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Diabetes - Made Simple

Type 1 Diabetes

Type 1 diabetes is an auto-immune condition where the body has destroyed the insulin producing cells in the pancreas, thereby making the person with Type 1 diabetes dependant on insulin injections for the rest of their lives.

Auto-immune - this is a disorder of the body’s immune system that mistakes certain cells in the body as being “foreign” to the body, and thus the immune system destroys these cells.

The majority (75%) of type 1 diabetes patients are diagnosed under the age of 18years, however the diagnosis can be made up to the age of 35. Only 10% of all people living with diabetes nave type 1 diabetes. 

Symptoms of Type 1 Diabetes

The following are symptoms of type 1 diabetes that should alert you to take your child to the doctor or for you to visit your doctor
  • Excessive thirst – known as polydipsia
  • Excessive urination – known as polyuria
  • Weight loss
  • Bedwetting in a previously toilet-trained child.
  • Vaginal infections (candidiasis) especially in pre-puberty girls
  • Irritability and decreasing school performance
  • Recurrent skin infections
The following are more severe symptoms and immediate medical help should be sought
  • Severe dehydration
  • Frequent vomiting
  • Stomach / abdominal pain
  • Flushed cheeks and rapid / sighing type of breathing

Treating Type 1 Diabetes

Due to the fact that the body cannot produce any insulin, the hormone that is needed to move sugar (glucose) from the food we eat, into the body’s cells where it can be used for energy, people with type 1 diabetes have to inject insulin every day. This is quite overwhelming when you have to start injecting, and therefore it is important that you receive the proper education and training on injecting insulin as well as all the related aspects of using insulin, like storing your insulin and testing your blood sugar (glucose) levels daily.

The easiest way to inject insulin is using an “insulin-pen”. All the insulin’s that are available in South Africa are available in an “insulin-pen”. Below is are examples of what an insulin pen looks like:

Insulin pens open

There are also “insulin-pumps” available in South Africa, but they are very expensive and your doctor will have to request this specifically from your medical aid.

Types of insulin

There are different types of insulin that used to treat diabetes. For type 1 diabetes your doctor will probably prescribe what is known as a “basal-bolus” regimen.  Your will inject 2 different types of insulin: Rapid acting insulin at meals and basal / long acting insulin either in the morning or in the evening. The picture below shows when the insulin injections are given.

Bolus / Rapid acting insulin

This is normally injected immediately before the meal. Types of rapid acting insulin available in South Africa are: Apidra®; Humalog®; NovoRapid®

Bolus / Rapid acting insulin is clear / colourless and thus you do not have to mix / shake your insulin before injecting.

Basal / long acting insulin

This is normally injected any time between dinner time and bedtime, but should always be injected at the same time every day. Sometimes the basal insulin can be injected in the morning.  Types of basal / long acting insulin available in South Africa are: Intermediate-acting insulin: Biosulin® N; Humulin® N; Protaphane®   Long-acting basal insulinLantus®; Levemir®


Intermediate-acting insulin should always be shaken  / mixed before it is injected. This is to make sure that all the insulin is mixed into the liquid. The insulin should be "milky" before you inject. Ask your doctor to show you how to mix / shake your insulin. 

Long- acting basal insulin is a clear  / colourless insulin, and thus you do not have mix / shake it before you inject.

Below is a diagram illustrating when the Bolus / Rapid-acting insulin and the Basal / Long acting insulin should be injected.

Basal Bolus



Blood sugar (glucose) monitoring

All people living with diabetes should be testing (monitoring) their blood sugar levels. This is necessary to monitor how much sugar (glucose) is circulating in your blood so that you can adjust your eating, exercise and / or medication to ensure that your blood sugar (glucose) levels are within “range” or are “on target” .

Major studies have been done in diabetes that have proven that controlling blood sugar(glucose) levels can prevent hypo (low) and hyper (high) blood sugar levels as well as the onset and / or progression of diabetes related complications like, blindness, heart attacks, strokes, kidney damage and amputations.

Your doctor will tell you what targets to aim for, but below is a table that indicates the range that most people living with diabetes should aim for to prevent complications.

Home blood sugar (glucose) monitoring is done using a blood glucose monitor and blood glucose test strips.

Below is a table indicating the targets that you should be aiming for. If you are not reaching these targets your doctor may adjust your treatment.

Fasting Blood Glucose: First thing in the morning before eating or drinking

Less than 7mmol/l (<7.0mmol/l)

Post Prandial Glucose: 2 hours after eating a meal

Between 5 and 10mmol/l (5.0-10.0mmol/l)

HbA1c: 3 monthly blood test 

 Less than or equal 7% (≤7%)

NOTE: that your doctor may set different targets for you depending your health status.

Hypoglycaemia

All people living with diabetes are at risk of developing hypoglycaemia.

Hypoglycaemia: “hypo” means low; gly = glucose; aemia = blood: therefore hypoglycaemia means LOW BLOOD GLUCOSE levels.  A blood glucose levels less than 4.0mmol/l are considered to be hypoglycaemia.

The causes of hypoglycaemia are:

  • Taking too much medication especially too much insulin
  • Not eating / missing a meal
  • Unplanned exercise or too strenuous exercise
  • Drinking alcohol, especially without eating
  • Vomiting
Symptoms will normally appear when blood glucose (sugar) levels are less than 4.0mmol/l. The brain needs glucose (sugar) to function, so if your blood glucose level drops too much then this will affect your ability to function normally. If left untreated it can lead to a coma.

The early warning signs or symptoms of hypoglycaemia are: (these are syptoms of MILD / MODERATE Hypoglycaemia i.e. you are still able to treat yourself) 

Shaking

Sweating

Trembling

Pounding heart /racing pulse

Dizziness

Feeling hungry

Headache

Irritability

Feeling anxious

Pale skin

   

Should you feel any of these symptoms you should immediately test your blood sugar levels and treat as outlined below. (Take action even if you are unable to test your blood sugar levels).

Treating mild to moderate hypoglycaemia

  1. Immediately take about 20gms of glucose /sugar. There are fast acting glucose tablets available called Dex4, you can get these at your local pharmacy. Taking 4 of these tablets is equal to 20gms of glucose. You can also eat about 3-5 Super-C sweets.
  2. Drink a sugary drink like ½ Coke, or ½ glass fruit juice, or a 100ml Lucozade
  3. Try and avoid chocolates and foods with a high fat content as this delays the absorption of the sugar.
  4. Test your blood sugar level after 15 minutes, if it is still low and you still have symptoms treat as above, and re-test in 15 minutes.
  5. If your next meal is quite soon – eat your meal, if not then eat a snack like a slice of bread with cheese / peanut butter, fruit or milk. Check your blood glucose again in an hour.
  6. Do not attempt to drive your car if you are still feeling hypo, and do not do any exercise until a proper meal has been eaten.
Remember the best way to prevent hypoglycaemia is to be aware of what causes hypoglycaemia. 

Later and more severe symptoms of hypoglycaemia include:

Weakness

Clumsiness

Slurred speech, difficulty speaking

Blurred or double vision

Confusion

Convulsions or seizures

Unconsciousness

   
Often at this stage you will not be able to treat yourself and a family member or friend may have to assist you. If left untreated this can lead to a coma.

Speak to your doctor about a Glucagon Hypokit.  This is an emergency kit that you can keep with you at all times that a family member or friend can use to assist you when you are experiencing severe symptoms. Below is a video on how to use the EMERGENCY HYPOKIT


Hyperglycaemia

Hyperglycaemia is common in people living with diabetes, even if your blood sugar (glucose) levels are well controlled you may experience episodes of hyperglycaemia.

Hyperglycaemia: “hyper” means high; gly = glucose; aemia = blood: therefore hyperglycaemia means HIGH BLOOD GLUCOSE levels. Normally symptoms of hyperglycaemia will only appear if the blood glucose (sugar) level is greater than 11.0mmol/l. 

The causes of hyperglycaemia are:

  • Not using enough insulin or oral diabetes medication
  • Not injecting insulin properly or missing an insulin injection
  • Not following your diabetes eating plan
  • Being inactive
  • Having an illness or infection
  • Using certain medications, such as steroids
  • Being injured or having surgery
  • Experiencing emotional stress, such as family conflict or workplace challenges
The symptoms of hyperglycaemia are:

  • Frequent urination (needing to go to the toilet more often than normal)
  • Increased thirst
  • Blurred vision
  • Fatigue (unusual tiredness)
  • Headache
When you feel these symptoms, you should test your blood sugar (glucose) levels, and you should try and drink as much water and or DIET coke as possible.  When your blood sugar (glucose) levels are high, it can result in you losing extra fluid and thus result in dehydration. Try and avoid eating any sugar foods or drinking any sugary liquids like Coke and fruit juice.  If your blood sugar level is greater than 14mmol/l do not exercise as this could make your blood sugar levels go even higher.

If you have missed your medication, do not double up on your next dose, just take your next normal dose as prescribed by your doctor.

If you start experiencing any of the following symptoms, contact your doctor.

Vomiting and or diarrhoea, stomach ache, chest pain and or difficulty in breathing, a fruity smell on your breath, difficulty in concentrating and staying awake, as these are the symptoms of Diabetic Ketoacidosis (DKA), and if left untreated could lead to a coma.

Continue to drink as much water and or DIET coke as possible.

Diabetic Ketoacidosis (DKA) is a serious condition that occurs when there is a lack of insulin in the body, leading to high blood sugar (glucose) levels, and a build-up of ketones in the blood and urine. Ketones are formed when the body breaks down fat for energy. DKA is more common in Type 1 diabetes, but may occur in people with long duration type 2 diabetes who are on insulin.