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OMAR HOSPITAL
& caRDIAC CENTRE

Life with
Diabetes

Dr A�f Munir
Consultant Diabetologist & Endocrinologist
Assistant Professor Fa�ma Memorial Medical College
MRCP Medicine (UK), MRCP Diabetes & Endocrinology (UK)
CCT Diabetes & Endocrinology (UK)

Miss Fariha Naz

Consultant Clinical Psychologist, life skills
trainer & Diabetes counselor Jail road Lahore
MS (Clinical & counseling Psychology)
For appointment contact:
111-111-127 (ext 277)
www.omarhospital.com
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What is Diabetes?
Diabetes develops when the insulin-producing cells in the body are
unable to produce enough insulin, or more commonly when the insulin
that is produced does not work properly (known as insulin resistance).
What is insulin?
Insulin is a hormone. It works as a chemical messenger that helps your
body use the glucose in your blood to give you energy. You can think of
it as the key that unlocks the door to the body’s cells. Once the door is
unlocked glucose can enter the cells where it is used as fuel.
Who typically gets Diabetes?
Type 2 diabetes usually appears in people over the age of 25. Being
overweight and family history of diabetes increases the risk. Diabetes is
treated with a healthy diet and increased physical activity. In addition to
this, medication and/or insulin are often required.
What are the signs and symptoms of diabetes?
• Going to the toilet a lot, especially at night.
• Being really thirsty.
• Feeling more tired than usual.
• Losing weight without trying to.
• Genital itching or thrush.
• Cuts and wounds take longer to heal.
• Blurred vision.
Most people with Diabetes may not have any of these symptoms and
diabetes may be diagnosed on blood test results.
Why does diabetes cause these symptoms?
These symptoms occur because some or all of the glucose stays in the
blood, and isn’t being used as fuel for energy. The body tries to reduce
blood glucose levels by flushing the excess glucose out of the body in the
urine.
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I have some diabetes symptoms. What now?
If you have any of symptoms of diabetes, you should contact your
specialist who will suggest blood tests for diabetes. Early diagnosis,
treatment and good control are vital for good health and reduce the
chances of developing serious complications.
Managing your diabetes:
Managing your diabetes, making changes and fitting the demands of
diabetes into your lifestyle can be challenging. Effective diabetes care
can only be achieved through working closely with your diabetes
specialist who should support you in self-managing your diabetes.
Taking responsibility for your diabetes will enable you to manage your
diabetes more effectively. Ask questions and request more information
from your doctor if you need to.
Lifestyle changes (dietary modification, exercise and weight loss if you
are overweight) is the cornerstone of diabetes management.
Healthy eating:
No food is out of bounds but food choices are an important part of
your diabetes management. Eating a balanced diet – that is fruit and
vegetables, starchy foods, non-dairy sources of protein and dairy – is
something we should all try to do. It’s fine to have a treat every now and
again but the foods you choose are an important part of your diabetes
treatment,
Food groups:
Food can be divided in five groups:
• Fruit and vegetables
• Bread, rice, pasta, potatoes and other starchy foods
• Dairy products
• Meat, fish, eggs and beans and other non-dairy sources of protein
• Foods high in fat and/or sugar.
The number of portions you need varies from person to person. Your
specialist or dietitian will be able to guide you on how much of each
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food group you need depending on your requirements and nutritional
goals - e.g. Weight loss, blood glucose management
Fruit and vegetables:
Fruits and vegetables are naturally low in fat and calories, while being
packed with vitamins, minerals and fiber. They can help protect against
stroke, heart disease, high blood pressure and certain cancers.
How much per day?
Aim for at least five portions. Aim for a mix of colors to get as wide a
range of vitamins and minerals as possible.
What’s a portion?
Roughly what you can fit into the palm of your hand. For example:
• 1 piece of fruit, like an apple
• 1 handful of grapes
• 3 heaped tablespoons vegetables
Starchy foods:
Choose carbohydrates that are more slowly absorbed as these won’t
affect your blood glucose levels as much and they’ll keep you feeling
fuller for longer. Starchy foods are naturally low in fat and high-fiber
choices will also help keep your bowels regular, preventing digestive
disorders. Bread, rice, potatoes and chapattis contain carbohydrate,
which is broken slowly down into glucose and used by your cells as fuel.
Basmati rice is an even better option.
How much per day?
• Try to have some starchy food, everyday.
• Carbohydrates breakdown to glucose in the blood so keep an eye on
how much you eat.
Dairy products:
Milk, cheese and yoghurt contain calcium, which helps to keep your
bones and teeth strong. They are also a good source of protein, but some
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can be high in fat, so choose lower-fat alternatives where you can.
How much per day?
Aim for three portions.
What’s a portion?
One portion is equal to: 190ml (2/3rd of a glass) of milk; a small pot
of yogurt; 2 tablespoon cheese; a matchbox-sized portion of cheese
(45g/1oz).
Meat, fish, eggs and pulses:
These foods are high in protein, which is needed for building and
replacing muscle cells in the body. They also contain minerals, such
as iron, which are needed for producing red blood cells. Omega-3 fish
oils, found in fish can help to protect the heart. Good sources of protein
among vegetables include beans and pulses.
How much per day?
Include some food from this group everyday and aim for two portions
of fish a week.
Foods high in fat and sugar:
Technically, your body doesn’t need any foods in this group, but eating
them in moderation can be part a healthy, balanced diet. Sugary foods
and drinks will raise your blood glucose so opt for diet/light or low-
calorie alternatives. It’s also worth remembering that fat is high in
calories, so try to reduce the amount of oil you use in your cooking and
choose lower-fat alternatives wherever possible. Reduce your intake of
saturated fats by replacing butter, ghee etc with unsaturated fats such as
olive, sunflower oils and spreads.
How much per day?
The fewer the better, especially if you are trying to lose weight
Salt, herbs and spices:
Eating too much salt (6g/0.2oz or more per day) can raise your blood
pressure, which can lead to stroke and heart disease, so limit the amount
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of processed foods you eat and try flavoring foods with herbs and spices
instead.
Top tips for healthy eating:
The food choices we make can make a big difference to our health.
Having diabetes, or trying to reduce your risk of Diabetes, doesn’t have
to mean denying yourself the foods you love. Follow the following tips,
and you can still enjoy a wide variety of foods while staying healthy.
1. Eat regular meals:
Avoid skipping meals and space your breakfast, lunch and evening meal
out over the day. This will help control your appetite and blood glucose
levels – especially if you are on insulin.
2. Include some carbohydrates:
The amount of carbohydrate you eat is important, especially if you are
managing your weight or blood glucose levels. Try to include those that
are more slowly absorbed. Good choices include fruit and vegetables,
pulses, starchy foods and some dairy foods.
3. Cut down on fat:
Eat less fat (fried food) especially saturated fat. Unsaturated fats from
sources like olive oil, sunflower oil, nuts and avocados are better for your
heart.
• Try using skimmed or semi-skimmed milk.
• Watch out for creamy sauces and dressings.
• Reduce your intake of cheese, butter and other spread.
• Grill, steam or bake food instead of frying.
4. Try to eat five a day:
Fruit and vegetables will give your body the vitamins, minerals and fibre
it needs, and we should all aim to eat five or more portions a day. A
portion is:
• One piece of fruit like a banana or an apple
• A handful of grapes
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• A tablespoon of dried fruit
• A small glass (150ml) of fruit juice
• Three heaped tablespoons of vegetables
5. Eat more pulses:
Beans, peas and lentils are lower in fat, high in fiber, cheap to buy and
packed with nutrients. They don’t have a big impact on blood glucose
and may help to control blood fats such as cholesterol. Try kidney beans,
chickpeas, green lentils, and even baked beans.
6. Eat more fish:
All types of fish are healthy provided they’re not fried, they are rich in
omega-3 (polyunsaturated fat) which helps protect against heart disease.
Aim to eat two portions of fish a week,
7. Cut back on sugar:
Having diabetes, or aiming to lose weight to reduce your risk of Diabetes,
doesn’t mean you need to eat a completely sugar-free diet – but it is
important to reduce the amount you eat. There are some easy ways to cut
back on your sugar intake:
• Choose sugar-free, diet or no-added sugar drinks
• Cut out the sugar in your tea or coffee
• Read food labels and reduce your intake of high sugar foods
• Use sweeteners instead of sugar
8. Cut down on salt:
Aim to eat 6g of salt or less a day. Too much salt can raise your blood
pressure, which can increase your risk of type 2 diabetes, stroke or heart
attack. Around 75 per cent of our salt intake comes from processed
foods – so try to cut back on pre-prepared foods, and try flavoring your
food with herbs and spices instead of salt.
10. Be aware of portion sizes:
It’s not just what’s on your plate, but how much. Are you checking your
portions? Be mindful of your overall portion sizes. If you are trying to
lose weight, you may need to reduce them.
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• Try using smaller plates
• For main meals, dish out your vegetable first and let this fill up your
plate
• Separate the different foods on the plate rather than pilling them on
each other
• Resist the temptation for a second helping; have a glass of water first
Your plate could be half-filled with vegetables or salad, with the rest of
the plate divided between protein foods such as meat, fish, eggs or
beans and starchy carbohydrate foods.
11. Avoid diabetic foods:
These products offer no benefit to people with diabetes and may still
affect your blood glucose levels. They usually contain as much fat and
calories as ordinary versions are expensive and can have a laxative effect.
12. Visit a dietitian:
We recommend that everyone with diabetes should see a dietitian. Ask
your specialist to refer you to see a dietitian.
Getting active and staying active:
Being active can make you feel better, reduce your stress levels, keep your
weight down and protect your health. Whether you have diabetes, or are
taking steps to reduce your risk of Diabetes, there are many reasons to
get more active:
• Being active will help you lose weight or maintain a healthy weight.
• It increases the amount of glucose used by the muscles for energy, so
it may lower blood glucose levels.
• Being active helps the body to use insulin more efficiently, and regular
activity can help reduce the amount of insulin you have to take.
• Losing any weight that may be necessary and maintaining a healthy
weight will improve management of Diabetes.
• Being active strengthens your bones.
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• You’ll be more mobile, less out of breath and you’ll sleep better.
• Daily physical activity has been shown to reduce symptoms of
depression and anxiety.
How much activity do we need to do?
All physical activity counts, from doing the housework to running.
Recommended guidelines are
150 minutes (two and half hours) each week of moderate- to vigorous-
intensity physical activity. Activity can be spread out through the day.
One way to do your recommended 150 minutes of weekly physical
activity is to do 30 minutes on five days a week.
What is moderate physical activity?
Moderate-intensity activity will raise your heart rate, make you breathe
faster and feel warmer. One way to tell if you’re working at a moderate
intensity is if you can still talk, but you can’t sing the words to a song.
What is vigorous intensity physical activity?
Vigorous-intensity activity means you’re breathing hard and fast and
your heart rate has gone up quite a bit. If you’re working at this level, you
won’t be able to say more than a few words without pausing for a breath.
Top tips for getting active:
Being more physically active does not have to involve gym memberships,
long-distance runs and aerobics. But the great news is that you can
become more active by making small changes to your lifestyle – you can
fit it around your daily life and in your budget. Follow these top tips to
help make your life more active.
1. Start slow:
Doing just a little bit more than you did before will still make a
difference. So build up gradually, and give your body time to adapt as
your muscles strengthen. If you have any medical conditions, do speak
to your specialist before starting any new activity.
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2. Make small changes to your routine:
Walking is free, and a simple way to improve your fitness. Beat the traffic
and leave the car at home for small trips, or get off the bus one or two
stops earlier and walk the rest of the way. Ride a bicycle. Other household
activities, like hovering and gardening also count.
3. Get fit with family or friends:
Instead of meeting friends or family for a lunch/dinner at a restaurant or
to watch TV, why not suggest doing something active? You could go for
a walk in the park, visit the shops or play cricket.
4. Find an activity you enjoy:
Don’t be afraid to try new things. Was there a sport you did years ago
you’d like to start again?
5. Set yourself goals:
You’re more likely to stick to your more active life if you set goals – be
realistic with both short- and long-term goals. You can set your goals to
be more challenging each time. Keep an exercise diary and tick off your
achievements – you’ll be amazed at the improvement and progress you’ll
see.
6. Keep it varied:
Once you are fitter and exercising regularly, vary your routine.
7. Don’t give up:
Although your body benefits as soon as you become more active, you
may not see visible changes straight away. It can also take time for your
body to adapt to the activity, so keep going and set goals that are right
for you.
Exercise and blood glucose levels:
Activity may affect blood glucose levels both during and after exercise.
Regular blood glucose monitoring will help you to understand how
activity affects your blood glucose levels. Be aware of hypos. And
remember to keep an eye on your feet too.
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Medication:
As well as making lifestyle changes, people with diabetes often need
additional treatments. Medication is not a substitute for following a
healthy diet and taking regular physical activity – you will still need to
carry on with this.
Diabetes medication lowers blood glucose levels, and there are a number
of different types which work in different ways. Diabetes medication
cannot cure diabetes, and most people will have to take it for the rest of
their lives.
You may find that, despite keeping to a healthy diet, physical activity
and taking your diabetes medication regularly, your diabetes control is
not as good as it was. This is because Diabetes is a progressive condition
and, over time, you may need more than one medication or insulin to
manage your blood glucose levels.
Monitoring your diabetes:
Monitoring your diabetes is crucial to preventing some of the possible
complications associated with diabetes. This involves knowing your
blood glucose, blood pressure and blood fat levels, as well as the
condition of your feet and getting your eyes and kidneys screened for
early signs of damage.
There are two aspects to monitoring your diabetes. The monitoring you
do yourself at home, and the monitoring that your specialist will do for
you.
Testing:
There are a range of tests which will need to be done to monitor your
health and your diabetes. Some of these, such as your blood glucose
levels, you will be able to do yourself. Others will be done by your
specialist.
Blood glucose (sugar) levels:
Self-monitoring of blood glucose can be a beneficial part of diabetes
management. As part of the day-to-day routine it can help with necessary
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lifestyle and treatment choices as well as help to monitor for symptoms
of hypoglycaemia (low blood sugar) or hyperglycaemia (high blood
sugar). Monitoring can also help you and your healthcare team to alter
treatment which in turn can help prevent any long-term complications
from developing. Some people with diabetes (but not all) will test their
blood glucose levels at home. Home blood glucose testing gives an
accurate picture of your blood glucose level at the time of the test. It
involves pricking the side of your finger (as opposed to the pad) with
a finger-pricking device and putting a drop of blood on a testing strip.
Blood glucose (sugar) targets:
It is important that the blood glucose levels being aimed for are as near
normal as possible (that is in the range of those of a person who does not
have diabetes). These are:
• 72–126 mg/dl in fasting state and before meals
• Less than 162 mg/dl two hours after meals.
There are many different opinions about the ideal range to aim for. As
this is so individual to each person, the target levels must be agreed
between the person and their diabetes specialist.
Blood glucose meters:
Your specialist should help you with choosing a meter that suits your
individual needs. It’s essential that you are taught how to carry out a test
properly – poor technique may lead to incorrect results which could
lead to inaccurate medication dosing.
Worried about finger-pricking?
Many people new to life with diabetes worry about having to do blood
tests. This is natural, and with help from their diabetes care team the
majority of people adapt well and find it is not as bad as they feared.
There are ways to make blood glucose testing easier such as washing the
hand in warm water and shaking it to increase blood flow before you test
• You should always use the sides of the fingers rather than the more
sensitive fleshy pulp at the tips.
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Recording your results:
It’s really important to record the blood tests that you do, to help you and
your specialist to assess how well your diabetes is being managed. You
might choose to record your results in a diary, use a computer software
package or smart phone app.
HbA1c (glycated haemoglobin):
At least once a year, your doctor should check your long-term diabetes
control by taking a blood sample from your arm.
HbA1c:
The most common test is the HbA1c test, which indicates your blood
glucose levels for the previous three months. The hbA1c measures the
amount of glucose that is being carried by the red blood cells in the body.
HbA1c targets:
For most adults with diabetes, the HbA1c target is up to 7% , since
evidence shows that this can reduce the risk of developing complications,
such as nerve damage, eye disease, kidney disease and heart disease.
This target will be individualized by your specialist as per your other
health conditions and risk of hypoglycaemia (low blood sugar).
Blood pressure (hypertension):
It is important to have your blood pressure checked at least once a year
as part of your annual review for diabetes. This helps to ensure that it is
in the target range and not increasing your risk of developing diabetes
complications.
Blood fats (lipids):
These need to be checked with a blood test once a year. Lipids are the
cholesterol and triglycerides in your blood. High levels are linked with
an increased risk of heart disease and stroke.
Care from your diabetes specialist
Whether you have just been diagnosed or had diabetes for some time it
is important that you get the right support for managing your diabetes.
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This will help to ensure that your diabetes, blood pressure and blood fats
are all kept in check, as well as detecting any early signs of complications
so that they can be caught and treated successfully. Your diabetes
specialist will monitor your diabetes control, and you should have a full
diabetes check at least once a year.
Taking care of your feet:
People with diabetes have a much greater risk of developing problems
with their feet, due to the damage raised blood sugars can cause to
sensation and circulation. So I encourage you to keep an eye on your
feet at home and make sure that you get a foot check from your specialist
once a year.
Top tips for healthy feet
• Check your feet every day - look for any signs of redness, pain, build-
up of hard skin or changes in the shape of your feet
• Be aware of any loss of feeling in your feet because you may not feel if
you hurt your feet.
• Look after your toenails.
• Do not use corn-removing plasters or blades as these can damage
healthy skin.
• Use moisturizing cream every day but avoid to apply it between your
toes.
• Wear well-fitting shoes that protect and support your feet.
• Always examine the inside of your shoes for sharp objects or stones
before putting them on and replace ruffled innersole linings. Avoid
socks, stockings or tights with wrinkles or prominent seams.
• Stockings or socks with elastic tops should also be avoided because
they may restrict the circulation.
• Contact your diabetes specialist at the first sign of any new foot
problem.
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Footwear:
The right shoes and stockings/tights/socks will help to keep your feet
healthy. This is why your choice of footwear is so important. It is not
normally necessary to buy special or expensive shoes. As long as you
follow the guidelines below, you should be able to buy the right footwear
in a high street store and at a reasonable price.
Shoes that do not fit well, even those that feel comfortable, can cause
corns, calluses, in growing toe-nails, blisters and ulcers. If you have
nerve damage (neuropathy) or poor circulation, wearing unsuitable
shoes is likely to make even simple foot problems worse. Finding shoes
that fit is not just a matter of buying a pair that feel comfortable or snug.
Buy shoes that:
• Are broad fitting
• Have a deep and rounded toe area
• Are flat or low heeled
• Are fastened by a lace or buckle to keep the heel in the back of the
shoe: the foot can then not slide forward and crush the toes at the end
of the shoe.
Living with diabetes:
Being diagnosed with diabetes, or knowing someone who is diagnosed
with the condition, may throw up many questions about how it fits into
your daily life, from how it makes you feel to managing diabetes at work,
or whilst you are driving. This section provides information about how
diabetes can fit around you and your life. Being diagnosed with diabetes
and living with diabetes can sometimes feel overwhelming – this is
quite normal. In the following section you can find out more about how
diabetes may affect your emotions and how you feel.
Your emotions:
One of the most difficult things to come to terms with is that diabetes
is for life. In the weeks and months after being diagnosed with diabetes,
emotions are often pushed to one side as you try to get to grips with new
treatments and changing your lifestyle. Everyone reacts differently when
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they hear the news. You may be overwhelmed, shocked, afraid, angry your mental stress is negatively affecting you blood sugar.
and anxious. Some people go through a stage very similar to mourning
– as though they are grieving for lost health. Some people hide these
What are the symptoms of stress?
feelings, but that doesn’t necessarily mean that they are coping without If you’re stressed, you may experience:
difficulty. Over time it is likely that you will become more confident in • headaches
your ability to cope with everyday activities, and the initial turmoil you
• muscle pain or tension
may have felt should start to fade.
• sleeping too much or too little
Stress management in Diabetes: • general feelings of illness
Diabetes management is a lifelong process. Stress can be a major barrier • fatigue
to effective glucose control. Stress, whether physical or mental has been If you’re stressed, you may feel:
proven to stimulate rapid changes in blood sugar level. When you’re
stressed, your blood sugar levels rise. • unmotivated

When under mental stress, people with diabetes generally experience an • irritable
increase in blood glucose levels. Your blood sugar can also increase when • depressed
your body is under physical stress. This can happen when you’re sick or
• restless
injured. Anything upsetting like going through a breakup or being laid
off is certainly emotionally draining. Being down with flu or suffering • anxious
from a urine infection places physical stress on the body. It’s generally It’s also common for people who are stressed to engage in behavior that
these longer-term stressors that tax your system and have much more may be out of character. This includes:
effect on blood sugar levels.
• withdrawing from friends and family
How can you determine if mental stress is affecting your • eating too much or too little
glucose levels?
• acting out in anger
Keeping track of additional information, such as the date and what you
were doing at the time you were stressed, may help you determine specific • using tobacco
triggers. For example, are you more stressed on Monday mornings? If How to reduce your stress levels:
so, you know now to take special steps on Monday mornings to lower
your stress and keep your glucose in check. You can figure out if this Reducing mental stress:
is happening to you by capturing your stress and glucose levels. If you Meditating can help remove negative thoughts and allow your mind to
feel stressed, rate your level of mental stress on a scale from 1 to 10. Ten relax. Consider starting each morning with a 15-minute meditation.
represents the highest level of stress. Write this number down. This will set the tone for the rest of your day.
After rating your stress, you should check your glucose levels. Continue Process:
doing this for the next couple of weeks. Before long, you may see a pattern
emerge. If you notice that your glucose is regularly high, it’s likely that Sit in a chair with your feet firmly planted on the floor and your eyes
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closed. Recite a mantra that makes sense to you, such as “I will have
a good day” or “I feel at peace with the world.” Push away any other
thoughts if they enter your head, and allow yourself to be present in the
moment.
Reducing emotional stress:
If you find yourself in an unwanted emotional state, take five minutes to
be by yourself. Remove yourself from your current environment. Find a
quiet space to focus on your breathing. Put your hand on your belly, and
feel it rise and fall. Inhale deep breaths, and exhale slowly and loudly.
This will slow your heartbeat down, and help bring you back to a stable
emotional state. This act of centering yourself may improve how you
deal with whatever is causing the stress.
Reducing physical stress:
Adding yoga to your daily routine can provide both physical activity
and meditation at the same time. Practicing yoga can lower your blood
pressure, too. Whether its yoga or another form of exercise, you should
aim for 30 minutes of cardiovascular exercise per day. You can do 10
minutes of exercise when you wake up, 10 minutes in the afternoon, and
10 minutes before you go to sleep.
Reducing family stress:
If you’re feeling overwhelmed by family obligations, remember that it’s
OK to say no. Your family will understand if you can’t make it to all
events. If your stress stems from not seeing your family as often as you’d
like, consider having a family fun night weekly or biweekly. You can
play board games or participate in outdoor activities. This can include
hiking, swimming, or signing up for a fun run together.
Reducing work stress:
Stress issues at work can come home with you. Talk to your supervisor
if you’re having a hard time at work. There may be options to alleviate
or work through any issues you may be having. If that doesn’t help, you
may want to consider transferring to a different department or even
finding new job altogether. Although stress levels elevate when looking
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for a new job, you may find it settles down with a different position
better suited for your skills and personality. Diabetes is a disease where
you have to be constantly monitoring your sugar levels because it has
a lot of impact on how you feel on a day to day basis. Too much or too
little of it makes you feel like you are on a roller coaster in terms of your
moods. Not only that, when you let it go up and down it can create more
complications in the long run.
How to incorporate walk and exercise in diabetes manage-
ment?
1. Take it one step at a time: A good way to start something new is to take
it slow, set achievable goals, and then make them more ambitious over
time. If you don’t walk at all right now, make a goal to walk in chunks.
After every 2 hours walk for like 15 minutes, if you feel exhausted then
bring it to 10. Your walk should be in chunks. Starting small and building
up over time makes starting a new goal less daunting. Plus, the gains you
make will give you a sense of satisfaction and encourage you to keep
going.
2. Make a schedule:
One easy way to remind yourself to walk or exercise is to schedule it
on your calendar this can serve as a daily reminder, as well as a way to
protect that time and avoid over scheduling yourself. And if your goal
is 60 minutes of walking per day, a calendar can make it seem manage-
able.
3. Involve friends and family:
Having someone join you in an exercise program can help keep you
accountable (i.e., you may be less likely to skip out on a session if you
know you’d be letting your partner down), make the time pass more
quickly, and even help foster some healthy competition.
4. Make it fun:
To pass the time while walking, options include listening to audiobooks,
music, or calling family members. There are also a variety of smartphone
apps that are designed to make walking more fun, trackable over time,
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and even more competitive. Activity trackers like Fitbit, which can be
very motivating for increasing daily steps.
Your specialist:
Your healthcare team is there to give you emotional support, reassurance
and help you to build your confidence in coping with diabetes.
Travel & diabetes:
People with diabetes can travel all over the world – diabetes is no barrier.
Make the right preparations and you should be able to minimize any
potential problems.
Things to check before you go:
• Carry diabetes identity (card/bracelet/necklace etc) and a letter from
your specialist, which says you have diabetes and the medication you
need to treat it if you are carrying insulin.
• Take twice the quantity of medical supplies you would normally use
for your diabetes.
Packing for your trip:
• Split your diabetes supplies in separate bags.
• If flying make sure you have some diabetes supplies in your hand
luggage in case your bags get lost.
• Pack extra snacks in case of delay with your journey.
• Make sure you have all your diabetes medication and equipment
packed.
• If you are carrying syringes and insulin on your flight take a letter
from your doctor.
Driving & diabetes:
Having diabetes does not mean that you need to give up driving, but it
does mean that you need to plan in advance before you get behind the
wheel.
If you are on insulin, check your blood glucose within two hours before
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getting behind the wheel and every two hours whilst driving.If blood
glucose is low you should take carbohydrate before driving.
Safe driving tips:
• Avoid delaying or missing meals and snacks
• Take breaks on long journeys
• Always keep hypo (low blood sugar) treatments to hand in the car
Many of the accidents caused by hypoglycaemia (low blood sugar) are
because drivers have continued to drive, ignoring their hypo (low blood
sugar) warning signs (eg hunger, sweating, feeling faint). If you have a
hypo (low blood sugar) whilst driving:
• Stop the vehicle as soon as possible
• Switch off the engine, remove the keys from the ignition and move
from the driver’s seat
• Take some fast-acting carbohydrate, such as sugary drink/jellies or
sweets, and some form of longer-acting carbohydrate.
• Do not start driving until 45 minutes after blood glucose has
normalised.
Pregnancy & diabetes:
Having children is a big decision for any female. Most women who have
type 2 diabetes have healthy pregnancies and healthy babies however
diabetes can have certain adverse effects on health of the baby and lead
to complications during pregnancy hence it if you are planning to have
a baby or think you are pregnant then it is vital that you speak to your
diabetes specialist.
Diabetes complications:
People living with diabetes may have to deal with short-term or long-term
complications as a result of their condition. Short-term complications
include hypoglycaemia (low blood sugar). Long-term complications
include how diabetes affects your heart (cardiovascular disease), eyes
(retinopathy), kidneys (nephropathy), and nerves and feet (neuropathy).
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Hypoglycaemia (low blood sugar):
Hypoglycaemia means ‘low blood sugar levels’ – less than 72 mg/dl. This
is too low to provide enough energy for your body’s activities.
Symptoms:
Hypoglycaemia can come on quickly and everyone has different
symptoms, but common ones are: feeling shaky, sweating, hunger,
tiredness, blurred vision, lack of concentration, headaches, feeling
tearful, stroppy or moody, going pale.
Why do hypos (low blood sugar) happen?
There’s no rule as to why they happen, but some things make it more
likely: excess insulin, delayed or missed meal or snack, not enough
carbohydrates or unplanned physical activity. Sometimes there just is
no obvious cause.
How to prevent hypoglycaemia:
• Don’t miss a meal.
• Eat enough carbohydrates.
• Eat extra carbohydrates if you are more active than normal.
• Take your tablets and/or insulin injections correctly.
Treating hypoglycaemia:
Treat immediately with 15–20g of fast-acting carbohydrate. Examples
include
• Small glass/pack of sugary (non-diet) drink (juice, squash, regular
pepsi/coke)
• One tablespoon of sugar dissolved in water
• Five jellies or sweets
Don’t treat your hypoglycaemia with foods that are high in fat such as
chocolate and biscuits because the fat will delay the absorption of the
glucose and won’t treat the hypoglycaemia quickly enough.
Follow this treatment with a snack of 15–20g of slower-acting
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carbohydrate to prevent their blood glucose levels getting low again.
This snack could be a sandwich, piece of fruit, cereal or some biscuits
and milk – or even your next meal, if it’s due.
It’s recommended that you retest your blood glucose (sugar) levels after
15–20 minutes and re-treat if your blood glucose levels are still less than
72 mg/dl. The choice of hypo treatment is up to you, so you’ll need to
decide how much and which treatment works best for you.
If you become unconscious:
If you have severe hypoglycaemia (low blood sugar) and become
unconscious you will need help from someone. Food or drink should
never be given by mouth in such a situation because there is a danger of
choking. You will need to be taken you to the nearest hospital.
Should I keep my blood glucose (sugar) levels high to avoid
hypoglycaemia?
No. It can be harmful for you if you try to run your blood glucose levels
consistently very high. You may start to feel thirsty, go to the toilet
frequently and feel tired. In the long term, prolonged high blood glucose
levels can lead to complications such as blindness, heart attack, stroke,
kidney disease and lower limb amputations.
Will hypos (low blood sugar) affect my quality of life?
Hypos should not be frequent or severe. If they are, contact your diabetes
diabetes specialist.
Cardiovascular disease:
Damage to the heart and blood vessels is collectively known as
cardiovascular disease and people with diabetes have a higher chance
of developing it. The term cardiovascular disease (CVD) includes heart
disease, stroke and all other diseases of the heart and circulation.
Cardiovascular problems:
Your major blood vessels consist of arteries which carry blood away
from your heart, and veins which return it. Blockage of an artery leads to
the part of the body it supplies being starved of the oxygen and nutrients
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it needs. This is the cause of heart attack or strokes (affecting the brain).
Narrowing of the blood vessels can affect other parts of the body, such as
the arms or legs. This is called peripheral vascular disease (PVD). PVD
may produce intermittent claudication (pain in the calf muscle). If left
untreated, amputation of the limb may eventually be necessary.
What causes cardiovascular disease?
Blood vessels are damaged by high blood glucose levels, high blood
pressure, smoking or high levels of cholesterol. This is a gradual process
and takes years to decades. So, it is important for people with diabetes to
manage these levels both short and long term.
Steps you can take to help prevent cardiovascular problems:
• If you smoke, stop.
• Eat a healthy, balanced diet.
• Be more physically active.
• If you are overweight, try to get down to a healthy weight. Your
specialist can guide you about your target weight. Any weight loss
will be of benefit.
• Take your medication as prescribed.
• Get your blood glucose levels, blood pressure and blood cholesterol
checked at least once a year and aim to keep to the target agreed with
your specialist.
Eyes (retinopathy):
Diabetic retinopathy is damage to the retina (the ‘seeing’ part at the back
of the eye) and is a complication that can affect people with diabetes.
Retinopathy is the most common cause of blindness among people of
working age. Diabetes can lead to damage in your eyes. To reduce the
risk of eye problems, blood glucose, blood pressure and blood fats need
to be kept within a target range, which should be agreed by you and your
specialist. Smoking also plays a major part in eye damage so, if you do
smoke, stopping will be extremely helpful. Your eyes in general along
with back of the eye examination needs to be undertaken by an eye
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(ophthalmology) specialist once a year. As retinopathy frequently has no
symptoms until it is well advanced, you may not be aware of changes to
the retina until your vision has been impaired. Annual examination will
detect retinopathy early and therefore increase the chances of minimal
and more effective treatment.
Kidneys (nephropathy):
Kidney disease can happen to anyone but it is much more common
in people with diabetes and people with high blood pressure. Kidney
disease in diabetes develops very slowly, over many years. It is most
common in people who have had the condition for over 20 years. About
one in three people with diabetes might go on to develop kidney disease,
although, as treatments improve, fewer people are affected.
What is kidney disease?
The kidneys regulate the amount of fluid and various salts in the body,
helping to control blood pressure. They also release several hormones.
Kidney disease ( nephropathy) is when the kidneys start to fail. If the
kidneys start to fail they cannot carry out their jobs so well. In the very
early stages there are usually no symptoms and you may not feel unwell.
As kidney disease progresses, the kidneys become less and less efficient
and the person can become very ill. This happens as a result of the build
up of waste products in the blood, which the body cannot get rid of.
There are changes in blood pressure and in the fluid balance of the body.
This can lead to swelling, especially in the feet and ankles..
Why are people with diabetes more at risk?
Kidney disease is caused by damage to small blood vessels. This damage
can cause the vessels to become leaky or, in some cases, to stop working,
making the kidneys work less efficiently. Keeping blood glucose levels
as near normal as possible can greatly reduce the risk of kidney disease
developing as well as other diabetes complications. It is also very
important to keep blood pressure controlled.
How does my specialist check for kidney disease?
As part of your diabetes review you should have a blood and urine test
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once a year. Your urine will be checked for tiny particles of protein. These
appear during the first stages of kidney disease, as the kidneys become
‘leaky’ and lose protein. At this stage, kidney disease can often be treated
successfully, so this test is very important. The blood test will measure
how well the kidneys are working.
What sort of treatment might be recommended?
This depends on multiple factors such as blood pressure. Keeping blood
pressure under control is extremely important, and tablets for lowering
blood pressure are often used. Your specialist is likely to prescribe a
common treatment (tablet) which is particularly successful as they not
only lower blood pressure but also help protect the kidneys from further
damage. These medications are sometimes used in people who have
normal blood pressure, due to their protective effect on the kidneys.
What if kidney disease gets worse?
There are many ways of treating kidney disease if the kidneys are no
longer able to function properly. You may need to limit certain foods in
your diet, such as protein foods or foods high in potassium, phosphate
or sodium. This aims to prevent waste products building up in your
body. Controlling blood pressure is also very important. If the kidneys
have been damaged, the filtering and cleaning of the blood cannot be
done normally. In such cases, dialysis might be needed to do this job for
the kidneys.
What can I do to look after my kidneys?
Taking care of your kidneys is an essential part of managing your
diabetes.
• Attend all your diabetes appointments.
• Keep your blood glucose (sugar) levels and blood pressure levels on
target.
• Have your urine and blood test to measure kidney function once a
year.
• Stop smoking.
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• Eat healthily and keep active.
Nerves (neuropathy):
Neuropathy is one of the long-term complications of diabetes.
What is neuropathy?
Neuropathy is one of the long-term complications which affects the
nerves. Nerves carry messages between the brain and every part of our
bodies, making it possible to see, hear, feel and move. Nerves also carry
signals that we are not aware of to parts of the body such as the heart,
causing it to beat, and the lungs, so we can breathe. So, damage to the
nerves can cause problems in various parts of the body. Diabetes can
cause neuropathy as a result of high blood glucose levels damaging the
small blood vessels which supply the nerves. This prevents essential
nutrients reaching the nerves. Neuropathy mainly affects the nerves in
the feet and the legs, but people can also develop this type of neuropathy
in their arms and hands.
Symptoms can include:
• Tingling and numbness.
• Loss of ability to feel pain.
• Loss of ability to detect changes in temperature.
• Loss of coordination – when you lose your joint position sense.
• Burning or shooting pains – these may be worse at night time.
The main danger of sensory neuropathy for someone with diabetes
is loss of feeling in the feet, especially if you don’t realize that this has
happened. This is dangerous because you may not notice minor injuries
caused by:
• Walking around barefoot.
• Sharp objects in shoes.
• Friction from badly fitting shoes.
If ignored, minor injuries may develop into infections or ulcers. People
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with diabetes are more likely to be admitted to hospital with a foot ulcer
than with any other diabetes complication.
Charcot joint is a rare complication of people with diabetes who have
severe neuropathy. It happens when an injury to the foot causes a broken
bone, which may go unnoticed because of the existing neuropathy. The
bone then heals abnormally, causing the foot to become deformed.
Treatment includes immobilizing the foot in a plaster cast and in some
cases surgery.
There are many treatments available to relieve the symptoms caused by
neuropathy.
Steps you can take to avoid neuropathy
• Keep your blood glucose levels within your target range.
• Examining your feet regularly.
• Having your feet checked by your specialist at least once a year.
Myths and frequently asked questions:
Myths:
Knowing the facts about diabetes is important when it comes to
managing the condition. There is so much information out there, but it
is not all true. It is often difficult to know what is right and what is not.
This section aims to help dispel some of the most common myths about
diabetes – let’s have a look at some of them.
Myth: people with Diabetes cannot have sugar:
Having diabetes does not mean you have to have a sugar-free diet. People
with diabetes should follow a healthy balanced diet – that is low in fat,
salt and sugar. You should still be able to enjoy a wide variety of foods,
including some with sugar.
Myth: people with Diabetes should eat ‘diabetic’ foods:
‘Diabetic’ labelling tends to be used on sweets, biscuits and similar foods
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that are generally high in fat, especially saturated fat and calories. I do
not recommend eating ‘diabetic’ foods, including diabetic chocolate,
because they still affect your blood glucose levels, they are expensive
and they can give you diarrhoea.
Myth: people with Diabetes eventually go blind:
Although diabetes is the leading cause of blindness in people of working
age research has proved you can reduce your chances of developing
diabetes complications – such as damage to your eyes – if you:
• Control your blood pressure, glucose, and blood fat levels
• Keep active
• Maintain your ideal body weight
• Give up smoking.
Myth: it’s not safe to drive if you have diabetes:
If you are responsible and have good control of your diabetes, research
shows that people with diabetes are no less safe on the roads than anyone
else.
Myth: people with diabetes can’t play sport:
People with diabetes are encouraged to exercise as part of a healthy
lifestyle. Keeping active can help reduce the risk of complications
associated with diabetes, such as heart disease. Many well known sport
athletes around the world have diabetes. However, there may be some
considerations to take into account before taking up a new exercise
regime. Talk to your specialist for more information.
Myth: people with diabetes are more likely to get colds and
other illnesses:
Not true. While there is some medical research that may suggest people
with diabetes are at higher risk of developing illnesses, there’s nothing
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to prove this conclusively. But there are certain illnesses that are more
common in people with diabetes, and diabetes may also alter the course
of an illness – for example, a person with diabetes may become more
unwell or be unwell for longer than a person without diabetes.

Myth: people with diabetes can’t eat fruits like grapes, man-
goes or bananas:
People sometimes think that if they have diabetes they can’t eat grapes
and bananas as they taste sweet. But if you eat a diet that includes these
fruits in reasonable quantity, you can still achieve good blood glucose
control. In fact, grapes and bananas, like all fruit, make a very healthy
choice. Fruit is high in fibre, low in fat and full of vitamins and minerals.
It helps to protect against heart disease, cancer and certain stomach
problems.

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