Diabetes
What Does it Mean for Me?
Leader Diabetes Initiative
2005
What is Diabetes?

People with diabetes have
high blood sugar levels.
This is because their
pancreas doesn’t make
enough insulin, or their
cells don’t respond to the
insulin normally (insulin
resistance), or both.

The liver stores sugar and
releases it when the body
needs it (between meals).
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What Does Insulin Do?

Food that you eat is broken down into
nutrients, one of which is sugar (also
called glucose).

Glucose is a fuel, which is changed into
energy that the body needs to live.

Insulin causes blood glucose levels to
come back down because it moves
glucose from the blood stream into the
fat, muscle and liver cells where it can be
used for energy.

If there isn’t enough insulin available, or
the insulin doesn’t work well enough, the
sugar cannot leave the blood as well as it
should.
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What Does Insulin Do?

If insulin levels are
correctly regulated
by your body, the
amount of glucose in
your bloodstream
does not get too high
or too low.
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Type of Diabetes…

There are three types of diabetes:

Type I
Type II
Gestational
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Type I Diabetes
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Usually diagnosed in
childhood.
The body makes little
or no insulin, and
daily injections are
needed to live.
Without proper daily
management,
medical emergencies
can occur.
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Type II Diabetes


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About 90% of all cases
of diabetes.
Usually occurs in
adulthood.
The pancreas doesn’t
make enough insulin
and/or the insulin can’t
work properly because
the cells aren’t
responding normally.
Sometimes the liver
releases sugar when it
isn’t needed (“leaky
liver”).
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Gestational Diabetes

High blood glucose
that develops at any
time during
pregnancy in women
who do not have
diabetes.
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Risk Factors for Developing Diabetes

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Family history of diabetes
(parent or sibling)
Obesity
Age greater than 45 years
Certain ethnic groups
(Aboriginal, AfricanAmerican)
Gestational diabetes or
delivering a baby weighing
more than 9 pounds
High blood pressure
High cholesterol levels
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Symptoms of Type I Diabetes

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Increased thirst
Increased urination
Weight loss in spite
of increased appetite
Fatigue
Nausea
Vomiting
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Symptoms of Type II Diabetes
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Increased thirst
Increased urination
Increased appetite
Fatigue
Blurred vision
Slow-healing infections
Impotence in men
Many people do not
even know they have
diabetes, as they don’t
have any symptoms
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Treatment for Diabetes



There is no cure for diabetes.
The goals of treatment are to stabilize the
blood sugar, eliminate the symptoms of high
blood sugar, and prevent further
complications of diabetes.
Education, diet, exercise, weight, blood
pressure and cholesterol control, medication,
blood glucose self-testing, and foot care are
vital for good control of diabetes and
prevention of its complications.
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Diet

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A well controlled diet is very important in
controlling and even preventing some
cases of diabetes.
Every person with diabetes should meet
with a dietitian to receive important dietary
information.
Canada’s Food Guide is another excellent
resource for making dietary decisions.
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Canada’s Food Guide
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Alcohol Usage
Moderate consumption
of alcohol (1-2 standard
drinks) will not
significantly alter blood
sugar levels.
 It is better to drink
alcohol with a meal than
alone, as alcohol may
mask the symptoms of
low blood sugar.
 Recommendations:
-Men = <14 drinks/week
-Women = <9 drinks/week

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Exercise

Exercise does many
positive things for
diabetes and our bodies:
-Lowers blood sugar levels
-Helps insulin to work
better
-Helps use up extra fat in
our bodies
-Improves overall health
(lowers blood pressure,
cholesterol, etc.)
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Exercise

Start exercising slowly, gradually build
up to at least 30 minutes, five days a
week.
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Quitting Smoking

Quitting smoking is
essential for helping
control blood sugars,
blood pressure, and
cholesterol, and for
preventing some
forms of cancer.
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“Sugar” Medications

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There are many medications used for lowering
or controlling blood sugar.
Your doctor will help you to decide which
medication(s) are right for you.
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Sulfonylureas
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Gliclazide (Diamicron®)
Glyburide (Diabeta®)
Glimepiride (Amaryl®)
These medications stimulate the pancreas to produce
more insulin and help insulin work better in the body.
These medications should be taken with your meals.
Possible side effects include: low blood sugar, upset
stomach, skin rash or itching, weight gain.
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Meglitinides
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Repaglinide (Gluconorm®)
Nateglinide (Starlix®)
These medications stimulate the pancreas to
release insulin and help the body use insulin
more effectively.
These medications should only be taken right
before a meal (if a meal is skipped, the dose
should also be skipped).
Possible side effects include: low blood sugar,
weight gain.
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Biguanides
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Metformin (Glucophage®)
This medication helps the glucose move into the cells and
stops the “leaky” liver from releasing sugar.
This medication should be taken with your meals.
Possible side effects include: nausea, diarrhea, weight
loss, metallic taste in your mouth.
Metformin will not cause your blood sugar to drop too low.
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Thiozolidinediones
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Rosiglitazone (Avandia®)
Pioglitazone (Actos®)
These medications increase
insulin’s action in the body by
helping move the glucose into
the cells, and they decrease
the “leaky” liver.
These medications will not
cause the blood sugar to drop
too low.
Possible side effects: weight
gain, swelling (edema).
May take up to 8 weeks to
have their full effect.
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Alpha-glucosidase Inhibitor
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Acarbose®
This medication slows the
body’s absorption of
sugar and starches
(carbohydrates) from
food.
Possible side effects:
stomach upset, gas,
diarrhea.
This medication is not
commonly used anymore.
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Insulin
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Type I diabetes requires the use of insulin.
Some people with Type II diabetes will
eventually have to use insulin.
Insulin injections replace the insulin that should
normally be produced by the pancreas.
There are many types of insulin available, and
differ by how fast and for how long they work.
Onset of actions range from 30 minutes to 6
hours.
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Insulin

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People who use insulin must monitor their
blood sugar often.
When insulin is being used, it is important that
meals are eaten at regular times, so blood
sugar levels do not fluctuate too much.
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Blood Sugar Monitoring

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Your doctor will do regular blood tests to
determine how well your blood sugar is
being controlled.
It is important that you regularly test your
blood sugar at home.
By ensuring that your blood sugar is
within the target range, you help prevent
future complications.
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Home Monitoring

Ideally, you should test your blood sugar 2-4 times daily.

Self-monitoring of blood glucose is done by checking the
sugar content of a drop of blood. Regular testing tells you
how well diet, medication, and exercise are working
together to control your diabetes.

Recording your blood sugar levels provides valuable
information for your health care provider, identifies high
and low blood sugar levels, and allows for changes to be
made, before serious problems develop.
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Blood Sugar Targets

Home monitoring:

Lab tests
• Before meals = 4.0 – 7.0 mmol/L
• After meals (2 hours) = 5.0 – 10.0 mmol/L
• A1c = <7.0% (blood glucose control over last
•
3 months)
Fasting Plasma Glucose <6.1 mmol/L
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Sick Days
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When you are sick, your
blood sugar levels will be
higher than normal, no
matter how little you eat
during that day.
It is important to still take
your medications when
you are sick.
You may have to make
adjustments in your
insulin.
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Diabetic Complications
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Over time, high levels of sugar in the
blood can damage the blood vessels and
nerves in your body.
This damage can cause problems in
many parts of the body, with the main
areas being the heart, kidneys, eyes,
legs, and feet.
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Diabetic Complications
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There are two types of complications that can occur with
diabetes:
Acute = complications that occur quickly.
-Hypoglycemia
-Hyperglycemia
Chronic = complications that take a long time to develop.
-Heart disease/stroke
-Eye problems
-Kidney problems
-Foot problems
-Nerve problems
-Erectile dysfunction
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Hypoglycemia
(Low Blood Sugar)
Symptoms:
-Mood changes
-Headaches
-Trembling
-Hunger
-Paleness
-Sweating
-Extreme tiredness
-Dizziness
-Blurred Vision
Causes:
-Failure to eat
-Too much physical activity
-Too much medication
-Side effect of certain
medications
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Treatment of Hypoglycemia

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Hypoglycemia can become a serious medical
emergency.
It is important to raise the blood sugar level
quickly to a safe level in order to avoid the risk
of injury and to alleviate symptoms.
15 of carbohydrates (1/2 Cup of fruit juice, 8
Lifesavers®, 3 glucose tablets) will increase
your blood sugar by 2.1 mmol in 20 minutes.
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Hyperglycemia
(High Blood Sugar)
Symptoms:
-Dry mouth
-Extreme thirst
-Frequent urge to
urinate/bedwetting
-Drowsiness
-Stomach pain
Causes:
-Eating too many
sugars/starches
(carbohydrates)
-Failure to take
medications
-Liver’s response to
low blood sugar
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Cardiovascular Complications
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Approximately 80% of patients with diabetes
will die as a result of a vascular event.
Over time, high blood sugar levels damage
large and small blood vessels.
This is why your doctor may want to help
protect your heart and blood vessels with
medications and lifestyle changes that help
control:
-Blood Pressure
-Cholesterol
-Blood clot formation
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Hypertension
(High Blood Pressure)

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Blood pressure is the
force applied against the
walls of the arteries as
the heart pumps blood
through the body.
The pressure is
determined by the force
and amount of blood
pumped and the size
and flexibility of the
arteries.
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Hypertension
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The top number of your
blood pressure
measurement (systolic)
represents the pressure
generated when the
heart beats, while the
bottom number
(diastolic) is the pressure
when the heart is at rest.
The target blood
pressure for patients
with diabetes is 130/80
mmHg.
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Hypertension
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When high blood
pressure is left
untreated, damage
to organs throughout
the body can occur.
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Hypertension
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Blood pressure can
be controlled by diet,
exercise, and quitting
smoking.
Sometimes
medications are also
needed.
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Cholesterol
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A soft, waxy substance that is present in all
parts of the body including the nervous system,
skin, muscle, liver, intestines, and heart.
It is made by the body and obtained from
animal products in the diet.
Cholesterol is manufactured in the liver for
normal body functions including the production
of hormones, bile acid, and Vitamin D. It is
transported in the blood to be used by all parts
of the body.
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Cholesterol
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Cholesterol

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Excessive cholesterol
contributes to
atherosclerosis and
subsequent heart
disease.
The risk of developing
heart disease or
atherosclerosis
increases as the level of
blood cholesterol
increases.
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Cholesterol

Because patients
with diabetes already
have an increased
risk of heart disease
we want to make
sure we control
cholesterol levels.
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Cholesterol

Medications can also
help control
cholesterol by either
reducing the amount
of cholesterol made
by the body, or by
decreasing how
much cholesterol is
absorbed from the
food we eat.
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Cholesterol Targets

There are 3 major
types of cholesterol:


HDL (Good Cholesterol)
LDL (Bad Cholesterol)
TG (Triglycerides)

Cholesterol targets for
people with diabetes
are:
LDL <2.5 mmol/L

TC Ratio < 4.0

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TC = Total Cholesterol
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Kidney Complications
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Kidney damage related to diabetes is the
most common cause of kidney failure in
the world.
Damage to the blood vessels that supply
the kidneys can result in eventual organ
failure.
High blood pressure and smoking also
contribute to kidney damage.
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Nerve Damage
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Signs of nerve damage will become
apparent in 40-50% of patients with
diabetes within 10 years of the initial
diagnosis.
High blood sugar levels damage nerves
and can lead to pain, loss of
feeling/reflexes, cramping, impotence,
diabetic diarrhea, incontinence, and
motor weakness.
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Foot Problems
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Common cause of all below-the-knee
amputations.
Damage to blood vessels and nerves
supplying the feet results in loss of feeling.
When minor injuries occur to the feet (blisters,
ingrown toenails, splinters, etc.) they go
unnoticed because nothing is felt, and infection
occurs.
Infections go untreated, can become serious
and may result in amputation.
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Eye Problems
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High blood sugar levels damage the small
blood vessels supplying the eyes.
Diabetes related eye problems are the leading
cause of blindness in people aged 25-75
years.
90% of Type I patients will have some form of
eye damage after only 15 years of diagnosis.
Patients with diabetes should have their eyes
examined regularly.
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The Good News…
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
YOU can prevent most of these
complications with good blood sugar,
blood pressure and cholesterol control.
These can be controlled with diet,
exercise and in some cases,
medications.
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Support


Your health care
providers are a good
source of support
and information for
diabetes.
There are also many
organizations that
provide support for,
and information on
diabetes.
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Notes
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