diabetes for canadians for dummies, 3rd edition
DESCRIPTION
Diabetes For Canadians For Dummies, Third Edition features new nutritional data, facts on prediabetes, and advice for prevention tactics, all of which provide you with an arsenal of information that will help you manage your diabetes confidently and wisely.TRANSCRIPT
Table of Contents
Introduction ................................................................. 1About This Book .............................................................................................. 1
Conventions Used in This Book ..................................................................... 2
What You Don’t Have to Read ........................................................................ 2
Foolish Assumptions ....................................................................................... 3
How This Book Is Organized .......................................................................... 3
Part I: Dealing with the Diagnosis of Diabetes ................................... 3
Part II: How Diabetes Can Affect Your Body....................................... 3
Part III: Rule Your Diabetes: Don’t Let It Rule You ............................ 4
Part IV: Particular Patients and Special Circumstances ................... 4
Part V: The Part of Tens ........................................................................ 4
Part VI: Appendixes ............................................................................... 4
Icons Used in This Book ................................................................................. 5
Part I: Dealing with the Diagnosis of Diabetes ................ 7
Chapter 1: Membership in a Club You Didn’t Ask to Join. . . . . . . . . . . .9
Figuring Out What Diabetes Is ....................................................................... 9
You’re Not Alone ........................................................................................... 10
Handling the News ......................................................................................... 11
The Impact of Your Diabetes
on Your Relationships .............................................................................. 12
Looking at the impact of your diabetes on your
relationships with your family ....................................................... 12
Looking at the impact of your diabetes on your
relationships with your friends ...................................................... 13
Looking at the impact of your diabetes on your
relationships with your workmates ............................................... 14
Juggling Your Diabetes and Your “Real Life” ............................................. 15
Juggling your diabetes and your family life ...................................... 15
Juggling your diabetes and your work life ........................................ 16
Putting Your Energies into Your Diabetes ................................................. 17
Feeling guilty with your diabetes ....................................................... 17
Feeling frustrated with your diabetes ............................................... 18
Coping with diabetes ........................................................................... 18
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Diabetes For Canadians For Dummies, 3rd Edition xivChapter 2: You and Your Blood Glucose . . . . . . . . . . . . . . . . . . . . . . . . .21
What Is Glucose? ............................................................................................ 21
Diagnosing Diabetes ...................................................................................... 22
How High Blood Glucose Makes You Feel .................................................. 24
Understanding how your body handles blood glucose .................. 24
Examining symptoms caused by high blood glucose ..................... 25
Controlling Your Blood Glucose .................................................................. 27
What You Can Do If You Lose Control of Your Blood Glucose ................ 27
Chapter 3: Discovering the Cause of Your Diabetes . . . . . . . . . . . . . . .29
How Your Organs Make Music ..................................................................... 29
Presenting your pancreas ................................................................... 30
Looking at your liver ........................................................................... 31
Going on about your gut ..................................................................... 32
Mentioning your muscles ................................................................... 32
Chewing the fat .................................................................................... 32
Being brainy .......................................................................................... 33
Playing a beautiful melody ................................................................. 33
What Happens When Your Organs Hit the Wrong Notes? ....................... 34
Insulin resistance ................................................................................. 35
Insulin defi ciency ................................................................................. 35
Defective incretin action ..................................................................... 36
Chapter 4: Looking at the Different Types of Diabetes . . . . . . . . . . . . .39
Type 1 Diabetes and You .............................................................................. 40
Identifying the symptoms of type 1 diabetes ................................... 41
Investigating the causes of type 1 diabetes ...................................... 42
Latent autoimmune diabetes of adults ............................................. 44
Preventing type 1 diabetes ................................................................. 45
Type 2 Diabetes and You .............................................................................. 45
Identifying the symptoms of type 2 diabetes ................................... 47
Investigating the causes of type 2 diabetes ...................................... 49
Screening for type 2 diabetes ............................................................. 50
Preventing type 2 diabetes ................................................................. 51
Key Differences between Type 1 and Type 2 Diabetes ............................. 53
Gestational and Pregestational Diabetes and You .................................... 54
The Metabolic Syndrome and You .............................................................. 54
Prediabetes and You ..................................................................................... 55
Recognizing Other Types of Diabetes ......................................................... 57
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xv Table of Contents
Part II: How Diabetes Can Affect Your Body ................. 59
Chapter 5: Handling Low and High Blood Glucose Emergencies . . . .61
Understanding Hypoglycemia (Low Blood Glucose) ................................ 61
Looking at the symptoms of hypoglycemia...................................... 63
Considering the causes of hypoglycemia ......................................... 66
Treating hypoglycemia ....................................................................... 67
Preventing hypoglycemia ................................................................... 71
Coping with hypoglycemia unawareness ......................................... 74
Dealing with Ketoacidosis ............................................................................ 75
Exploring how ketoacidosis develops ............................................... 75
Investigating the symptoms of ketoacidosis .................................... 76
Understanding the causes of ketoacidosis ....................................... 77
Treating ketoacidosis .......................................................................... 77
Preventing ketoacidosis ...................................................................... 78
Hyperosmolar Hyperglycemic State ........................................................... 79
Identifying the symptoms of the hyperosmolar
hyperglycemic state ......................................................................... 80
Examining the causes of the hyperosmolar hyperglycemic state ... 81
Treating the hyperosmolar hyperglycemic state ............................ 81
Preventing the hyperosmolar hyperglycemic state ........................ 81
Chapter 6: As Time Goes By: Handling Long-Term Complications . . .83
Complications Aren’t Inevitable .................................................................. 83
Categorizing Long-Term Complications ..................................................... 84
Coronary Artery Disease and Cerebrovascular Disease .......................... 86
Preventing a heart attack or stroke ................................................... 87
Quitting smoking .................................................................................. 88
Peripheral Arterial Disease .......................................................................... 89
The Lowdown on High Blood Pressure ............................................. 90
Abnormal Cholesterol and Triglyceride Levels (Dyslipidemia) .............. 91
Looking at healthy cholesterol levels ............................................... 93
Keeping your lipids under control..................................................... 94
Eye Disease ..................................................................................................... 95
Retinopathy .......................................................................................... 95
Cataracts ............................................................................................... 98
Glaucoma .............................................................................................. 98
Resources to help you if you are blind or visually impaired ......... 98
Kidney Disease ............................................................................................... 99
Diagnosing diabetes kidney damage ............................................... 100
Treating diabetes kidney damage .................................................... 101
Neuropathy (Nerve Damage) ..................................................................... 102
Peripheral neuropathy ...................................................................... 103
Autonomic neuropathy ..................................................................... 105
Other types of neuropathy ............................................................... 105
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Diabetes For Canadians For Dummies, 3rd Edition xviPreventing Pneumonia ................................................................................ 106
Mental Health Problems ............................................................................. 106
Depression .......................................................................................... 107
Dementia ............................................................................................. 107
Digestive Disorders: Problems of the Stomach, Intestines, and Liver .... 107
Gastroparesis ..................................................................................... 108
Diarrhea .............................................................................................. 108
Celiac disease ..................................................................................... 108
Liver disease ....................................................................................... 109
Foot Disease in Diabetes ............................................................................. 109
Protecting your feet ........................................................................... 110
Skin Disease in Diabetes ............................................................................. 113
Musculoskeletal Problems (Muscles, Joints, and Such) ......................... 114
Thyroid Disease and Diabetes ................................................................... 115
Gum Disease in Diabetes ............................................................................ 116
Erectile Dysfunction Due to Diabetes ....................................................... 116
Why the spirit may be willing, but the penis isn’t ......................... 116
How to improve erectile dysfunction .............................................. 117
Dealing with Female Sexual Problems Related to Diabetes ................... 119
Chapter 7: Diabetes and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Gestational Diabetes ................................................................................... 121
Exploring the causes of gestational diabetes ................................. 122
Diagnosing gestational diabetes ...................................................... 122
Determining if you are at high risk for gestational diabetes ........ 124
Treating gestational diabetes ........................................................... 125
Monitoring gestational diabetes ...................................................... 128
Understanding the potential complications for the mother ........ 129
Considering the potential complications for the baby ................. 130
Knowing what to do after you’ve had your baby .......................... 130
Pregestational Diabetes (Pregnancy in Women with
Type 1 or Type 2 Diabetes) .................................................................... 132
Knowing what can happen to the mom .......................................... 133
Knowing what can happen to the fetus and baby ......................... 134
Reviewing things to do before you get pregnant ........................... 134
Managing your health while you are pregnant .............................. 137
Knowing what to expect during labour and delivery .................... 139
Handling your diabetes for the fi rst few months after
having your baby ........................................................................... 141
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xvii Table of Contents
Part III: Rule Your Diabetes: Don’t Let It Rule You ...... 143
Chapter 8: Meet Your Diabetes Team. . . . . . . . . . . . . . . . . . . . . . . . . . .145
You Are the Captain of the Team .............................................................. 146
The Family Physician: Your Coach ............................................................ 148
The Diabetes Specialist: Your General Manager ..................................... 149
The Diabetes Educator: Your Trainer ....................................................... 150
The Dietitian: Your Energizer ..................................................................... 151
The Eye Specialist: Your Cameraperson .................................................. 152
The Pharmacist: Your Equipment Manager ............................................. 153
The Foot Doctor: Your Sole Mate .............................................................. 154
The Dentist: Your Opening Act .................................................................. 155
Your Family and Friends: Your Fans and Cheerleaders ......................... 155
Chapter 9: Monitoring and Understanding Your Blood Glucose Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Understanding the Importance of Measuring Your
Blood Glucose Levels .............................................................................. 158
Determining if Your Blood Glucose Is in Control .................................... 159
Testing with a Blood Glucose Meter ......................................................... 160
Reviewing the supplies you need .................................................... 160
Performing a test with a blood glucose meter ............................... 161
Knowing how often to test your blood glucose ............................. 162
Looking at when you should test your blood glucose .................. 165
Choosing a Blood Glucose Meter ..................................................... 166
Recording Your Results .............................................................................. 171
Discovering Your Blood Glucose Targets ................................................ 175
Interpreting Your Blood Glucose Results ................................................. 176
When your before-breakfast readings are high
(and other readings good) ............................................................ 176
When your after-meal readings are high
(and other readings good) ............................................................ 177
When all your readings are elevated ............................................... 178
When you are having too many lows .............................................. 179
When your readings have no pattern .............................................. 180
Testing for Longer-Term Blood Glucose Control with the A1C Test .... 184
Learning the importance of your A1C ............................................. 184
Understanding your A1C result........................................................ 186
Looking at why your A1C and your blood glucose
readings don’t fi t ............................................................................ 187
Using a Continuous Glucose Monitoring System .................................... 190
Understanding continuous glucose monitoring ............................ 190
Checking out the benefi ts of continuous glucose monitoring ..... 193
Looking at the drawbacks of continuous glucose monitoring ..... 197
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Diabetes For Canadians For Dummies, 3rd Edition xviiiChapter 10: You Are What You Eat: Staying Healthy with Good Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
The Key Ingredients .................................................................................... 202
Carbohydrates.................................................................................... 203
Proteins ............................................................................................... 208
Fats ...................................................................................................... 209
Getting Enough Vitamins, Minerals, and Water ....................................... 211
Counting Alcohol as Part of Your Diet ...................................................... 213
Non-nutritive Sweeteners ........................................................................... 214
Looking at Other Dietary Strategies .......................................................... 215
Eating Out ..................................................................................................... 216
Weighty Issues ............................................................................................. 218
Weight-loss challenges ...................................................................... 218
The best strategy for losing weight ................................................. 219
Portion control for weight loss ........................................................ 220
Medication therapy for losing weight ............................................. 220
Surgery for weight loss (bariatric surgery) .................................... 220
Behaviour modifi cation ..................................................................... 221
Coping with Eating Disorders .................................................................... 223
Chapter 11: Exercising Your Way to Good Health . . . . . . . . . . . . . . . .225
How Exercise Can Improve Your Diabetes Health .................................. 226
Finding the Right Type of Exercise ............................................................ 227
Cardiovascular exercise and you..................................................... 228
Resistance exercise and you ............................................................ 231
Taking Precautions Before You Start Exercising ..................................... 232
Exercising if You Are Taking Antihyperglycemic Medication ............... 233
Finding a Supervised Exercise Program ................................................... 235
Chapter 12: Controlling Your Blood Glucose with Non-insulin Antihyperglycemic Medications and Alternative Therapies. . . . . . .237
To Take or Not to Take: That Is the Antihyperglycemic
Medication Question ............................................................................... 238
Choosing the right medication for you ........................................... 239
Understanding how antihyperglycemic medications work .......... 240
Investigating the Types of Antihyperglycemic Medications .................. 241
Metformin ........................................................................................... 241
Sulfonylureas ...................................................................................... 243
Meglitinides ........................................................................................ 243
Thiazolidinediones ............................................................................ 244
Alpha-glucosidase inhibitors ............................................................ 245
DPP-4 inhibitors ................................................................................. 246
GLP-1 analogues ................................................................................. 247
Other antihyperglycemic medications............................................ 249
Using Antihyperglycemic Medication Effectively: The CDA-
Recommended Approach to Treating Type 2 Diabetes ...................... 251
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xix Table of Contents
As Time Goes By: Antihyperglycemic Medications,
Type 2 Diabetes and You ........................................................................ 253
Complementary and Alternative Therapies ............................................. 255
Cautions concerning CAMs .............................................................. 255
Looking at some types of CAMS ....................................................... 256
Chapter 13: Using Insulin Effectively . . . . . . . . . . . . . . . . . . . . . . . . . . .259
What Is Insulin? ............................................................................................ 260
Looking at the Types of Insulin .................................................................. 260
Understanding Insulin Terminology ......................................................... 263
Rapid-acting insulin ........................................................................... 264
Regular insulin.................................................................................... 265
Intermediate-acting insulin ............................................................... 265
Long-acting insulin ............................................................................. 266
Premixed insulin ................................................................................ 267
Inhaled insulin .................................................................................... 268
Animal insulins ................................................................................... 268
Type 1 Diabetes and Insulin Therapy ....................................................... 268
Type 2 Diabetes and Insulin Therapy ....................................................... 269
Debunking Insulin Myths ............................................................................ 270
How to Give Insulin ..................................................................................... 272
Using an insulin pen .......................................................................... 272
Using an insulin pump ....................................................................... 274
Caring for Your Insulin ................................................................................ 282
Adjusting Your Insulin Dose ....................................................................... 283
Adjusting your insulin dose to lower your fasting
blood glucose ................................................................................. 285
Adjusting your insulin dose to avoid overnight hypoglycemia ... 285
Adjusting your insulin dose to improve elevated
after-meal blood glucose levels .................................................... 286
Carbohydrate Counting .............................................................................. 287
Travelling with Your Insulin ....................................................................... 290
Breezing through the border ............................................................ 290
Adjusting your doses between time zones ..................................... 291
Part IV: Particular Patients and Special Circumstances .............................................. 293
Chapter 14: Your Child Has Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Your Baby or Toddler Has Type 1 Diabetes ............................................ 296
Diagnosing type 1 diabetes in a baby or toddler ........................... 296
Blood glucose targets for your baby or toddler
with type 1 diabetes ....................................................................... 296
Managing your baby or toddler’s type 1 diabetes ......................... 297
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Diabetes For Canadians For Dummies, 3rd Edition xxYour Primary School-Aged Child Has Type 1 Diabetes ........................... 298
Blood glucose targets for a primary school-aged child ................ 299
Meeting with primary school teachers and administrators ......... 300
Your Adolescent Has Type 1 Diabetes ...................................................... 301
Your Young Adult Child Has Type 1 Diabetes ......................................... 303
Transitioning Care: Moving from Pediatric to Adult
Diabetes Specialist Care .......................................................................... 304
Sick Day Solutions for Your Child with Type 1 Diabetes ........................ 306
Screening Tests for Organ Injury in Children and
Adolescents with Type 1 Diabetes......................................................... 307
Summer Camps for Children with Type 1 Diabetes ................................ 308
Your Child Has Type 2 Diabetes ................................................................ 309
Your Child Has MODY ................................................................................. 311
Chapter 15: Diabetes in Special Groups: The Elderly and Aboriginal Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313
Diabetes and the Elderly ............................................................................. 313
Diagnosing diabetes in the elderly .................................................. 314
Evaluating intellectual functioning .................................................. 315
Dealing with eye problems ............................................................... 315
Coping with urinary and sexual problems ..................................... 315
Monitoring foot problems ................................................................. 316
Considering treatment for high blood glucose .............................. 317
Diabetes and Aboriginal Peoples ............................................................... 320
Considering the extent of the problem ........................................... 320
Screening for diabetes for Aboriginal peoples ............................... 321
Looking at how Aboriginal peoples are combatting the problem.... 321
Chapter 16: Special Circumstances: Employment, Insurance, Safe Driving, and Preparing for Disaster . . . . . . . . . . . . . . . . . . . . . . . .323
Employing Both You and Your Rights ...................................................... 323
Fighting for your rights ..................................................................... 324
Affecting your ability to work ........................................................... 325
Exploring your avenues of recourse ............................................... 326
Insuring Your Health ................................................................................... 327
Life insurance ..................................................................................... 328
Disability insurance ........................................................................... 328
Travel insurance ................................................................................ 328
Driving When You Have Diabetes .............................................................. 329
Determining if you’re medically fi t to drive .................................... 329
Taking necessary precautions ......................................................... 329
Applying for a commercial licence .................................................. 330
Keeping your driver’s licence .......................................................... 332
Regaining your driver’s licence........................................................ 333
Preparing for When Disaster Strikes ......................................................... 333
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xxi Table of Contents
Part V: The Part of Tens ............................................ 335
Chapter 17: Ten Ways to Stay Healthy and Avoid Complications . . .337
Learn for Life ................................................................................................ 338
Eat Earnestly ................................................................................................ 339
Exercise Enthusiastically ............................................................................ 339
Give the Heave-Ho to Harmful Habits ....................................................... 340
Controlling Your Numbers: Optimizing Your Blood Glucose,
Blood Pressure, Cholesterol, and Kidney Function ............................. 340
Blood glucose levels .......................................................................... 341
Cholesterol ......................................................................................... 341
Blood pressure ................................................................................... 342
Kidney function .................................................................................. 342
See Your Eye Doctor ................................................................................... 342
Fuss Over Your Feet .................................................................................... 342
Master Your Medicines ............................................................................... 343
Help Your Doctor Help You ........................................................................ 344
Don’t Try to Do It Alone .............................................................................. 344
Chapter 18: Ten Frequently Asked Questions about Diabetes. . . . . .345
Why Are My Blood Glucose Levels Higher When I Get Up
in the Morning than When I Go to Bed? ................................................ 345
Why Are My Blood Glucose Levels All Over the Place? ......................... 346
Why Are My Blood Glucose Levels Getting Worse as Time Goes By? .... 347
What’s the Difference between an A1C Level and a Blood
Glucose Level? .......................................................................................... 347
I Used to Be on Pills, but Now I’m on Insulin. Does that Mean I’ve
Developed Type 1 Diabetes? .................................................................. 348
When You’re on Insulin, You’re on It Forever, Right? ............................ 348
I’m Watching My Diet, So Why Is My Cholesterol Level High? .............. 348
Why Do I Need Blood Pressure Pills If My Blood Pressure Is Good? .... 349
How Can I Get My Doctor to Be More Communicative? ......................... 349
Will I Always Have Diabetes? ..................................................................... 350
Part VI: Appendixes .................................................. 353
Appendix A: The Food Group System . . . . . . . . . . . . . . . . . . . . . . . . . . .355
Grains and Starches .................................................................................... 356
Fruits ............................................................................................................. 357
Milk and Alternatives .................................................................................. 359
Other Choices (sweet foods and snacks) ................................................. 360
Vegetables .................................................................................................... 360
Meat and Alternatives ................................................................................. 361
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Diabetes For Canadians For Dummies, 3rd Edition xxiiFats ................................................................................................................ 363
Free Foods .................................................................................................... 364
Using “Beyond the Basics” to Create a Nutrition Plan ............................ 364
Appendix B: Straight Goods on a Tangled Web: Diabetes Websites Worth Visiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . .367
Ian’s and Alan’s Websites ........................................................................... 368
General Sites ................................................................................................. 368
Recipe Websites for People with Diabetes ............................................... 369
Appendix C: Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .371
Index ....................................................................... 381
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Chapter 1
Membership in a Club You Didn’t Ask to Join
In This Chapter▶ Understanding what diabetes is
▶ Knowing you’re not alone
▶ Dealing with the news that you have diabetes
▶ Looking at the impact of diabetes on your relationships
▶ Fitting diabetes management into your busy life
▶ Coping with diabetes
As a person with diabetes, you already know that diabetes isn’t “just a
sugar problem.” In fact, the moment you were told you had diabetes,
many different thoughts may have run through your mind. You have feelings,
and you have your own personal story. You’re not the same person as your
next-door neighbour or your sister or your friend, and your diabetes and the
way you respond to its challenges are unique to you.
And unless you live alone on a desert island, your diabetes doesn’t affect just
you. Your family, friends, and co-workers are influenced by your diabetes and
by their desire to help you.
In this chapter we consider how you might feel after you first find out you
have diabetes, and we also look at some coping strategies to help you deal
with this unwelcome news.
Figuring Out What Diabetes IsBecause we spend so much time discussing diabetes in this book, we want
to start by defining the condition. Diabetes is a metabolic disorder (a problem
with the body’s internal chemistry) characterized by the presence of high
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10 Part I: Dealing with the Diagnosis of Diabetes
blood glucose because the pancreas is unable to make enough insulin hor-
mone or because the insulin the pancreas makes is not working properly, or
both. (We take a closer look at glucose in Chapter 2.)
That may be the technically correct definition of diabetes, but to leave it at
that would be akin to defining Paris as “a city with a metal tower located in
France.” France does indeed have a metal tower — and diabetes does indeed
have high blood glucose — but to limit your perspective to such simple defi-
nitions would be to miss out on so, so much. Diabetes isn’t just a sugar prob-
lem; it’s a whole body problem. But fortunately this is a problem with many
available ways to tackle it head on.
Diabetes is actually the short form for diabetes mellitus. The Romans noticed
that the urine of certain people was mellitus, the Latin word for “sweet.” The
Greeks noticed that when people with sweet urine drank, fluids came out in
the urine almost as fast as they went in the mouth, like a siphon. They called
this by the Greek word for “siphon” — diabetes. Hence “diabetes mellitus.”
Nonetheless, we think the essence of diabetes is much better captured by the
17th-century definition of diabetes: “the pissing evil.” Talk about calling it the
way you see it!
You may have done some searching in books or on the Internet and come
across another form of diabetes called diabetes insipidus. This term refers
to an entirely different condition than diabetes mellitus. The only thing they
have in common is a tendency to pass lots of urine. And now that we’ve clari-
fied that, you won’t see diabetes insipidus mentioned again in this book.
You’re Not AloneIt seems unimaginable, but the number of people worldwide living with diabe-
tes has risen from an estimated 30 million in 1985 to a mind boggling 366 mil-
lion in 2011 and, by 2030, it is predicted 552 million people will be living with
diabetes. In Canada, currently over 2.5 million people are living with diabe-
tes. Clearly, as the title of this section says, you are most definitely not alone.
Hardly a day goes by when a person with diabetes isn’t in the news. Even
better, so far as we’re concerned, is that their diabetes is not part of the
news. Clearly the media and society in general have come to recognize that
living with diabetes is, in and of itself, not the newsworthy part of most sto-
ries. We couldn’t have found a better example of this than the 2009 appoint-
ment of Sonia Sotomayor to the US Supreme Court. Nearly all the news
stories spoke of her intelligence and education and hard work and abilities.
Her having diabetes was hardly mentioned. And those stories that did men-
tion it did so in passing. Diabetes didn’t — and doesn’t — define her life.
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11 Chapter 1: Membership in a Club You Didn’t Ask to Join
It is not hard to find other examples of people living with diabetes who have
achieved the loftiest of goals. Sebastien Sasseville (www.sebinspires.com)
did so quite literally when he successfully climbed Mount Everest. And Gary
Hall Junior is one of the most successful athletes in Olympic history with a
bucketful of medals to his credit. Ian remembers meeting John Chick when
John was playing with the CFL’s Saskatchewan Roughriders (he now plays
in the NFL). (Ian never felt so small in his life than he did that day, standing
beside the towering athlete!) John is a past winner of the CFL Most Outstanding
Defensive Player award. All these amazing individuals have diabetes.
Away from the sports arena, Ernest Hemingway, Thomas Edison, Jack Benny,
Elizabeth Taylor, Drew Carey, and — Ian’s all-time favourite piece of diabetes
lore — Elvis Presley have all lived with diabetes.
You may not have spoken to Stephen Steele, but he has quite possibly
spoken to you. Stephen is a commercial pilot with a major Canadian airline.
And if you’ve ever had the bad luck to be on some sinking vessel off the
Atlantic coast, the hero who plucked you from the ocean may have been
none other than Major Chuck Grenkow, a Medal of Bravery-winning former
Canadian Forces pilot and aircraft commander, who performed search and
rescue operations with the Canadian military. Oh, by the way, they both
have diabetes.
Diabetes is a common disease, so it’s bound to occur in some very uncom-
mon people. But you don’t have to be famous to be considered exceptional.
Indeed, every day of the week in our practices we see special people, people
who have diabetes yet look after families, work in automotive plants or office
buildings, write exams, go to movies, and do their best to live life to the
fullest — people, perhaps, just like you.
The point is, diabetes shouldn’t define your life. You’re the same person
the day after you found out you had diabetes as you were the day before.
But you’ve been given an additional challenge to contend with. Diabetes
shouldn’t stop you from doing what you want to do with your life. Certainly,
it does complicate things in some ways. But if you follow the principles of
good diabetes care that we discuss in this book, you may actually be health-
ier than people without diabetes who smoke, overeat, under-exercise, or
engage in other unhealthy activities.
Handling the NewsIf you are like most people, you were likely quite shocked when you were first
told you had diabetes. Nobody wants to have diabetes and your first thought
may well have been, “How can this be?” But, alas, it did come to be and you
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12 Part I: Dealing with the Diagnosis of Diabetes
have had to deal with it ever since. You may have had your share of emo-
tional ups and downs in coming to terms with your diabetes. For each person
with this condition the journey toward acceptance is unique.
Hopefully, you not only came to accept your diabetes diagnosis, but also
shared the news with your family and other people close to you. Having
diabetes isn’t something to be ashamed of, and it isn’t something that you
should have to hide from anyone. Your diabetes isn’t your fault. You didn’t
want to have diabetes. You didn’t try to get diabetes. And no one can catch it
from you.
The Impact of Your Diabetes on Your Relationships
Everyone is involved in relationships with others. These might be family
relationships, relationships with friends or workmates or, with some other
people. And although living with diabetes needn’t be front and centre in your
interactions with people, it needn’t be a secret either. In this section we look
at how having diabetes may affect your relationships.
Looking at the impact of your diabetes on your relationships with your familyIf one person in a family has diabetes, then, in a sense, everyone in the family
has diabetes. Or at least has to live with it and deal with it.
If you’ve recently been diagnosed with diabetes, your family likely has had
as many questions as you. What is diabetes? How can it affect you? How is it
treated? Will you be okay? Some of the answers are simple. Some are com-
plicated. (To help answer their questions we’d suggest you let your family
members borrow this book from you and read it, too.) The fact your family
is asking these questions isn’t, of course, to play J. Edgar Hoover on you.
Rather, it is simply a reflection of their concern and caring.
Ultimately, your diabetes is, well, your diabetes, and you need to take owner-
ship of it. It is — and always will be — your decision about how you eat, if
and how you exercise, if you test your blood glucose levels, attend doctors’
appointments, and so forth. But all of this will be easier if you see your family
as partners in your journey with diabetes. This may not, however, always be
easy or straightforward.
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13 Chapter 1: Membership in a Club You Didn’t Ask to Join
Here are some ways you can help maintain positive, mentoring family
relationships:
✓ Don’t keep your feelings about your diabetes to yourself. Let your
family members know if your diabetes is getting you down. Let them
know if you are feeling positive about how things are going.
✓ Feel free to test your blood glucose and, if you’re giving insulin, inject this in front of family members. You’re the one doing it; it’s a far lesser
deal for someone else to watch when you’re doing it. (And even at that, it
will soon become routine enough to your family that they won’t
even notice.)
✓ Remember that your blood glucose results are yours. You only need to
share the numbers if you want to. (We discuss this further later in this
chapter.)
✓ Make grocery shopping a collective experience and share your knowl-edge about healthy food with your family members. Indeed, you can
help ensure the whole family is eating healthfully because, as we dis-
cover in Chapter 10, a “diabetic diet” is, basically, a healthy eating diet.
✓ Make exercising a family experience. As we look at in Chapter 11,
diabetes loves exercise and should be a regular part of your existence.
But it should also be a part of everyone’s existence, whether or not they
have diabetes.
✓ If you feel you’d like a supportive “extra set of ears” when you see a member of your health care team, bring a sufficiently mature family member with you to your appointment. This is especially helpful for
appointments with your diabetes educator or dietitian. (We discuss the
members and roles of the diabetes health care team in Chapter 8.)
✓ Remember that your family cares about you and wants to help you. This is especially important when helping you in an emergency situa-
tion. Teach your family members what to do if ever you should need
their help to treat a bad episode of low blood glucose. We discuss this in
detail in Chapter 5.
Looking at the impact of your diabetes on your relationships with your friendsYour friends are your friends for a reason. Maybe you share the same inter-
ests in music or sports or hobbies, or perhaps you share opposite sides of
the same picket fence. Whatever the case, your diabetes needn’t interfere
with your relationships with your friends. If anything, it can strengthen
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14 Part I: Dealing with the Diagnosis of Diabetes
friendships and even foster developing new relationships. Indeed, we know
many people living with diabetes who developed friendships because of their diabetes. For example, they met new friends at meetings of the CDA
(Canadian Diabetes Association) or JDRF (Juvenile Diabetes Research
Foundation) or at local diabetes support groups.
Here are a couple of ways that diabetes may affect your friendships:
✓ As with family (see the preceding section), your friends care about you. Therefore, if you want to share your thoughts or feelings about
your diabetes with your friends, do so. And if you need to test your
blood glucose or you need to give yourself an injection of insulin, don’t
feel obliged to do this in private. (You’re welcome to, of course, but we
hope you won’t feel you have to.)
✓ Keep right on doing the same activities with your friends that you’ve always done. You may have to modify to some degree the way in which
you do the activities, but your friends won’t mind. For example, if you
like to bike, because of your diabetes you may need to sometimes
stop to check your blood glucose or to take some extra fluid to keep
hydrated. Your friends will likely enjoy the excuse to rest; Ian sure does
when he bikes with his friends who have diabetes!
We never recommend drinking alcohol to excess. But it is a fact of life —
especially among teenagers and young adults — that overindulging with
friends may happen. If you and your friends like to drink together and you’ve
had more than your share, make sure your friends know the difference
between being drunk and having low blood glucose. If ever your friends are
unsure if you’re drunk or having low blood glucose — especially if you are get-
ting sleepy or confused and are unable to check your blood glucose — then
your friends should call 9-1-1. We discuss the treatment of low blood glucose
in Chapter 5.
Looking at the impact of your diabetes on your relationships with your workmatesAlthough we encourage you to share the fact of your diabetes (and its impact
on you) with your family and friends, it’s not quite as straightforward with
your workmates.
Of course, some of your workmates may also be your friends; people you
play hockey with, have over for a barbeque, and so forth. For these par-
ticular workplace relationships our advice is the same as in the preceding
section about friends. Most of your workmates, however, are probably not
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15 Chapter 1: Membership in a Club You Didn’t Ask to Join
your friends. They’re more likely to be people that you work with, but do not
socialize with much, if at all. Regarding these relationships and your diabe-
tes, we suggest the following:
✓ Be as open or as closed about your diabetes as you wish. If you want
to share the fact of your diabetes, feel free to do so. If you want to keep
it private, do that. It is no one else’s business unless you want it to be.
(Exceptions do apply, however. For example, if you have a job in which
you can be endangered or can endanger others if you have a diabetes
emergency, you may be obliged to let your workplace know you have
diabetes.)
✓ If you are on medication — particularly insulin — that can cause your blood glucose level to go low, and especially if you have previously experienced bad episodes of hypoglycemia that required someone to assist you, try to find at least one workmate you can confide in and who can help you out if you run into a bad low. Show this person where
you keep your diabetes emergency supplies (such as dextrose tablets
or juice). Also keep a glucagon kit at work (we discuss glucagon kits in
Chapter 5) and teach your trusted workmate when and how to use it.
Juggling Your Diabetes and Your “Real Life”
Most people these days feel like they are constantly run off their feet. They
juggle work (in or out of the home) and family life. They run here, run there,
and try to squeeze in time for friends, sports, hobbies, volunteering, and so
on. This never-ending rush of activity, often accompanied by stress, leaves
very little time or energy for anything else. Oh, but wait, you have diabetes.
How in the world are you going to fit managing your diabetes into your life?
We look at that in this section.
Juggling your diabetes and your family lifeMany of Ian’s patients — especially the mothers of young children — tell
us that they are so busy looking after their family that they have no time or
energy to look after themselves. Time and again we see young women who
manage their diabetes beautifully leading up to and during pregnancy, only to
see it go off the rails when the realities of having a newborn (then infant then
toddler. . .) are added to the mix. Whether you are the mother of a youngster
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16 Part I: Dealing with the Diagnosis of Diabetes
or the father of a teenager or live in some other sort of family relationship,
you likely find that sometimes family commitments get in the way of paying
close attention to your diabetes. That makes perfect sense. However, your
diabetes isn’t going away and you have to deal with it. Here are some tips you
may find helpful for juggling your diabetes and your family life:
✓ Involve your family in your diabetes. Take your kids grocery shopping
(okay, sure, it will double the time it takes . . . maybe don’t do this every
time), have your child help you write down your blood glucose readings,
and so on.
✓ Exercise with your family. Make it a collective experience. Or go out for
a walk after you’ve dropped your kids off at hockey or soccer practice.
✓ Make time for yourself. Looking after your own health isn’t selfish.
Quite the opposite: Keeping yourself healthy is one of the very best things you can do for your whole family.
Juggling your diabetes and your work lifeDepending on your occupation and where you work, time constraints or
other challenges can make looking after your diabetes difficult while on the
job. Table 1-1 illustrates some examples of these challenges and possible
options available to help. (In Chapter 16 we look in detail at diabetes, employ-
ment issues, and your rights.)
Table 1-1 Dealing with Challenges at Work
If Your Work . . . We Recommend You . . .Provides no or insufficient breaks for eating, blood glucose testing, or inject-ing insulin
Speak to your employer. It is your legal right to be given sufficient time to per-form these health-related tasks.
Makes it impossible to do fingerstick blood glucose tests because your hands are always dirty or greasy
Talk to your pharmacist about alterna-tive-site blood glucose meters that allow you to test your blood glucose from, for example, your forearm. (We discuss this topic in more detail in Chapter 9.)
Does not have a discrete place for you to give your insulin and you’re not comfort-able injecting yourself in front of others
Speak to your diabetes specialist or diabetes educator about discrete ways to give your insulin.
Is in a hot environment and you do not have access to a fridge to store your insulin
Bring an insulated container to work in which to keep your insulin. (We discuss insulin storage in Chapter 13.)
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17 Chapter 1: Membership in a Club You Didn’t Ask to Join
Putting Your Energies into Your DiabetesLiving with diabetes is a time-consuming, energy-demanding, unceasing com-
mitment. Diabetes doesn’t take holidays, breaks, or any time off. Indeed,
living with diabetes can sometimes feel like a full-time job. So if ever anyone
has the audacity to tell you that your diabetes is no big deal, ask them if they
want to try having diabetes for a while! Anyhow, the fact remains that you do
have diabetes, it’s not going away, and you have to invest time and energy to
keep yourself healthy. This isn’t easy, but it is essential.
How much energy goes into managing your diabetes? Well, you need to
invest energy into choosing the right foods and preparing them in the right
way. You need to check your blood glucose and take your medicines. You
need to attend appointments with doctors and nurses and dietitians and
other health care professionals. You need to visit the pharmacy regularly
and you need to do lab tests and go for eye exams and check your feet. And
you need to put physical energy into expending energy; that is, exercising.
And you need to do all this in addition to doing everything else that goes
on in your life. To effectively juggle and manage all these many things is, for
most people, simply going to be impossible at times and something will, for a
time, slip through the cracks. This is perfectly understandable, but for many
people leads to feelings of guilt. We discuss this next.
Feeling guilty with your diabetesGiven what we say in the preceding sections, sometimes you’ll find that you
simply can’t muster all the energy you need, and something has to give. If
you’ve been living with diabetes for a while, you probably can recall different
times when you let your diabetes slide. Perhaps you didn’t eat as healthfully
as you knew you should, or you tested your blood less often, or you stopped
exercising. If so, we hope you didn’t feel guilty about it. Or at least kept your
guilt to a minimum. It is perfectly normal to have stages where your energy
feels sapped and looking after your diabetes seems like more effort than you
can muster. The key is to recognize that although this is both understandable
and normal, you need to get back on track — preferably sooner than later.
Your diabetes demands it and you deserve it. And as for feelings of guilt,
don’t beat yourself up over what you think you should’ve done better in the
past; instead think about how you’re going to better manage your diabetes
in the future. Just like driving a car, you should be spending a lot more time
looking forward than in your rear-view mirror.
We provide coping tips later in this chapter.
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18 Part I: Dealing with the Diagnosis of Diabetes
Feeling frustrated with your diabetesThe fact that you have diabetes doesn’t change day-to-day, but lots of other
things do. We’re talking changes in the workplace, stresses at home, short-
term illnesses, travel, and so forth. And that, in turn, will impact on your dia-
betes and in particular on your blood glucose control. It can be frustrating,
indeed, when factors often beyond your control adversely impact your diabe-
tes. Longer-term changes can also impact on your diabetes and lead to feelings
of frustration. For example, perhaps you have developed arthritis and cannot
exercise as much. Or, as typically happens if you have type 2 diabetes, the
medications that were working just fine at first start to work less well.
Faced with all these changes that affect your glucose control, you may feel
like you’re trying to hit a moving target. Actually, it’s not like trying to hit a
moving target. It is trying to hit a moving target! Everything can seem to be
going well, your blood glucose levels in check, your diet on track, your daily
walks a well-honed ritual, then, Wham! A few holiday dinners or a sprained
ankle or a bout of bronchitis or trouble at the office, and all of a sudden your
blood glucose levels are up. Or pills that were working well start to be inef-
fective, and your blood glucose levels are on the rise. Or the insulin dose
you give seems to work beautifully one day, and poorly the next. Feeling
frustrated? Who wouldn’t! Although your diabetes isn’t going away, coping
strategies can help you deal with the frustrations that diabetes presents. We
look at this topic in the very next section. (As for bringing your glucose levels
back in check, we discuss this in Chapters 10 to 13.)
Coping with diabetesWhether you’ve had diabetes for ten days or ten years (or much longer), some-
times you will feel frustrated, discouraged, or simply fed up with dealing with
it. This is perfectly understandable. Diabetes is a full-time job that you didn’t
apply for and would rather not have been hired for, thank you very much.
If your diabetes is getting you down, you can do a whole host of things to
help lift yourself out of the doldrums. Here are some options:
✓ Don’t deny your feelings. They are not unjustified and in any event,
your feelings are your feelings.
✓ Don’t bottle up your emotions. Share your feelings with those that are
close to you, especially your family.
✓ Seek support. Participate in a support group (whether virtual or
in-the-flesh).
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19 Chapter 1: Membership in a Club You Didn’t Ask to Join
✓ Don’t be too hard on yourself if your blood glucose levels are not as good or as consistent as they should be. Perfect blood glucose control
is not possible given that we have imperfect therapy. (Speaking of which,
one of Ian’s dictums is that the word “perfect” and the word “diabetes”
should never be used in the same sentence.)
✓ Think positively. Focus on your successes (be they eating a healthy
meal, going out for a walk, and so on) and pat yourself on the back
more often.
✓ Exercise regularly. If you’re feeling stressed and tired and burnt out with
your diabetes, the idea of exercising may be the furthest thing from your
mind. But exercise can hugely improve one’s energy level and well-being.
✓ Speak to your doctor about how you’re feeling. Discuss temporarily
lightening some of your diabetes workload. For example, ask if for a
period of time you can safely test your blood glucose less often. Or, if
you’re on four times daily insulin, ask if you can safely, temporarily,
switch to a different insulin that is given twice per day.
✓ Know that help is available. Your doctor, depending on your specific
situation, may recommend antidepressant medication or other forms of
psychological support.
Feeling at wits’ end with diabetes is common enough that an entire book is
devoted to the subject. Diabetes Burnout by Dr. William Polonsky is an excel-
lent resource to help you cope.
Diabetes etiquetteIf you have diabetes, you’ve probably run into situations where people have offered you well-intentioned, but unsolicited and unhelpful advice. (We love the term for these people — especially those who question your food choices when you’re in the cafeteria lineup or at a restaurant: the diabetes police!) The Behavioral Diabetes Institute (BDI; www.behavioraldiabetesinstitute.org) has developed etiquette cards for people with diabetes to give out to others (who don’t have diabetes). With the BDI’s kind permission, here’s what the card says:
1. DON’T offer unsolicited advice about my eating or other aspects of diabetes. You may mean well, but giving advice about some-one’s personal habits, especially when it is not requested, isn’t very nice. Besides, many of the popularly held beliefs about diabetes (“you should just stop eating sugar”) are out of date or just plain wrong.
2. DO realize and appreciate that diabetes is hard work. Diabetes management is a full-time job that I didn’t apply for, didn’t want and can’t quit. It Involves thinking about what, when, and
(continued)
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20 Part I: Dealing with the Diagnosis of Diabetes
(continued)
how much I eat, while also factoring in exer-cise, medication, stress, blood sugar monitor-ing, and so much more — each and every day.
3. DON’T tell me horror stories about your grandmother or other people with diabetes you have heard about. Diabetes is scary enough, and stories like these are not reassuring! Besides, we now know that with good manage-ment, odds are good you can live a long, healthy and happy life with diabetes.
4. DO offer to join me in making healthy lifestyle changes. Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!
5. DON’T look so horrified when I check my blood sugars or give myself an injection. It is not a lot of fun for me either. Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes it much harder for me.
6. DO ask how you might be helpful. If you want to be supportive, there may be lots of little things I would probably appreciate your help with. However, what I really need may be very different than what you think I need, so please ask first.
7. DON’T offer thoughtless reassurances. When you first learn about my diabetes, you may want to reassure me by saying things like, “Hey, it could be worse; you could have cancer!” This won’t make me feel better. And the implicit mes-sage seems to be that diabetes is no big deal. However, diabetes (like cancer) IS a big deal.
8. DO be supportive of my efforts for self-care. Help me set up an environment for success by supporting healthy food choices. Please honor my decision to decline a particular food, even when you really want me to try it. You are most helpful when you are not being a source of unnecessary temptation.
9. DON’T peek at or comment on my blood glucose numbers without asking me first. These numbers are private unless I choose to share them. It is normal to have numbers that are sometimes too low or too high. Your unsolicited comments about these numbers can add to the disappointment, frustration and anger I already feel.
10. DO offer your love and encouragement. As I work hard to manage diabetes successfully, sometimes just knowing that you care can be very helpful and motivating.
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Index
• A •Aboriginal peoples and diabetes
overview, 320–321
prevention and treatment, 321–322
screening schedule, 321
A1C
blood glucose readings not matching,
187–189
defi ned, 371
diagnosing diabetes, A1C level as
criteria for, 22–23
importance of, 184–186
monitoring, 146
overview, 184
pregnancy, testing during, 138
readings, understanding your, 186–187
reporting, new methods of, 185
target readings, 187
acanthosis nigricans, 113
acarbose, 52, 245, 371
accepting your diabetes, 11–12
ACCU-CHEK Spirit Combo (Roche), 275
ACE inhibitor, 371
ACR (albumin/creatinine ratio), 100
acromegaly, 57
actos. See pioglitazone
adolescents with diabetes, 301–303
adult-onset diabetes. See type 2 diabetes
aerobic exercise. See cardiovascular
exercise
airline security and traveling with
insulin, 290–291
albumin, 100
alcohol
hypoglycemia, avoiding overuse of
alcohol as method of preventing,
72–73
moderation in drinking, 340
overview, 213–214
alpha-glucosidase inhibitors, 245–246
alternate therapies. See CAMs
amaryl. See glimepiride
American Diabetes Association (ADA)
website, 368, 369
American Foundation for the Blind, 99
amino acids, 371
amylin, 31, 33
analgesics (pain relievers) for nerve
damage, 104
animal insulin, 268
anorexia nervosa, 223
antibodies, 371
antihyperglycemic medications
alpha-glucosidase inhibitors, 245–246
bromocriptine, 249
CDA-recommended approach to
treating type 2 diabetes with, 251–253
choosing, 239
colesevelam, 249
defi ned, 371
DPP-4 inhibitors, 246–247
GLP-1 analogues, 247–249
how it works, 240
long-term treatment, 253–254
meglitinides, 243–244
metformin, 241–242
orlistat, 249
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382 Diabetes For Canadians For Dummies, 3rd Edition
antihyperglycemic medications (continued)
pramlintide, 249
reasons for not taking, 238
reasons to take, 239
SGLT-2 inhibitors, 250
sulfonylureas, 243
thiazolidinediones (TZDs), 244–245
types of, 241–250
anxiety as symptom of hypoglycemia, 64
apidra. See glulisine
apolipoprotein B, 92, 93
ARB, 371
arterial circulatory disease, 85
Ask NOAH about Diabetes (website), 368
aspart insulin, 264, 371
aspartame, 215
atherosclerosis, 48, 85, 371
atorvastatin, 94, 95
autoimmune disorder, 42, 372
autonomic neuropathy (nerve damage),
105, 372
autonomic symptoms of hypoglycemia,
63, 64–65
avandia. See rosiglitazone
average blood glucose, 186–187
• B •babies with diabetes, 296–298
balanitis, 48
Banting, Dr. Frederick (Nobel Prize
winner), 37
bariatric surgery, 220–221
basal-bolus insulin therapy, 263–264,
268–269, 270, 275, 372
basal insulin, 263–264, 268–269, 292, 372
bedtime snack as method of prevention
of hypoglycemia, 72
Behavioral Diabetes Institute (BDI),
19, 368
behaviour modifi cation for weight
reduction, 221–222
Belviq, 220
Benny, Jack (actor), 11
Best, Charles H. (Nobel Prize winner), 37
beta blockers, 73, 75
beta cell, 30, 372
Beyond the Basics: Meal Planning for
Healthy Eating, Diabetes Prevention
and Management, 355, 356
biguanides, 242
bile acid binding resins, 94
birth defects, 134
bladder malfunction, 105
blind or visually impaired persons,
resources for, 98–99
blinded CGM. See professional CGM
Blindness Resource Center, 99
Bliss, Michael (The Discovery of Insulin),
37
blood, donating, 289
blood glucose
average, 186–187
macrovascular complications, reducing
high blood glucose to prevent, 86
peripheral neuropathy, effect on, 104
unsolicited comments on your
numbers, 20
blood glucose meter
alternative sites, ability to test from,
169
calibration, 169
choosing, 166, 168–171
defi ned, 372
diagnosis of diabetes from, avoid
making a, 23
display readability and features, 169
download capabilities, 170
esthetics and ergonomics, 168
iPhone compatibility, 170
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383383 Index
ketone testing ability, 170
manufacturers, 171
mealtime insulin doses, help
calculating, 169–170
multiple test strips, ability to hold, 170
overview, 160–161
patterns, ability to interpret blood
glucose, 169
with speech capability, 99
using, 161–162
blood glucose monitoring
with A1C test, 184–189
for elderly people, 317–320
erratic blood glucose levels, possible
causes of, 181–184
frequency of testing, 162–165
high readings all the time, 178–179
high two-hour after-meal readings,
177–178
hypoglycemia, setting higher blood
glucose targets as method of
preventing, 73
importance of, 158–159
interpreting your results, 176–184
ketoacidosis, preventing, 78
methods of, 159–160
overview, 146
during pregnancy, 138
recording your results, 171–175
sharing results, 13
target readings, 175–176
testing and reaching your target
levels, 341
when to test your blood glucose,
165–167
blood pressure
low blood pressure when standing, 105
lowering, 342
monitoring, 146–147
blot hemorrhages, 95
Blumer, Ian (Understanding Prescription
Drugs For Canadians For
Dummies), 73
blurred vision
blood glucose and, 25, 26
type 1 diabetes symptom, 41
type 2 diabetes symptom, 48
body mass index (BMI), 52, 372
bolus insulin, 264, 268, 292, 372
brain’s role in glucose regulation, 33
breastfeeding, 131, 141
brittle diabetes, 183–184
bromocriptine, 249
bronze diabetes, 57
bruising, 113
bulimia nervosa, 223
byetta. See exenatide
• C •CAD (coronary artery disease), 85–88
calcium, 212
calorie, 203
The Calorie King Calorie, Fat &
Carbohydrate Counter (Family
Health), 288
CAMs (complementary or alternative
therapies)
chromium, 256
cinnamon, 257
evaluating, 255–256
fenugreek, 257
garlic, 257
ginkgo, 257
ginseng, 257
gymnema sylvestre, 257
overview, 255
Canadian Council of the Blind, 99
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384 Diabetes For Canadians For Dummies, 3rd Edition
Canadian Diabetes Association (CDA)
antihyperglycemic medications,
recommended approach to treating
type 2 diabetes with, 251–253
blood glucose targets, recommendation
of, 175
Clinical Practice Guidelines, 1, 62, 123
Eating Well with Canada’s Food
Guide, 202
food group system, 355–366, 374
heart attack and stroke prevention
strategies, 87
statins, recommendation of, 94
type 2 diabetes screening for at risk
people, recommendation of, 47, 50
website, 368, 369
Canadian National Institute for the Blind
(CNIB), 99
CANRISK (Canadian Diabetes Risk
Questionnaire), 51
capsaicin, 104
carbohydrate
defi ned, 372
fi bre, 207
glycemic index (GI), 205–207
overview, 22, 203–205
role of, 204
carbohydrate counting, 152, 207,
287–289, 372
cardiovascular disease, 85
cardiovascular exercise
moderate, 230
overview, 228–229
recommended amount of, 230–231
starting, 229–230
vigorous, 230
Carey, Drew (actor), 11
carpal tunnel syndrome, 105, 114
cataract, 98, 372
catheter method of insulin delivery, 274
causes
hypoglycemia, 66–67
type 1 diabetes, 42–43
type 2 diabetes, 49–50
CDA. See Canadian Diabetes Association
CDE (certifi ed diabetes educator), 150
celiac disease, 108–109, 182
Celiac Disease For Dummies (Crowe), 109
cerebrovascular disease, 48, 50, 85–88
CGM (continuous glucose monitoring)
advantages of, 193–197
components, 190–191
disadvantages of, 197–199
hypoglycemia, as method of
preventing, 73
overview, 190–193
professional, 190, 193, 196–197
real-time, 190–193, 194–196
receiver (display), 193
sensor, 193
transmitter, 193
Charles H. Best Diabetes Centre, 301
chemical exposure as cause of type 1
diabetes, 43
Chick, John (athlete), 11
children with diabetes
adolescents, 301–303
babies, 296–298
MODY (maturity onset diabetes of the
young), 311
primary school children, 298–301
screening tests for organ injury, 307–308
sick day solutions, 306–307
summer camps for, 308–309
toddlers, 296–298
transition from pediatric to adult
diabetes specialist care, 304–306
type 2 diabetes, 309–311
young adult children, 303
Children with Diabetes (website), 369
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385385 Index
cholesterol
defi ned, 372
overview, 209–210
reducing, 341
cholestyramine, 94
chromium, 256
Chromosome 20, HNF-4alpha. See MODY
Cialis, 118
cinnamon, 257
claudication, 89
Clement, Dr. Maureen (family
physician), 150
CNIB (Canadian National Institute for the
Blind), 99
colesevelam, 94, 249
Collip, J. B. (Nobel Prize winner), 37
commercial driver’s licence, 330–331
complementary or alternative therapies.
See CAMs
confusion as symptom of
hypoglycemia, 65
congenital anomaly, 134
consciousness, loss of, 65
continuous glucose monitoring. See CGM
continuous glucose monitoring system,
373
continuous subcutaneous insulin
infusion therapy (CSII), 275
controlling your blood glucose
corrective action for, 27–28
lose control of your blood glucose,
what to do if you, 27–28
overview, 27
coping with diabetes, 18–19
coronary artery disease, 50
coronary heart disease, 48, 85
correction factor, 289
corrective action for controlling your
blood glucose, 27–28
cow’s milk as cause of type 1 diabetes,
early exposure to, 43
creatinine, 100, 373
Crestor, 94, 95
criteria for diagnosing diabetes, 22–23
Crowe, Dr. Sheila (Celiac Disease For
Dummies), 109
cure for diabetes, progress for, 351
Cushing’s syndrome, 57
• D •DASH (Dietary Approaches to Stop
Hypertension), 215
dawn phenomenon, 177, 285, 346, 373
degludec, 373
delivery of large baby as risk factor for
type 2 diabetes, 50
dementia, 107, 315
dentist, 155
depression, 107
detemir, 373
Dex4 tablets for mild/moderate
hypoglycemia, 67–68
Dexcom CGMS, 191–192
diabeta. See glyburide
diabetes
accepting your, 11–12
coping with, 18–19
etiquette, 19–20
family, impact of your diabetes on your
relationships with your, 12–13
friends, impact of your diabetes on
your relationships with your, 13–14
frustration with managing your, 18
guilt over not doing better managing
your, 17
increase in, 10
managing, energy needed for, 17
number of people living with, 10
overview, 9–10
sharing news of your, 12
types of, 57
workmates, impact of your diabetes on
your relationships with your, 14–15
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386 Diabetes For Canadians For Dummies, 3rd Edition
Diabetes Burnout (Polonsky), 19
diabetes education centres, 151
diabetes educator, 150–151, 235
Diabetes in the Workplace: A Guide for
Employers and Employees, 327
diabetes insipidus, 10
diabetes mellitus, 10, 373
Diabetes Monitor (website), 368
diabetes nurse educators, 151
diabetes specialist, 149–150
Diabetic Gourmet Magazine (website), 369
diabetic hand syndrome, 115
diabetic ketoacidosis. See ketoacidosis
diabetologist, 373
diagnosing diabetes
A1C level as criteria for, 22–23
criteria for, 22–23
in elderly people, 314
fasting blood glucose level as criteria
for, 22–23
glucose tolerance test as criteria for,
22–23
history of, 21
overview, 21, 22–23
random blood glucose level as criteria
for, 22–23
dialysis, 102, 373
diamicron. See gliclazide
diarrhea, 108
diet
alcohol, 213–214
carbohydrates, 203–207
DASH (Dietary Approaches to Stop
Hypertension), 215
eating out, 216–217
for elderly people, 317–318
fats, 209–211
food group system, nutrition plan
created with, 364–366
gestational diabetes treated with, 126
importance of following a healthy, 339
Mediterranean, 215
minerals, 212
non-nutritive sweeteners, 214–215
overview, 202–203
plan, 181
during pregnancy, 138
proteins, 208–209
sugar, 204
vegan, 215
vegetarian, 215
vitamins, 211–212
water, 213
Dietary Approaches to Stop
Hypertension (DASH), 215
dietitians. See registered dietitians
digestive disorders, 108–109
disability insurance, 328
disaster preparation, 333–334
The Discovery of Insulin (Bliss), 37
discrimination, employment, 323–324,
326–327
disposable pens for insulin delivery,
272–273
Disraeli, Benjamin (British prime
minister), 43
dizziness as symptom of
hypoglycemia, 65
doctor. See also specifi c types of doctors
duty to report patients unsafe to
drive, 332
working with your, 344
donating blood, 289
dose, adjusting your insulin, 283–287
dot hemorrhages, 95
double diabetes, 36
DPP-4 inhibitors, 246–247, 320, 373
Dr. Rubin (website), 368
driving when you have diabetes
commercial licence, 330–331
losing your licence, avoiding, 332–333
medically fi t to drive, determining if
you are, 329
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387387 Index
physician’s duty to report patients
unsafe to drive, 332
precautions, 329–330
reinstating your licence, 333
drowsiness as symptom of
hypoglycemia, 65
Drucker, Dr. Daniel (research
scientist), 32
drug availability in countries other than
Canada, 250
drug-induced diabetes, 57, 58
drunk, difference between having low
blood glucose and being, 14
dysesthesiae, 103
dyslipidemia, 373
• E •eating disorders, 223
eating out, 216–217
Eating Well with Canada’s Food
Guide, 202
ED (erectile dysfunction), 116–119
Edison, Thomas (inventor), 11
eGFR (estimated glomerular fi ltration
rate), 100–101
elderly people and diabetes
blood glucose control, 317–320
diagnosis, 314
elderly defi ned, 313
exercise, 318
eye problems, 315
foot problems, 316
intellectual function evaluation, 315
medication, 319–320
nutrition, 317–318
overview, 313–314
sexual dysfunction, 316
urinary problems, 315
elevated blood glucose, extreme.
See HHS
employment
discrimination, 323–324, 326–327
job interviews, 325
legal protections, 324–325
recourse against discrimination,
326–327
safety-sensitive positions, 325–326
endocrine function, 30
endocrinologist, 149, 373
estimated average glucose, 185
etiquette, diabetes, 19–20
exenatide, 247, 373
exercise
advantages of, 226–227
cardiovascular, 227, 228–231
checking with doctor before starting a
program of, 232–233
daily exercise, importance of, 339
for elderly people, 318
with family members, 13
fl exibility, 227
gestational diabetes treated with, 126
hypoglycemia, exercise plan as method
of preventing, 72
regular, 19
resistance, 227, 231–232
supervised exercise programs, 235
types of, 227–228
exercise stress test, 232
extra-ocular muscle palsy, 106
eye disease
cataracts, 98
in elderly people, 315
glaucoma, 98
overview, 95
retinopathy, 95–98
eye doctor, 152–153, 342
ezetimibe, 94
Ezetrol, 94
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388 Diabetes For Canadians For Dummies, 3rd Edition
• F •family
biological fi rst-degree relative with
type 2
diabetes as risk factor for type 2
diabetes, 50
exercising with your, 16
health care team, as part of, 155–156
impact of your diabetes on your
relationships with your, 12–13
involvement, importance of, 16, 344
juggling your diabetes and your family
life, 15–16
yourself, making time for, 16
family physician, 148–149, 150, 235
FAQs (frequently asked questions)
“How can I get my doctor to be more
communicative?”, 349–350
“I used to be on pills, but now I’m
on insulin. Does that mean I’ve
developed type 1 diabetes?”, 348
“I’m watching my diet, so why is my
cholesterol level high?”, 348
“What’s the difference between an A1C
level and a blood glucose level?”, 347
“When you’re on insulin, you’re on it
forever, right?”, 348
“Why are my blood glucose levels all
over the place?”, 346
“Why are my blood glucose levels
getting worse as time goes by?”, 347
“Why are my blood glucose levels
higher when I get up in the morning
than when I go to bed?”, 345–346
“Why do I need blood pressure pills if
my blood pressure is good?”, 349
“Will I always have diabetes?”, 350–351
fasting, 22
fasting blood glucose
diagnosing diabetes, as criteria for,
22–23
insulin dose adjusted to lower your,
285
fat carried in midsection, 52, 55
fatigue
high blood glucose symptom, 26
type 1 diabetes symptom, 41
type 2 diabetes symptom, 48
fats
cholesterol, 209–210
defi ned, 373
food group system, category in, 363
monounsaturated, 210
omega-3 fatty acids, 210
overview, 209
polyunsaturated, 210
saturated, 210
trans fatty acids, 210–211
unsaturated, 210
feet. See also foot disease
maintaining your, 342–343
numbness of feet as type 2 diabetes
symptom, 48
female sexual dysfunction, 119–120
fenofi brate, 97
fenugreek, 257
fi brate, 94
fi bre, 207, 373
First Nations peoples. See Aboriginal
peoples
fl exibility exercise, 227
folic acid, 137
Food and Diabetes (Yasui and Hatton), 299
food group system
defi ned, 374
fats, 363
free foods, 364
fruits, 357–359
grains and starches, 356–357
meat and alternatives, 361–362
milk and alternatives, 359
nutrition plan created with, 364–366
other choices (sweet foods and
snacks), 360
overview, 355–356
sample menus, 364–366
vegetables, 360–361
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389389 Index
foot disease
in elderly people, 316
overview, 109
protecting your feet, 110–112
foot doctor, 154–155
free foods, 364
frequently asked questions. See FAQs
friends as part of your health care team,
155–156
frozen shoulder, 115
fructosamine level, testing, 160
fructose, 22, 374
fruits, 357–359
fruity breath
ketoacidosis symptom, 76
type 1 diabetes symptom, 41
frustration with managing your
diabetes, 18
• G •garlic, 257
gastric bypass, 221
gastroparesis, 108, 182, 264, 374
GDM. See gestational diabetes
genetic risk for type 2 diabetes, 49
gestational diabetes
after baby is born, 130–132
causes, 122
defi ned, 374
diagnosing, 122–124, 125
monitoring, 128
one-step approach to diagnosing, 124
overview, 121–122
potential complications
for baby, 130
for mother, 129
risk for, determining, 124–125
treating, 125–127
two-step approach to diagnosing, 123
type 2 diabetes, risk factor for, 50
GFR (glomerular fi ltration rate), 100–101
GI (glycemic index), 205–207, 375
gingivitis, 115, 155
ginkgo, 257
ginseng, 257
glargine, 374
glaucoma, 98
gliclazide, 243, 374
glimepiride, 243, 374
GLP-1 analogues, 247–249, 374
glucagon
defi ned, 374
hypoglycemia, as treatment of, 69–71
overview, 31, 33
glucagon kit, 69–70
Glucobay. See acarbose
GlucoNorm. See repaglinide
glucose, 2, 21–22, 374
glucose tolerance test, 22–23, 374
glulisine insulin, 264, 374
glumetza, 374
glyburide, 243, 374
glycemic index (GI), 205–207, 375
glycogen, 375
glycohemoglobin. See A1C
glycosylated hemoglobin. See A1C
grains and starches, 356–357
Grenkow, Chuck (former Canadian
Forces pilot), 11
grocery shopping with family
members, 13
GTT (glucose tolerance test), 131
guilt over not doing better managing
your diabetes, 17
gum disease, 115, 155
gymnema sylvestre, 257
• H •Hall, Gary Junior (athlete), 11
handling and storage of insulin, 282–283
hardening of the arteries. See
atherosclerosis
Hatton, Doreen (Food and Diabetes), 299
HDL (high-density lipoprotein), 92, 375
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390 Diabetes For Canadians For Dummies, 3rd Edition
health care team
defi ned, 375
dentist, 155
diabetes educator, 150–151
diabetes specialist, 149–150
eye doctor, 152–153
family and friends, 13, 155–156
family physician, 148–149
foot doctor, 154–155
pharmacist, 153–154
questioning your, 147–148
registered dietitians, 151–152
scheduling visits to members of
your, 147
your responsibilities, 146–148
health maintenance tips
blood glucose levels, testing and
reaching your target, 341
blood pressure, lowering your, 342
cholesterol, reducing your, 341
diet, following a healthy, 339
doctor, working with your, 344
drinking moderately, 340
exercise, daily, 339
eye doctor, visiting your, 342
family involvement, importance of, 344
feet, maintaining your, 342–343
kidney function, monitoring, 342
learning everything you can about
diabetes, 338
medication, taking proper, 343–344
numbers, importance of knowing your,
340–342
smoking, quitting, 340
heart attack
prediabetes as risk for, 56
preventing, 87–88
risk for, determining, 147
heart disease, 48, 232
heart rate, abnormal, 105
helpful, ways to be, 20
Hemingway, Ernest (writer), 11
hemochromatosis, 57
hemoglobin, 347
hemoglobin A1C. See A1C
HHS (hyperosmolar hyperglycemic
state)
causes of, 81
defi ned, 375
overview, 79–80
prevention of, 81–82
symptoms of, 80–81
treatment of, 81
high blood glucose, symptoms caused
by, 25–26
high blood pressure (hypertension),
90–91, 133, 232
high-density lipoprotein (HDL), 92, 375
high-risk population member as risk
factor for type 2 diabetes, 50
history of diagnosing diabetes, 21
honeymoon phase, 287, 375
hormonal disease-induced diabetes, 57
hormones, 24, 30–31. See also insulin
horror stories, 20
hospitalization
for HHS, 80
ketoacidosis, treatment of, 77–78
humalog insulin. See Lispro insulin
hunger
high blood glucose symptom, 25
hypoglycemia symptom, 64, 65
type 1 diabetes symptom, 41
hyperglycemia
after baby is born, 131
defi ned, 375
and exercise, 232–234
overview, 36, 297
hyperosmolar hyperglycemic state.
See HHS
hyperthyroidism, 57, 115
hypoglycemia (low blood glucose)
baby, after having a, 141–142
baby developing, 130
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391391 Index
causes of, 66–67
defi ned, 62, 375
and exercise, 232–234, 233–234
mild, 63
moderate, 63
overly frequent, 179–180
overview, 61–62, 297
pregestational diabetes and risk of, 133
prevention of, 71–74
repeated hypoglycemia, 74
severe, 63, 64
severity of, 63
symptoms of
autonomic, 63, 64–65
neuroglycopenic, 63, 65–66
overview, 63–64
treatment of
glucagon as, 69–71
mild hypoglycemia, 67–68
moderate hypoglycemia, 67–68
overview, 67
severe hypoglycemia, 69–71
hypoglycemia unawareness, 74–75
hypothyroidism, 115
Hypurin NPH insulin, 268
Hypurin Regular insulin, 268
• I •impaired fasting glucose (IFG), 375
impaired glucose tolerance (IGT), 375
incretin mimetic, 375
incretins, 32, 36, 375
infants with diabetes, 296–298
infusion set malfunctions causing
ketoacidosis, 78
inhaled insulin, 268
inheritance of type 1 diabetes, 43
insoluble fi bre, 207
insulin
animal, 268
basal, 263–264, 268–269, 292, 372
bolus, 264, 268, 292, 372
defective insulin as cause of
ketoacidosis, 77
defi ned, 376
discovery of, 37
dose, adjusting your, 283–287
for elderly people, 320
gestational diabetes treated with,
126–127
hypoglycemia
insulin as cause of, 66
switching type of insulin you are
taking as method of preventing, 72
inhaled, 268
intermediate-acting, 263, 265–266
ketoacidosis
fresh insulin used as method of
preventing, 78
low insulin doses as cause of, 77
missing insulin doses as cause of, 77
taking insulin as method of
preventing, 78
long-acting, 263, 266–267
myths about, 270–271
overview, 24, 260
pregnancy, adjusting during, 138–139
premixed, 263, 267, 270
rapid-acting, 263, 264, 291
regular, 265
short-acting, 263
storage and handling, 282–283
terminology, 263–264
traveling with, 290–292
types of, 260–263
insulin defi ciency, 35–36
insulin delivery
with catheter, 274
with jet injection device, 274
overview, 272
with pen devices, 272–273
with pump, 274–282
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392 Diabetes For Canadians For Dummies, 3rd Edition
insulin dependent diabetes. See type 1
diabetes
Insulin for Life, 132, 260
insulin injection
family members, in front of, 13
friends, in front of, 14
reaction to, 20
insulin reaction, 66, 376
insulin resistance, 35, 49, 376
insulin sensitivity factor, 289
insulin shock, 66
insulin therapy
basal-bolus, 263–264, 268–269, 270,
275, 372
with carbohydrate counting, 287–289
and exercise, 234
inconsistent blood glucose readings,
182–184
intensifi ed, 275
pump therapy, 270
for type 1 diabetes, 268–269
for type 2 diabetes, 269–270
insurance
disability, 328
life, 328
overview, 327
travel, 328
intellectual function evaluation for
elderly people, 315
intensifi ed insulin therapy. See basal-
bolus insulin therapy
intensive diabetes management, 376
intermediate-acting insulin, 263, 265–266
intermittent claudication, 89
internists, 149–150
interpreting your blood glucose results
high before-breakfast readings, 176–177
high readings all the time, 178–179
high two-hour after-meal readings,
177–178
hypoglycemia, overly frequent, 179–180
inconsistent readings, 180–184
overview, 176
intestine, role in glucose regulation of, 32
Inuit peoples. See Aboriginal peoples
islet cells, 30, 376
• J •januvia. See sitagliptin
JDRF (Juvenile Diabetes Research
Foundation), 14
jet injection device for insulin
delivery, 274
job interviews, 325
juice for mild/moderate hypoglycemia,
67–68
juvenile-onset diabetes. See type 1
diabetes
• K •ketoacidosis
causes of, 77
defi ned, 376
overview, 40, 75
prevention of, 78–79
symptoms of, 76
treatment of, 77–78
ketone
defi ned, 376
overview, 41, 128
when to test for, 76
kidney disease
diagnosing, 100–101
overview, 99
treating, 101–102
kidney failure, 100
kidney function
monitoring, 342
worsening of, 133
kilocalorie, 203
kilojoules, 203
Kimball, Charlie (race car driver), 194
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393393 Index
• L •labour and delivery, 139–141
lactic acidosis, 242
LADA (latent autoimmune diabetes of
adults), 44
lancet, 160, 376
lancet holder, 161
lantus. See glargine
laparoscopic banding, 221
laser treatment, 376
lateral femoral cutaneous nerve
syndrome, 106
LDL (low-density lipoprotein),
92, 93, 94, 377
learning everything you can about
diabetes, 338
legal protection for employment, 324–325
Levemir insulin, 266–267
Levitra, 118
life insurance, 328
lifestyle treatment plan, 51–52, 146
Lilly Diabetes Journey Awards, 288
linagliptin, 247, 376
lipid levels, monitoring, 147
lipids, 91–95
Lipitor, 94, 95
lipohypertrophy, 113, 183, 283, 376
liraglutide, 247, 377
lispro insulin, 264, 377
liver disease, 109
liver’s role in glucose regulation, 31–32
logbooks, maintaining, 171–175
long-acting insulin, 263, 266–267, 376
long-term complications
abnormal cholesterol and triglyceride
levels (dyslipidemia), 91–95
CAD (coronary artery disease),
85, 86–89
cardiovascular disease, 85
categories of, 84–85
cerebrovascular disease, 85, 86–89
digestive disorders, 108–109
ED (erectile dysfunction), 116–119
eye disease, 95–99
female sexual dysfunction, 119–120
foot disease, 109–112
gum disease, 115
high blood pressure, 90–91
kidney disease, 99–102
macrovascular complications, 84–86
mental health issues, 107
microvascular complications, 84, 86
musculoskeletal problems, 114–115
neuropathy (nerve damage), 102–106
overview, 83–84
PAD (peripheral arterial disease),
85, 89–90
skin disease, 113–114
thyroid disease, 115
long-term treatment, 253–254
longstanding diabetes as cause of
hypoglycemia unawareness, 74
losing your licence, avoiding, 332–333
low blood glucose. See hypoglycemia
low blood pressure when standing, 105
low-density lipoprotein (LDL),
92, 93, 94, 377
• M •Macleod, Dr. John (Nobel Prize
winner), 37
macrosomia, 50, 130, 377
macrovascular complications
overview, 84–85
reducing high blood glucose to
prevent, 86
macrovascular syndrome, 377
macula, 95
macular edema, 95
managing your diabetes, energy needed
for, 17
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394 Diabetes For Canadians For Dummies, 3rd Edition
McDonald-Blumer, Heather
(Understanding Prescription Drugs For
Canadians For Dummies), 73
meals
after-meal blood glucose levels, insulin
dose adjusted to improve, 286–287
after you’ve eaten, organs role in
glucose regulation, 33–34
high before-breakfast blood glucose
readings, 176–177
missing or delaying meals as cause of
hypoglycemia, 71
meat and alternatives, 361–362
medical alert bracelets/necklaces, 63
medical assistance, when to seek, 28
medical care team. See health care team
medically fi t to drive, determining if you
are, 329
medication. See also antihyperglycemic
medications
bringing all your medication to medical
appointments, 147
for elderly people, 319–320
for erectile dysfunction, 118
exercise and medication therapy, 233
for high cholesterol, 94–95
for high triglycerides, 94
hypoglycemia
medication impairing your ability to
recognize, 75
reviewing your non-diabetes
medications with your physician as
method of preventing, 73
importance of taking proper, 343–344
for nerve damage, 104
for weight reduction, 220
Mediterranean, 215
MedLinePlus Drug Information
(website), 368
Medtronic, 191–192
Medtronic CGMS, 195
meglitinides, 66–67, 243–244
Mendosa, David (medical writer), 369
menstrual cycle, 182
mental health issues, 107
metabolic syndrome, 54–55, 377
metabolism, 377
metformin, 52, 241–242, 319, 377
Métis peoples. See Aboriginal peoples
microalbuminuria, 100, 377
microaneurysms, 95
microvascular complications
defi ned, 377
overview, 84
reducing high blood glucose to
prevent, 86
mild hypoglycemia (low blood glucose),
63, 67–68
milk and alternatives, 359
milligrams per decilitre (mg/dL), 23
minerals, 212
mini-dose glucagon, 297, 300
MiniMed Paradigm Veo (Medtronic), 275
miscarriage, 134
missing or delaying meals as cause of
hypoglycemia, 71
mmol/L (millimoles per litre), 2
moderate cardiovascular exercise, 230
moderate hypoglycemia (low blood
glucose), 63, 67–68
MODY (maturity onset diabetes of the
young), 57, 311
monounsaturated fat, 210, 377
multivitamins, 137
muscles’ role in glucose regulation, 32
musculoskeletal problems, 114–115
myths about insulin, 270–271
• N •nail infections, 113–114
nateglinide, 244, 377
natural health products. See CAMs
Natural Health Products Regulations, 256
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395395 Index
nausea, vomiting, and abdominal pain as
symptom of ketoacidosis, 76
necrobiosis lipoidica diabeticorum, 114
neovascularization, 95, 377
nephropathy, 50, 377
neuroglycopenic symptoms of
hypoglycemia (low blood glucose),
63, 65–66
neuropathy (nerve damage)
autonomic, 105
defi ned, 377
overview, 102–103
peripheral, 103–104
types of, 105–106
niacin, 94
non-HDL cholesterol, 92, 93
non-insulin antihyperglycemic
medication, 377
non-insulin dependent diabetes.
See type 2 diabetes
non-nutritive sweeteners, 214–215
non-proliferative retinopathy, 95
non-visceral fat, 33
Novo Nordisk Half Century Award
Program, 288
NovoRapid (aspart) insulin, 127, 264
NPH insulin, 126, 265–266, 378
numbers, importance of knowing your,
340–342
nurse educators, 151
nutrition. See diet
nutrition food labels, 217
• O •omega-3 fatty acids, 210, 378
OneTouch Ping (Animas), 275
onglyza. See saxagliptin
Online Diabetes Resources by David
Mendosa (website), 369
open sores on your feet, 110, 113
ophthalmologist, 97, 378
optometrists, 97
oral antidiabetic agents. See
antihyperglycemic medications
oral hypoglycemic agent, 378
Oral-lyn insulin, 268
organs’ role in glucose regulation
after you’ve eaten, 33–34
brain, 33
fat, 32–33
intestine, 32
liver, 31–32
muscles, 32
overview, 29–30
pancreas, 30–31, 33–34
when you haven’t recently eaten, 34
orlistat, 249
orthotics, 154
Our Diabetes (website), 368
overnight hypoglycemia
children, reducing risk for, 299
insulin dose adjusted to avoid, 285–286
overweight, determining if you are, 52
oxygen free radicals exposure as cause
of type 1 diabetes, 43
• P •PAD (peripheral arterial disease),
48, 50, 85, 89–90
palpitations as symptom of
hypoglycemia, 64, 65
pancreas
beta cell, 30
defi ned, 378
diabetes caused from damage to, 57
endocrine function, 30
exocrine function, 30
glucose regulation, 30–31, 33–34
hormones produced by, 30–31
islet cells, 30
overview, 24, 30
pancreatitis, 57, 93
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396 Diabetes For Canadians For Dummies, 3rd Edition
patch pumps, 275, 277, 281
PDE5 (phosphodiesterase type 5)
inhibitors, 118, 119
pen devices for insulin delivery
for blind or visually impaired people, 99
disposable pens, 272–273
overview, 272–274
refi llable pens, 272–273
perfection, not striving for, 19
peripheral arterial disease. See PAD
peripheral neuropathy (nerve damage),
103–104, 233, 378
personal CGM. See real-time CGM
pharmacist, 153–154
pheochromocytoma, 57
physical limitations and exercise, 233
pioglitazone, 244, 378
A Place for All: A Guide to Creating an
Inclusive Workplace, 325
placenta, 122
plaque, 85
pneumonia, 106
podiatrist, 378
Polonsky, William (Diabetes Burnout), 19
polydipsia, 378
polyunsaturated fat, 210, 378
polyuria, 378
portion control for weight reduction, 220
positive thinking, 19
post-prandial, 378
postpartum thyroiditis, 142
pramlintide, 249
pre-prandial, 378
precautions for driving when you have
diabetes, 329–330
prediabetes
criteria for, 56
defi ned, 378
overview, 55
risks of, 56–57
type 2 diabetes, as risk for, 50, 56
prednisone, 58
pregestational diabetes
after having your baby, managing your
diabetes, 141–142
overview, 54, 132–133
pregnancy, managing your health
during, 137–139
before pregnancy, review of what to do,
134–137
risks
for baby, 134
for fetus, 134
for mother, 133
pregnancy
after having your baby, managing your
diabetes, 141–142
gestational diabetes, 121–132
labour and delivery, 139–141
managing your health during, 137–139
pregestational diabetes, 132–142
premixed insulin, 263, 267, 270
prepackaged foods, 217
Presley, Elvis (singer), 11
preventative strategies
Aboriginal peoples and diabetes,
321–322
hypoglycemia (low blood glucose),
71–74
type 1 diabetes, 45
type 2 diabetes, 51–53
primary school children with diabetes,
298–301
professional CGM, 190, 193, 196–197
proliferative retinopathy, 95
protein, 208–209, 378
Public Health Agency of Canada, 51
pump for insulin delivery
defective delivery of insulin as cause of
ketoacidosis, 77
insulin pump defi ned, 376
during labour and delivery, 140
malfunctions causing ketoacidosis, 78
overview, 270, 274–282
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397397 Index
• Q •Qsymia, 220
quitting smoking, 88–89
• R •random blood glucose level as criteria
for diagnosing diabetes, 22–23
rapid-acting insulin, 127, 263, 264,
291, 378
rapid breathing as symptom of
ketoacidosis, 76
real-time CGM, 190–193, 194–196
recourse against discrimination in
workplace, 326–327
refi llable pens for insulin delivery,
272–273
registered dietitians, 151–152
regular insulin, 265, 378
reinstating your licence, 333
relationships, impact of your diabetes on
your, 12–15
repaglinide, 244, 379
repeated hypoglycemia, 74
resistance exercise, 227, 231–232
responsibilities for your health, your
day-to-day, 146–148
restaurant meals, 216–217
retina, 379
retinal detachment, 95
retinopathy
defi ned, 379
non-proliferative, 95
overview, 50, 95–96, 133
preventing, 96–97
proliferative, 95
screening for, 97–98
retrograde ejaculation, 116
rosiglitazone, 244, 379
rosuvastatin, 94, 95
• S •safety-sensitive positions, 325–326
sample menus, 364–366
Sasseville, Sebastien (mountain
climber), 11
saturated fat, 210, 379
Saudek, Dr. Christopher (previous
president of American Diabetes
Association), 150
saxagliptin, 247, 379
scheduling visits to members of your
health care team, 147
screening
Aboriginal peoples and diabetes, 321
for organ injury, 307–308
for type 2 diabetes, 50–51
secondary prevention strategies for
type 1 diabetes, 45
seizures as symptom of hypoglycemia, 65
severe hypoglycemia (low blood
glucose)
overview, 63, 64
treatment, 69–71
sexual dysfunction
ED (erectile dysfunction), 116–119
elderly people, 316
female, 119–120
SGLT-2 inhibitors, 250
sharing news of your diabetes, 12
sharps container, 161
short-acting insulin, 263
shoulder dystocia, 130
Sigal, Dr. Ron (researcher), 231
sitagliptin, 246, 379
skin disease, 113–114
smoking
PAD, infl uence on, 90
pregnancy, effect on, 137
quitting, importance of, 88–89, 340
sodium, 212
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398 Diabetes For Canadians For Dummies, 3rd Edition
soluble fi bre, 207
somogyi phenomenon (effect), 286, 379
sores on feet, 112
Sotomayor, Sonia (US Supreme Court
judge), 10
Standards of Care for Students with Type 1
Diabetes in Schools, 301
starlix. See nateglinide
statin, 94, 379
Steele, Stephen (pilot), 11
storage and handling of insulin, 282–283
stress, 182
stroke
prediabetes as risk for, 56
preventing, 87–88
risk for, determining, 147
sucrose, 22
sugar, 204
sugar alcohols, 215
sulfonylureas, 66, 243, 319, 379
summer camps for children with
diabetes, 308–309
supervised exercise programs, 235
supportive, being, 20
surgery for weight reduction, 220–221
sweating, 64, 65, 105
sweet foods and snacks, 360
sweet urine, 36
sweeteners, non-nutritive, 214–215
symptoms
HHS (hyperosmolar hyperglycemic
state), 80–81
hypoglycemia, 63–66, 72
type 1 diabetes, 41
type 2 diabetes, 47–48
• T •Taylor, Elizabeth (actor), 11
test strip, 161
thiazolidinedione, 244–245, 379
thickened skin, 114
thirst
type 1 diabetes symptom, 41
type 2 diabetes symptom, 48
Thompson, Leonard (test subject for
insulin), 37
thyroid disease, 115
time zones, adjusting your insulin doses
between, 291–292
toddlers with diabetes, 296–298
Toronto insulin. See regular insulin
total cholesterol, 92
total cholesterol/HDL ratio, 92
toxemia, 133
trajenta. See linagliptin
trans fatty acids, 210–211, 379
travel insurance, 328
traveling with insulin, 290–292
treatment. See specifi c treatments
trembling as symptom of
hypoglycemia, 64
tresiba. See degludec
Tresiba insulin, 266
TrialNet5, 4
triglycerides, 55, 92, 93, 94, 379
tube-requiring insulin pumps,
276–277, 281
type 1 diabetes
adolescents, 301–303
babies with, 296–298
causes of
chemicals, exposure to certain, 43
cow’s milk, early exposure to, 43
overview, 42–43
oxygen free radicals, exposure to, 43
viral infection triggering abnormal
immune system response, 42
virus damaging pancreas by directly
attacking it, 43
double diabetes, 36
inheritance of, 43
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399399 Index
insulin therapy, 268–269
LADA (latent autoimmune diabetes of
adults), 44
overview, 34, 40
preventative strategies, 45
primary school children with, 298–301
retinopathy screening, 97
symptoms, 41
toddlers with, 296–298
type 2 diabetes compared, 53–54
young adult children, 303
type 2 diabetes
causes, 49–50
children with diabetes, 309–311
described, 35
frequency of testing
when being treated with insulin,
164–165
when not being treated with insulin,
163–164
genetic risk for, 49
insulin defi ciency, 35–36
insulin resistance, 35, 49
insulin therapy, 269–270
LADA (latent autoimmune diabetes of
adults) compared, 44
lifestyle therapy for, 51–52
long-term treatment, 253–254
overview, 45–47
prediabetes as risk for, 56
preventing, 51–53
retinopathy screening, 98
risk factors, 50–51
screening for, 50–51
screening someone who had
gestational diabetes for, 131
symptoms, 47–48
type 1 diabetes compared, 53–54
TZD. See thiazolidinedione
• U •ulcers of the foot, 110, 113
Understanding Prescription Drugs For
Canadians For Dummies (Blumer and
McDonald-Blumer), 73, 320
unsaturated fats, 210
unsolicited advice, 19
urination
elderly people and problems with, 315
type 1 diabetes symptom, 41
type 2 diabetes symptom, 48
• V •vaccinations for pneumonia, 106
vaginal infections as symptom of high
blood glucose, 26
vascular disease risk factors as risk
factor for type 2 diabetes, 50
vegan diet, 215
vegetables, 360–361
vegetarian diet, 215
Vegetarian Resource Group (website), 369
Viagra, 118
vigorous cardiovascular exercise, 230
viral infection triggering abnormal
immune system response as cause of
type 1 diabetes, 42
virus damaging pancreas by directly
attacking it as cause of type 1
diabetes, 43
visceral fat, 33
vision changes as symptom of
hypoglycemia, 65
visually impaired or blind persons,
resources for, 98–99
vitamins, 211–212
vitiligo, 114
vitrectomy, 97
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400 Diabetes For Canadians For Dummies, 3rd Edition
• W •waist circumference, measuring your, 52
water, 213
websites
American Diabetes Association (ADA),
368, 369
Ask NOAH about Diabetes, 368
Behavioral Diabetes Institute, 368
Canadian Diabetes Association (CDA),
368, 369
Children with Diabetes, 369
Diabetes Monitor, 368
Diabetic Gourmet Magazine, 369
Dr. Rubin, 368
MedLinePlus Drug Information, 368
Online Diabetes Resources by David
Mendosa, 369
Our Diabetes, 368
Vegetarian Resource Group, 369
weight
BMI (body mass index), 52
overweight, determining if you are, 52
weight loss
high blood glucose symptom, 26
overview, 36
type 1 diabetes symptom, 41
type 2 diabetes symptom, 48
weight reduction
advantages of, 218
with behaviour modifi cation, 221–222
best strategy for, 219
challenges, 218–219
medication therapy for, 220
overview, 218
portion control, 220
surgery for, 220–221
weight training, 231
weightlifting, 231
work
blood glucose testing at, 16
challenges at work, dealing with, 16
insulin, storing and injecting, 16
schedule, 182
workmates, impact of your diabetes on
your relationships with your, 14–15
wound healing, slow, 48
• X •xanthomata, 114
Xenical, 220
• Y •Yasui, Doreen (Food and Diabetes), 299
yeast infections, 48
young adult children with diabetes, 303
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