The Day To Day

INSULIN

What is it & how does it work?

Insulin is a hormone made by the pancreas that helps our body use glucose from the food we eat to give us energy.

When you have type 1 diabetes, the pancreas stops making insulin. When this happens, your body can’t get the glucose it needs. When you have type 1 diabetes you need to replace the insulin that your body’s stopped making. The only way to give insulin is by injection, you can’t take insulin as a pill because when it’s digested by the body, it becomes inactive and doesn’t work.

Getting your insulin script

Insulin is available only on prescription from your Endocrinologist, Diabetes Specialist or GP. If you have a Health Care Card you will get the script at a cheaper rate.

Where to keep your insulin

It’s really important that your insulin is kept somewhere safe that’s not too hot or cold. If you don’t, it can go off and not work properly.

Bottles and penfills of insulin that you are not using should be stored in the fridge until the use by date. They shouldn’t be frozen and if they are, they have to be thrown away.

The insulin bottle or penfill you are using can be kept out of the fridge somewhere safe that’s not too hot or cold. There are special packs you can buy to protect your insulin in hot or cold places. It’s best to take your insulin out of the fridge before you use it because cold insulin can sting when you inject it. You should throw insulin away if it’s been open for more than a month. Remember don’t shake up your insulin too much because this can damage it. Make sure you have spare bottles or penfills in case you break one.

TESTING

Testing BGLs helps you manage your diabetes. Your doctor and diabetes educator will tell you how often to test and when to test. Most teenagers test before meals, before bed, when they’re playing sport or feeling unwell. Not everyone with diabetes does all of these tests, your diabetes team will let you know what tests you should be doing.

Some people think they don’t need to test or that they can guess their BGL depending on how they’re feeling. We know that this doesn’t really work and can put you at risk of problems like hypos or high BGLs and ketoacidosis (DKA) if you get it wrong. It can also make it hard for your doctor to adjust your insulin if they don’t have any accurate BGLs.

Meters

To test your BGL you need a blood glucose meter. There are lots of different meters for you to choose from. You can download information from some meters on to a computer so you can see what your BGLs are doing from day to day. Talk to your diabetes educator about the different meters available.

It’s important to look after your meter so that it works properly. Try to keep it clean, don’t drop it and make sure it doesn’t get too hot or cold. There are special packs you can buy to protect your meter in hot or cold places.

Finger Prickers / Lancets

A finger pricker or lancet is used to get the drop of blood to test your BGL. There are lots of different types and you can change how deep they go into your finger or skin so that it doesn’t hurt too much. When you prick your finger, try to do it on the sides at the top of your finger not on the soft part at the tip or your fingers will get very sore. It’s also important to change where you do your finger prick each time. Don’t forget to change the lancet (sharp bit) of your finger pricker before it gets blunt otherwise it might hurt or not work properly. Always dispose of your used lancets in a recognised sharps container.

Alternate Site Testing

Some meters let you use the blood from different parts of the body to test BGLs. These include the forearm, base of thumb, thigh and calf. You need a special lancet that goes with the meter. You can’t do alternate site testing with a regular meter or lancet. There may be some difference in BGL results if you use alternative sites. This is because the blood flow to your hands is faster than it is to these other sites which means that differences in BGL readings could delay picking up a hypo.

Blood Glucose Test Strips

There are special testing strips that you need to use with your blood glucose meter. Once you’ve obtained a drop of blood, place it on the testing strip. Some strips need more blood than others, and these days most strips suck up the blood from the point of contact. Every meter has its own testing strips that you use once and then throw away carefully (wrap in test strip cover or within a tissue).

Everyone with diabetes should join the National Diabetes Services Scheme (NDSS) to be able to buy cheaper strips.

Ketone Testing
When your BGLs are high (more than 15 mmol/L) or when you’re sick it’s important to test for ketones. Ketones are a sign that things are out of balance and you may be at risk of diabetic ketoacidosis (DKA). There are two ways you can test for ketones – by testing your blood or by testing your urine

Blood – There are meters you can get to test your blood for ketones. You can use the same drop of blood to test your BGL and test for ketones, so you only need to prick your finger once. There are different strips to test your BGL and for testing ketones.

Urine – If you don’t have a meter that tests for ketones, you need to test your urine (wee) for ketones. There are special strips for this. To do this test, wee on the strip when you go to the toilet. It might sound gross, but it’s really important.

Continuous Blood Glucose Monitoring (CGMS)

There are meters that allow for continuous monitoring of BGLs by using a small sensor placed just under the skin. These monitors are not designed to replace your usual meter, but may be used for short periods of time to assess what’s happening with BGLs. There are also CGMS devices that can be used in conjunction with some of the insulin pumps available. Ask your diabetes educator for more info.

 HYPOS

A hypo or low BGL happens when your level drops below 4mmol/L. When this happens you might feel:

  • Sweaty
  • Shaky
  • Sleepy
  • Cross
  • Weak
  • Like it’s hard to concentrate
  • Have a headache
  • Emotional

Everyone is different, you need to know how you feel when you have a hypo. Hypos can be caused by different things, like:

  • Exercise or sport
  • Not eating enough at meals
  • Skipping meals
  • Too much insulin
  • Stress or anxiety

Sometimes you can have a hypo for no reason at all!

Common times for hypos are just before recess or lunch and during and after sport, but remember they can happen at any time.

When you have a hypo you need to quickly eat or drink something sweet straight away like:

  • 125 – 200ml fruit juice (1 small popper) or
  • 1/3 – ½ can regular soft drink (not diet) or
  • 3 teaspoons honey or sugar or
  • 4 large or 7 small jelly beans
  • Then eat something else to stop the hypo from coming back, like:
  • A piece of fruit or
  • A slice of bread or
  • Two plain sweet biscuits or
  • A glass of milk

OR

If it’s just before recess, lunch or a meal, eat or drink something sweet then eat your meal. If you are using an insulin pump you may only need the quick acting treatment to manage a hypo. Talk to your diabetes educator, dietitian or doctor for more info.

Don’t forget to always carry hypo foods with you and always tell someone when you have a hypo. It’s important not to ignore a hypo even if you are worried about drawing attention to yourself or having everyone look at you. No one likes to be embarrassed, but ignoring a hypo can make you feel worse and can be more embarrassing if you don’t treat it.

HYPERS & SICK DAYS

Sometimes your BGLs can go too high. This can be when you:

  • Feel sick or unwell
  • Are stressed, worried or excited
  • Are less active than usual
  • Eat more than usual
  • Don’t have enough insulin in your body (eg. you forgot your insulin injection or didn’t give the right dose) Sometimes your BGLs can go high for no reason at all.

If your BGLs above 15mmol/L and you’re feeling OK, you can still do most of the things that your friends are doing, but it’s not a good idea to play really active sports like football until your BGL comes down. Drink plenty of water and do another test if you are not feeling well.

If your BGLs above 15mmol/L and you’re feeling sick, you might have ketones. High BGLs and ketones can make you really unwell and give you stomach pain, make you feel thirsty and want to go to the toilet a lot. This means that things are out of balance in your body.

When you feel like this, you need to let someone know, test your BGL more often, drink plenty of water and take some time out. When your BGLs are high and you have ketones, you need extra insulin – talk to your mum, dad or someone at home about what to do with your insulin dose. Remember you can call your diabetes educator about what to do for sick days.

If your BGL is above 15mmol/L you should test for ketones – whether you are feeling well or not!

Diabetic Ketoacidosis

High BGLs and ketones can lead to DKA, a very serous condition that occurs when there is not enough insulin and BGLs and ketones in the blood are extremely high. The blood becomes too acid, body fluid and salt levels become unbalanced, leading to dehydration. You can then feel sick, start vomiting, have severe stomach pain and feel very sleepy.

Ketoacidosis occurs when high BGLs, a high level of ketones and a lack of insulin have been present due to illness or missing insulin.

It is very important that you go straight to hospital for urgent treatment.