A SMART Guide for Families: Diabetes Care for Youth with ...€¦ · Much of the food you eat becomes a type of sugar called glucose. w Pancreas cannot make insulin so the glucose

SMART Guide

!

A

for Families:

Diabetes Care for Youth with Type 2 Diabetes

© 2015 BC Children’s Hospital

http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf

Endocrinology & Diabetes UnitBC Children’s Hospital4480 Oak Street, Room K4-213 (mail), K4-125 (clinic)Vancouver, BC V6H 3V4 CanadaPhone: 604-875-2868Toll-free: 1-888-300-3088, x286824-hour Emergency: 604-875-2161Fax: 604-875-3231E-mail: [email protected]: http://endodiab.bcchildrens.ca

SMART Guide

A

for Families:

Diabetes Care for Youth with Type 2 Diabetes

Table of Contents

September 2015 http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf

1. What is Diabetes

}Pre-diabetes and Type 2 diabetes} How the Body Uses Sugar for Energy } Blood Sugar Levels } What is Type 2 Diabetes? } What is Type 1 Diabetes?

2. Check Your Blood Sugar

}Check Your Blood Sugar

3. Steps to Healthy Eating

} Food and Type 2 Diabetes} Eating Smart: Easy as 1, 2, 3!} What to Look for on a Food Label} Let’s Make Meals Together} Incredible Fibre} Sources of Fibre

4. Physical Activity and Type 2 Diabetes

} Be Smart! Be Active! Have Fun!} Ready, Set, Go!} Be Active Every Day: What Are You Doing Now? } Ideas to Be Active Every Day

5. Pills and Insulin for Type 2 Diabetes

} Pills and Insulin} Metformin} Glyburide} Insulin Action Times } How to Give Insulin } Where to Give Insulin} Taking Care with Insulin and Sharps

6. Low Blood Sugar

} Low Blood Sugar and Type 2 Diabetes

} Physical Activity and Low Blood Sugar

} Glucagon for Severe Low Blood Sugar

7. High Blood Sugar

8. Type 2 Diabetes and Sick Days

9. Type 2 Diabetes and Alcohol

10. SMART Goals

} Setting SMART Goals.

11. Tips for Family and Friends

} Type 2 Diabetes: 10 Tips for Being Supportive

September 2015 http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf

Pre-Diabetes and Type 2 Diabetes

What are they and why do they matter? � Both are conditions where the blood sugar is too high.

• People with pre-diabetes have high blood sugar, but it is not high enough to diagnose type 2 diabetes. Other terms for pre-diabetes are “impaired fasting glucose” (IFG) and “impaired glucose tolerance” (IGT).

� Blood pressure and blood fats (lipids) may also be too high.

� Treating pre-diabetes can help lower the chance of getting type 2 diabetes

� Treating pre-diabetes and type 2 diabetes lowers the risk of other health problems such as heart or kidney disease.

� You will have more energy and feel better if your blood sugar is not high.

See the pictures on the next few pages to learn more about:• how the body uses sugar for energy• why blood sugar gets too high in people with diabetes or pre-diabetes

What can I do about pre-diabetes or type 2 diabetes?

There are many things you can do to lower your blood sugar and risk of health problems linked to diabetes:

� Be active every day. Walk, bike, play sports, dance or do other things you enjoy. For more ideas about getting active, read: Ideas to be Active Every Day.

September 2015 http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf Page 1 of 2

� Spend less time watching TV and sitting at your computer or phone.

� Eat a balanced diet. Choose foods from all food groups.

� Start your day with breakfast. Then space your meals and snacks about 4–6 hours apart so you’re not too hungry and not too full.

� Cut down on liquid sugars like pop and juice.

� Take your prescribed diabetes pills or insulin, if needed.

� Learn to check your blood sugar. Use this information to make wise choices.

� Talk to your doctor, a dietitian or a nurse to learn more. Ask what else you can do if you have pre-diabetes or type 2 diabetes.

“And, carry on with being you!” Diabetes and pre-diabetes are only one part of you. True, you have a few more things to do each day if you have pre-diabetes or diabetes. It’s also true that you can still do the things in life that you want to do.


Pre-Diabetes and Type 2 Diabetes

Your body needs sugar (glucose) for energy

w Much of the food you eat

becomes a type of sugar

called glucose.

w The blood takes the glucose to all parts of your body.

w The pancreas makes a

hormone called insulin.

w Insulin carries the glucose from

your blood to the rest of your body.

w Your body uses glucose for energy.

316506 Patient E

ducation Resource K

it (PER

K)

Notes

i = insulins = sugar

“Feeling good”

Blood sugar before eating 4

–7 mm

ol/L

Blood sugar 2 hours after eating

5–10 m

mol/L

Your blood sugar level changes when you eat

Food and activity affect your blood sugars.

Lowm

mol/L

High

Food Sugar Sugar used by body

Insulin

Your blood sugar levels

Notes

diabetes.ca | 1-800-BAN

TING

(226-8464)

Across the country, the Canadian Diabetes Association is leading the fight against diabetes by helping people w

ith diabetes live healthy lives while w

e work to find a cure. W

e are supported in our efforts by a com

munity-based netw

ork of volunteers, employees, healthcare professionals, researchers and partners. By providing education and services, advocating on behalf of people

with diabetes, supporting research and translating research into practical applications – w

e are delivering on our mission.

w Much of the food you eat

becomes a type of sugar

called glucose.

w Pancreas makes som

e insulin.

w Insulin works poorly.

w Much of the glucose stays

in the blood.

w Your body cannot use all of the glucose for energy.

w Your body tries to get rid of the extra glucose through the urine.

Notes

diabetes.ca | 1-800-BAN

TING

(226-8464)

Across the country, the Canadian Diabetes Association is leading the fight against diabetes by helping people w

ith diabetes live healthy lives while w

e work to find a cure. W

e are supported in our efforts by a com

munity-based netw

ork of volunteers, employees, healthcare professionals, researchers and partners. By providing education and services, advocating on behalf of

people with diabetes, supporting research and translating research into practical applications – w

e are delivering on our mission.

What is type 2 diabetes?

Kidney


What is type 1 diabetes?

w Much of the food you

eat becomes a type of

sugar called glucose.

w Pancreas cannot make

insulin so the glucose stays in the blood.

w Your body requires insulin by injection.

w Without insulin your body

cannot use the glucose for energy.

w Your body tries to get rid of the extra glucose through the urine.

316507 Patient E

ducation Resource K

it (PER

K)

Notes

Kidney


Type 2 Diabetes

Check Your Blood Sugar


Blood Sugar = Blood Glucose

When?} Before meals and 2 hours after

eating are good times to check. Some people with type 2 diabetes need to check a few times each day. Others only need to check a few times a week.

}Your health care team can help you decide when and how often to check.

Goals:Keeping most blood sugars between 4 and 7 mmol/L before meals and less than 10 mmol/L after meals will help you:} feel well}avoid health problems caused by

high blood sugar.

How often should I check? r Each dayr 2 days each weekr 3 days each weekr Other: __________________

When should I check? r before each meal & before

your bedtime snackr before breakfastr before dinnerr 2 hours after breakfast OR

dinnerr other: __________________

My blood sugar goals are:

} Before meals: ____________

} After meals: ____________

}Check more often if you are sick.

}Check if you think your sugar is too low.

Record your blood sugars and review often to see if:

Date: ____________________

Name: ___________________

}Check before driving. If you take insulin or diabetes pills, don’t drive if your blood sugar is under 5!

}your food, activity and medicine are in balance

} any parts of your treatment need to be changed.

Notes:

Type 2 Diabetes

Food and Type 2 Diabetes


Food provides us with energy or calories to grow. The three major food groups are carbohydrates, fats and proteins. Carbohydrate is the preferred fuel for the body. It can also increase blood sugars.

What is carbohydrate?

Carbohydrate is found in many types of foods and drinks. Here are some examples:

} Grains } Milk, soy/rice beverages and yogurt

} Fruits } Starchy vegetables

} Sugar and sweets } Juices and sugar-sweetened drinks

Carbohydrates in these foods are broken down into small units of sugar called glucose. Our body uses glucose for fuel.

• Carbohydrate, raises blood sugar.

• Physical activity and diabetes medicine help lower blood sugar.

Can I Eat Sweet Foods, Sweet Drinks, Sugars and Desserts?

Sugars, sweets and desserts contain carbohydrate. It is best to plan when you are going to eat these foods and how much. They can still be enjoyed in small amounts. Smart planning will prevent you from eating too much at one time.

Juices and sugar-sweetened drinks (like regular soft drinks) raise blood sugars very fast. They also add extra calories which the body may not need. Try to limit the total amount in a day to 120ml (1/2 cup or 4 oz.).


Guess how sugary these foods can be! They can raise your blood sugar a lot!

1 teaspoon of sugar = about 5 grams of carbohydrate

1Soda

icedcafe

mocha

250 ml Juice (1 cup or 8 oz.) – 5 teaspoons of sugar

355 ml (1 can) Coke™ – 10 teaspoons of sugar

500 ml (2 cups or 16 oz). Cold specialty coffee/flavoured milk drink - 12 teaspoons of sugar

Slushie

Big Gulp™ Slurpee – 13 teaspoons of sugar

Bubble Tea. 350 ml (12oz. milk tea with tapioca pearls) – 14 teaspoons of sugar

Medium Cookies n’crème soft service ice cream treat – 20 teaspoons of sugar

Type 2 Diabetes: Food and Diabetes

List the sweet foods, sugars, desserts or sugar-sweetened drinks you eat or drink now:

Can you think of smarter choices?

1Soda


What about Fast Foods?

Most fast foods are high in carbohydrate and dietary fats. These foods often provide more energy than your body needs. This extra energy is stored by the body and can lead to weight gain.

Did you know?... It takes a lot of work to use up food energy!

See how much activity is needed to use up the calories provided by these foods and drinks!

2 minutes of taking the stairs (about 2-3 flights of stairs)

= 2 packages of ketchup

10 minutes of swiffering the floor = 10 Jelly beans

20 minutes of leisure biking = 1/2 cup of fruit juice

30 minutes of Wii Sport = 7 chips

30 minutes of walking, slow pace = ½ can of pop

30 minutes on an elliptical trainer = 5 oreo cookies or 1 peanut butter sandwich

30 minutes of continuous swimming = 1 Chocolate Bar

30 minutes shooting basketball hoops continuously

= ½ Cheeseburger

35 minutes of jogging = 1 slice of cake or 4 medium apples

60 minutes of ice hockey = 1 medium fries

Type 2 Diabetes: Food and Diabetes

Notes:


Type 2 Diabetes

Eating Smart: Easy as 1, 2, 3!

1. Space your meals and snacks

It is easier for your body to use food in small amounts spaced throughout the day. It is hard for the body to manage a lot of food at one time. Eat meals 4 to 6 hours apart and have small snacks in between.

I eat at these times:

2. Balance your plate

Sample Eating Times for School Days:Breakfast 7:30 amSnack at break 10:15 amLunch 12:00 pmAfter school snack 3:30 pmSupper 5:30 pmBedtime snack 8:00 pm

Milk or alternatives(yogurt, kefir, cheese, unsweetened and calcium-fortified soy milk, rice and almond milk)

+Vegetables

Meat, eggs, fish, seafood, beans & legumes (tofu, chickpeas, kidney beans, pinto beans, black beans, lentils and other dried beans)

Starchy Foods - bread, rice, pasta, potatoes, roti, chapati, flatbread, naan, tortilla


} Take a standard sized plate (around a 9-inch plate) and divide it into 3 sections. Fill 1 section of your plate with non-starchy vegetables such as:• Spinach• Lettuce• Peppers• Cucumbers• Broccoli• Cauliflower• Cabbage• Carrots• Onions• Tomatoes

Make this section on your plate as colourful as possible. You can combine vegetables to make a salad or just eat any one by itself. Make at least 1 fist-size or one cup of vegetables at most meals.

Pick fruits for snacks! Apples, oranges, berries, pears, peaches, melon, bananas, kiwi and many other colour fruits contain vitamins that strengthen your body.

Type 2 Diabetes: Eating smart as easy as 1, 2, 3

} Fill another section of your plate with a high fibre starchy food such as:• Brown rice, red rice• Pasta, Smart pasta, whole wheat pasta• Bread, whole grain bread, stone-ground wheat bread• Corn• Potatoes• Tortilla• Roti• Cereal• Oatmeal• Quinoa• Buckwheat

Make the starchy food portion equal to the size of 1 or 1 ½ fist-size!


} Fill the last section of your plate with a lean protein-rich food such as:• Skinless chicken or turkey• Fish• Lean beef or pork • Seafood• Tofu or veggie meat• Legumes: lentils, chick peas, hummus, dried beans• Make the protein portion about the size of your palm (3 ounces).

*Legumes such as lentils, chick peas and dried beans have both protein and carbohydrate.

3. Enjoy your meal with a glass of milk, unsweetened soy/almond milk or yogurt.

(250 ml) (175 ml)

OR

Choose high fibre foods

Why should I eat more fibre?Eating whole grains, vegetables and fruits provide us with the right amount of fibre for good health. Fibre is good for you in many ways.

See “Incredible Fibre” for more information.

Type 2 Diabetes: Eating smart as easy as 1, 2, 3

Notes:


Type 2 Diabetes

What to Look For on a Food Label?

Nutrition information on food labels can help you:} Compare products} Find out the nutritional value of foods} Make smart food choices

Some facts about the food label:

Information on the food label is based on a specific amount of food. Compare this to the amount you eat.

Use the %Daily Value (DV) to see if a food has a little or a lot of a nutrient.

The DV can help you compare the nutrient content of different food products. 5% or less is a little. 15% or more is a lot! Try to choose products with lower fat, sodium and carbohydrates.

Choose products with more fibre. A food with good source of fibre will contain about 3-5 g of fibre per serving. When the label says high or very high source of fibre, the food will have at least 4-6 g of fibre per serving.

Net carbohydrate is the amount of carbohydrate the body uses. A food with lower net carbohydrate generally raises blood sugar less.

You can calculate net carbohydrate by subtracting grams of fibre from grams of carbohydrate.

In this example, the net carbohydrate is 12 grams:

15g carbohydrate – 3g fibre = 12 g net carbohydrate

The ingredient listThe main ingredients are listed first on the label.

INGREDIENTS: Whole wheat, wheat bran, salt, corn flour, malted barley, margarine, baking soda, vitamins (thiamine hydrochloride, pyridoxine hydrochloride, folic acid, d-calcium pantothenate), minerals (iron, zinc oxide).

Look for whole wheat or whole grains to be listed at the beginning.

Choose products with no sugar added or those that list sugar near the end of the list.

Let’s Practice Reading the Nutrition Label of a Granola Bar

Can you find whole grains in the ingredient list?

How many grams of carbohydrate are in 1 granola bar? How about in 2 granola bars?

How many grams of net carbohydrate is there in 1 granola bar?

Is this granola bar a smart choice? Why or why not?


Type 2 Diabetes: What to look for on a food label

Choose foods with lower carbohydrate and high fibre


Type 2 Diabetes

Incredible Fibre

What is Dietary Fibre?Fibre plays an important role in good health. Fibre can:} Make you feel full longer} Help control blood sugar levels} Lower blood cholesterol} Help your bowel stay healthy and prevent colon cancer

There are two types of fibre: soluble and insoluble. You can think of soluble fibre as able to melt in water and form a gel. Insoluble fibre is tough and does not dissolve in water. Think of insoluble fibre as the skin on fruits or the hard parts of a vegetable.

Where is Fibre Found?Fibre is found in foods of plant origin and is part of the plant we cannot digest.

Soluble fibre: mostly found in dried peas, dried beans, lentils, barley, oat bran, flax meal, some fruits and vegetables.

Insoluble fibre: mostly found in wheat bran, wheat bran cereals, whole grain products, nuts and seeds, some vegetables (for example carrots, broccoli, peas), and the skins of fruits.

How much fibre do I need?On average, you can aim for the following amount of fibre each day:

Age (years) Fibre (g) for Males Fibre (g) for Females4 to 8 25 25

9 to 14 31 2614 to 18 38 2619 to 50 38 25

51 to 70+ 30 21

*Compare your fibre needs with that of your parents’, sister’s/brother’s or grandparents’. Are their fibre needs different than yours?

Read Labels for Fibre} Look for labels that say high or very high source of fibre. This means the food

has at least 4 to 6 grams of fibre per serving.

} Check the Nutrition Facts table on packages for the amount or grams of fibre in a serving

} Check the ingredient list and look for:

• Bran, whole grain, wheat, oatmeal, rye flour

• Enriched wheat flour and unbleached flour are both refined white flour. These are not the best sources of fibre.

• Multigrain may mean that only a small amount of whole grain has been added to enriched flour. This product may not be a good source of fibre.


Ways to Increase Fibre} Start your day with a cereal that has high or very high source

of fibre

} A serving of 125ml or ½ cup of fresh, frozen or canned vegetables or fruit has higher fibre than juice. Fit in 5-6 servings of vegetables and fruit each day.

} Eat 100% whole grain breads, brown rice and whole wheat pasta

} Add legumes such as dried beans and lentils to soups and casseroles

} Add ancient grains such as quinoa, buckwheat, amaranth, barley to soups and salads.

} Add nuts, seeds to oatmeal, breakfast cereal, yogurt, muffins or salads

} Add fibre gradually to avoid stomach discomfort.} Be sure to drink more water when you start adding more

fibre.

Type 2 Diabetes: Incredible Fibre


Sources of FibreWhole grains, whole fruit (with skin) and many types of vegetables contain good amounts of both soluble and insoluble fibre. To get the benefits of both types of fibre, eat a variety of high fibre foods each day.

Fibre Content in Foods: Examples

Grains, Pasta and Rice Serving Size Total Fibre (g)White rice, cooked ½ cup 0.8Spaghetti, white, cooked ½ cup 0.9Amaranth flakes, dry ½ cup 1.5Brown rice, long grain, cooked ½ cup 1.8Quinoa, cooked ½ cup 2.6Spaghetti, whole wheat, cooked ½ cup 2.7Pearled barley, cooked ½ cup 3.0Wheat germ 3 Tbsp. 3.9Wheat bran 3 Tbsp. 4.7

Breads & CrackersSaltine Crackers 5 crackers 0Graham crackers 1 sheet (4 crackers) 0.2White bread 1 slice 0Pumpernickel bread 1 slice 1.7Rye bread 1 slice 1.9100% whole wheat bread 1 sice 2Multigrain bread 1 slice 2 to 4

CerealsRice Krispies, Special K 1 cup 0Cream of wheat, cooked with water 1 cup 0Cornflakes 1 cup 1Cheerios, original 1 cup 3Old fashioned oatmeal, cooked with water

1 cup 4

Shredded wheat 1 cup 6 All bran 1 cup 20Fibre One 1 cup 28

Type 2 Diabetes


Legumes Serving Size Total Fibre (g)Hummus 3 Tbsp. 1.5 to 2.5Soy nuts, unsalted, roasted ¼ cup 5Black-eyed peas, boiled ½ cup 5Chick peas, canned ½ cup 5.3Kidney beans, canned ½ cup 5.5Tofu, firm, cooked 1x11.4 oz. block

(about 1 cup)5.8

Lima beans, boiled ½ cup 6.6Pinto beans, boiled ½ cup 7.7Lentils, boiled ½ cup 7.8

Nuts and SeedsCashews, unsalted 1 oz. (about 18 kernels) 0.9Peanut butter, natural, smooth 1 Tbsp 1Sesame seeds, toasted 1 Tbsp 1.3Peanuts, roasted, unsalted 20 peanuts 1.6Sunflower seeds 2 Tbsp 1.8Walnuts 14 halves 1.9Flaxseeds, ground 1 Tbsp 2Chia seeds 1 Tbsp 4Almonds 1 oz. (about 23 almonds) 5.4

VegetablesCucumbers, raw 1 cup sliced 0.7Spinach, raw 1 cup 0.7Romaine lettuce, raw 1 cup shredded 1Asparagus, cooked 5 spears 1.5Red cabbage, raw 1 cup shredded 1.5Tomato, raw 1 medium 1.5Onions, raw 1 cup sliced 1.6Green peppers, raw 1 cup sliced 1.6Baby carrots, raw 10 medium 1.8White mushrooms, cooked 1 cup sliced 1.9Cherry tomatoes, raw 10 2.0Zucchini, cooked 1 cup sliced 2.5Kale, cooked 1 cup chopped 2.6Green cabbage, cooked 1 cup shredded 2.6Cauliflower, cooked or raw 1 cup in 1” pieces 3.3Green beans, cooked 1 cup 4Broccoli, cooked or raw 1 cup chopped 5.1 cooked

2.4 raw

Type 2 Diabetes: Sources of Fibre


Fruits Serving Size Total Fibre (g)Watermelon 1 cup, cut 0.6Grapes, fresh with skin 15 0.7Applesauce, canned ½ cup 1.0Grapes, fresh with skin 17 0.7Strawberries, fresh 6 medium 1.4Canteloupe, fresh 1 cup, cubed 1.4Plums, red, fresh 2 1.8Kiwi 1 2.1Figs dried 3 2.5Peach, fresh 1 medium 2.2Cherries 15 2.6Banana 1 medium 3.1Orange 1 medium 3.1Mango, flesh only 1 medium 3.5Apple, with skin 1 small 3.7Raspberries, fresh ½ cup 4Blueberries, fresh ½ cup 1.8

Note: Fibre content may vary depending on referenced source.

References: www.calorieking.com; HealthLink BC Nutrition Series no. 68, Jan 2011: Fibre and Your Health Tips for Reading Food Labels (also refer to “What to Look for on a Food Label”)

Canadian Nutrient File: http://webprod3.hc-sc.gc.ca/cnf-fce/index-eng.jsp

USDA National Nutrient Database for Standard Reference: http://ndb.nal.usda.gov/

Are there any foods you eat that are high in fibre?

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

How can you add more fibre every day?

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

Type 2 Diabetes: Sources of Fibre

Notes:


Type 2 Diabetes

Let’s Make Meals TogetherMake a smart breakfast: (choose 3-4 groups) High Fibre Grain/Starchy food: Whole grain toast _________________

Protein: Peanut butter _____________________

Milk and Alternatives: milk ____________________________

Fruit: kiwi ____________________________

Make a smart lunch:(choose 3-4 groups)Vegetables: _______________________________

High Fibre Grain/Starchy food: _______________________________

Protein: _______________________________

Milk and Alternatives: _______________________________

Fruit: _______________________________

Make a smart afternoon snack: (choose 1-2 groups)Vegetables: _______________________________


Protein: _______________________________


Fruit: _______________________________

Make a smart supper:(choose 3-4 groups)Vegetables: _______________________________


Protein: _______________________________


Make a smart night snack:(choose 1-2 groups)Vegetables: _______________________________


Protein: _______________________________


Fruit: _______________________________

Notes:


Type 2 Diabetes

Physical Activity

Be Smart! Be Active! Have Fun!

Be SMART!

Being active is smart in type 2 diabetes.It helps your body, your mood and your mind!

What interests you?q feeling happier

q feeling more alert and doing better at school

q stronger muscles

q stronger bones

q lower blood sugar

q insulin working better

q a weight that is right for me

q healthier heart and lower blood pressure

q sleeping better

q feeling less stressed

q feeling more confident

Regular physical activity helps with all of these things! Work toward the goals that are important to you.

Be ACTIVE!

How often should I be active?} Every day.} For best results work up to 60

minutes a day.} For ideas on how to be active

every day see: Ideas to Be Active Every Day.

Keep track of your activity and see your progress.

See: Be Active Every Day: What are you doing now?


What Types of Activity Help?

3 types of activity are important.

1. Stretch – also called flexibility. Examples: yoga, stretching

2. Strength – also called resistance. Examples: elastic exercise bands, weights, tai chi

3. Cardio – also called aerobic or endurance. Examples: fast walk, dance, bike, climb stairs, swim

Can physical activity cause my blood sugar to get too low?

It depends…q Yes,if you take insulin or some types of diabetes pills. Your blood sugar could get

too low if you are more active than usual. This problem can be prevented. Read Physical Activity and Low Blood Sugar.

q You are not at risk for low blood sugar if you do not take insulin or pills for your diabetes.

Type 2 Diabetes and Physical Activity

Have FUN!q Be active with friends and family. This can be fun and

motivating!q Do something you enjoy every day and try new

activities too.q Be real. If you don’t do much activity now, start small.

Work up to longer stretches of active time.q Cut down on your screen time. Be active instead. Aim

for less than 2 hours of screen time each day. This will give you more time to be active.

q Check your blood sugar before and after activity to see how it changes.

q Ask your diabetes team if your diabetes medication needs to be reduced for activity.

«September 2015 http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf Page 1 of 1

Type 2 Diabetes

Physical Activity: Ready, Set, Go!

True or False?: Less “Screen time” can help you be more active.

Answer: True!

} Spend less time watching TV, texting, using the computer, and playing video games. This will give you more time to be active and get fit!

} Health experts say it is best to limit screen time to less than 2 hours a day.

Be Smart. Just Start.} Set your own goals for physical activity and less screen time.} Start with small goals that you will feel good about.

Are you ready to start?Fill in the blanks and write down your goals:

Date: _____________________________________________

Activity:q My goal is to be active ___ days this week.q The activity I will do this week is ___________ and / or _____________.q My goal is to be active for a total of ____ minutes for each activity.

Screen Time:

q This week I will decrease my screen time by ___ minutes or ___ hours

on these days:________________________________________.

q I will do this by: ________________________________________.

Example: This week I will play baseball for 30 minutes after school on Monday and Thursday instead of watching TV.

Ready? Set? Go!« ««

BONUS QUESTION:

Notes:

Be Smart! Be Active!

Have Fun!

What are you doing now?� Keep track of your ACTIVE time and SCREEN time for 1 week. � Keep track of time you spend SITTING in a car or bus too.

Screen time is time spent watching TV, videos, surfing the internet, playing passive video games, texting, using the computer, tablet or smartphone

Type of Activity How Long? Type of Screen Time or Sitting

How Long?

Sample Walking 45 minutes after school

TV 1 hour after dinner

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Choose some days to cut down on your screen time. � Less screen time means more time to be active. Swap screen time for active time. � Limit screen time to less than 2 hours.

Add activity to every day. Every little bit adds up!� Make your activities add up to 10 minute blocks. � Keep adding until you are up to 30 minutes of activity every day. � Space your 10 minute blocks throughout the day or do them all at once. � If you are already at 30 minutes, aim for 60 minutes a day.


Type 2 Diabetes

Be Active Every Day!

Cals

km

Steps

~STEP UPPedometer

Notes:


Stand up for your health!� Studies show that people who stand up more are healthier!� Stand up instead of sitting down whenever you can.� Walk more.

r Try activities that are easy and fun to do. Find some challenges too.r Choose activities that you enjoy and can fit into daily life.r Walk every day.

Make a list of places you can walk:m ____________________________________

m ____________________________________

m ____________________________________

m ____________________________________

m ____________________________________

m If you walk at the mall, walk fast.

r Use active transportation whenever you can:m Walk or bike to where you need to gom Walk part way to or from your transit stationm If you get a ride, get out as far away from the entrance as possible and

walk.

r Use a pedometer to see how many steps you take each day. You may be surprised!

r Walk a dog. If you don’t have a dog, can you walk a dog for a friend or community organization like the SPCA?

r Get up often to get a glass of water to drinkr Take the stairs instead of the elevatorr Find some stairs that you can climb every dayr Skip

Type 2 Diabetes

Ideas to Be Active Every Day!


r Jump r Swimr Juggle r Use a hula hoop

r ___________________________ r ___________________________r Try some activities at your community centre

m Register for a free gym orientationm Register for a fitness class or aqua-fitm Drop-in for a basketball, hockey or badminton gamem _________________________________________

r Dancem Listen to a new song and dance to itm Pick a style you want to learn and practicem Move to the beat any way you want

r Help with active chores:m Vacuum m Carry the groceriesm Rake leaves m Shovel snowm Wash a car m ______________m Mow the lawn m ______________

r Think of activities you can do on:m Rainy days: ________________________________________________

m Sunny days: _______________________________________________

m Warm days: _________________________________________________

m Cold days: __________________________________________________

m Snow days: _________________________________________________

r Trade screen time for active time:

Instead of: I will:Surfing the net for 1 hour after dinner. Use our exercise bike for 30 minutes and

then surf the net for 30 minutes.Texting my friends during my free time. Meet a friend and go for a walk.

Add your ideas here: Add your ideas here:1.

2.

3.

Type 2 Diabetes: Ideas to be active every day!


r Do 3 types of activity for the best results:

m Stretching (Flexibility) activities like bending, stretching, reaching and yoga.

m Strength activities like weight lifting, shoveling snow, carrying the groceries. These build your muscles and bones.

m Cardio (Endurance) activities like walking, dancing, running, biking, swimming, roller-blading, skiing, snowboarding. This type of activity will make you breathe deeper and your heart beat faster.

r Make a list of light, moderate and vigorous activities that you like or want to try.

Examples:� Light: slow walking, yoga, gardening, stretching

� Moderate: brisk walking, biking, raking leaves, dancing, swimming, tennis, water aerobics, Aquafit

� Vigorous: jogging, soccer, basketball, aerobics, hockey, fast dancing, fast swimming

Activities that I like or want to try:Light Moderate Vigorous

1. 1. 1.

2. 2. 2.

3. 3. 3.

Make being active a habit!

lets go 4 a walk

� Start your day with a plan.� When you wake up in the morning, think about

• what you will do • how long you will do it • when you will do it

� End your day by looking at all the ways you were active. GOOD JOB!

Type 2 Diabetes: Ideas to be active every day!

Notes:


Type 2 Diabetes

Pills and Insulin Will I need pills or insulin if I have type 2 diabetes?

� Many people with type 2 diabetes need diabetes pills or insulin. Some people need both.

Is it still important to be active and eat well if I take pills or insulin?

� Yes. Healthy eating, being active, and a healthy weight are very important. Some-times these things can help so much that pills or insulin can be stopped.

Insulin

The pancreas normally makes insulin. In type 2 diabetes, the pancreas may not make enough insulin. Or, sometimes the pancreas makes a lot of insulin but it does not work well. This leads to high blood sugar that can cause health problems if left untreated.

Many people with type 2 diabetes need to take insulin to keep their blood sugars in a healthy range. Sometimes insulin is only needed for a short period of time.

If you have an A1c level above 9, your doctor will most likely recommend that you start on insulin. A1c is a blood test that shows how high your blood sugar has been for the past 2-3 months.

How does insulin work?

� Insulin helps our bodies use glucose for energy. Glucose is a type of sugar. We need glucose for everything we do – thinking, playing, working, growing, healing, being strong and more! Some glucose comes from foods we eat. Some glucose is made by the body. Without insulin, we can’t use glucose for energy and the blood sugar gets too high.

� Insulin lowers blood sugar. Insulin helps move glucose (sugar) from the blood to other parts of the body where it is needed for energy.

� Insulin needs to be injected. It does not work if taken by mouth.

� There are a few types of insulin. Some work quickly and last a short time in the body. Others work slowly and last a long time.

See: Insulin Action Times


Diabetes Pills

There are many types of diabetes pills. Look at the list below. Circle the name of any pills you take or add your diabetes pills to the list.

� Metformin or Glucophage®

� Glyburide or Diabeta® ê

� Glimepiride or Amaryl® ê

� Replaglinide or Prandin® ê

� Nateglinide or Starlix® ê

� Acarbose or Precose®

� ____________________________

How do diabetes pills work?

Diabetes pills are not insulin.

Not all pills work the same way. These are some of the ways diabetes pills work: � Some help the body’s own insulin work better.� Some decrease the amount of sugar made by the liver.� Some stop some food from turning into sugar.� Some help the pancreas make more insulin.

Caution:

� Some pills can not be used by people who have kidney or liver problems. Your doctor may need to do some blood tests to make sure your kidneys and liver are ok.

� Insulin and some diabetes pills can cause blood sugar to drop too low. This is called hypoglycemia. Learn about low blood sugar if you are taking insulin or any of the pills on the list that are marked with a ê. (Read: Type 2 Diabetes and Low Blood Sugar.)

Type 2 Diabetes Pills & Insulin


Type 2 Diabetes

Metformin

What is Metformin?

� Metformin is a type of pill used to treat type 2 diabetes. It helps lower blood sugar.

� It is not insulin and it does not cure diabetes.

How does Metformin help lower blood sugar in type 2 diabetes?

� It helps your own insulin work better. � It reduces the amount of glucose (sugar) made by the liver.

• Sugar in your body is called glucose. The liver makes glucose. In type 2 diabetes, the liver often makes too much glucose.

� It stops some sugar from being absorbed.

Are there other names for metformin?

Yes. Metformin is sold under a few names in Canada. Some of these are:

� Glucophage � Nu-Metformin� Glycon � Novo-Metformin � Apo-Metformin

How much Metformin should I take?

� Your doctor will tell you how much metformin you should take. You may be told to go up on the dose slowly. This can help reduce side effects.

What are the most common side-effects of Metformin?

� upset stomach� gas or feeling bloated� diarrhea

These usually goes away after a few weeks. Talk to your doctor if they last longer.

Some people get an odd taste in their mouth after taking metformin.


Caution

Fluids: Drink plenty of sugar free fluids when you are taking metformin. Tell your doctor if you are peeing less than usual or have diarrhea for more than 1 or 2 days. Passing a very low amount of urine may cause metformin to build up in your body. This can increase the chance of a rare but serious medical problem called lactic acidosis.

Sick Days: Stop your metformin if you are throwing up or have serious diarrhea. Restart when you are able to eat again. Drink lots of fluids to stay well hydrated.

X–Rays and Surgery: Metformin should be stopped before X rays or scans that use dyes. It may also need to be stopped before surgery. Ask your doctor when you should stop and restart your metformin.

Alcohol: Alcohol can cause your blood sugar to get too low. Always have something to eat if you are drinking alcohol, or abstain.

Pregnancy: Let your doctor know if you are pregnant or you plan to get pregnant. Your treatment may need to be changed.

� Take metformin with food to help prevent side effects.� Drink lots of water or other sugar free fluids.� Be active every day.

� Make healthy food choices� If you miss a dose:

• take it as soon as you think about it• if it is almost time for your next dose, skip the missed dose• do not give 2 doses at the same time.

Note: Metformin helps lower blood sugar but should not cause it to get too low. If you are taking metformin and insulin or other types of diabetes pills, your blood sugar could get too low. This is called hypoglycemia. If you are at risk for hypoglycemia, learn more about it. Read: Type 2 Diabetes and Low Blood Sugar.



Type 2 Diabetes

Glyburide

What is Glyburide?

� Glyburide is a type of pill used to treat type 2 diabetes. It helps lower blood sugar.

� It is not insulin and it does not cure diabetes.

How does Glyburide help lower blood sugar in type 2 diabetes? � It helps the pancreas make more insulin. Insulin then helps move sugar from

the blood to parts of the body that need energy.

Are there other names for Glyburide?

Yes. Glyburide is sold under a few names in Canada. Some of these are:

� DiaBeta � Nu-Glyburide� Gen-Glybe � Euglucon� Apo-Glyburide

How much Glyburide should I take? When should I take it?

� Your doctor will tell you how much you should take.

� Glyburide is most often taken once or twice a day with food: • once daily with breakfast OR • twice daily with breakfast and dinner.

What are the most common side-effects of Glyburide?

� low blood sugar (also called hypoglycemia)

� heartburn or upset stomach

Take your Glyburide with food to help prevent side-effects.


� Exercise and healthy eating are still important if you take Glyburide. � Be active every day. � Make healthy food choices.� Take Glyburide with food.� Drink lots of water or other sugar free fluids.� If you miss a dose:

• take it as soon as you think about it• if it is almost time for your next dose, skip the missed dose• do not give 2 doses at the same time.

Note: Glyburide will help lower blood sugar but can also cause it too drop too low. This is called hypoglycemia. Learn more about hypoglycemia. Read: Type 2 Diabetes and Low Blood Sugar.


Caution Low Blood Sugar (Hypoglycemia): Glyburide can cause your blood sugar to drop too low. Always take your medicine with food and eat all your meals and snacks. This will help prevent low blood sugar. Avoid drinking alcohol or drink with caution.

Alcohol: Alcohol can cause your blood sugar to get too low. Do not drink or if you do, make sure you eat some carbohydrate. Do not drink on an empty stomach.

Sick Days: � If you are sick with a cold, flu, or other infections but you are not throwing

up, keep taking your glyburide as usual. Check your blood sugar often.� If you are throwing up you may need to stop your glyburide or take a lower

dose. Talk to your diabetes team about this. Restart when you are able to eat again.

� Drink lots of fluids to stay well hydrated. Discuss this with your diabetes team.

Surgery: If you need to fast before surgery, your glyburide should be stopped until you are able to eat again. Glyburide taken without food can cause serious low blood sugar. Talk to your doctor about a plan for managing your blood sugars before and after surgery.

Pregnancy: Glyburide is not used during pregnancy. Tell your doctor if you are pregnant or plan to get pregnant. Your treatment will need to be changed.


0 2 4 6 8 10 12hours

Humalog / NovoRapid / ApidraRegular / TorontoNPHLantus / Levemir

Insulin Action Times

Insulin Name Starts Strongest LastsHumalog / NovoRapid / Apidra

(Rapid)10–15 min 60–90 min 4–5 hrs

Regular / Toronto(Fast)

30–60 min 2–4 hrs 5–8 hrs

NPH(Intermediate)

1–3 hrs 5–8 hrs Up to 18 hrs

Levemir(Long)

1–1½ hrs None 16–24 hrs

Lantus(Long)

1–1½ hrs None Up to 24 hrs

Type 2 Diabetes

There are many types of insulin. Your doctor or diabetes educator will talk to you about which insulins are best for you. Some people need more than one type of insulin. Other people may need only a long acting insulin. See the chart below for a list of insulins and their action times.

What is the name of your insulin?

_______________________________________________________________________

_______________________________________________________________________

What is the best time to give your insulin each day?

_______________________________________________________________________

_______________________________________________________________________

Type 2 Diabetes: Insulin Action Times



How to Give Insulin

You can give insulin with a syringe or an insulin pen. Most teens use insulin pens. They are easy to use and the needles are very small. Talk to your diabetes educator about these choices.

The steps below explain how to give insulin. The steps are the same if you use a syringe or an insulin pen.

1. Prepare your insulin pen or syringe. Make sure you have the right type and amount of insulin.

2. Choose a spot to give your insulin. Pick a new spot each time.

3. Hold the syringe or pen straight up and down. Push the needle into the skin.

4. Push down on the plunger or the top of the insulin pen. Make sure all the insulin is given.

5. Count to 10 slowly. Then pull out the needle.

6. Put the used needle in a sharps box.

Type 2 Diabetes


� There are many types of insulin pens. See the instructions that come with your pen for details on how to use it.

� Use a 4, 5 or 6 mm pen needle to stay away from muscle.

Type 2 Diabetes: How to give insulin?

� If you use an insulin syringe, choose short needles option (8mm). Gently lift up some skin to make a small hill shape. Then push the needle straight into the top of the hill of skin.

� Don’t use the same spots all the time for your insulin. Overuse can cause:• Lumps and bumps• Uneven insulin action. This can affect your blood sugar.


Where to Give Insulin

You can give insulin in these areas:

� arms� legs � abdomen (tummy)� backside

There are quite a few spots you can use in each area. Give your insulin in a new spot every time.

What happens if you use the same spot too often?A hard lump will form under the skin. This can affect your insulin action and your blood sugar.

Which area is the best?The abdomen is usually best for teens. Most teens can use this area all the time. � easy to reach� insulin works at a smoother rate� good to use if exercise is planned� more space to move around where you inject

Arms and legs are OK but...� arms are hard to do by yourself� exercise with arms or legs can cause insulin to work too fast

Choose a new spot in the area you are using each time you give your insulin. This is called rotating.

Think about this...How can you rotate your insulin to make sure you don’t overuse an area?

Type 2 Diabetes


Type 2 Diabetes: Where to give insulin?

� Don’t use the same spots all the time for your insulin. Overuse can cause:• Lumps and bumps• Uneven insulin action. This can affect your blood sugar.

� Space insulin about 1 finger width apart each time. This will help to keep your skin smooth.

� Exercise can change how smoothly and quickly insulin works. For example, your insulin may work too quickly if you give it in your arm and then go for a swim or play tennis. Choose your abdomen if you plan to use your arms or legs a lot after giving your insulin.

Taking Care with Insulin and Sharps

� Check the expiry date of your insulin.

� Make sure your insulin does not get too warm or too cold. • The insulin you are using is good for about 1 month at room

temperature. • Extra insulin should be kept in the fridge. • Do not freeze.

� Put used needles and syringes in a sharps box. Do not put them in the garbage.

� Sharps boxes are also called sharps containers.

Many pharmacies provide them for free or a small charge.

• Ask your pharmacy for a sharps box.• Ask if you can bring the box back to the pharmacy when it is

full.• If your pharmacy will not take back a full sharps box, ask

where else you can take it.

You can also ask your nurse or public health unit about this.


30o C

2o C�

�

�

�

35o F

86o F

Keep sharps out of reach of children and pets.

Type 2 Diabetes

Notes:


Type 2 Diabetes

Low Blood Sugar: Hypoglycemia Blood sugar less than 4 is too low. Treat right away!� Hypoglycemia is another word for low blood sugar.

Will my blood sugar ever get low?

� If you take insulin or some types of diabetes pills, your blood sugar may sometimes get too low. Most low blood sugar can be treated quickly and easily. Always carry supplies to treat low blood sugar.

� You are not at risk for low blood sugar if you do not take insulin or diabetes pills.

What are the signs of low blood sugar?

� Sweaty� Pale � Shaky � Hungry

� Dizzy� Weak

� Mood changes� Acting strange

� Trouble focusing or thinking� Feeling or acting confused

� Feeling sleepy or tired.

�Some people get other signs such as tingling in their lips or nausea.

�If not treated, low blood sugar can cause seizures or loss of consciousness.

How is low blood sugar treated?

1. Take 15 grams of fast-acting sugar. Any of these choices have about 15 grams of fast-acting sugar:

� ½ to 3/4 cup of fruit juice (125 ml to 175 ml)

� 4 Dex 4 tablets™

� 5 DextroEnergy™ tablets

� 1 tablespoon of honey or syrup

2. Wait 15 minutes and recheck your blood sugar. This gives the fast-acting sugar time to work. Eating other food too soon slows down fast-acting sugar.

êRepeat step 1 if your blood sugar is still less than 4.

3. Eat 15 grams of longer lasting carbs once your blood sugar is OK.

This can be part of your usual meal or snack.

If it will be more than 45 minutes until your usual meal or snack, eat an extra snack. This will help prevent another low blood sugar.

Ideas for 15g of longer lasting carbs• 1/2 sandwich• granola bar

What causes low blood sugar?� Too much insulin or diabetes medication

� Eating later or less than usual

� Missing a planned meal or snack

� Waiting too long to eat after taking your insulin or pills

� Extra physical activity without adjusting your insulin or food

� Drinking alcohol


Type 2 Diabes & Low Blood Sugar


Help prevent problems with low blood sugar:� Always carry fast-acting sugar and food.

� Eat meals and snacks on time.

� Measure insulin carefully.

� Take diabetes pills as prescribed.

� Before giving your meal-time insulin, make sure there is food ready to eat.

� Plan for activity. Give less insulin if you plan to be more active than usual. Or eat some extra carbohydrate.

� If you drink alcohol, always eat some carbohydrate. Limit how much you drink.

� Teach family and friends about low blood sugar in case they need to help.

� Tell your doctor or nurse if your blood sugar is low more than twice a week.

� Wear diabetes medical ID at all times.

Think 15, 15, 15 for low blood sugar� Take 15 grams of fast acting sugar.

� Wait 15 minutes. Recheck blood sugar. Is it 4 or more?

� Eat 15 grams of slower acting carbohydrate.

Most low blood sugar can be treated quickly and easily. Severe low blood sugar requires emergency help. Call 911 or give glucagon. If you are an adult family member, learn how to give glucagon. It can be used to treat severe low blood sugar. Read: Glucagon for Severe Low Blood Sugar.

Type 2 Diabes & Low Blood Sugar

Notes:

Physical Activity and Low Blood Sugar

Being active is an important part of taking care of type 2 diabetes.

� Try to be active every day or work up to this.

� Physical activity helps lower blood sugar. This is a good thing as long as your blood sugar does not get too low.

Can physical activity cause my blood sugar to get too low?

� Only some people with type 2 diabetes are at risk for low blood sugar. Your risk for low blood sugar depends on the type of diabetes medicine that you take.

Are you at risk for low blood sugar?r If you do NOT take insulin or any diabetes pills: Nor If you take only metformin: Nor If you take insulin: Yesr If you take metformin AND insulin: Yesr If you take metformin AND other types of diabetes pills: Yesr If you take glyburide (Diaβeta): Yesr If you take any other diabetes pills, ask your diabetes team if they can cause

low blood sugar.

Planning to be more active?You can help prevent low blood sugar.

If you take insulin or any pills that can cause low blood sugar:� Keep a supply of glucose tabs or other fast acting sugar with you.� Eat your usual meal or snack before your activity.� Check with your diabetes team to see if you need less insulin or diabetes pills

for extra activity.� If you have not reduced your insulin or diabetes pills, you may need extra food

for extra activity that uses a lot of energy. Add 15 grams of carbohydrate for each hour of being very active.


Type 2 Diabetes

� Extra activity means more activity than you would do on a normal day.

� Taking less insulin or a lower dose of some diabetes pills when you are more active than usual can help:• prevent low blood sugar, and• decrease the need for extra food.


If you are doing about the same amount of activity that you do most days, you probably don’t need to change your food, insulin or pills.

Be Smart! Be Active! Have Fun!

Type 2 Diabetes: Physical Activity & Low Blood Sugar

� Check your blood sugar before and after being active. This is the best way to see what works well for you.

� Read Low Blood Sugar and Type 2 Diabetes. Learn how to recognize, treat and prevent low blood sugar.

(4) (2) (3) (1) September 2015 http://www.bcchildrens.ca/endocrinology-diabetes-site/Documents/chbctype2kids.pdf Page 1 of 2

Glucagon for Severe Low Blood Sugar (Hypoglycemia)What is Glucagon?Glucagon is used to treat severe low blood sugar. It raises the blood sugar by sending a signal to the liver to release stored sugar. Glucagon is given by injection. It can be used when it is not safe or possible to take anything by mouth for low blood sugar.

Most youth with type 2 diabetes never need glucagon. Still, if you are on insulin, your doctor may prescribe it. It is a quick and effective way to treat severe low blood sugar. If your doctor prescribes Glucagon, a parent or caregiver must learn to give it.

When should glucagon be given?Give glucagon if your child or teen is having a severe low blood sugar. During a severe low your child or teen may be:� unconscious� having a seizure� so uncooperative that you cannot get him or her to take anything by mouth

Turn your child or teen on their side if they are unconscious or having a seizure.

How do I give glucagon?� You must inject it. You cannot give glucagon by mouth. � Glucagon is injected with a syringe, the same way as insulin.

Glucagon comes in a kit. The kit includes:� A small bottle that contains 1 milligram (mg) of glucagon. The glucagon is a dry powder.� A syringe that is filled with 1 ml of sterile liquid.

Follow these steps:1. Remove the cap from the bottle.2. Inject the liquid from the syringe into the dry powder bottle.3. Roll the bottle gently to dissolve the powder. Do not shake the bottle.4. Draw the liquid

back into the syringe.

Type 2 Diabetes


5. Inject glucagon the same way that you would inject insulin with a syringe.6. It may take 10–20 minutes to respond fully.7. Once your child is alert, give juice or other fast-acting sugar.8. After the fast-acting sugar, give some longer-acting carbohydrate. This is to stop the blood

sugar from dropping too low again.

9. If your child is not alert and able to swallow after 15 minutes, give another dose of glucagon or call 911.

10. Contact your family doctor or your diabetes team before giving the next dose of insulin. Your child’s insulin dose may need to be changed.

How much glucagon should I give my child? Give 1 bottle of glucagon. This is a dose of 1 mg of glucagon.

Note: Young children need smaller amounts of glucagon.

Does glucagon cause any side effects?Glucagon is safe to use. Sometimes glucagon causes upset stomach or vomiting.

� Make sure your supply is never out of date. Check the expiry date on your supply of glucagon. � Use the glucagon solution as soon as it is mixed.� Get glucagon from your pharmacy. It is sold under 2 names in

Canada:• Glucagon (made by Eli Lilly)• Glucagen HypoKit (made by NovoNordisk)

Novo Nordisk has a video showing how to mix up and give GlucaGen®:www.novonordisk.com/images/diabetes/glucagon/demo/hypokit-demo.wmv

Eli Lilly has an online tutorial showing how to mix up and give Lilly Glucagon™:www.humalog.com/Pages/glucagon-severe-low-blood-sugar.aspx

Eli Lilly also has an iPhone® app for Lilly Glucagon™,:www.glucagonapp.com/Pages/index.aspx

Type 2 Diabetes: Glucagon for Severe Low Blood Sugar (Hypoglycemia)

Type 2 Diabetes High Blood Sugar


What are the signs of high blood sugar?}Some signs of high blood sugar are:

Thirst and drinking lots Peeing lots Blurry vision Feeling tired

}High blood sugar that lasts a long time may also cause:• Yeast infections • Poor healing• Other health problems called “long term complications” of diabetes. These are

health problems that can happen after years of high blood sugar. Long term complications can include problems with the blood vessels, heart, eyes, nerves or kidneys.

Keeping your blood sugar in a healthy range most of the time will help prevent long term complications. Healthy blood pressure will help too. Your diabetes team can tell you more about how to prevent long term complications.

What should I do about high blood sugar?

} If you feel well and your blood sugar is high for only a short time, you usually don’t need to do anything right away. Your treatment plan may need to be changed if your sugar stays high or there is a pattern of high blood sugar. A pattern of high blood sugar means it is high at the same time of day for more than 2 days in a row.

} If your blood sugar is high and you do NOT feel well, treatment may be needed right away. Call your doctor if your blood sugar is high and you notice any of these signs:• Very thirsty • Drinking lots• Peeing lots• Very tired • Flushed face • Warm, dry skin

What are ketones?

} Ketones are made when there is a severe lack of insulin in the body. When this happens, blood sugar levels are also high. This can lead to a serious problem called ketoacidosis or DKA. • DKA is not common in Type 2 diabetes but may develop when type 2

diabetes is first diagnosed or during illness. • If your blood sugar is high and you have ketones, get medical advice right

away.

} Small amounts of ketones can also be made if you are eating a very low carb diet and losing weight. This does not cause high blood sugar and generally, only small amounts of ketones are made. This is sometimes called dietary ketosis. It is not the same as DKA.• If your blood sugar is ok and you have just “small” amounts of ketones,

ask your diabetes team if you need to adjust your diet.

} Healthy A1c levels can help prevent long term complications of diabetes. Ask your doctor or diabetes team what your A1c is. A1c is a blood test that shows how high your blood sugar has been for the past 2-3 months.

} If you have high blood sugar and are not feeling well, get medical advice.} Ask your diabetes doctor or nurse if and when you need to check for ketones.

It is easy to check for ketones in your urine or blood.} If you have high blood sugar and ketones, get medical advice immediately.

Early treatment can prevent a serious problem called DKA or ketoacidosis. } Learn what to do when you are sick. Illness can cause high blood sugar and

may also cause ketones. Read: Type 2 Diabetes and Sick Days.

Type 2 Diabetes: High Blood Sugar


• Dark urine • Vomiting• Confusion• Ketones in the urine or blood

- Check for ketones if the blood sugar is higher than 15 mmol/L.


Type 2 Diabetes Sick Days

Illness can upset blood sugar control. � Illness often causes high blood sugar. This can happen even if

you are eating less than usual.

� Your blood sugars may get low if you are throwing up (vomiting) or have diarrhea.

� Check blood sugars more often during illness.

What do I need to do during illness?

1. Check blood sugars every 3-4 hours. Check more often if vomiting.

2. Drink lots of sugar free fluids to prevent dehydration.

3. Know what to do if you are taking diabetes pills or insulin. The amount you take may need to be changed.

Diabetes pills:� Take your diabetes pills if you are able to eat or drink.

� Your diabetes pills may need to be stopped if you are throwing up or have serious diarrhea. Ask your doctor or diabetes nurse if you should stop your diabetes pills.

• Metformin can build up in the body if a person is throwing up or unable to drink fluids. This can cause a serious medical problem.

• Diabetes pills such as DiaBeta can cause low blood sugar if taken when unable to eat or drink.

� Restart diabetes pills when you are able to eat and drink.

Insulin: � Do not stop your insulin.

• Illness is a stress on the body. It may cause your blood sugar to rise. You may need more insulin. If your blood sugars are high call for advice on extra insulin.

• If you are throwing up and unable to eat: you may need less insulin. Call your diabetes team for advice.

4. Eat if you can and drink lots of fluids.

� Try to eat normal amounts of food at usual eating times.


5. Drink fluids every hour if you are not eating well. Take small sips often.

� If your blood sugar is higher than 8 mmol/L, choose sugar free fluids like water, diet pop, diet jello, broth, diet popsicles.

� If your blood sugar is less than 8 mmol/L, choose fluids with sugar like apple juice, regular pop, jello or a popsicle.

Sip fluids slowly over 1 hour. It is better to take small amounts often than a large amount at one time.

� Try adding semi-solid or solid food after you are able to drink fluids.• Start with foods you feel like eating.• Semi-solids are foods like flavored yogurt, ice cream, sherbet,

pudding, milkshakes or chicken noodle soup.• Solids are foods like bread, crackers, rice, noodles or dry cereal.

Call your diabetes team if:� you need advice on your diabetes pills or how much insulin to take� your blood sugar is higher than 15 mmol/L twice in a row� you have ketones. � you are vomiting� your blood sugar is less than 4 mmol/L more than twice in a row

For urgent questions, phone :� ________________________________________________________________

For non-urgent questions phone:� ________________________________________________________________� _________________________________________________________________

� Your diabetes team may teach you how to check for ketones during illness.

� Make a plan for sick days before you get sick. Talk to your Diabetes Team to make sure you know what to do.

Note: Children and teens need help with their diabetes when they are sick. An informed adult must help.

� If your blood sugar is low and your stomach is upset, try fast acting sugars that most appeal to you. Some ideas are sips of ginger ale or some maple syrup. You only need 1 tablespoon of syrup to get 15 grams of fast acting sugar. A small amount like this may be easier to keep down than juice or ginger ale.

Type 2 Diabetes: Sick Days


� Tell your friends you have diabetes. Teach them about low blood sugar and how to help you if you get low.

� Don’t mix exercise and alcohol. Together, they increase the risk of severe hypoglycemia.

Type 2 Diabetes

Alcohol

What Do I Need to Know?� If you take insulin or some diabetes pills, alcohol

can cause blood sugar to drop too low. Low blood sugar is called hypoglycemia. It can cause confusion, weakness, shaking, sweating, sleepiness, headache and poor coordination.Severe hypoglycemia can cause seizures or loss of conscious (passing out).

� Some signs of hypoglycemia can be mistaken for being drunk. You or your friends may miss the warning signs of hypoglycemia

If you choose to drink:� If you take insulin or some types of diabetes pills, eat when you are drinking

and before you go to bed. Get snacks or meals with carbohydrate. This will help prevent low blood sugars.

• The liver usually makes a bit of sugar (glucose) to help keep your blood sugar level through the night. Alcohol blocks this action and can cause hypoglycemia.

� Limit the amount you drink. Drinking too much is not safe and can impair your judgement.

Poor judgement makes it difficult to recognize signs of hypoglycemia. It may also cause you to forget parts of your diabetes care plan, like eating, checking your blood sugar, and taking your medications.

� Check your blood sugars more often and before going to bed. Check during the night too. Alcohol can cause low blood sugar many hours after drinking.

1BEER

What is the legal drinking age in BC? Answer: 19BONUS QUESTION:

For more information about this see: http://engage.gov.bc.ca/liquorpolicyreview/who-can-drink/

Wine

Cooler

Notes:


Type 2 Diabetes

Setting SMART GoalsThere are many things you can do to live well with type 2 diabetes. It may take a while to get the hang of doing them. So, start by choosing just a few goals to work on. This will be easier than trying to do a bunch of new things at the same time.

Setting SMART goals can help you reach your goals.

What are SMART Goals?Each letter in SMART stands for at least one thing to help you reach your goals. SMART goals:

� are Specific� can be Measured� include an Action plan� are Realistic� are Time-based

Here is an example of a smart goal:

Use 15 minutes of my TV time to dance to good music every day after school for the month of May.

Compare it to: Exercise more. This is too general to be helpful.

Here are a few more “smart” ways to think about your goals. Set goals that are:

Significant to you – Think of what’s important from your point of view.

Motivating – You want to take some steps to work on them and you believe they are worth the effort.

Agreed upon – You set them and you agree to them. Someone else doesn’t set your goals for you.

Rewarding – Not only are your goals realistic but they are rewarding too! Think of ways that you can reward yourself or feel rewarded for working on your goals.

Time-based – Set some time to work on your goals and take some time to review how you are doing.

Setting Your Own SMART Goals

Be Smart and Start.

� Set one or two goals that you feel ready to work on.� Track your progress for each goal. How are you doing?

r I’m still working on it and I’m doing ok

r I’m still working on it but I could use some help

r Yay! I did it!

Goal 1:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Date: ________________________ Signature: __________________________

Dates that I plan to review my goal: ____________________________________

Goal 2:

_____________________________________________________________________

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Date: ________________________ Signature: __________________________

Dates that I plan to review my goal: ____________________________________


Type 2 Diabetes: Setting SMART Goals

Type 2 Diabetes

Want to Help?

10 Tips for Parents and Others Who Want to Be Supportive

Do you know a teen with type 2 diabetes?� Do you want to support a teen with diabetes?

� Do you want to help but find that some things you say or do are taken the wrong way?

� Does this leave everyone in a bad mood or not talking at all?

If you answer yes to any of these questions, here are some tips for you!� The tips are adapted from some wise words from the folks at the Behavioral Diabetes

Institute in California (www.behavioraldiabetes.org). We’ve made a few changes to the original and added a few more ideas for family and friends of teens with type 2 diabetes. Teens with diabetes have added some of their own tips too!

1. DO ask how you might be helpful.

� If you want to help, that’s great.

� You and I may have different ideas about what I need though, so please ask me first.

2. DON’T give me advice about my eating or activity unless I ask you for it.

� Remember, I’ve already been given information on healthy eating and activity.

� Let me ask questions and discover some things on my own. That is more helpful than lectures or giving me advice.

� Rather than talking about my weight, focus on my health.

3. DO accept that I need to check my blood sugar and I may need to take insulin or pills.

� This is part of having type 2 diabetes. It’s best not to make a big deal about these things but please let me know if you have any questions. It’s also ok to ask how I am doing or if I need a hand with anything.

4. DO understand that diabetes is a lot of work.

� It is not easy to do all the things that I need to do.

� Sometimes I get tired of all the things I need to do. Ask me what you can do to help.


W“Exercise is good for you too. Sometimes we could be active together but you might need to try something new because we don’t always like the same things.”

5. DON’T tell me all the scary things you’ve heard about diabetes.

� I don’t want to hear about other people’s problems and complications.

� I need to know what it takes to stay healthy and I need to know this is possible. My health care team will explain what I need to do to avoid problems.

6. Do offer to join me in making changes that will be good for me. � Many of these same things could be good for you too– like being more active and

choosing healthy foods.

7. Do help me succeed.� Help make healthy choices easy choices. It’s best to have healthy foods and snacks

around. � Don’t tempt me by buying or offering things that are not good for me.

8. Don’t judge me based on my blood sugars. � There will be times my numbers are too high and times they are too low. It’s not easy

to keep all my blood sugars in the goal range.� I will be more likely to share my numbers with you if you ask me first.

9. Do offer your support and encouragement. � Help me focus on my strengths when I am feeling discouraged. � Think about the words you use when you talk to me. Words can make a big difference

to how I feel about myself. For example, it’s helpful if you say something like “I need some exercise today too. I would like to go for a walk. What do you want to do”? - instead of saying- “ You haven’t done any exercise today. Go for a bike ride.”

10. Do notice what I am doing well – not just what I’m not doing.� I’ve been told to do a lot and it’s not all easy. It helps when you notice I am trying. � It’s great when you cheer me on or say good job.� Please remember that I appreciate your support, even if I don’t always let you know.

Type 2 diabetes: want to help?

“Don’t keep telling me the same things over and over again. It’s annoying and after a while I will just

block things out”.K“Rather than trying to make me do things,

ask me what I would like to do instead.” W


Adapted from Diabetes Etiquette for People Who DON’T Have Diabetes and Diabetes Etiquette for Parents of Teens: What Teens Would Like You to Know. For more info visit the BDI website: www.behavioraldiabetes.org.

“I hear what you are

saying but I am already

on a program and maybe

you don’t know what I am

already doing or what’s

working for me.” W