Diabetes and Heart Health

People with diabetes are more likely to develop heart disease or have a stroke than people without diabetes, and they are more likely to develop these problems at a younger age.

This is due, at least in part, to the fact that high blood glucose (blood sugar) levels can damage blood vessels as well as the nerves that control the heart and blood vessels. Additionally, people with diabetes often have a number of other risk factors that increase the chances of developing heart disease. These risk factors include being overweight (especially if the excess fat is found around the waist), high blood pressure, high cholesterol, being inactive, and smoking or using other tobacco products. Having a family history of heart disease or stroke also increases the risk. Because there is nothing we can do about our family history, it is even more important to take actions to minimize those risk factors that we can control.

Reducing your risk

Fortunately, you can reduce your risk of developing heart disease or having a stroke by taking steps to manage your blood glucose, monitoring your health, and making wise lifestyle choices. Here are some guidelines that will help.

• Alcohol intake: If you consume alcohol, check with your doctor to make sure it is all right for you to do so. Alcohol raises blood pressure by interfering with blood flow to and from the heart, and it can affect blood glucose levels. If your doctor says it is okay for you to drink alcohol, do so in moderation.

• Blood glucose: Aim for an A1C level of 7% or less by following your diabetes management plan.

• Blood pressure: Test your blood pressure regularly to make sure it is within the range your healthcare team has established for you, and have it professionally checked every time you visit your healthcare provider.

• Cholesterol: LDL cholesterol (sometimes called “bad” cholesterol) increases the risk of heart problems. Aim to keep yours below 2.0 mmol/L. To limit your LDL cholesterol and raise your HDL (“good”) cholesterol, limit the amount of animal fats you consume and eat more plant-based foods. Triglycerides, another type of blood fat related to cholesterol, can also raise heart disease risk. Check with your healthcare team to find out what range your triglycerides should be in and have your triglyceride levels checked periodically to make sure they are in that range.

• Smoking: The nicotine in tobacco causes blood vessels to narrow, which raises blood pressure. Smoking also makes blood pressure medications less effective. If you are a smoker and need help quitting, your London Drugs pharmacists can help with tips and smoking cessation products that can help you quit successfully.

• Stress: Stress can affect both blood pressure and blood glucose. Learn to manage stress in a healthy manner. Some options include socializing, being physically active, listening to soothing music, and engaging in a hobby you enjoy. Practicing relaxation techniques for just a few minutes each day can also help you manage your stress in a healthy manner.

Helpful relaxation techniques include:

• Yoga and tai chi are ancient arts that combine rhythmic breathing with postures or flowing movements. They provide a mental focus that is calming and can distract you from distressing thoughts.

• Mindful meditation involves sitting comfortably and focusing your attention on your breathing and on the present moment. Don’t let your mind drift to another time or place or to things you are concerned about. Research shows that mindful meditation may be helpful in relieving anxiety, depression, and pain.

• Guided imagery involves calling to mind images of places or experiences that you find soothing to help you relax.

• Breath focus is a simple technique in which you focus on taking long, slow, deep breaths and try to distance your mind from distracting thoughts.

• Body scan combines progressive muscle relaxation with breath focus. After a few minutes of deep breathing, focus your mind on one part of your body or one muscle group at a time and mentally release any physical tension you feel there. When the tension in that spot eases, shift your focus to another part of your body, moving your attention methodically until you have relaxed your entire body.

• Weight: Being overweight can make it more difficult to manage diabetes and can raise the risk for many health problems including high blood pressure and heart disease. A healthy eating plan and more physical activity often help. Excess fat carried around the waist can raise the risk of heart disease even in people who are not overweight. Ask your healthcare team to assess your waist circumference to see if your belly fat is in the healthy range.

When lifestyle changes aren’t enough to reduce your risk, your doctor may prescribe medication. It is important to take the medicine exactly as prescribed in order to get the most benefit from it. If you have any questions about your medicines or how to take them, your London Drugs pharmacists will be happy to answer them. Learn more about the Diabetes Management Clinics offered at London Drugs.

Managing your heart health

Coronary artery disease is the most common form of heart disease for people living with diabetes. This is caused by a buildup of plaque, or cholesterol deposits in the coronary artery walls. These arteries serve to supply oxygen and blood to the heart. When the plaque narrows or blocks the arteries, it decreases the blood flow to the heart, which can then cause a heart attack. If the blood flow to the brain is decreased, a stroke can occur. 1

Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. 2 Gradually, high blood sugar can cause damage to your blood vessels and nerves. When your blood vessels are weak, they can become leaky and susceptible to cholesterol buildup. 3 However, you can make changes today to lower your risk of a heart attack or stroke by knowing you ABCDEsss 4*.

A – A1C of 7.0% or less
This lab test is done every 3 to 6 months measures your blood sugar control.

B – Blood pressure (BP) of less than 130/80 mmHg
Systolic is your top number. Diastolic is your bottom number.

C – Cholesterol (LDL cholesterol) less than 2.0 mmol/L
Buildup of LDL (low-density lipoprotein) and low HDL (high-density lipoprotein) increases the risk of heart attack and stroke.

Drugs
Speak to your health care team about medication to lower your risk of a heart attack or stroke.

Exercise and healthy eating.
See below for some tips.

Self-management support
People with diabetes should set personalized goals to manage their diabetes.

Screening for diabetes complications
Most people with diabetes will need a yearly foot exam, kidney evaluation and an eye exam.

Smoking increases your risk of heart attack and stroke
If you smoke, you should quit.

How to reduce your risk of a heart attack and stroke*

Maintain a healthy plate. 6

• Cook at home. Try to limit highly processed food and restaurant food that are high in salt, fat, and sugar. 7

• Read food labels. Look for foods with a % daily value (%DV) of less than 5% for fat, sodium, sugars. 8

• Make a grocery list. This helps to prevent impulse buys, helps you stay on budget and reduces food waste. 9

Exercise: Keeping active helps your diabetes and your heart

Experts recommend that keeping active can have major benefits for your diabetes, heart, and your weight. It is recommended that you should try to get 5*:

• 150 minutes of aerobic exercise per week. Aerobic is exercise that makes you breathe faster and raises your heart rate. e.g. brisk walking, swimming, dancing, and riding a bike.

• Lifting weights 2 to 3 times per week.

Symptoms of heart disease. 10

The symptoms of heart disease may differ between men and women. Signs may include:

• Chest pain, including a burning sensation, heaviness or pressure/discomfort in the chest

• Upper body discomfort in your arms, neck, shoulders, back or jaw

• Shortness of breath

• Lightheadedness/fainting

• Sweating

• Nausea

If you experience any of these symptoms, immediately call 911 or your local emergency number.

TM see www.ascensiadiabetes.ca/tm-mc. All other trademarks are the property of their respective owners © 2021 Ascensia Diabetes Care Canada Inc.
* Patient should consult with their health care provider about taking medications and prior to making any changes to treatment regimen. 1. Centers for Disease Control and Prevention (2021). Diabetes and Your Heart. https://www.cdc.gov/diabetges/library/features/diabetes-and-heart.html. 2. National Institute of Diabetes and Digestive and Kidney Diseases (2020 NIDDK). Diabetes, Heart Disease, and Stroke. https://www.niddk.nih.gov/health-information/diabetes/overview/preventingproblems/heart-disease-stroke. 3. Heart and Stroke Foundation. Diabetes and heart disease: your top 3 questions answered. https://www.heartandstroke.ca/articles/diabetes-and-heart-disease-your-top-3-questions-answered. 4. Diabetes Canada (2020 Canadian Diabetes Association). Staying healthy with diabetes. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/staying-healthy-with-diabetes.pdf?ext=.pdf. 5. Diabetes Canada (2020 Canadian Diabetes Association). Physical activity and diabetes. http://guidelines.diabetes.ca/docs/patient-resources/physical-activityand-diabetes.pdf. 6. Canada’s Food Guide (2019 Government of Canada). Food guide snapshot. https://food-guide.canada.ca/en/food-guide-snapshot. 7. Canada’s Food Guide (2019 Government of Canada). Cook more often. https://food-guide.canada.ca/en/healthy-eating-recommendations/cook-more-often. 8. Canada’s Food Guide (2019 Government of Canada). Use food labels. https://food-guide.canada.ca/en/healthy-eatingrecommendations/using-food-labels. 9. Canada’s Food Guide (2019 Government of Canada). Meal planning. https://food-guide.canada.ca/en/tips-for-healthy-eating/meal-planning. 10. Heart and Stroke Foundation. Emergency Signs. https://www.heartandstroke.ca/heart-disease/emergency-signs.

Blood Glucose Monitoring

Self-monitoring of blood glucose (blood sugar) levels is a critical part of managing
diabetes, because it provides a picture of how well blood glucose is being controlled. In addition to providing an indication of long-term control, it helps identify impending problems, and this allows people to make necessary adjustments to prevent highs and lows. For example, if blood glucose drops, the person can eat something; if it rises, a medication adjustment may be necessary.

Traditionally, blood glucose self-monitoring has been done using a blood sample obtained by pricking part of the body—usually a finger—with a lancet and applying the sample to a special strip that is read by a glucose testing device.

Continuous glucose monitoring

Another testing option is also available. Called continuous glucose monitoring (CGM), it involves a small, disposable sensor that is worn under the skin (commonly on the arm or stomach) and tests blood glucose every few minutes all day and night. The readings are sent to a transmitter and usually to a separate device as well, allowing the data to be read by the patient, caregiver, or healthcare provider. The CGM can also be paired with an insulin pump, which is called integrated CGM.

CGM is a good option for some patients, because:

• It allows people to see their blood glucose reading 24 hours a day with few—or
sometimes even no—finger prick tests.

• It improves the ability to identify glucose patterns, so daily management decisions can be made in a timely manner.

• Because CGM monitors blood glucose continually, it can be particularly helpful overnight when regular testing is not likely to be done. Alarms and alerts can warn users when blood glucose drops too low.

• It provides more information than sporadic finger prick tests. The device shows the current glucose reading, a graph of glucose readings over the previous hours, and
the rate of change in the levels.

• The ease of use and greater information provided can lead to improved glycemic control.

According to Diabetes Canada, there is evidence to suggest that CGM may be beneficial for both adults and children with type 1 diabetes who have not achieved their blood glucose targets or who have difficulty with hypoglycemia.

Diabetes apps

Apps that help manage blood glucose have been shown to be beneficial in improving the health of people with diabetes. Many diabetes devices—including glucose meters, continuous monitors, and insulin pumps—come with integrated apps that sync the device to a mobile phone. A diabetes educator can help you learn how they work.

The bottom line

Diabetes management must be individualized. People living with diabetes should work with their healthcare team to determine the meal plan, activity program, blood glucose monitoring device and schedule, and the diabetes supplies that will best meet their personal needs.

Your London Drugs pharmacists are always happy to answer your questions and counsel you on products to help you manage your diabetes and lead a healthy life.

Could you have diabetes?

On average, every day 480 Canadians are diagnosed with diabetes, more than 20 Canadians die of diabetes-related complications, and 14 Canadians have a lower limb amputated due to diabetes. Could you have diabetes and not know it? It is important to know whether you have diabetes, because if you are aware of it, you can take steps to manage your condition and lead a healthier life. However, if left untreated, diabetes can cause very serious complications.

Different types of diabetes

There are several different types of diabetes:

• Type 1 diabetes is a condition in which the body’s immune system destroys the insulin-producing cells of the pancreas, making the affected people dependent on injecting insulin into their bodies. Type 1 diabetes usually develops in children and youths, but it can occur in adults as well.

• Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body cannot properly use the insulin it produces. In some cases, type 2 diabetes can be managed with oral medication, but some people with type 2 will need to inject insulin.

• Gestational diabetes may develop during pregnancy if a woman’s blood sugar reaches too high a level. It usually disappears following delivery of the baby, but it increases the woman’s chances of developing type 2 diabetes.

What causes diabetes?

There is a lot of misinformation about diabetes floating around. For example, diabetes is not caused by eating too much sugar, and people do not give themselves diabetes. The causes of diabetes depend on the type of diabetes the person has—type 1 diabetes, type 2 diabetes, or gestational diabetes. Among the possible causes are your genes, family medical history, ethnic background, and your general health.

Symptoms

Some people with diabetes don’t experience any obvious warning signs, but those who do may have some of the following symptoms:

• cuts and bruises that are slow to heal
• lack of energy or extreme fatigue
• frequent or recurring infections
• unusual thirst
• frequent urination
• tingling or numbness in the hands or feet
• trouble achieving or maintaining an erection
• blurred vision
• weight loss or weight gain

Prediabetes

Prediabetes is a condition in which blood glucose (blood sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. Nearly six million Canadians have prediabetes. If left untreated, prediabetes can develop into type 2 diabetes. If you have prediabetes, taking steps to manage your blood glucose levels can help prevent you from developing diabetes.

Managing blood glucose

There are several measures you can take to help manage your blood glucose levels:

• Eat a healthy diet
• Be physically active
• Achieve and maintain a healthy body weight
• Monitor your blood glucose levels regularly
• Take any medication your doctor prescribes exactly according to the directions

Diagnosing diabetes

If you think you or someone you know may have diabetes, seek medical attention as soon as possible, so you can begin managing the condition and prevent complications. There are several tests used to diagnose diabetes:

• Fasting blood glucose test
• Random blood glucose test
• A1C test
• Oral glucose tolerance test

While diabetes cannot be cured, it can be managed, and people with diabetes can lead happy, fulfilling lives. Diabetes Management Clinics are also available at London Drugs for one-on-one consultations.

Read other articles in our Fall-Winter 2021 volume of our Bettercare magazine here or learn more about the Diabetes services offered at London Drugs.

Kids, Diabetes and School

Students with diabetes spend more than half of their waking hours in school during weekdays, so it is extremely important that the students, their parents or guardians, school personnel, and healthcare providers understand their roles and responsibilities in helping these students manage their diabetes and their schoolwork. They must all work together to meet the varying needs of each individual student.

Daily management

Daily diabetes management requires a balance of medication, food, and activity. A student whose blood glucose climbs too high or dips too low may be unable to perform school-related tasks. Often help from school personnel can provide the assistance that students need to manage their diabetes effectively.

Individual care plan

It all begins with the student’s individual care plan (ICP), which should be given to the school by the student’s parents or guardians. The ICP provides the school with pertinent details about the student’s daily diabetes management program and plans for dealing with emergencies.

The plan should provide the following information:

• Emergency contact information for the student’s parents or guardians and contact information for the student’s healthcare provider
• The type of diabetes the student has
• Medication/insulin dosing schedule
• Blood glucose (blood sugar) target range and frequency of testing
• Symptoms of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose) along with instructions for appropriate treatment
• Treatment options for dealing with hypoglycemia and hyperglycemia, including emergency procedures for dealing with severe hypoglycemia and hyperglycemia
• A plan for preventing hypoglycemia following periods of increased activity
• Information about the proper storage of medical supplies and equipment the student might require while in school

Nutrition

It is important that students with diabetes eat all meals and snacks on time. School personnel must make sure that the students have enough time to finish all of the food they are supposed to eat. Younger students may need supervision to ensure that they consume everything they are supposed to eat when they are supposed to eat it.

Physical activity

Being physically active is important for people with diabetes, so students should be encouraged to participate in sports and other activities that include exercise. However, planning is important to ensure that their blood glucose levels remain in the safe range. Physical activity can trigger hypoglycemia. Sometimes an extra snack can bring blood glucose levels back into the safe range, but it is important that school personnel recognize the signs of hypoglycemia and hyperglycemia so that they can take appropriate action in a timely manner.

Warning signs of hypoglycemia (less than 4 mmol/L):
• Confused, unable to concentrate
• Drowsy
• Feeling shaky
• Headachy
• Hungry
• Increased heart rate
• Light-headed
• Nauseated
• Nervous, irritable, anxious
• Numbness or tingling on the lips or tongue
• Sweaty
• Weak

Warning signs of severe hypoglycemia (less than 2.8 mmol/L):
• Confused and disoriented
• Having a seizure
• Loss of consciousness

Warning sign of hyperglycemia:
• Being tired
• Feeling thirsty
• Urinating more often than usual

Medications & insulin

The medication management schedule outlined in the student’s ICP should be followed very carefully. Some students may require supervision with medication or insulin administration, and parents/guardians must provide permission for school personnel to administer medications or insulin, and the school personnel must be provided with proper training. While some students with diabetes may have type 2, which can often be managed with oral medications, most students with diabetes have type 1, which means they require insulin. Insulin is delivered in three ways: by syringe, by insulin pen, and by insulin pump.

Syringe:
Insulin is stored in a vial and drawn into a syringe that is used to inject the insulin under the skin into an arm, thigh, buttocks, or stomach.

Insulin pen:
The pen contains a cartridge of insulin and a dial that permits the user to select the proper dose. A pin on the tip of the pen is used to inject the insulin.

Insulin pump:
This device administers insulin continuously through a small tube under the skin. The user can direct the pump to deliver an extra dose when more insulin is needed.

Insulin must be stored properly in order to be effective. Unopened vials or cartridges should be refrigerated until ready to be used. It is important to make sure the insulin does not freeze. Once opened, most vials and cartridges can be left at room temperature for up to 30 days. Insulin that has passed its expiry date should not be used.

Special accommodations

Special accommodations may need to be made for students with diabetes. For example:
• They must be given time and a place to test their blood glucose levels and to take their medications or insulin in accordance with their ICPs.
• They should be allowed to keep a water bottle with them.
• They should be allowed to take bathroom breaks as often as necessary.
• They should be allowed to snack when necessary to maintain a safe blood glucose level.
• They should be allowed to participate in school parties, field trips, and other events, but plans must be made in advance to accommodate any special needs.
• Accommodations should be made for taking tests. Both hypoglycemia and hyperglycemia can affect the ability to concentrate. It may be necessary to allow the student to measure his or her blood glucose prior to taking the test and to allow extra time to complete the test. In some cases, the test may need to be rescheduled for a student whose blood glucose is too low or too high.

Communication is key

Every child with diabetes is different, and needs vary. To provide the support each child needs to thrive requires good communication between parents/guardians, school personnel, and the child’s healthcare team. When everyone works together for the benefit of children with diabetes, these students can achieve academic success. Diabetes Management Clinics are also available at London Drugs for one-on-one consultations.

Read other articles in our latest issue of our Living with Diabetes magazine here or learn more about the Diabetes services offered at London Drugs.

Newly Diagnosed: Meeting the Challenge

You’ve just received the diagnosis: you have diabetes. This can be an overwhelming experience. You may feel shocked, stressed, or even depressed. You may have difficulty coming to terms with the fact that diabetes is a serious condition. Coping with a new diagnosis takes time, but with the right support you can do it. The good news is that there are many resources available to assist you in understanding the changes that you will have to make in your life.

Take control

You might be tempted to ignore the diagnosis and continue living your life as you have been, but taking control of your diabetes right away will deliver big benefits in the long run, helping you live a healthier life and preventing or delaying the development of complications. Taking an active role in managing your diabetes will help put you in control and make you feel better—both emotionally and physically. This means following your meal plan, being physically active, monitoring your blood glucose (blood sugar) levels daily, and being diligent about taking your medicines or injecting your insulin on schedule. Recording and monitoring your blood glucose readings will help you identify patterns that will enable you to see which factors are affecting your blood sugar levels and what lifestyle changes you may need to make.

Accept what you are feeling

The first step in learning to cope with the diagnosis is accepting that your emotions are likely to swing back and forth between feeling confident that you can manage your condition and struggling to cope with what might seem to be an endless list of new things to learn and do. That’s natural. You aren’t the only one to feel these things. Be kind to yourself and don’t expect perfection right away. There is always a learning curve; things take time. You can’t fix everything overnight. Don’t try to hide your diabetes from the people around you. Share your experiences with trusted family members, friends, and coworkers. They can be a resource for helping you cope when you are feeling sad, and they can help watch for signs that your diabetes may not be well managed. Starting a mood journal or diary may also help. This will provide a safe place to share your hopes and fears. By recording your emotions you may discover links between what you are doing physically and what you are experiencing emotionally. This can help you identify things in your life that you may want to change. As time goes on and you begin to adjust to the changes you are making in your life, you will start to become more comfortable and will begin to feel confident in your ability to manage your diabetes. Your negative feelings may return from time to time, because it is difficult to be positive all of the time. If your down moods don’t last too long, it’s probably nothing to be concerned about; however, if they start to take over your emotions, ask your healthcare provider if a professional counselor would be helpful.

Looking for help

It is important to learn everything you can about diabetes. The more you know, the better able you will be to manage the condition in a healthy manner. If you are looking for information on programs and services to help people newly diagnosed with diabetes, Diabetes Canada can help. Contact information for regional offices across Canada is available at https://www.diabetes.ca/contact-us/regional-offices. Your healthcare team is there to help you. Don’t overlook this important resource. Doctors, certified diabetes educators, dietitians, and pharmacists all have a role to play in helping you live a healthy life.

If you have any questions about managing your diabetes or about where to go for additional help, your London Drugs pharmacists are always happy to help.

Hypoglycemia: understand it, prevent it, treat it

Hypoglycemia is the medical name for low blood glucose (low blood sugar)—specifically, a blood glucose level below 4 mmol/L. Frequent or severe hypoglycemia can have a very negative effect on your diabetes management and your overall quality of life, making it important to be able to recognize the warning signs, to have strategies in place for preventing it, and to know how to treat it if it does occur.

Causes

Hypoglycemia may result from a number of factors including:
• not eating on time
• not eating enough
• getting more physical activity than usual
• taking too much medication
• drinking alcoholic beverages

Warning signs

The warning signs of hypoglycemia can vary from person to person, and some people don’t experience any warning signs at all. When warning signs do occur, they may include feeling:
• lightheaded
• shaky
• sweaty
• headachy
• hungry
• nauseated
• nervous, irritable, or anxious
• weak or drowsy
• unable to concentrate
• numbness or tingling in your lips or tongue
• fast heart rate

Very low blood sugar can cause:
• confusion and disorientation
• loss of consciousness
• seizures

Hypoglycemia can happen rapidly. Knowing the signs to watch for will enable you to treat it quickly.

Preventing hypoglycemia

It’s always better to prevent a problem than it is to be faced with the need to treat it, and these tips will help you prevent hypoglycemia:
• Follow the blood glucose monitoring schedule your diabetes care team has created for you. Careful monitoring is critical to making sure your blood sugar level remains within your target range.
• Eat on schedule. Don’t skip meals or snacks.
• Take your diabetes medication or insulin on schedule.
• If you are going to be very physically active, adjust your medication or have additional snacks.
• If you chose to drink alcohol, don’t do it on an empty stomach.
• Keep a log of your low glucose readings so you will be able to identify patterns.

Treating hypoglycemia

Sometimes, even the best efforts to prevent a problem aren’t enough. If you think your blood sugar may be low, check it immediately. If you don’t have access to your meter, treat the symptoms anyway. Treat hypoglycemia by eating or drinking 15 grams of a fast-acting carbohydrate, such as:
• 15 g of glucose in the form of glucose tablets
• 15 mL (1 tablespoon) or 3 packets of sugar dissolved in water
• 15 mL (1 tablespoon) of honey (Do NOT give honey to a child younger than one year of age.)
• 150 mL (2/3cup) of juice or regular (not diet) soft drink
• 6 LifeSavers® candies

Wait 15 minutes, then check your blood sugar again. If it is still low, treat it again with another 15 grams of fast-acting carbohydrates. Wait another 15 minutes, and then check it again. Keep doing this until your blood glucose is above 4 mmol/L. Once your blood sugar reaches 4 mmol/L, if your next meal is more than an hour away or if you are going to be physically active, have a snack that contains 15 grams of carbohydrate plus a protein source—such as half of a sandwich or cheese and crackers. Be sure to wait at least 40 minutes after your blood sugar reaches at least 5 mmol/L before driving, because your brain may need that long to recover before you can drive safely again.

If your blood sugar remains below 4 mmol/L or if you become sleepy and less alert, call 911 or your local emergency number immediately.

Severe hypoglycemia

Severe hypoglycemia in a conscious person is treated with 20 grams of fast-acting carbohydrates, preferably in the form of glucose tablets. Blood glucose should be retested in 15 minutes and retreated with another 15 grams of fast-acting carbohydrates if blood glucose remains below 4 mmol/L. Severe hypoglycemia in an unconscious person is treated with an injection of glucagon administered either subcutaneously (under the skin) or intramuscularly (into a muscle). The effectiveness of glucagon will be reduced in people who have consumed more than two standard alcoholic drinks in the previous few hours, in those who have been fasting, and in those who have advanced liver disease. People with diabetes should wear medical identification jewelry. That way, if they lose consciousness and are unable to speak for themselves, emergency responders will know what to look for and what to do.

Hypoglycemia in a child

Even mild symptoms in a child require immediate attention. In a child under six years of age who has symptoms, a blood glucose level below 6 mmol/L with symptoms is enough to trigger treatment. In a child at least six years old who has symptoms, a blood glucose level less than 4 mmol/L is enough for treatment.

Treatment will depend on the child’s weight.
• A child weighing less than 15 kg (33 lbs.) should be given 5 grams of carbohydrates.
• A child weighing between 15 and 30 kg (33 to 66 lbs.) should be given 10 grams of carbohydrates.
• A child weighing more than 30 kg (66 lbs.) should be given 15 grams of carbohydrates, the same as an adult.

5 grams of carbohydrate:
• 11/2 oz. (45 mL) of fruit juice
• 1/2 cup (125 mL) of white milk
• 1/4 cup (60 mL) of chocolate milk
• 1/4 cup (60 mL) of regular (not diet) pop
• 1-11/2 teaspoons (4-6 g) of jelly or jam

10 grams of carbohydrate:
• 3 oz. (90 mL) of fruit juice
• 3/4 cup (185 mL) of white milk
• 1/3 cup (80 mL) of chocolate milk
• 1/4 cup (60 mL) of regular (not diet) pop
• 2-3 teaspoons (8-12 g) of jelly or jam

Tips for family, friends, and coworkers

If you have diabetes, it is important that the people around you know what to do if your blood sugar drops too low. These tips will help:

If you are unconscious:
• The person should prepare a shot of glucagon and administer the shot following the instructions that came with the medication.
• As soon as the injection has been administered, the person should call 911 or your local emergency number.

If you are conscious and able to swallow:
• The person should lift your head and give you ½ teaspoon (7.5 mL) of water to swallow.

If you swallow the water without coughing or choking:
• The person should give you 15 grams of glucose tablets or 15 grams of fast-acting carbohydrates, then wait 15 minutes and see if you need help testing your blood glucose level.
• If you are feeling better but your blood glucose is still low or you still have symptoms, the person should give you another 15 grams of glucose tablets or fast-acting carbohydrates then wait with you for another 15 minutes until you test your blood glucose again.
• If you become sleepy or lethargic, the person should call 911 or your local emergency number immediately and stay with you until help arrives.

If you cough or choke on the water:
• The person should turn you on your side and make sure your airway isn’t blocked.
• Then the person should prepare a shot of glucagon and administer the shot following the instructions that came with the medication.
• As soon as the injection has been administered, the person should call 911 or your local emergency number.
• If you are unconscious and emergency help hasn’t arrived within five minutes, the person should give you another glucagon shot and stay with you until the emergency help arrives.

Diabetes & Covid-19

COVID-19 is a virus that affects the respiratory system (the system that enables us to breathe). People with diabetes are not more likely than others to catch the COVID-19 virus, but if they do catch it, they are more likely to have a severe form of the infection and to suffer more complications. This makes it particularly important for people with diabetes to do everything they can to protect themselves from this virus. Here are some things you can do to help protect yourself.

• Wash your hands thoroughly and often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth.
• Regularly clean commonly used surfaces and devices you touch or handle.
• Don’t make unnecessary trips away from home.
• If you do have to leave your home, try to stay at least 2 metres away from anyone else.
• Avoid contact with people who appear to be sick with a respiratory illness.
• Watch carefully to see if you develop any symptoms.

Common symptoms of COVID-19 to watch for include fever, tiredness, dry cough, aches and pains, nasal congestion, runny nose, sore throat, and diarrhea. However, some people who become infected with the virus never develop symptoms. If you do develop any of the symptoms, continue following your diabetes management plan and call your doctor to see whether you should make an appointment to go in for a checkup and for advice on how to treat your symptoms. Research has shown that insulin and other treatments for blood sugar control do not increase the risk of severe COVID-19, and you should continue to take them. In fact, you should not make any changes to your diabetes management plan without checking first with your doctor. It is always better to be prepared than to be surprised by something unexpected. For people with diabetes, this includes having a sick day management plan in place before you get sick.

The article “Sick Day Management” below will help you prepare for COVID-19 or any other illness you may develop.

Sick Day Management

Even a minor illness can cause serious problems for people with diabetes. When we are sick, our body reacts by releasing hormones to fight infection, but this can raise blood glucose (blood sugar) levels and make it more difficult for insulin to lower blood glucose. A little planning can reduce the likelihood of developing dangerously high blood glucose levels if you get sick.

Plan ahead
While you are still healthy, you should talk to your doctor or diabetes care team to create a sick day management plan. Your plan should include your target blood glucose goal during an illness, how often to test your blood glucose and ketone levels, how your diabetes medication schedule or insulin might have to be adjusted, if you should stop taking any other medications, and what warning signs indicate it’s time to contact a doctor. Make sure you keep your sick day management plan where it will be handy when you need it. Prepare a sick day kit that includes:
• glucose tablets to treat hypoglycemia (low blood sugar)
• sugar-free beverages
• a thermometer
• enough blood glucose testing strips
• a ketone meter and strips

Managing your blood sugar
If you are on insulin, continue taking it even if you are vomiting or have trouble eating or drinking. If you are managing your diabetes with medications or if you are taking medicines for other conditions, you may need to stop taking them if you are at risk of becoming dehydrated as a result of vomiting or diarrhea.

Speak with your doctor if you take any of these types of medicines to make sure you know what to do if you get sick:
• blood pressure medications
• diuretics (“water pills”)
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• pain medicines
• sulfonylureas

Be careful about taking over-the-counter medicines. For example, if you have a cough or cold and you are looking for relief from your symptoms, you should be aware that some products contain sugar. Ask your London Drugs pharmacist for assistance in choosing a product that will help you feel better without affecting your blood glucose control.

Stay hydrated

If you are vomiting, have diarrhea, have a fever, or are exposed to excessive heat, you are at risk of dehydration. Be sure to drink plenty of fluids that contain minimal or no sugar. Try to drink at least one cup (250 mL/8 oz.) of sugar-free fluids periodically for a total of at least nine cups (2.2L/72 oz.) daily to prevent dehydration. Good choices of fluids include water, clear soup or broth, herbal tea, and caffeine-free diet pop (such as diet ginger ale). Limit the amount of caffeine-containing beverages you drink (e.g., coffee, some teas, and some types of carbonated soft drinks), because caffeine makes dehydration worse. You may want to consider electrolyte replacement solutions.

Eating while you are sick

If you can, try to stick with your meal plan. If you can’t eat the foods you usually eat, try to consume light foods or fluids that contain 15 grams of carbohydrates every hour. Options include:
• 1 slice of bread
• 7 soda crackers
• 1 medium-size piece of fruit
• 1 twin popsicle
• ¹/2 cup (125 mL) of unsweetened applesauce
• ¹/2 cup (125 mL) of 100% fruit juice
• 2/3 cup (165 mL) juice
• ¹/2 cup (125 mL) regular Jell-O®
• 2/3 cup (165 mL) regular soft drink that does not contain caffeine
• ¼ cup (60 mL) regular pudding or ½ cup (125 mL) sugar-free pudding

If you are not vomiting and don’t have diarrhea, you may also want to try:
• 1 cup (250 mL) of milk
• ¹/2 cup (125 mL) of flavoured yogurt
• ¹/2 cup (125 mL) of ice cream

If you are eating less than normal and the symptoms last for more than 24 hours, you may need to temporarily stop taking some medications, including certain diabetes pills, blood pressure and heart medications, and anti-inflammatory pain medicines, and you may need to stop taking all diuretics (water pills). Check with your healthcare professional before you get sick to find out if any of your medications should be stopped, and incorporate this into your sick day management plan.

Test, test, test
Your sick day management plan should include instructions for what tests you should perform and how often to do them, but the following are some general guidelines to consider:
• Check your blood glucose at least every two to four hours. If it is rising quickly, check it more often, even throughout the night.
• If you take insulin, test your blood or urine for ketones.
• If your blood glucose tests above 16 mmol/L twice in a row, test your blood or urine for ketones every four hours.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently.

When to seek help
There are some warning signs that point to a more serious problem. You should contact your healthcare provider if:
• You are sick for more than 24 hours and aren’t getting better or if you start to feel worse
• You can’t drink enough liquids
• You take any medicines and aren’t sure if you should change your dosage or stop taking them when you are sick
• You take insulin and aren’t sure if or how you should change your dosage
• You have been told to check your ketones and they are moderate to high
• You are unable to keep your blood glucose level above 4 mmol/L

If you can’t reach your healthcare provider and are not getting better, consider going to the emergency
department of your local hospital.

Read all other articles in our Living with Diabetes Magazine here.

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