weight on, so it makes sense
medicines
High blood glucose levels can make Complementary medicines
that it will take time to take it off.
it difficult for you to gain weight. should complement,
Successful long-term weight loss
In addition to modifying your food rather than replace
involves making practical changes
intake, your doctor may recommend conventional treatments.
to your lifestyle. Losing 5 to 10 per
a temporary or permanent change to They include herbal,
cent of your body weight a year until
your diabetes traditional, natural and
you reach a healthy target weight is
medication. alternative preparations.
the ideal way to shed those excess
kilograms and improve your health. Some Australian standards for
people take complementary medicines are designed
Start your journey to better health for quality and safety, not effectiveness.
supplements
by eating regularly through the day – Complementary medicines have risks
to increase
including breakfast. Don’t skip meals and side-effects just like conventional
their nutritional
because this slows your metabolism. treatments. Some may interact with each
intake.
To lose weight you need to use more other or with prescription and over-the-
Some supplements are
energy (measured in kilojoules) than counter medicines.
unsuitable for people with diabetes,
you consume. You may need to cut
so always discuss any plan to take To minimise any risk when using either
back on portion sizes and this may
supplements with your dietitian or over-the-counter or complementary
require a reduction in insulin dosages.
doctor. This is especially important medicines, you need to:
If you are looking for more tips if you have problems with kidney
on healthy eating, check out The function or diabetes control. • Be honest with your doctor, diabetes
Australian Guide to Healthy Eating and educator and dietitian about the
the Diabetes Australia fact sheets: Do Practical tips medication you are taking. Don’t stop
you need to lose some weight? and for gaining taking prescription medication without
first discussing it with your doctor
Healthy Eating Guide.
weight
• Consider the cost
Underweight • Eat small frequent meals
Diabetes: What you need to know
• Remember some can interfere with
Being underweight can make it • Add more mono or polyunsaturated
prescription medicine
difficult to stay healthy. If you have margarine and oil to your food
unexplained weight loss, it could mean • Bear in mind that these medications
• Add skim milk powder to drinks,
something is wrong. have possible risks and side-effects
soups and stews
Your dietitian can provide you with a • Speak to your pharmacist about
• Add grated cheese to cooked foods
personal treatment plan to meet your your current medication and any
nutritional needs. The plan will include • Snack on small serves of crackers, possible risks associated with adding
more protein, fat and energy in your cold meat, nuts and dried fruit complementary medications to your
diet while managing the carbohydrate diabetes management
10Chapter 2: Lifestyle
Alcohol
Diabetes and drinking alcohol
do not go well together but if
you follow a few basic rules,
there is no reason why you can’t
enjoy a couple of drinks.
Smoking But remember ... alcohol increases
the risk of having low blood
glucose (hypo) because it slows
the release of glucose from the liver.
The risk continues for some time
Giving up smoking is one of the most Plan your efforts to get the best results after you stop drinking.
positive things you can do for your and get support from your doctor,
health. It will reduce the risk of long- pharmacist, friends and family. Tips: The National Health and Medical
term diabetes complications. Research Council recommends that
Ring Quitline 13 7848 for even
healthy men and women consume
If you have diabetes, you already have more help.
no more than two standard drinks a
an increased chance of developing
Instead of focusing day and include alcohol free days to
heart disease or having a stroke.
on the dangers of reduce the risk of harm from alcohol-
Smoking also increases the risk of
smoking, here are related disease or injury.
other diabetes complications.
the benefits of
You may have tried a few times to give having a smoke- • Don’t drink on an empty stomach
up – it can be difficult. free life:
• Avoid drinking excessively – the
more you drink the greater the
hypo risk
• Tell your friends you have
diabetes and make sure they
After 48 hours, the
After three to nine know what to do if you have a
nicotine has left your
months, your coughs, hypo
body and your sense
of taste and smell are wheezing and breathing • Wear diabetes ID
dramatically improved problems will improve
• Carry fast-acting glucose
and your blood glucose meter in
After one year, case of a hypo
the risk of a heart • Check your blood glucose before you
After eight attack falls to go out and before bed
hours, the levels around half that of
a smoker • Carry extra snacks in case you go low
of bad products
in the blood • Eat before and after you go out
such as nicotine
• You may need a carbohydrate snack
and carbon
during the night or before bed
monoxide are
reduced by half • Drink plenty of water to prevent
and oxygen dehydration
levels return to
• Think you have a hangover? Check
normal
your blood glucose level – you may be
Diabetes: What you need to know
having a hypo. Treat immediately
Within 20 minutes of
• If you are sick or can’t take food, have
stopping, your blood After three months,
a sugary drink and monitor your blood
pressure and pulse your circulation will
glucose level regularly. You may need to
rate return to normal improve and your
follow your sick day management plan
skin will look better
• Never stop taking your insulin. Eat
breakfast to help with blood glucose
control
11Chapter 2: Lifestyle
Recreational
drugs websites
NDSS
www.ndss.com.au
1300 136 588
Queensland Health
www.health.qld.gov.au
The most commonly used recreational drug is alcohol. (07) 3234 0111
Other recreational drugs are illegal and dangerous and involve a Find Your 30 Campaign
higher degree of risk to your health if you have diabetes. (Eat Well Be Active)
www.your30.qld.gov.au
Other drugs: Hallucinogenic drugs
Know the score include cannabis, LSD and magic
GI database
www.glycemicindex.com
The effect of any drug on the body mushrooms. Hallucinogenic drugs,
varies from person to person but Go For 2 & 5
also known as psychedelics, change
young people are perhaps more likely www.gofor2and5.com.au
the way a person perceives the world.
to consider experimenting with illegal Health Insite (Australian
and dangerous recreational drugs. Drugs such as cannabis can cause
Government Initiative)
feelings of hunger and lead to a rise
Drug use can cause serious problems www.healthinsite.gov.au/topics/
in blood glucose levels. They can
for people with diabetes. Diabetes
also cause forgetfulness - including
1800 022 222
Depressants: Also called downers, forgetting to take insulin.
include alcohol and sleeping pills. Lighten Up
LSD and magic mushrooms can
They also include illegal drugs such www.health.qld.gov.au/lightenup
cause hallucinations, which can last
as heroin, methadone and cannabis. (07) 3246 3399
up to 12 hours, affecting insulin and
Downers slow the body down, food intake.. Measure Up Health Campaign
clouding thought processes, slowing www.measureup.gov.au
the heart rate and breathing. Anyone Stay safe Smart Choices – The Healthy
who takes them will feel relaxed and
• The risk associated with taking Food and Drink Supply Strategy
be more prone to forgetting about
illegal drugs is extreme for people for Queensland Schools
insulin or testing.
with diabetes http://education.qld.gov.au/
Uppers: Also called stimulants, schools/healthy/food-drink-
• Some drugs carry heavy penalties
include illegal drugs such as speed, strategy.html
for possession or supply
ecstasy and cocaine. These drugs
can make a person more active and
Diabetes: What you need to know
• If you go clubbing, wear
talkative than usual. When the drug diabetes ID
wears off, it can cause depression and Fact sheets
• Tell your friends about your
tiredness. Diabetes Australia –
diabetes and how to treat a hypo
Uppers can also suppress appetite, Queensland
• Have carbohydrates before you go www.diabetesqld.org.au
which can cause hypos, especially if
out and when you get home 1300 136 588
combined with dancing.
• Don’t mix drugs and alcohol Diabetes Australia – National
www.diabetesaustralia.com.au
12CHAPTER THREE
Monitoring and Care
As you develop strategies Blood glucose and the amount of exercise you do,
your diet and other lifestyle factors
to help you cope with type monitoring such as travel, stress and illness
1 diabetes, you will find that Measuring and recording your blood
• Understand how your lifestyle
monitoring your own blood glucose levels is important because it
helps us understand how your body choices and treatment can make a
glucose levels is a valuable real difference
responds to changes in insulin levels,
tool that puts you in charge eating patterns, physical activity and • Know immediately if your blood
of your self-management other factors. A change in the pattern glucose level is too high or too
plan. Your diabetes educator can alert you to possible problems low, so you can make informed
will teach you how to check that may need to be discussed with decisions about eating before
your diabetes health care team.
Diabetes: What you need to know
exercise, treating a hypo or seeking
your blood glucose levels and
Monitoring your blood glucose medical advice if you are sick
understand your targets. You
levels, recording and reviewing • Know when to seek advice from
will need to do a check at least the results will help you to: your health care team about
four times a day and extra adjusting your insulin
• Become more confident managing
checks are needed if you are your diabetes • Improve meals or snack planning
sick, change your activity level when you are not achieving your
• Better understand the relationship
or are experiencing unusual between your blood glucose levels glucose targets
symptoms.
13Chapter 3: Care
Storing insulin
All insulin needs to be kept below 30°C
out of the fridge and ideally between
2 and 6°C in the fridge. Store insulin
Insulin
you are using in a cool, dry place and
away from direct light. Your supply of
insulin should be stored in the fridge
until needed.
Don’t place insulin in, or close to, the
Insulin is a hormone produced in the Intermediate-acting insulin freezer compartment. Keep at least one
pancreas. Your body uses insulin to vial or cartridge of each type of your
move glucose from the bloodstream • Taken once or twice a day insulin in the fridge as a spare. Insulin
into cells where it is used as energy. • Peak action – four to 12 hours can be safely carried in your handbag
Insulin injections are required because or pocket.
your body is not producing insulin. • Lasts up to 24 hours
Don’t use insulin if:
• Cloudy in appearance – must be
Why inject mixed before each injection • Clear insulin has turned cloudy
insulin? Mixed insulin
or changed colour
Insulin is a protein. It can’t be given in • The expiry date has been reached
• Combination of intermediate and/
tablet form because stomach acids
or rapid-acting insulin or short • Insulin has been frozen or exposed
destroy the proteins before the insulin
acting insulin to high temperatures
can be absorbed.
• Taken once, twice or sometimes • Lumps or flakes can be seen
Types of insulin three times a day • The vial has been opened for more
There are three groups of insulin – • Peak action – one to 12 hours than 28 days
animal, human and analogues. Human
insulin is not from a living person but • Lasts up to 24 hours
is produced synthetically to exactly • Cloudy in appearance – must be
match human insulin. Most people use mixed before injecting
human insulin and insulin analogues,
although a small number of people still Insulin
use animal insulin.
injections
There are five main types The needles used to inject insulin are
of insulin: very small because insulin only needs
Rapid-acting analogues to be injected under the skin. Once
it has been injected, it is carried into
• Injected just before food the bloodstream.
• Peak action – one to three hours The three main areas for injecting
• Lasts three to five hours insulin are the stomach, buttocks
and thighs. Your diabetes health care
• Clear in appearance team can help you decide which is
the best for you. It is important to
Disposal
Long-acting analogues
rotate injection sites, as injecting into of sharps
• Injected once or twice a day to the same site can cause a build-up Dispose of syringes and needles in an
provide background insulin of lumps under the skin, affecting approved sharps container, which must
• These don’t have a peak action absorption of insulin and control of be kept out of the reach of children.
time – so no need to take with food blood glucose levels. These containers are available from
your pharmacist or Diabetes Australia –
• Lasts up to 24 hours The first time you inject can be
Queensland.
frightening, but as your confidence
Diabetes: What you need to know
• Clear in appearance When full, sharps containers must be
grows it becomes easier. If you are
Short-acting insulin worried about your technique you properly disposed of through your local
should talk to your diabetes health council. Do not dispose of sharps in
• Injected up to 30 minutes before
care team. Insulin injection is not anything other than an approved sharps
a meal
painful if performed properly – pain is container.
• Peak action – two to four hours a sign of poor technique.
Never share needles, syringes, pens,
• Lasts up to eight hours insulin cartridges or bottles because of
the risk of contamination and infection.
• Clear in appearance
14Chapter 3: Care
Insulin pumps
What does an or playing contact sports. It must not
be removed for longer than two hours.
insulin pump do? Insulin pumps are becoming more
An insulin pump is a small, commonly used.
computerised device worn outside the
body – it looks a little like a pager. The You may
pump works like a healthy pancreas
delivering tiny, regular doses of insulin
consider a pump
via a flexible canula that is inserted if you are:
under the skin. The canula is changed • Monitoring carbohydrate
every three days. intake closely
• Ready to learn lots of new
Is it for me? information
Insulin pumps are not for everyone.
• Able to use simple menus such as
those on a mobile phone
How does it or computer
work?
• Given the go-ahead from your
An insulin pump is programmed
diabetes specialist
to give a small dose of insulin
continuously over 24 hours, depending
on the individual’s needs. An extra
An insulin pump
dose of insulin is programmed when may be for you
meals are eaten, or when blood if you:
glucose levels are too high. » Have recurrent hypoglycaemic
An insulin pump contains only rapid- episodes or have lost the ability
acting insulin. No long-acting insulin to sense a hypo
is used. • Want increased flexibility for
insulin dosing
New skills • Are a shift-worker or change
You will have to learn new skills when your insulin doses often
you first start using a pump – there
are a few adjustments to make. • Have unpredictable blood
Dosing is different on a pump, as the glucose levels
amounts of insulin are often lower than • Have rising blood glucose
you used previously. Understanding levels overnight
carbohydrates and adjusting your
insulin doses for different meals gives • Are planning to start a family
you more flexibility, but you will have and want better control before you
to work at becoming familiar with the fall pregnant
new program. You will need support • Are in a private health
from your diabetes health care team to insurance scheme
make the most of an insulin pump.
Diabetes: What you need to know
• Are under 18 years – you can apply
for a government subsidy
How long do
you wear it? To learn more about pumps see
the Diabetes Australia - Queensland
The insulin pump must be worn all the
booklet “I’m considering an
time, but can be removed for short
insulin pump”.
periods when showering, swimming
15Chapter 3: Care
Hypoglycaemia
Hypoglycaemia is commonly referred Step 1
to as ‘a hypo’. Generally it occurs
Have about 15g of quick-acting
What happens
when your blood glucose level drops
glucose IMMEDIATELY, such as: if a hypo is not
below 4mmol/L, although this can vary.
It is important to treat a hypo quickly • Six to seven glucose jellybeans OR
treated?
to stop the blood glucose levels from If not treated quickly, your blood
• 100ml sweet soft drink, not ‘diet’ OR glucose level can continue to drop
falling even lower.
• Three teaspoons sugar or honey OR which may progress to:
What causes • 125 to 200ml of fruit juice OR • Loss of co-ordination
hypos: • Slurred speech
• 100ml of Lucozade
• Delaying or missing a meal
If you can, re-check your blood • Confusion
• Not eating enough carbohydrates for
glucose level after 15 minutes to make • Loss of consciousness/fitting
a given dose of insulin
sure it has risen above 4mmol/L. If the
• Unplanned physical activity symptoms don’t go away or if you are
still below 4mmol/L, REPEAT Step 1
• More strenuous exercise than usual
IMPORTANT: If after repeating Step
• Drinking alcohol
1, your blood glucose level still does
What are the not rise above 4mmol/L, get help
immediately. Your blood glucose level
symptoms: could continue to drop and you could
• Weakness, trembling or shaking become unconscious.
• Sweating Step 2
• Light headedness/headache If your next meal is more than
20 minutes away, you will need
• Lack of concentration
to eat about 15g of long-acting
• Behaviour change carbohydrates. This could be one of
• Dizziness the following:
Diabetes: What you need to know
• Tearfulness/crying • A slice of bread OR
• Irritability • A glass of low fat milk or soy milk
OR
• Numbness around the lips/fingers
• A piece of fruit OR
• Hunger
• Two to three pieces of dried
If you feel any of these symptoms, apricots, figs or other dried fruit OR
check your blood glucose level. If you
are unable to do so, treat as a hypo • 200ml tub natural low-fat yoghurt
anyway, just to be sure. The first thing OR
to do is make sure you’re safe. • Six small dry biscuits and cheese
16Chapter 3: Care
Emergency
What to do if someone with type
1 diabetes becomes drowsy,
Hypos can occur while you are asleep.
The hypo may wake you up, or you
What else
unconscious or unable to swallow: may wake later feeling tired, with a
should I do?
headache or hangover sensation. If • Wear diabetes identification alert
• Don’t give any food or drink
you are concerned about overnight • Note any hypos you have
• Place them on their side, make sure hypos, check your blood glucose
their airway is clear between two am and three am when • Make sure your family, friends and
hypos are most likely to occur. Keep co-workers know how to recognise
• Phone for an ambulance (dial 000) and treat a hypo
something sugary beside your bed
stating a ‘diabetes emergency’
just in case. You may like to check • Look for the cause of your hypo so
• Give an injection of glucagon if your blood glucose level before bed you can try to prevent the situation
available and you are trained to do so and if concerned, have a snack before from reoccurring
• Wait with the person until the bedtime such as biscuits and milk, half
a sandwich, fruit or yoghurt. • Contact your doctor or diabetes
ambulance arrives educator if you are having hypos
• When conscious, they’ll require Hypoglycaemia often
carbohydrates to maintain their
blood glucose levels
unawareness • Always carry rapid-acting hypo
Some people feel no symptoms of a treatment with you
Glucagon hypo, or experience symptoms only • Eat carbohydrates if you are
Diabetes: What you need to know
when the blood glucose level drops drinking alcohol
Glucagon is a hormone that raises the very low. This problem is more likely
blood glucose levels and is injected in a • Before driving a motor vehicle, test
to occur in someone who has had
similar way to insulin. your blood glucose level, make
diabetes for a number of years or in
sure it is above 5mmol/L
Using it is recommended to treat severe people who have hypos frequently. If
life-threatening hypoglycaemia. There you have hypoglycaemia unawareness • You will eventually recognise your
may be times when you can’t treat your you must check your blood glucose own hypo warning signs
own severe hypo, so it is important to level more frequently and you should
show your family and friends how to discuss the situation with a specialist
use your emergency glucagon. or diabetes educator.
17Diabetes: What you need to know
18
Chapter 3: Care
days
SickChapter 3: Care
Hyperglycaemia (high blood glucose
levels) is when the blood glucose
2. Test your blood glucose levels –
every two hours at first. If your
What are
is higher than the desirable range – blood glucose level is more than
ketones?
usually above 15mmol/L. Most people 15mmol/L over two consecutive When there is too little insulin in the
with diabetes have a short-term rise in tests and you have ketones, you body, glucose can’t enter cells to
blood glucose readings that lasts need extra insulin – contact provide energy, so the body begins
a few hours but falls back to the your doctor. to break down fat and muscle as an
target range. alternative source of energy.
3. Test for ketones regularly – use
Reasons for high blood either ketone urine test strips This process causes ketones to be
glucose readings: or a meter, which allows blood produced. Ketones also need insulin
ketones to be checked. Test strips to enter the cells and when there is
• Eating extra carbohydrates insufficient insulin the ketones build
are available from a pharmacy or
• Not enough insulin or the dose through NDSS. up in the blood and are eventually
may be too low, or may have passed through the kidneys and
4. Rest – have a friend or relative into the urine. While large quantities
been forgotten
stay with you or check on you of ketones can be serious, small
• Less exercise than usual frequently. Exercise with caution if amounts are not harmful and can
your blood glucose level is above also be found in people who do not
• Can be temporary during or
15mmol/L. have diabetes.
just after vigorous exercise
(adrenaline effect) 5. Keep drinking and (if possible)
• Measuring the blood glucose too
eating – eat or drink carbohydrate- What is
soon after a meal – wait two hours
containing foods/fluids if your blood ketoacidosis?
glucose level is under 15mmol/L.
after eating Ketoacidosis is a life-threatening
Eat or drink non-carbohydrate
condition that can occur when you
• Emotion, such as excitement foods if 15mmol/L or above.
are ill or have a very high blood
or stress
glucose level resulting from a lack
• Infection or other illness of insulin. The presence of large
When do I get amounts of ketones in the blood or
• Inaccurate blood glucose levels –
clean hands, check expiry date
medical help? urine is called ketoacidosis.
There are certain times during illness
on strips, retest Signs of ketoacidosis include:
when your diabetes health care
If your blood glucose level is usually professional will need to increase your • Nausea, vomiting and/or
well controlled, an occasional higher insulin dose. abdominal pain
reading is nothing to worry about.
Contact your doctor or diabetes • Deep rapid breathing or
However if your readings continue to
educator if: breathlessness
rise, or are higher than they should be
over a period of time, your treatment • You can’t keep food or fluids down • Extreme drowsiness
may need to be reviewed. Illness and have persistent vomiting, • A ‘fruity’ odour to the breath
or infections generally cause blood diarrhoea and/or abdominal pain
glucose levels to rise – take action at The most likely time for developing
• Urine ketones are moderate/ ketoacidosis is when a person
the first sign of illness.
heavy and blood glucose is over is unwell or has an illness due to
Have a Sick Day Plan in place. 15mmol/L infection. During periods of illness,
Discuss what you will do with your
• Blood ketones are more than even if you are not eating, you
diabetes health care team.
0.6mmol/L and blood glucose is still need insulin. It is important to
over 15mmol/L continue taking your insulin and to do
Sick Day Plan more frequent blood glucose testing.
When to start: Start even if you feel You should contact the hospital or
medical centre immediately when: Ketones are easily detected by a
OK but there are ketones in your
simple urine test or blood test with
blood/urine or your blood glucose • You have deep rapid breathing or
certain meters. You should test for
level is greater than 15mmol/L for two breathlessness
ketones if your blood glucose is high
Diabetes: What you need to know
consecutive readings within a 2-6 hour
• You are extremely drowsy (usually over 15mmol/L) or if you
time frame.
have any symptoms of ketoacidosis.
• You have a ‘fruity’ odour to your
Important steps:
breath If you discover a high level of ketones
1. Always take your insulin – even and especially if your blood glucose
• You are unable to keep fluids down
when you are unwell. Seek advice level is high, you should call your
from your diabetes health care (See ketoacidosis following.) doctor immediately, or go to your
team if you are told to stop. It is nearest emergency department.
rare for doses to be reduced – you
may need more, not less.
19Chapter 3: Care
Complications
High blood glucose levels can cause
serious damage to your body over
Common Peripheral vascular disease:
Damage to the blood vessels in the
time but there are things you can do to
complications feet means their blood supply is
reduce your risk of developing them. If Damage to the large blood vessels limited. This can cause delayed healing
blood glucose, cholesterol and blood Heart attacks and stroke: Having from blisters or sores. If sores are not
pressure levels are kept within the diabetes increases your risk of properly cared for, they can develop
normal range, the risk of damage to developing these problems. People into ulcers and become infected. In
your body is reduced. with diabetes may have raised very serious cases, surgery may be
cholesterol and blood pressure. A necessary and amputation may
Reducing complications family history of heart disease or be required.
from diabetes stroke, smoking and being physically Neuropathy: Neuropathy is nerve
• Have well-managed diabetes inactive increases your risk. damage caused by high blood glucose
Damage to the small blood vessels levels. Nerve damage can lead to pain
• Keep your blood glucose,
and loss of feeling to the hands and
blood pressure and cholesterol Retinopathy: Damage to the retinas feet, called peripheral neuropathy. It
at target levels at the back of your eyes, if left commonly affects the nerves in feet but
• Regularly test your blood unchecked, can cause blindness. any nerves can be involved including
glucose levels Have your eyes examined regularly those that control internal organs.
by a qualified optometrist or eye
• Remember to see your doctor for all Symptoms include:
specialist. If you experience a sudden
your recommended screening tests
loss of vision, seek advice from an • Tingling
• Take all prescribed treatments optometrist immediately.
• Numbness
Diabetes: What you need to know
• Don’t smoke. Call Quitline 13 7848 Nephropathy: High blood glucose
levels can damage your kidneys • Burning or pain at rest
• Be physically active for at least 30
over time, especially if you have high Avoid foot problems
minutes five times a week
blood pressure. Keeping your blood
• Keep your blood glucose level
• Follow a healthy eating plan glucose and blood pressure under
well controlled
control will help reduce your risk of
• Limit your alcohol intake
kidney damage. Have an annual • Stop smoking
• Lose excess weight urine microalbumin test to check for
• Wash feet every day with lukewarm
evidence of kidney damage.
• Look after your feet and choose water and mild soap
footwear that protects your feet
20Chapter 3: Care
• Dry feet well, especially between
the toes. Use a soft towel and
Sex and diabetes Pregnancy
pat gently Sex is an important part of Having a family is a big decision,
relationships. Sex can be an energetic especially if you are a woman who has
• Keep the skin smooth with creams, exercise, which means there is a diabetes because there are more factors
especially on the heels but not chance of having a hypo either during to take into account. Your diabetes
between the toes. If the skin is or after sex. health care team can guide you through
cracked, seek help to treat your planning and your pregnancy.
Make sure you have fast-acting
• Keep feet dry – dust with non- Make sure you talk to them BEFORE
glucose on hand. You may also want
medicated powder before putting getting pregnant.
to tell your partner what to expect if
on footwear you have a hypo. This could be the Many women who have diabetes go
• Check feet daily – at the first sign time to tell them a bit more about on to have healthy pregnancies and
of redness, swelling, lasting pain, diabetes as well. healthy babies. You can increase your
numbness or tingling, seek chances of delivering a healthy baby by
In the longer term, problems while
medical advice keeping your blood glucose levels well
having sex are more common in
controlled before conception and during
• Use a mirror if you cannot easily people with diabetes.
pregnancy. It is important to have folic
reach or see your feet acid before falling pregnant.
Sexual
• Don’t treat calluses, corns or
bunions by yourself
complications The first eight weeks are important:
Erectile dysfunction (ED) • Persistently high blood glucose
• Cut toenails straight across to levels increase the risk of abnormal
avoid ingrown nails and use a nail ED or impotence is the inability to
development to the baby and
file to remove sharp edges. Soak achieve or maintain an erection for
complications for the mother. Your
your toenails in warm water to sexual intercourse. It is one of the
doctor can measure your longer-term
soften before you cut them most common sexual problems
blood glucose levels using the HbA1c
experienced by men.
• Don’t let your feet get too hot test. The risks increase if this result
or too cold The main causes are tiredness, goes above 7 per cent
stress, emotion, alcohol, smoking, (See page 23, for more information.)
• Don’t go barefoot recreational drugs, diabetes, certain
• Hypos can cause miscarriage early
• Cover small cuts with a mild medication, surgery and other
in the pregnancy. Ideal control is
antiseptic and dressing illnesses.
recommended and preparation for
There is a wide range of treatments pregnancy should be discussed with
Teeth and gum for ED including sex therapy, your diabetes health care team
care medication (oral, injection and urethral
• Have your eyes checked before you
High blood glucose levels can cause suppository) and vacuum therapy.
fall pregnant as pregnancy can place
tooth decay and gum infection, Less commonly, surgery may
extra pressure on the small vessels
which can increase your risk of heart be required.
in your eyes. If you have advanced
disease. Signs to watch out for When starting treatment for erection retinopathy that has not been treated,
include a dry mouth, burning tongue, problems it is vital that your diabetes make sure it is treated before you
red, sore, swollen or bleeding gums and any other linked conditions such become pregnant
and white film on your gums or on the as heart disease are well controlled.
inside of your checks or tongue. Your main goals:
Having diabetes does not mean you
Make sure your dentist knows you will go on to develop ED, but it is » Check your blood glucose levels
have diabetes and visit regularly. important to be aware of it in case you more regularly – discuss with your
experience problems. health care team
If you have a dry mouth, drink
water rather than sugar-filled drinks. Female sexual dysfunction (FSD) » Follow diet and exercise guidelines,
Sugarless gum can help increase stop smoking and reduce or stop
FSD can be caused by physical,
saliva production. drinking alcohol
emotional and lifestyle factors,
medication and diabetes-related » Contact your diabetes health care
Diabetes: What you need to know
complications. team if you have problems with
nausea and vomiting
Women experiencing FSD may have
problems with desire, arousal, pain » Continue taking folic acid
during intercourse and achieving
» Test your urine or blood for ketones
orgasm.
» Have a glucagon kit and make sure
Currently there is no medical treatment
someone in the household or nearby
for FSD, but research is ongoing.
knows how to use it
Treatments in the form of therapy
and aids for lubrication and clitoral » Attend all antenatal clinic
stimulation are available. appointments
21Chapter 3: Care
On target
Being actively involved in the
management of your diabetes means
you need to know what tests you
should have on a regular basis with
your health care team. These tests
will help determine how your health is
tracking.
HbA1c testing
This blood test reflects your average
blood glucose reading for an eight
to 12-week period. You should have
this test at least once a year, but
you can have the test as frequently There are two types of cholesterol
– HDL (the good cholesterol that
Foot
as every three to six months. It
protects against heart disease) and
examination
provides a snapshot of your diabetes
LDL (the bad cholesterol which can Check at least every 6 months for
management.
damage your heart). changes in sensation, decreased
Your HbA1c value should be 7 per circulation and infection.
cent or less (this can vary according Triglycerides are another kind of
to individual circumstances). The blood fat that increases the risk of
heart disease. Triglycerides should be
Annual cycle of
aim is to get it as low as possible
less than 1.5 mmol/L.
care (Minimum
without causing hypos. At this level,
complications are minimised and the
requirements)
Generally your HDL should be
risk of hypos is low. Every six months:
greater than 1.0 mmol/L and your
For each 1 per cent reduction in LDL should be less than 2.5 mmol/L. • Blood pressure
the HbA1c value there is a 20 to These levels are achievable through
• Weight
40 per cent reduction in the risk of regular physical activity, weight loss,
a healthy diet low in saturated fats • Body mass index
complications.
and by taking cholesterol-lowering
• Waist circumference
If your HbA1c is elevated, you may medication.
need to increase your physical activity, • Foot care
lose weight or adjust your insulin, but Urine Every year:
talk to your diabetes health care team
before doing this.
microalbumin • HbA1c
This test detects evidence of kidney
• Total cholesterol, LDL cholesterol
Blood pressure disease. You should have this test at
least once a year. Achieving target and triglycerides
monitoring levels for your HbA1c and blood • Kidney check (urine microalbumin
Checking your blood pressure and pressure will help prevent and treat test)
treating elevated levels reduces your kidney problems. Your doctor may
risk of blood vessel damage and prescribe medication if needed. • Medication review
kidney disease.
• Smoking status
Check at least twice a year. Generally Eye examination • Healthy eating plan
your blood pressure should be Diabetes puts people at increased
130/80mmHg. Physical activity, weight risk of developing cataracts, • Physical activity
loss, stopping smoking and some glaucoma and diabetic retinopathy –
Diabetes: What you need to know
• Self care education
medication can help lower blood a leading cause of blindness.
pressure if it’s too high. At least every two years:
An eye exam every two years,
or more frequently, can identify • Eye examination (more frequently
Lipids (blood fat complications early. Keeping your if evidence of disease)
levels) HbA1c level on target, controlling Please note that the recommendations
These need to be monitored annually blood pressure and being a non- for children and adolescents with
because diabetes, when combined smoker can prevent vision loss. type 1 diabetes may vary from those
with high lipid levels, place you at listed. Discuss this with your health
higher risk of heart attack and stroke. professionals.
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