What is Type 1 Diabetes?
Diabetes means too much sugar or glucose in the bloodstream. Glucose comes from the food that we eat and gives us energy.
Insulin, a hormone made in the pancreas acts like a key allowing the glucose to go from the blood into our body cells so that we can use this energy.
Type 1 diabetes happens when the pancreas stops making insulin. So the glucose can't get into the cells and it builds up in the bloodstream which can make you very sick. You feel tired, thirsty, you want to go to the toilet all the time and you’ve got no energy. All of this happens because your blood glucose levels (BGLs) are too high. Type 1 diabetes is an autoimmune disease that happens when your immune system, which normally protects you from infection, starts to destroy the cells that make insulin. For type 1 diabetes to develop you need to carry the ‘at risk’ genes as well as a trigger to start the damage to the cells.
Type 1 diabetes happens when the pancreas stops making insulin. So the glucose can't get into the cells and it builds up in the bloodstream which can make you very sick. You feel tired, thirsty, you want to go to the toilet all the time and you’ve got no energy. All of this happens because your blood glucose levels (BGLs) are too high.
Type 1 diabetes is an autoimmune disease that happens when your immune system, which normally protects you from infection, starts to destroy the cells that make insulin. For type 1 diabetes to develop you need to carry the ‘at risk’ genes as well as a trigger to start the damage to the cells.Treatment for type 1 diabetes is with insulin injections or an insulin pump, plus balancing this with your food and exercise and regularly testing your BGLs.
The Day To Day
What is it & how does it work?
Insulin is a hormone made by the pancreas that helps our body use glucose from the food we eat to give us energy.
When you have type 1 diabetes, the pancreas stops making insulin. When this happens, your body can’t get the glucose it needs. When you have type 1 diabetes you need to replace the insulin that your body's stopped making. The only way to give insulin is by injection, you can’t take insulin as a pill because when it's digested by the body, it becomes inactive and doesn't work.
Getting your insulin script
Insulin is available only on prescription from your Endocrinologist, Diabetes Specialist or GP. If you have a Health Care Card you will get the script at a cheaper rate.
Where to keep your insulin
It’s really important that your insulin is kept somewhere safe that’s not too hot or cold. If you don’t, it can go off and not work properly.
Bottles and penfills of insulin that you are not using should be stored in the fridge until the use by date. They shouldn’t be frozen and if they are, they have to be thrown away.
The insulin bottle or penfill you are using can be kept out of the fridge somewhere safe that’s not too hot or cold. There are special packs you can buy to protect your insulin in hot or cold places. It’s best to take your insulin out of the fridge before you use it because cold insulin can sting when you inject it. You should throw insulin away if it’s been open for more than a month. Remember don’t shake up your insulin too much because this can damage it. Make sure you have spare bottles or penfills in case you break one.
Testing BGLs helps you manage your diabetes. Your doctor and diabetes educator will tell you how often to test and when to test. Most teenagers test before meals, before bed, when they're playing sport or feeling unwell. Not everyone with diabetes does all of these tests, your diabetes team will let you know what tests you should be doing.
Some people think they don't need to test or that they can guess their BGL depending on how they're feeling. We know that this doesn't really work and can put you at risk of problems like hypos or high BGLs and ketoacidosis (DKA) if you get it wrong. It can also make it hard for your doctor to adjust your insulin if they don't have any accurate BGLs.
To test your BGL you need a blood glucose meter. There are lots of different meters for you to choose from. You can download information from some meters on to a computer so you can see what your BGLs are doing from day to day. Talk to your diabetes educator about the different meters available.
It’s important to look after your meter so that it works properly. Try to keep it clean, don't drop it and make sure it doesn’t get too hot or cold. There are special packs you can buy to protect your meter in hot or cold places.
Finger Prickers / Lancets
A finger pricker or lancet is used to get the drop of blood to test your BGL. There are lots of different types and you can change how deep they go into your finger or skin so that it doesn’t hurt too much. When you prick your finger, try to do it on the sides at the top of your finger not on the soft part at the tip or your fingers will get very sore. It’s also important to change where you do your finger prick each time. Don’t forget to change the lancet (sharp bit) of your finger pricker before it gets blunt otherwise it might hurt or not work properly. Always dispose of your used lancets in a recognised sharps container.
Alternate Site Testing
Some meters let you use the blood from different parts of the body to test BGLs. These include the forearm, base of thumb, thigh and calf. You need a special lancet that goes with the meter. You can’t do alternate site testing with a regular meter or lancet. There may be some difference in BGL results if you use alternative sites. This is because the blood flow to your hands is faster than it is to these other sites which means that differences in BGL readings could delay picking up a hypo.
Blood Glucose Test Strips
There are special testing strips that you need to use with your blood glucose meter. Once you've obtained a drop of blood, place it on the testing strip. Some strips need more blood than others, and these days most strips suck up the blood from the point of contact. Every meter has its own testing strips that you use once and then throw away carefully (wrap in test strip cover or within a tissue).
Everyone with diabetes should join the National Diabetes Services Scheme (NDSS) to be able to buy cheaper strips.
Ketone Testing When your BGLs are high (more than 15 mmol/L) or when you're sick it's important to test for ketones. Ketones are a sign that things are out of balance and you may be at risk of diabetic ketoacidosis (DKA). There are two ways you can test for ketones – by testing your blood or by testing your urine
Blood – There are meters you can get to test your blood for ketones. You can use the same drop of blood to test your BGL and test for ketones, so you only need to prick your finger once. There are different strips to test your BGL and for testing ketones.
Urine – If you don’t have a meter that tests for ketones, you need to test your urine (wee) for ketones. There are special strips for this. To do this test, wee on the strip when you go to the toilet. It might sound gross, but it's really important.
Continuous Blood Glucose Monitoring (CGMS)
There are meters that allow for continuous monitoring of BGLs by using a small sensor placed just under the skin. These monitors are not designed to replace your usual meter, but may be used for short periods of time to assess what’s happening with BGLs. There are also CGMS devices that can be used in conjunction with some of the insulin pumps available. Ask your diabetes educator for more info.
HYPOSA hypo or low BGL happens when your level drops below 4mmol/L. When this happens you might feel:
- Like it's hard to concentrate
- Have a headache
- Exercise or sport
- Not eating enough at meals
- Skipping meals
- Too much insulin
- Stress or anxiety
Sometimes you can have a hypo for no reason at all!Common times for hypos are just before recess or lunch and during and after sport, but remember they can happen at any time. When you have a hypo you need to quickly eat or drink something sweet straight away like:
- 125 – 200ml fruit juice (1 small popper) or
- 1/3 – ½ can regular soft drink (not diet) or
- 3 teaspoons honey or sugar or
- 4 large or 7 small jelly beans
- Then eat something else to stop the hypo from coming back, like:
- A piece of fruit or
- A slice of bread or
- Two plain sweet biscuits or
- A glass of milk
If it's just before recess, lunch or a meal, eat or drink something sweet then eat your meal. If you are using an insulin pump you may only need the quick acting treatment to manage a hypo. Talk to your diabetes educator, dietitian or doctor for more info.
Don’t forget to always carry hypo foods with you and always tell someone when you have a hypo. It’s important not to ignore a hypo even if you are worried about drawing attention to yourself or having everyone look at you. No one likes to be embarrassed, but ignoring a hypo can make you feel worse and can be more embarrassing if you don’t treat it.
HYPERS & SICK DAYS
Sometimes your BGLs can go too high. This can be when you:
- Feel sick or unwell
- Are stressed, worried or excited
- Are less active than usual
- Eat more than usual
- Don't have enough insulin in your body (eg. you forgot your insulin injection or didn't give the right dose) Sometimes your BGLs can go high for no reason at all.
If your BGLs above 15mmol/L and you're feeling OK, you can still do most of the things that your friends are doing, but it's not a good idea to play really active sports like football until your BGL comes down. Drink plenty of water and do another test if you are not feeling well.
If your BGLs above 15mmol/L and you're feeling sick, you might have ketones. High BGLs and ketones can make you really unwell and give you stomach pain, make you feel thirsty and want to go to the toilet a lot. This means that things are out of balance in your body.
When you feel like this, you need to let someone know, test your BGL more often, drink plenty of water and take some time out. When your BGLs are high and you have ketones, you need extra insulin – talk to your mum, dad or someone at home about what to do with your insulin dose. Remember you can call your diabetes educator about what to do for sick days.
If your BGL is above 15mmol/L you should test for ketones - whether you are feeling well or not!
High BGLs and ketones can lead to DKA, a very serous condition that occurs when there is not enough insulin and BGLs and ketones in the blood are extremely high. The blood becomes too acid, body fluid and salt levels become unbalanced, leading to dehydration. You can then feel sick, start vomiting, have severe stomach pain and feel very sleepy.
Ketoacidosis occurs when high BGLs, a high level of ketones and a lack of insulin have been present due to illness or missing insulin.
It is very important that you go straight to hospital for urgent treatment.
Dealing with Diabetes
Ever felt like there's too much stuff going on in your head? Or like everyone is carrying on about insulin injections and blood glucose levels, and all you want to do is shout "What about me?"
Feeling sad, angry and completely over diabetes is okay, in fact it’s pretty normal. But getting your head around having diabetes and working out ways to deal with it is important so that you can get on with enjoying your life.
Because diabetes usually comes out of the blue, you're not prepared for it and your whole life's turned upside down, so it’s normal to feel:
- In Denial
Going to School
- Get someone to talk to the teachers at the school about diabetes and what they have to look out for (e.g. hypos, testing, sport). You or your family can do this or ask your diabetes educator to visit the school. Communicating with everyone involved in your diabetes management will makes things easier for you.
- At first you might not want anyone to know that you have diabetes, this is understandable but it's safer if someone knows. Depending on how you feel you might want to explain simply what diabetes is to your friends and classmates - to the people that you trust.
- Make sure that your friends know about hypos and what to do if you have one. This might seem embarrassing, but it could be more embarrassing if your hypo goes untreated.
- Talk to your diabetes team about your usual school timetable and how to fit your diabetes into this without too much hassle.
You can play all sports and do the same activities as those without diabetes, you just have a few extra things to think about. Being active usually lowers BGLs but sometimes BGLs may be higher before and after sport because of being nervous or stressed. Sometimes BGLs can drop low and stay low later in the day or night after sport.
There are some important things you need to think about before, during and after sport, these are:
- Testing - it's important to do extra tests to see what different sports do to your BGLs. It's a good idea to test before, during and after sport.
- Insulin - you might need some changes to your insulin dose when you have sport at school, especially sports carnivals. You usually need to lower your insulin dose for exercise. This depends on things like type of activity, duration and your individual response to the activity. Try not to give your insulin in the area near exercising muscles, as it's absorbed more quickly and may increase the risk of hypos. Your stomach is the best place to give your insulin. It's a good idea to discuss insulin adjustments for physical activity with your diabetes team.
- Carbohydrate Foods - when you play sport, you usually need extra carbohydrate foods to stop your BGL going too low. It's a good idea to have a carbohydrate snack like a piece of fruit, juice or muesli bar before sport and extra carbohydrates to top up during and after sport.
- Hypos - when you do sport your BGLs can sometimes drop too low and you have a hypo. When you have a hypo you need to quickly eat or drink something sweet straight away and then eat something else to stop the hypo from coming back. It's important to have your hypo kit with you at all times. Remember that you can still be hypo a long time after sport, so you may need to eat extra carbohydrates later in the day and before bed.
FOOD AT SCHOOL
Healthy eating is important for all teenagers, whether you have diabetes or not. It's important that you eat the right amounts of healthy carbohydrate foods at recess and lunch to help keep your BGLs mostly within the normal range. Remember not to skip recess or lunch or you might have a hypo.
Excursions are a bit like sports days and can make your BGLs go high or low. You might need to make changes to your insulin dose and don't forget to take your testing kit and insulin, plenty of carbohydrate foods and a full hypo kit..
You don't have to miss out on school camp just because you've got diabetes. It's really important that the teachers and staff who are going to camp know about diabetes and that a management plan is in place. You'll need to be responsible for your diabetes care like finger pricks, injections, ketone testing and treating hypos. Going to a diabetes camp first can help you and your family feel more confident about going to school camp.
School exams can make a difference to your usual timetable at school and sometimes cause BGLs to go high or low because you might be worried or stressed. Make sure that you have your testing kit, extra carbohydrate foods and a full hypo kit with you. It's important the teachers know that you might need to stop and eat or go to the toilet more often during the exam.
There are "special provisions" for year 10 and 12 state exams conducted by each states board of studies.
In most States the school is required to send an "Application for Candidates with Disabilities" form together with a medical certificate, to the "Special Provisions for Students with Disabilities" Program at the Board of Studies. It's a good idea to send these forms in at least six months before the examination.
During exams you're usually allowed to:
- Take bite-sized carbohydrate foods like dried fruit (but no noisy wrappers) to 'top-up' blood glucose levels throughout a lengthy exam.
- Be seated near an exit so others are not disturbed if you have to leave the room.
- Take your blood glucose meter and test strips into the exam room.
- Have a maximum of 5 minutes extra time per half hour of exam time for toilet breaks.
- Have a maximum of 20 minutes extra time per exam to treat any problems (eg. hypos) if required.
- Sit in a separate room with a supervisor.
- Take your insulin pump into the exam room and operate it as your doctor advises.
Special provisions are made on an individual basis with recommendations from your diabetes doctor. If you have a hypo during exams then you should apply to be treated as an "illness or misadventure case". If this happens, you can usually receive a mark based on a school assessment instead of the exam.
Being on detention or being kept in class during breaks will make a difference to your usual timetable at school. If you are on detention, make sure that the teachers knows that you have diabetes and must have your testing kit, extra carbohydrate foods and a full hypo kit with you at all times. Don't skip lunch or recess because of detention - make sure that you and your parents have a discussion with the school.
Sometimes teenagers who don't understand diabetes hassle anyone who's different from them. If this happens, try and ignore them, although it's hard to pretend you don't care what they say - eventually they'll get fed up if you don't react. Your friends can also help out by backing you up and supporting you - they like you for who you are. Remember no one really likes bullies! For more support make sure you reach out - There is nothing wrong in asking for help or advice.
DON"T USE DIABETES AS AN EXCUSE
Sometimes you might have to eat in class, leave class and do things your friends don't have to do. It's important that your teachers and friends understand this, but remember that diabetes isn't an excuse to get out of things you don't want to do. If you use diabetes as an excuse, people might start to think that you can't do all the things that everyone else can do - then you'll be the one that feels different and misses out in the long run!
Forget the fad diets and latest food craze, healthy eating is pretty straight forward. It's as easy as choosing foods from the "eat most" section of the healthy food pyramid everyday, with smaller amounts of "eat moderately" foods each day. The "eat only a little" foods can be enjoyed for treats or on special occasions, like parties.
To be healthy you need to eat a variety of food every day - This food pyramid is a good guide to making good choices
WHAT"S THE STORY WITH FOOD?Healthy eating for teenagers with diabetes is the same as what's recommended for all teenagers. You don't need special foods, so your friends, brothers and sisters should all be eating the same healthy foods as you, everyday! The difference is, when you've got diabetes, there's a few extra things that you need to think about, like.
Carbs, proteins and fats
Food's made up of three main fuels - carbohydrates, proteins and fats. They all do something different in the body, but they're all important.
Everyone needs the right amounts of carbohydrates, proteins and fats each day for good health.
Carbohydrate foods give your body energy. When you eat carbohydrate foods, they break down into sugar or glucose in your body. With the help of insulin, your body uses this glucose for energy.Carbohydrate foods are things like:
- Bread and bread rolls
- Breakfast cereals
- Dairy and soy milk, yoghurt, ice cream and custard
- Fruit and fruit juice
- Starchy vegetables like potato, sweet potato and corn
- Rice, pasta and noodles
- Baked beans and lentils
- Snack foods like biscuits, chips, muesli bars
- Sugars and sugary foods
- Takeaway foods like pizza, fries and burger
Carbohydrates & DiabetesTo look after blood glucose levels (BGLs) it's important to eat carbohydrate foods at each meal and snack and try to balance these from day to day. Carbohydrate exchanges can help - exchanges (or serves) tell you how much carbohydrate is in different foods. Counting carbohydrate exchanges can help you balance the carbohydrate foods that you eat with your activity level and insulin dose.
The type of carbohydrate foods that you eat is also important. The best carbohydrates to choose every day are things like fruit, bread, cereals, milk, yoghurt, starchy vegetables, rice and pasta. Sugars and sugary foods are not the best carbohydrates to choose because they put a lot of glucose in to the blood stream and may cause high BGLs. Some carbohydrate foods give you longer lasting energy.These foods are called low glycemic index foods and include things like grainy breads, raisin bread, fruit, baked beans, pasta, noodles, yoghurt and milk. These carbohydrates are good when you need longer lasting energy, like before sport. They are also a great choice before bed to help stop your BGLs dropping low overnight. Proteins
Protein foods are important for growth and development. Protein foods are things like:
Fats are important for good health, but you only need a small amount everyday. Fats are found in lots of different foods, especially:
THE BIG PICTURE
It's important for everyone to make healthy food choices. When you have diabetes there's some extra stuff you also need to think about to help look after diabetes and keep you healthy. It's important to:
Eat your meals and snacks at the right time
Depending on the insulin you're on, you might need to eat every 3 hours or so. If you forget to eat, skip meals or leave it too long until you eat, you might have a hypo (low BGL).
Eat carbohydrate foods at each meal and snack
You need to make sure that you eat some carbohydrate foods at breakfast, lunch, dinner and snacks like recess, afternoon tea and supper. If you've been told to follow carbohydrate exchanges, try and eat around the same number of exchanges at meals and snacks each day.
Choose foods low in fat
Too much fat can be bad for your health. Try to choose low fat milk, yoghurt and cheese. Watch out for foods that are high in added fats, like snack foods - crisps, biscuits, chocolates, cakes, donuts, as well as takeaways, fatty meats and fried foods.
Watch out for foods that are high in sugar
Foods high in sugar like regular soft drinks, cordials and lollies can cause BGLs to go too high. Make sure that you use diet / low joule soft drinks and cordials and try to keep other high sugar foods for special occasions. Remember that foods high in sugar can be used to treat a hypo.
Always carry hypo foods
Sometimes your BGLs can drop too low and you might have a hypo. To treat a hypo, you need to quickly eat or drink something sweet and then eat something else straight away to stop the hypo from coming back. Make sure that you always have hypo foods like juice or jellybeans with you, plus follow up food like plain biscuits or a muesli bar to stop you from dropping low again.
Depending on the insulin that you're on, you might need snacks like recess, afternoon tea and supper to keep BGLs mostly in the normal range. Try some of these snack ideas
- Piece of fresh fruit eg. apple, pear, banana, orange
- Chopped fruit - rockmelon, pineapple, honeydew
- Fresh fruit salad
- Grapes or cherries
- Canned fruit snack pack eg. two fruits, peaches, pears, fruit salad
- Dried fruit boxes eg. sultanas, fruit salad, sultanas and apricots
- Low fat yoghurt or low fat dairy desserts
- Corn on the cob
- Pikelets or scones/ Crumpets or English muffins
- Fruit loaf, fruit bun or hot cross buns
- Crispbread or rice cakes with low fat toppings e.g. tomato, low fat cheese
- Rice crackers with low fat diet
- Rice crisps
- Low fat fruit bars
FOOD FOR SPORT
When you're active you usually find that you need some extra carbohydrate foods to top up your energy levels and stop you having a hypo.
You might need extra carbohydrate foods before, during and after exercise. One extra carbohydrate exchange for every 30-40 minutes of exercise is a good guide. So don't forget to throw in some extra carbohydrate foods. Hypos can happen for 12-16 hours after you stop exercising, so keep an eye on your BGLs and top up your carbs if you need to. If you find that sport always drops your BGLs, talk to your diabetes team about changes you can make to your insulin dose that might help.
Try these carbohydrates before sport :
- A piece of fruit
- A small flavoured milk
- A muesli bar
- A fruit snack pack
- A crumpet or slice of raisin toast
- A 'fun size' chocolate bar
To top up during sport , try:
- A 100% fruit juice popper
- A cup of sports drink
- A piece of fruit eg. banana, orange
Don't forget to pack a hypo kit with hypo foods for sport.
FOOD ON THE RUN
Lots of takeaway foods can be high in fat and sugar. To be healthy, it's a good idea not to eat takeaways any more than once a week. When you choose takeaways, it's important to try and make the healthiest choices, look for lower fat takeaways like:
- Lean meat or chicken salad roll / wrap
- Doner kebab with lots of salad
- Plain hamburger with lots of salad
- A grilled chicken burger with lots of salad
- Baked potato (skip the butter)
- Toasted sandwich
- Corn cob
- Sushi roll
- Vegie pizza or gourmet pizza
- Toasted sandwich or focaccia
- Small bowl of pasta with tomato based sauce
- Stir fried vegetables with noodles or plain rice
ON AN INSULIN PUMP
Insulin pumps can be a great way to help manage your diabetes. If you decide to start on a pump you might notice that a few things about food are a little bit different.like closer counting of your carbohydrate exchanges / amounts, and more flexible meal times and amounts of food.
Why do you need to count carbohydrates?
We know that carbohydrate foods put glucose (sugar) into your blood stream for energy. The insulin you inject needs to match your carbohydrate foods (and activity) to keep BGLs mostly in the normal range. This is important whether you're on a pump or not.
We know that carbohydrate foods put glucose (sugar) into your blood stream for energy. The insulin you inject needs to match your carbohydrate foods (and activity) to keep BGLs mostly in the normal range. This is important whether you're on a pump or not.
When you're on a pump you can match your food and insulin more closely because every time you eat, you program the pump to give you quick acting insulin (bolus). Your diabetes team will tell you how much insulin you need to give for every carbohydrate exchange you eat. If you're not sure how much carbohydrate you're going to eat you can also give the insulin after you eat. Some pumps even let you program in how many grams of carbohydrate you've eaten and it then works out how much insulin to give.
How do you work out how much carbohydrate is in different foods?
Your dietitian can help you work out how much carbohydrate is in different foods. You might need to weigh or measure out carbohydrate foods to help you count carbohydrates. You also need to be able read food labels to work out how much carbohydrate is in different foods.
Do you need to follow set carbohydrate exchanges?
When you're on an insulin pump you don't need to eat the same number of exchanges at your meals each day. If you're not very hungry you can eat less and if you're really hungry, you can eat more. You can then give your insulin depending on how much carbohydrate you've eaten.
Do you need to eat snacks between meals?
On an insulin pump you don't need to have snacks if you don't want to, but it's important to eat regular meals to be healthy.
Does being on a pump mean you eat anything you want?
When you're on a pump, you still need to make healthy food choices. Lollies, soft drinks, crisps and chocolates are not great choices for anyone. On a pump, you should still use diet or low joule soft drinks and keep snack foods as special occasion treats. What do you do at school when you're on a pump?
At school, you need to remember to give your insulin bolus when you eat. To do this, you need to know how much carbohydrate is in the foods that you have at recess and lunch. Knowing the amount of carbohydrate in different canteen choices is also important. What about food for sport when you're on a pump?
When you're on an insulin pump you can still play sport. You might find that you still need some extra carbohydrate foods for energy. On a pump you can reduce your insulin before and after sport and you might not need to eat as much extra food to prevent hypos. How do you find out more about food and pumping?
When you start on a pump your Dietitian can give you some extra healthy eating info.
When you're on a pump, you still need to make healthy food choices. Lollies, soft drinks, crisps and chocolates are not great choices for anyone. On a pump, you should still use diet or low joule soft drinks and keep snack foods as special occasion treats.
What do you do at school when you're on a pump?
At school, you need to remember to give your insulin bolus when you eat. To do this, you need to know how much carbohydrate is in the foods that you have at recess and lunch. Knowing the amount of carbohydrate in different canteen choices is also important.
What about food for sport when you're on a pump?
When you're on an insulin pump you can still play sport. You might find that you still need some extra carbohydrate foods for energy. On a pump you can reduce your insulin before and after sport and you might not need to eat as much extra food to prevent hypos.
How do you find out more about food and pumping?
When you start on a pump your Dietitian can give you some extra healthy eating info.
WHY BE ACTIVE?
There are heaps of reasons why it's good to be active. Regular exercise can help you to:
- Be a healthy weight
- Be happy, relaxed and sleep better
- Grow and develop well
- Feel good, inside and out
- Be coordinated and flexible
- Make new friends and be a team player
BEING ACTIVE AND DIABETES
Physical activity can help with managing diabetes and keeping blood glucose levels (BGLs) mostly in the normal range. Exercise usually lowers BGLs by making your body more sensitive to insulin. Sometimes BGLs may be higher before and after exercise because of other hormones released during the activity. Rises in BGLs during exercise are usually temporary and may be followed by lower BGLs and the risk of delayed hypos, up to 12-16 hours later.
There are some important things you need to think about before, during and after exercise, like…
Blood Glucose Testing
Testing tells you more about your body and how it responds to exercise. Your BGL test results can help you to work out how to adjust your diabetes plan for different activities. It's important to test before, during and after the exercise.
You will usually need to adjust your insulin dose before and possibly after exercise. This will depend on factors such as type of activity, duration and your individual response to the activity. Discuss insulin adjustments for physical activity with your parents and diabetes team.
It's not a good idea to give insulin into an exercising muscle as it's absorbed more quickly and may increase the risk of hypos. The abdomen (stomach area) is the best place to give your insulin.
You may need extra carbohydrate foods before, during and after physical activity. This depends on things like BGL before exercising, type of activity, duration, your individual response to the activity. A good guide is to have one extra serve or exchange of carbohydrate for every 30-40minutes of exercise. Lower GI foods such as fruit, yoghurt, milk or raisin toast before exercise can help maintain BGLs during physical activity.
Hypos or low BGLs can happen as a result of extra activity. It’s important to make sure that you have a hypo kit handy when you’re exercising. \Your teachers and sports coaches need to be aware of the risks of hypos during and following sport and allow you to treat immediately and re-treat if necessary.
Delayed hypos can occur up to 12-16 hours after exercise. To prevent delayed hypos, it's important to ensure that you eat additional carbohydrate following the activity and that your bedtime BGL is above 7mmol/L. Overnight testing is also a good idea after strenuous physical activity.
Lowering your insulin dose, having extra carbohydrate foods and regular blood glucose testing can reduce the risk of hypos.
Physical Activity & High BGLs
If your BGL is above 15mmol it’s really important to test for ketones – either by urine with a urine test strip or if you have an Optium meter, you can test your blood ketones. If you have ketones or are you are unwell then you shouldn’t play sport or do strenuous exercise. Having ketones means that you need more insulin – discuss this with your diabetes team.
If your BGL is over 15mmol, with no ketones and you’re not unwell, it’s OK to do some low or moderate intensity exercise (eg. walking, tennis) but not strenuous exercise like a game of competitive football or basketball. It’s a good idea to check your BGL again in 1-2 hours to see if it’s come down.
High Risk Activities
There are some activities that need a cautious approach if you're a teenager with type 1 diabetes. These include:
- Sports which are solo in nature
- Activities which take place in a potentially dangerous environment such as mid air or in water
- Those which limit your ability to recognise and self treat hypos
High risk activities include rock climbing, flying, abseiling, car and motorbike racing, skiing, swimming, surfing and snorkelling. Teenagers with type 1 diabetes should be able to participate in these activities with careful planning.
At present, it's recommended that people with type 1 diabetes should not participate in scuba diving, solo hang-gliding or solo flying.
WAYS TO GET MORE ACTIVE
If you're finding it hard to get the motivation to get off the couch, here's some ideas for getting more active…
- Turn off the TV
- Don't spend too much time on the computer or play station
- Walk the dog
- Walk to and from school (if possible)
- Try a new sport like dancing, netball, swimming, athletics, cricket or soccer
- Do active stuff with your friends, like shooting a few baskets
- Try something different like roller blading or beach volleybal
Alcohol, Sex and Drugs
Everyone's heard about the dangers of drinking and we know it's illegal until you're 18, but the more you know now, the better off you'll be. If you've got diabetes and you drink - there's important stuff you need to think about…
Alcohol can affect your brain, liver and general health. If you do choose to drink, the safe limits for adults are:
- Men - no more than 2 standard drinks each day
- Women - no more than 1 standard drink each day
- At least two alcohol free days a week
What's a standard drink?
A standard drink is not what fits in your glass, bottles and cans. All drink come in different sizes!
One standard drink is:
- 285ml regular beer (a middie or pot) or
- 425ml low alcohol beer (a schooner) or
- A nip / shot of spirits or
- A small glass of wine It’s not as much as you think!!
Alcohol can make you do things you normally wouldn't - and when you've got diabetes there are other risks you need to know about!
- Increase the risk of hypos because it stops your liver from releasing glucose. Especially if you’re out late, dancing or drink heaps.
- Make it more difficult for you to recognise the symptoms of a hypo - you may be mistaken for being drunk.
- Cause vomiting and dehydration which may lead to DKA (ketoacidosis) and a possible trip to hospital
- Make it easy for you to forget about looking after your diabetes
Before you go…
- Try and have dinner before you go out or head out for a meal before you start drinking
- Don't skip your insulin - talk to your doctor or diabetes educator about any changes that you might need to make to your dose if you're staying out late or dancing all night
- Test your blood glucose levels (BGLs) – if you’re low have some carbohydrates before you go out
While you're out…
- Have fun, don't get wasted - being out of it can be scary and dangerous if you've got diabetes
- Pace yourself - try not to drink too much too quickly, try to have a non-alcoholic drink in between drinks
- Don't mix drinks
- Steer clear of the alcohol and drug mix
- Make sure that you eat some carbohydrates before you drink and while you're drinking. If you're going to a party take some chips with you, munch out on the crackers and dip or if you’re out, try the late night pizza or kebab. Regular soft drinks or juice as mixers can give you some extra carbohydrate if there's no food available.
- Have something with you to treat a hypo like jelly beans - especially important if there's a long wait at the bar for juice or soft drink. Remember that being drunk can make it hard for you to tell when you're having a hypo!
- Make sure that one of the friends that you are out with (one who isn't drinking) knows about your diabetes and knows what to do if you have a hypo - tell them not to try and make you eat if you're unconscious and that they should call an ambulance.
- Wear some ID so that if anything happens, the ambulance or hospital knows you have diabetes
- Buy your own drinks and watch out for drink spiking - this can be really dangerous
- Don't drink drive, even if you feel OK you might still be over the limit
You might not feel like testing when you're looking good on the dance floor, but a test before bed is really smart. If you're low, treat the hypo and have some extra carbohydrates to keep your BGLs up. Even if you're not low, some extra carbohydrate foods before bed can stop a bad overnight hypo. Plan ahead - ask someone to wake you up or check your BGL for you overnight. Don’t forget to take your long acting insulin before bed - if you’re really late home, you may need to take less. Talk to your diabetes educator or doctor about how to adjust your insulin when you have a big night out.
The next day…
OK, so you might not be feeling great, but it's still important to drag yourself out of bed, take your insulin and have something to eat. You might find that you're more prone to hypos after a big night out - so make sure that you eat enough the next day (even if it's dry toast & vegemite). If you forgot your evening insulin or you’ve been vomiting – remember to check for ketones. If your BGL is high and you have ketones – treat it like you would a sick day. Don’t forget, ask for help if you need it!
Big night out DISASTERS…
Here's some important stuff NOT to do…
- Forget to take your insulin
- Drink too much, too quickly
- Leave your hypo foods at home
- Miss meals or not eat enough carbohydrates
- Forget to wear your ID
- Skip your BGL test and supper
- Ignore a hypo or not treat it properly
- Forget to test for ketones if you're sick or have high BGLs (over 15mmol/L)
- Lie about drinking
- Keep on drinking alcohol the next day
- Keep your diabetes a secret from your friends
- Drink alcohol if you're pregnant
Want more info? Check out these web sites for up to date info on alcohol…
- The National Drug and Alcohol Research Centre www.ndarc.med.unsw.edu.au/ndarc.nsf
- Reachout www.reachout.com.au
- Diabetes Australia Fact Sheet
When things get serious in relationships, and you find yourself thinking about having sex, the most important thing is to make sure it’s the right thing for you - remember it’s your call. You need to think things through and stay safe…
STDs (sexually transmitted diseases)
STDs are one of the biggest risks of unplanned / unprotected sex. The scary thing is that your partner could have an STD without even knowing it! STDs can be dangerous, they can affect fertility and some may even be life threatening (eg. HIV)
It you or your partner want to get pregnant – great! But if it’s unplanned it can stuff up your future plans and affect relationships. Think carefully and play it safe!
Drugs and alcohol can make you do stuff you wouldn’t normally do. You might feel like nothing can go wrong, but it might – unplanned sex (and unplanned pregnancy) are a real possibility. Getting wasted can be ugly and hangovers are not fun – neither is wondering what you did last night?
There’s no going back but…
You can always say “no”, it’s never too late! Make sure it’s right for you and don’t regret it in the morning. Talk to your friends about it, but remember everyone’s different and deals with things in their own way.
Where does diabetes fit in?
When things are “hotting up”, the last thing on your mind is usually diabetes! There’s some other stuff you should think about like -
Telling your partner about diabetes…
You might not want to tell them that you’ve got diabetes - what if they think they can catch it or they won’t like you any more? If they think like that, don’t feel bad – they just don’t understand. You’ll probably find that once you explain it they’ll be fine with it. You may wonder “why should I bother telling them anyway??” It’s about staying safe.
Condoms Condoms are the only way to protect yourself from STDs. No matter how well you know the other person or what other method of contraception you’re using, always use a condom.
The Pill The oral contraceptive pill can be used by most females with type 1 diabetes unless there is a history of high blood pressure or blood clots. Talk to your diabetes doctor or educator about the best choice for you.
Other choicesIntrauterine devices (IUDs) should not be used by females with type 1 diabetes because of the risk of infection.Contraceptive implants may affect insulin sensitivity – talk to your diabetes doctor or educator.
Pregnancy in females with diabetes should be planned. It’s important that blood glucose levels are well managed both before and during pregnancy. The pregnancy should be closely monitored by your diabetes team along with an obstetrician (baby doctor).
Sex is a form of physical activity and when you’ve got diabetes, this means you can be at risk of having a hypo. Have some hypo treatment handy.
Lots of guys worry about not being able to get an erection. This may occur in adults who have had diabetes for a long time but may happen for other reasons, often psychological. Good diabetes management is the way to go to reduce the risk.
Want more info? Check out: FPA Health http://www.fpahealth.org.au/
Drugs can be harmful to the health of everyone and they’re just not cool, especially if you've got diabetes. When you've got diabetes, drugs can also cause problems like:
- Changes in awareness, consciousness and understanding which means that you may not recognise your hypo symptoms and forget to look after your diabetes
- Affect your ability to make good judgements
- Make you forget about routines, injections, meal times and the stuff you need to do to look after your diabetes
- Poor appetite and lack of interest in food, increasing the risk of hypos
- Increased appetite (marijuana) leading to high BGLs
- Nausea and vomiting, which means you might be at risk of high or low BGLs
- Changes to the way you feel, like faster heart beat or sweating that may be mistaken for a hypo
- 'Hangover' effects after the drugs have worn off like depression or sleep problems which can make you lose interest in looking after your diabetes
Many drugs can have long term effects on your health, such as damage to the body's major organs - liver, heart and brain. Combined with diabetes the damage can be even worse. There's also the risk of over dose and bad reactions to drugs that can make you extremely unwell and in some cases cause death. Mixing drugs or combining drugs and alcohol can further increase these risks.
If you think you have a drug problem you need to tell someone and get some help. Contact your local drug and alcohol counselling service for advice on where to get help or you can call one of the following help lines: Lifeline: 131 114 (cost of a local call) Kids Help Line: 1800 55 1800 (free call, for people under 18)
Diabetes Australia Fact Sheet
Family & Friends
FAMILY - Parents
"Have you done your test?", "Have you given your insulin?","Are you low?", Should you be eating that?"
Yep it's the oldies nagging again! The words may be different but nearly every teenager with diabetes deals with questions like these at one time or another.
You might wonder why they keep hassling you and just wish they'd shut up. So why do parents nag??Parents nag because they worry. Maybe they're used to being responsible for your diabetes and now they have to hand some or all of it over to you. They know that diabetes isn't high on your list of priorities but it's way high on theirs. This may be a recipe for family arguments!!
Parents might have other feelings too, like feeling angry or upset about diabetes or even feeling guilty because you've got it. Parents don't want anything to go wrong for you and they worry about your future. This can come over as being over protective, with way too many questions, which can be really annoying!!
So how do you react? You might slam the door and storm off, try and ignore them, scream back at them or deliberately not do what you should just to get back at them. All of which can make the whole situation twice as bad and seem never ending. You'll probably find that none of these things work and they hassle you even more!
So how can you get them off your back a bit - Some useful tips:
- Don't ignore them, answer their question, even if you think it’s annoying.
- Talk to your parents calmly and let them know why their nagging makes you feel so frustrated.
- Show them that you can look after yourself and your diabetes. It shows you're responsible and may even stop the nagging, if they think you're doing OK.
- Include them in your diabetes care. Discuss issues with them and maybe even ask them to help you out with stuff (e.g. an overnight test, adjusting insulin doses, sick days) so that they still feel involved, trust you and understand that you're doing your best.
- Focus on the positives - your parents care about you and want you to be healthy.
- Talk to your parents about picking a “nag time” every other day when it’s OK for them to check in and nag - at least it won’t be all the time!
- If you can't deal with it, sit the oldies down and say something like "When you keep going on about blah, it makes me feel blah".
- But don’t lose your cool!!
When you've got diabetes you might feel that it makes you different from your friends. But really, you're just like them, you've just got extra stuff to do. You have to plan ahead and fit your diabetes in with your life. It can be hard work, but with the help of your friends it might make it easier.
Who to tell?
At first you might not want anyone to know that you have diabetes. This is understandable but it's safer if someone knows. Depending on how you feel you might want to explain simply what diabetes is to a few close friends. Make sure that your friends know about hypos and what to do if you have one. This might seem embarrassing, but it could be more embarrassing if your hypo goes untreated.
Being one of the crowd... Sometimes diabetes can get in the way of the stuff you and your friends are doing and it might seem easier to pretend it's not there or hope it'll go away. Like when you're eating out, at a party or just hanging out all day. It might be tempting to not test, skip your injection, run high so you don't have a hypo or miss meals. This might work in the short term and make you feel like one of the crowd but in the long run, you might get sick and miss hanging out with your friends altogether.
It also might be more embarrassing if you really let things go and you end up in hospital with ketoacidosis - this can be scarier for your friends than seeing you do a test or injection!
Driving and Jobs
As soon as you're old enough, you'll probably be keen to start driving and if you manage your diabetes responsibly there's no reason why diabetes should stop you. As long as you play it safe, research shows that people with diabetes don't have more car accidents than anyone else. Extra things you need to think about are:
Applying for a licence
When you apply for a licence you must tell the traffic authority in your state that you have type 1 diabetes. Each State and Territory has its own regulations regarding the allocation of licences to people with diabetes, but it's likely that you'll need a doctors report stating that your diabetes is well managed. You'll probably need a new letter from your doctor every two years. Your doctor will want to support you to get your licence and renewals, but remember that they are only able to do so, if you are making an effort to care for your diabetes.
Hypos (low BGLs) are the major risk for anyone driving who has diabetes. It's really important that you have a good knowledge about hypos - your symptoms, treatment and prevention. You always need to check your blood glucose level (BGL) before getting in the car and to have hypo treatment at hand. If your BGL is low before you drive, treat the hypo and wait until your BGL has come back up and you're feeling better. If you have a hypo while you're driving, pull over immediately and check your BGL. Don't think "I'll stop later" - it might be too late. Driving while having a hypo can slow your reaction time and put you, your passengers, other drivers and pedestrians in danger.
If you have hypo unawareness (that is, you don't feel your hypos coming on) it's important that you discuss this with your doctor, as driving in this situation is very dangerous.
Alcohol & Drugs
Driving, alcohol and drugs are not a good mix and are illegal. Alcohol and drugs can make you feel overconfident which can make you take risks and be more prone to an accident. Like a hypo, alcohol and drugs can also slow your reaction time while driving.
If you plan on drinking or taking drugs, don't drive - organise a designated driver or another way to get home. Remember, if you've got type 1 diabetes you're also at increased risk of delayed hypos from alcohol. If you've had a big night keep this in mind before you get in the car the next day.
Complications such as those affecting the eyes or feet can impact on your ability to drive safely. If you have any diabetes related complications, discuss this with your doctor before you drive.
For further information on driving and type 1 diabetes visit: www.austroads.com.au
Lots of teenagers work part time while they're still at school and there's no reason why having diabetes should stop you from doing this.
Telling the boss
One of the big questions when applying for a job is "should I tell them I've got diabetes?" It's understandable if you don't want to tell anyone, but if you don't you might run into trouble with testing, hypos, eating regularly and injections - so to avoid any problems it's best to be open and honest. You might be worried that they won't understand, but usually once you've explained about diabetes, people are OK with it. If you show that you're responsible, they realise that diabetes isn't such a big deal. Your employer has a duty of care to provide a safe work environment, but equally, you have a duty of care to be responsible and manage your diabetes.
It's a good idea to discuss with your employer about the need for:
- regular meal breaks
- somewhere private to test and inject
- time out to treat a hypo
- other staff to be aware of hypos, how to treat them and what to do in the case of an emergency
You may need support from your parents, someone at home or your diabetes educator when applying for a job. If you look after your diabetes well, you should be at no greater risk than anyone else of missing work opportunities. If you have any problems or you feel you are being discriminated against, contact your diabetes educator or Diabetes Australia in your state or territory.
When you’re at work
These tips can help you manage your diabetes when you’re at work:
- You may need to adjust your insulin (dose and/or timing) depending on the type of work you do eg. active on your feet type jobs. Discuss this with your doctor or diabetes team.
- Keep a well stocked hypo kit handy at all times
- Don’t skip meal breaks – stop when you need to eat
- Avoid leaving sharps (eg. syringes, pens, finger prickers) lying around
- Don’t ignore a hypo – treat it immediately and re-treat if necessary
- If you do shift work, talk to your diabetes team about changes you might need to make to your diabetes routine eg. injection times, meals etc.
People with type 1 diabetes can usually follow the career path of their choice, with a few exceptions:
- the defence forces e.g. army, navy, air force
- full time or volunteer fire brigade
- the police force
- the aviation industry - commercial and private
- careers that involve high risk activities e.g. at heights, underwater or solo in nature
Should you need further information regarding career options, please call your State or Territory Diabetes association
Changing Health Care Teams
As a teenager, you'll probably find yourself busy juggling things like study, work, relationships, finances and parties. You may be thinking about the future, things like work, uni and moving out of home. Having diabetes on top of all the usual teenage stuff like a busy social life and lots of demands can be tricky to manage.
As you get older you'll also find that you move on from paediatric to adult diabetes care. Depending on where you go, this might happen in your late teenage years or when other things change e.g. you start going to work. It’s important to plan your move from paediatric to adult care so that you can still enjoy yourself without running into too much trouble with your diabetes.
PAEDIATRIC CARE OR ADULT CARE - WHAT IS THE DIFFERENCE?
The paediatric system is a very supportive environment where your parents are mostly responsible for making sure you get to clinic and helping you manage your diabetes. HbA1c screening is performed at clinic and complications screening is done yearly and mostly on the one day. Most paediatric centres have an after hours number that can be called if you need help with your diabetes. If you live in the country or see a doctor privately then this may be managed a little differently.
The adult system is very different and attending clinic for the first time can be a shock.
You might find that waiting rooms are filled with people of all ages with different types of diabetes and waiting times in public hospitals can be long. You’ll see the doctor by yourself in the adult system and you need to know that what is said between you and the doctor and other health professionals is confidential. In other words they won’t be discussing your care with your parents unless it’s with your permission and with you present.
This is a time when you start realising that you’re the one now responsible for your diabetes.
Understanding it all…
Hospital clinics are free under Medicare but you'll need a referral from your GP. A specialist is in charge of the clinic and oversees the work of the trainee doctors. You may or may not see the same doctor each time. At the hospital clinic you'll also have the opportunity to see a diabetes educator and dietitian.
Private Specialist Doctors
A referral is needed from your GP. You’ll be charged a fee and there'll be a gap to pay between the Medicare payment and fee charged. You’ll need to complete a form for Medicare to get your money back. Under special circumstances (financial hardship) the specialist may negotiate the payment of the gap. You’ll see the same doctor every time and they'll keep in touch with your GP. You can also let your specialist know if you want letters sent to any other health professionals. A diabetes educator and dietitian are usually not available at private specialist clinics, so you'll need to arrange this separately.
The Role of the GP
It’s really important that you have a regular GP that you get along with and trust. It’s good to have someone else who can help and who knows what’s happening to you. If you get sick your GP can help and be in contact with your specialist. Medicare may cover visits to the GP if they bulk bill. Your GP can help with emergency insulin scripts, general illness and referrals to other health professionals, however, it’s still important that you see a diabetes specialist.
Private Health Funds
Private health funds cover many areas, there are different levels and the costs vary. Private health insurance can help with the cost of private hospital admissions, the cost of seeing other health care professionals in private practice (eg. psychologists, dietitians, and physiotherapists) – each fund deals with this differently. Private health Funds do not cover costs of seeing your diabetes specialist (except for hospital). You don’t have to be in a private health fund to see a specialist privately.
Other stuff to think about…
Getting yourself to appointments can be a challenge as your situation changes. There may not be anyone to take you to appointments and you may have to rely on public transport. There may not be enough time to get there between lectures or after work. The hours for most appointments are between 9 and 5pm. You need to think about all of this and plan ahead.
Not many centres run an after-hours or weekend clinic that you can attend. Some private specialists do a late clinic so this may make it easier to find a suitable time that fits in with you.
It’s important that you get an update about diabetes management, especially if your parents were the ones who were initially educated when you were diagnosed. There are many other things you need to think about like alcohol, driving, contraception, pregnancy and parties. You need to understand how to manage when you’re sick, how to adjust your insulin and manage from day to day.
DIABETES HEALTH CHECKS
To reduce your risk of long term complications, regular diabetes health checks are the go.
What & when.…?
- Blood glucose levels (BGLs) – frequent testing every day as advised by your diabetes team
- HbA1c – every 3 months either at your clinic visit or at a pathology lab
- Weight / height – every 3 months at your clinic visit
- Blood pressure – at least once a year, more often if needed
- Cholesterol – every 1-2 years
- Eyes – 2 years after diagnosis in teenagers, then every 2 years
- Kidneys - 2 years after diagnosis in teenagers, then every 2 years
- Feet – 2 years after diagnosis in teenagers, then every 2 years
Your diabetes doctor or educator can arrange these tests for you.
Even small improvements in diabetes control can make a difference to the risk of long-term complications – get checked!
Insulin Pump Information
The insulin pump is a small programmable device (about the size of a pager) that holds a reservoir of insulin. The pump is programmed to deliver insulin into the body through thin plastic tubing known as the infusion set or giving set. The pump is worn outside the body, in a pouch or on your belt.
The infusion set has a fine needle or flexible cannula that is inserted just below the skin (usually on the abdomen) where it stays in place for two to three days.
Only rapid acting insulins are used in the pump. Whenever food is eaten the pump is programmed to deliver a surge of insulin into the body similar to the way the pancreas does in people without diabetes. Between meals a small and steady rate of insulin is delivered.
The insulin pump is not suitable for everyone. So, if you’re considering using one, you must discuss it first with your diabetes health care team.
Insulin Pumps Available in AustraliaAustralian Government Insulin Pump Programme.
For all those things that can be easily forgotten, D-Life provides reminders on managing your diabetes, from blood glucose level (BGL) checks to three-monthly hBA1c tests, which provide an average BGL reading for the previous 10-12 weeks.
It also has advice on a range of topics, such as diabetes and sex, alcohol, drugs, and big nights out.
Moving On Up
‘Moving on up’ is a 32-page booklet which focuses on the challenges and opportunities that young people face as they become young adults; how they can live well with their diabetes through this time of transition from paediatric to adult healthcare services and, importantly, the responsibilities they have for their own diabetes care and the support they can expect to receive.
This resource has been developed for young adults living with diabetes (aged 16 – 24 years) and their parents
The resource includes six sections focused on moving on:
a) to an adult diabetes service
b) to work, university or TAFE
c) to four wheels (driving)
d) out of home
e) with life
f) with a new diabetes care team.
You can find the online e:book and pdf at www.ndss.com.au/young-people