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DIABETIC AWARENESS FOUNDATION OF MD-35 www.dafmd35.org

FLORIDA LIONS DIABETIC RETINOPATHY FOUNDATION www.fldrf.org

BLOOD GLUCOSE SCREENER

TRAINING AND PROCEDURE MANUAL Contact Lion Norma Callahan, PDG. lionnormacallahan@yahoo.com For any changes, corrections, or questions.

REV 11 Nov 1 2019 this draft contains Glenn’s edits, 4th edits

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CONTENTS

TRAINING Introduction 3

On-Line Resources 5

Training Objectives 6

OBJECTIVE 1: Why screening & grants 8

Lions and Diabetes Awareness Why? 9

Diabetes Awareness Grant - What Is It? 10

Sight First Grant 11

Overview of Diabetes Projects 12 OBJECTIVE 2: What is diabetes? 13

Diabetes Overview 14

Classification of Diabetes 15

Diabetes Awareness/Screening 19

Hyperglycemia 19

Hypoglycemia 20

OBJECTIVE 3: Results, diagnosis, treatment 22

How to Discuss Result With Clients 23

Diagnosis 25

Treatment 26

OBJECTIVE 4: Management of diabetes 27

Lifestyle Changes/Successful Management 28

Nutrition 29

Glycemic Index 31

Glycemic Load 32

How to Read Nutrition Labels 33

OBJECTIVE 5: Complications, A1C 35

Complications Caused by Diabetes 36

Goals for Glycemic Control 38

Understanding Hemoglobin A1C 38

Childhood Obesity/Diabetes in Children 39

OBJECTIVE 6: Retinopathy screening 41

Understanding Diabetic Retinopathy 42

Retina Screener Training 43

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PROCEDURES

OBJECTIVE 7: Forms 44 Forms 45

OBJECTIVE 8: Requirements for screening 46

Reporting Requirements 47

Screening Arrangements 48

Setting Up 49

Equipment 50

OBJECTIVE 9: Conducting screening 51

Screening Procedure 52

Referring and Counseling 54

Screening in Schools 56

How to finger stick a child 56

OBJECTIVE 10: Supplies, competency, emergencies 57

Ordering New Supplies 58

Competency in the Use of Lancets and Meters 59

Recertification/Expectations 60

Screening in Schools 60

OBJECTIVE 11: Discussing Results/Emergencies 61

How to Discuss Results with Clients 62

What to Do In Emergencies 63

APPENDIX Anatomy of the Endocrine System 64

Glossary 66

References 78

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INTRODUCTION

This manual will aid Lions involved in Blood Glucose screening and education to better

understand the complex condition known as Diabetes. The materials provided by the

Center for Disease Control and the ADA (American Diabetes Association) should also be

consulted. The information will help users to more effectively present the need for this

project and support fund raising at clubs and other groups.

Since some personnel will be more knowledgeable and experienced than others, there is an

index listing various topics for easy reference, and a glossary defining complex terminology.

The degree of pain and suffering that can be alleviated or prevented will save individuals,

families, and the health system billions of dollars. It is expected that the services given will

reflect our motto "We Serve".

A grateful thanks to LCIF for giving us the ability to form our foundation and provide free

Blood Glucose screening for the community and Free Retina Screening for the community

by LCIF Sight First Report.

Certification is required for all Blood Glucose screeners every year. We change equipment

and update our protocol as we continue to grow this program, requiring all certified

screeners to re-certify annually.

Lion Norma Callahan, PDG

Founder of Lions Diabetes Awareness Foundation of MD 35

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On-Line Resources

For the most recent forms and information for screening go to:

WWW.DAFMD35.ORG

For information of the Lions program on diabetic retinopathy go to:

www. fldrf .org

Additional helpful web-links include:

• National Diabetes Prevention Program at CDC.gov/diabetes/prevention

• The Mayo Clinic diabetes program at MayoClinic.org

• The Joslin Clinic diabetes program at Joslin.org

• American Diabetes Association at diabetes.org

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TRAINING OBJECTIVES

OBJECTIVE 1: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. DESCRIBE WHY LIONS SCREEN FOR DIABETES

2. DISCUSS THE DIFFERENT GRANTS WHICH WE HAVE RECEIVED

OBJECTIVE 2: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING

1. UNDERSTAND BASIC DIABETES

2. DIFFERENTIATE BETWEEN TYPES OF DIABETES (GENERAL)

3. UNDERSTAND WHY WE REFER HYPOGLYCEMICS

4. KNOW THE DIFFERENCE BETWEEN DIABETIC AND NON-DIABETIC HYPERGLYCEMIA

OBJECTIVE 3: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. APPRAISE IF THE CLIENT NEEDS TO BE REFERRED

2. UNDERSTAND YOUR ROLE IN DIABETIC SCREENING

3. DESCRIBE TREATMENT AND TESTING TO IDENTIFY DIABETES (BASIC)

4. UNDERSTAND HOW TO DISCUSS HIGH BLOOD SUGARS WITH CLIENTS

OBJECTIVE 4: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. DISCUSS BASIC LIFESTYLE CHANGES

2. SUCCESSFUL SELF MANAGEMENT

3. UNDERSTAND A BASIC HEALTHY DIET

4. LEARN HOW TO READ A LABEL

OBJECTIVE 5: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND THE COMPLICATIONS OF DIABETES

2. DESCRIBE DIABETIC RETINOPATHY (BASIC)

3. APPRECIATE THE IMPORTANCE OF A1C IN A DIABETIC

4. UNDERSTAND CHILDHOOD OBESITY AND THE PROBLEMS

ASSOCIATED WITH THIS CONDITION

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Objective 6: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND RETINA SCREENER TRAINING

2. RECOMMENDED REQUIREMENTS FOR RETINA CAMERA

3. DISCUSS LIONS DIABETIC PROJECTS EXPERIENCE

4. UNDERSTAND WHAT CAN BE DONE TO PREVENT COMPLICATIONS

5. IDENTIFY OPPORTUNITIES FOR SCREENING

OBJECTIVE 7: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND THE IMPORTANCE OF THE CONSENT FORM

2. DEMONSTRATE HOW TO COMPLETE THE CONSENT FORM

3. DISCUSS THE MOST COMMON ERRORS COMLETING THE FORMS

4. UNDERSTAND HOW TO RETURN FORMS

OBJECTIVE 8: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. ARRANGE SETTING UP FOR SCREENING

2. IDENTIFY THE EQUIPMENT WHICH IS REQUIRED

3. UNDERSTAND DEADLINES AND ORDERING TIMES

OBJECTIVE 9: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. CONDUCT A SCREENING EVENT

2. SUCCESSFULLY REFER AND COUNSEL THE CLIENT

3. DELIVER LITERATURE WHIS IS APPROPRIATE FOR THE FINDINGS

OBJECTIVE 10: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. SUCCESSFULLY REORDER SUPPLIES

2. DEMONSTRATE COMPETENCY IN USE OF LANCETS AND METER

3. UNDERSTAND WHAT TO DO IN AN EMERGENCY

OBJECTIVE 11: AT THE END OF THIS UNIT, YOU WILL KNOW HOW TO DO THE FOLLOWING:

1. DISCUSS RESULTS WITH CLIENTS

2. HANDLE EMERGENCIES

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OBJECTIVE #1

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. DESCRIBE WHY LIONS SCREEN FOR DIABETES

2. DISCUSS THE DIFFERENT GRANTS WHICH WE HAVE RECEIVED

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LIONS AND DIABETES AWARENESS: WHY?

DIABETES IS INCREASING AT EPIDEMIC LEVELS

In the US there are over 30 million Diabetics. Over 8 million of those diabetics do not know

that they have diabetes.

Free Blood Glucose screening is the only way we can reach the Diabetic population in order

to prevent complications from undiagnosed Diabetes and from Diabetics out of control.

Free Blood Glucose screening is the only way we can reach Pre-Diabetics and make them

aware of how important it is to take their condition seriously.

The average, newly diagnosed Type 2 Diabetic will have been a Diabetic (untreated) for at

least five years. Therefore, this Diabetic is more than likely to have many of the serious

Diabetic complications such as kidney, heart disease, neuropathy, and preventable

blindness.

By reaching out to Diabetics we can help educate them on how prevent complications and

how to get help to pay for their care.

THE LEADING CAUSE OF BLINDNESS IN ADULTS IS DIABETES.

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DIABETES AWARENESS GRANT: WHAT IS IT?

In 2008, The Lions of Florida and the Bahamas obtained The Diabetes Awareness Grant

from LCIF as a Core-4 grant to educate Lions in the fundamentals of Diabetes prevention,

and to identify Diabetics by screening early, before complications occur.

The grant provided funds for Lions to conduct Blood Glucose screening (particularly in

underserved areas and among high risk groups in Florida and the Bahamas), to offer

educational programs on prevention and care of Diabetes, and to provide nutrition

guidelines. The grant also allowed many Diabetic Lions to become better informed about

their own Diabetes. The original grant was assisted with the partnership of Florida Diabetic

camps. We continue to work with this very important partner.

Lions were able to work in schools, health events, and fairs to reach the youth population

that is at such high risk of developing Diabetes, due to lifestyle changes, and the very high

rate of obesity, (17%) according to the AMA.

We have had several co-partners in this important work: Florida Diabetic Camps is a major

donor of screening supplies including meters, test strips and lancets; Medicine Shoppe in

Deland donated meters and has contributed many supplies at cost; Liberty Medical donated

more than twenty-five meters and strips; a glove company donated over 8,000 pairs of

gloves; and Lions and friends routinely donated meters and strips, as do other medical

providers. Currently DBS, a medical supplier, has signed a contract to provide us with free

Metrix meters and to sell us a certain number of strips at very good cost.

Lions Diabetes Awareness Foundation of MD-35, Inc. was formed as a 501(c) 3 tax exempt

organization, to continue this project, one of the biggest hands-on projects Lions have ever

undertaken. As a result, Lions have more new members, old members have been

revitalized, we have visibility in new communities, and we have networked and partnered

with many other health care community service groups and health departments. This grant

was completed and closed in 2011.

Since that time we have screened over 160,000 individuals with a 39% referral rate.

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� Core 4 grant was approved by LCIF in March 2008 and completed on April 30, 2011.

� LCIF approved $33,000 for a pilot program of education and Diabetic screening.

SIGHT FIRST GRANT

We applied for a second LCIF grant under the Sight First Program to improve and enlarge

the Diabetes work that we are doing.

The purpose of the grant was to offer to our communities Free Diabetic Retinopathy

screening (without dilation) along with our free blood glucose screening.

This grant was approved on August 14, 2014. Due to the financial requirements of the grant

agreement, The Florida Lions Diabetic Retinopathy Foundation was formed. This grant was

officially started in Jan 2015 and was completed in Jan 2018.

The grant was for $179,900 to purchase DRS digital cameras and supplies, computers, and

to fund EKN network access. The EKN network allows images to be uploaded to a cloud site

for reading and grading by a Medical Doctor, Board Certified as a Retina Specialist.

The grant originally allowed the purchase of four computerized

Retina Cameras, but, due to significant cost savings achieved so far, this has been increased

to five cameras and support equipment.

This Diabetic Retinopathy program is a pilot project that has never been conducted before,

requiring us to develop all of the forms and protocols, as well as a training program to

certify Lions to conduct the screenings. As the program grows, we will continue to update

our procedures, training, and forms as we learn more from this important pilot study.

The final report has been submitted. Currently we have performed retinopathy screenings on over 18,000 individuals who have had a 49% referral rate

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OVERVIEW OF DIABETES PROJECTS

Since 2008 we have:

o Screened over 160,000 clients for diabetes

o Certified and re-certified over 1,800 screeners for diabetes

o Held screening classes several times a month

o Held “Train the Trainer” classes

o Currently screening blood glucose every week except some holidays

o Currently we have 16 trained instructors

What Can We Do?

• Screening in areas identified as high risk

• Education in prevention of Type II diabetes

• Education of Pre-Diabetics

• Referrals when a client is identified

• Network to refer uninsured and/or indigent patients to the correct agency

• Discussion of healthy eating habits

• Discussion of complications

• In children prevention by recognition and early referrals for medical attention and

teaching.

Where Can We Screen?

• Fairs

• Walks

• Schools

• Libraries

• Rural communities Festivals

• College campus

• Health Fairs

• Hospitals

• Meetings

•

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OBJECTIVE #2

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING

1. UNDERSTAND BASIC DIABETES

2. DIFFERENTIATE BETWEEN TYPES OF DIABETES (GENERAL)

3. UNDERSTAND WHY WE REFER HYPOGLYCEMICS

4. KNOW THE DIFFERENCE BETWEEN DIABETIC AND NON-DIABETIC

HYPERGLYCEMIA

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DIABETES OVERVIEW

The term Diabetes Mellitus refers to a group of diseases that impacts how your body uses

blood glucose, commonly called blood sugar. Glucose is essential to your health because it

is a critical source of energy for the cells that make up your muscles and tissues. Too

much or too little glucose will lead to serious health problems. The normal fasting levels

of glucose in the blood ranges from 70-100 mg/dl. Glucose levels increase after meals and

drops within 3 hours as glucose is absorbed.

Diabetes has been documented for many centuries. Diabetes means "flowing through",

and mellitus means "sweet as honey". The earliest recording of Diabetes is in an Egyptian

hieroglyphic from 1550 BC illustrating the symptoms of diabetes. In earlier days, diabetes

was diagnosed by tasting of the urine. At that time there was no treatment, and Type I

diabetes always ended in death, usually very quickly.

The term Diabetes comes from the Greek and it means to siphon, “passing of too much

water” Later in 1675, Thomas Willis added mellitus, meaning honey. Diabetes Mellitus

literally means siphoning off sweet water.

Diabetes is classified as a metabolic disorder. Much of our food is converted by our

digestive system into glucose or sugar. The glucose circulates in our blood stream to all

parts of the body. The body requires insulin for the glucose to enter the muscles, nerves,

fat and other cells. Insulin is a hormone produced in the pancreas. The pancreas releases

insulin to keep the blood sugar at an optimal level.

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CLASSIFICATION OF DIABETES

TYPE 1 DIABETES

Type 1 diabetes can occur at any age but usually occurs in children or young adults. In this

type of diabetes the pancreas makes little or no insulin. Type 1 occurs because the immune

system mistakenly destroys the insulin producing cells in the pancreas, as if they were

foreign cells. This is referred to as an autoimmune response. Without insulin, the body

cannot process glucose and begins to break down fat and muscle for energy. There are

several factors that researchers think are linked to type 1 diabetes: genetics, auto-

antibodies, viruses, and environmental triggers. The exact cause is unknown. Its onset has

nothing to do with diet or lifestyle. Family history is not a risk factor. There is nothing you

can do currently to prevent or cure Type 1. People with type 1 must inject insulin several

times each day or continuously infuse through an insulin pump.

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Type 1 has in the past been called brittle diabetes, juvenile diabetes, or early onset

diabetes. Type 1 accounts for 10% of all diabetics.

Type 1 symptoms occur suddenly, and include one or more of the following:

• Frequent urination

• Extreme thirst

• Extreme hunger

• Sudden weight loss

• Extreme fatigue and irritability

• Sudden vision changes

• Fruity or sweet odor on breath

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TYPE 2 DIABETES

Type 2 diabetes is a chronic condition in which the body fails to properly use and store

glucose. Instead of converting the glucose to energy, the glucose level increases in the blood

stream and causes a variety of symptoms. Type 2 diabetes (formerly called adult onset or

non-insulin dependent diabetes) results when the body does not produce enough insulin

and/or is unable to use insulin properly. (This may be referred to as insulin resistance.)

Usually this form of diabetes occurs in people over 40, although today it is increasingly

found in younger people.

Risk Factors include

• Family history

• Body weight, obesity, particularly abdominal obesity, is the major risk factor for

developing diabetes.

• Rate increases with age

• Race, ethnicity, most common in Native American, followed closely by African,

Hispanic and Asian Americans

• History of gestational diabetes.

• High cholesterol levels, High blood pressure

• Life style choices such as activity and diet

Slow onset of symptoms,

• Can be 5-10 years from onset to diagnosis

• Any of the type 1 symptoms

• Frequent infections

• Blurred vision or visual changes

• Cuts/bruises slow to heal

• Tingling/numbness in the hands or feet

• Recurring skin, gum or bladder infections

• Candida infections

• Many patients have few or no symptoms

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Currently, there is no cure for type 2, but it can be controlled with lifestyle changes and

medication.

LATENT AUTOIMMUNE DIABETES IN ADULTS (LADA)

Type 1 diabetes when diagnosed in adults over 30 may be LADA, sometimes called type1.5.

LADA is often misdiagnosed as type 2 because of age. However, in its early stages people

with LADA do produce insulin, but in inadequate amounts. People with LADA do not have

insulin resistance like type 2. LADA is characterized by age, lack of family history, and oral

insulin medication being ineffective. They also require insulin for treatment.

GESTATIONAL DIABETES

Women, who develop high blood sugar during pregnancy, are diagnosed as having

gestational diabetes. 85% of this type of diabetes disappears after the baby is born.

However, women who do revert to normal blood glucose levels are at greater risk for

developing type 2 diabetes later in life. Some of these patients appear as LADA and require

insulin.

Symptoms include:

• Frequent urination;

• Unusual thirst;

• Hunger;

• Extreme fatigue

• Irritability.

Risk factors for developing gestational diabetes:

• Being overweight prior to pregnancy

• Having had gestational diabetes in a prior pregnancy

• Having a family history of diabetes.

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PRE-DIABETES

Many are already being treated as diabetics. By the next update of this

manual, the pre-diabetes classification might have been combined with

type 2 diabetes.

In pre-diabetes, blood glucose levels are higher than normal but not high enough to be

classified as diabetes. Often the high blood glucose levels are due to illness, trauma, surgery

and other temporary situations. If this person does not make life-style changes, they have

the potential to become diabetic.

Glucose Levels for Pre-Diabetes:

• Fasting or =101-120 mg/dl

• 1 hour after eating= 151-180mg/dl

• 2 hours after eating =111-130 mg/dl

In addition to being a risk factor for diabetes, pre-diabetes also increases one’s risk for

cardiovascular disease and eye diseases that can lead to blindness.

Current research has demonstrated that pre-diabetes is often reversible, if lifestyle changes

are made. Therefore, screening is extremely important to find those at greater risk.

According to CDC, the rate of pre-diabetes is increasing. It is very troubling that most people

with pre-diabetes are unaware that they have it, which makes our Lion’s club program of

screening and education even more crucial.

According to the National Diabetes Statistics report 2014 there are 29.1 million or 9.3% of

the US population has diabetes, of which 21.0 million are diagnosed with 8.1 million

undiagnosed.

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DIABETES AWARENESS/SCREENING

The diagnosis of diabetes or pre-diabetes is not done with one finger stick. Finger stick

blood glucose screenings give only a snapshot in time or an alert that medical intervention

and further testing needs to be done. Results from screening tell us that a person at this

moment is hyperglycemic, hypoglycemic or has a glucose value within the normal range.

WE DO NOT DIAGNOSE….. We only screen….. PASS or REFER!!!!

HYPERGLYCEMIA/HYPOGLYCEMIA

HYPERGLYCEMIA (high blood glucose) is defined as:

fasting blood glucose levels above 100mg/dl

1 hour after eating above 150 mg/dl or below 90mg/dl

2 hours after eating above 110 or below 60mg/dl

A person is said to be HYPERGLYCEMIC when the levels of circulating glucose is high.

In this situation, the pancreas cannot produce enough insulin to regulate,

or the body is not responding to the insulin.

Hyperglycemia may be caused by:

• Metabolic disease such as diabetes

• Stress

• Dehydration

• Surgery or trauma

• Meals or snacks very high in carbohydrates

• Side effects of certain medications

• Hormones

• Inactivity

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HYPOGLYCEMIC (low blood sugar) is defined as fasting blood glucose levels below

70mg/dl

Hypoglycemia (low blood sugar) occurs when:

• The body’s glucose is used up too quickly

• Glucose is released into the bloodstream too slowly

• Too much insulin is released into the blood stream

The usual causes of hypoglycemia in people WITH DIABETES:

• Taking diabetic medicine at wrong time

• Taking too much medication

• Not eating enough after taking diabetic medicine

• Skipping meals

• Waiting to eat meals

• Exercising more or at a different time

• Drinking alcohol

Hypoglycemia in people who DO NOT HAVE DIABETES may be caused by:

• Drinking alcohol

• Excess dieting

• Excess exercise

• Skipping meals

• Medical conditions

• Medication side effects

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Symptoms of Hypoglycemia may include:

• Non-diabetics are often thin, cold hands; overdressed for the weather

• Often shaking if they do not eat every 2 hours

• Sugar makes the symptoms worse

• Double or blurred vision

• Fast or pounding heart beat

• Confused

• Shaking or trembling

• Sweating

• Tingling or numbness

• Feeling irritable or acting aggressive

When screening, a person with a low blood glucose and symptoms, should eat something

that has about 15 grams (1/2 ounce) of carbohydrates, (for example a 4oz or ½ cup of

regular soda). They should wait about 15 minutes before eating anything else then be re-

tested.

The screening results can be divided into three categories

Normal limits

Fasting---blood glucose level 70-100mg/dl

1-2 hours after eating – 90-150 mg/dl

2-3 hours after eating—60-110 mg/dl

Potential for Pre-Diabetes Education and referral to health care provider.

Fasting blood glucose 101-120mg/dl

1 hour after eating 151-180mg/dl

2 hours after eating 111-130mg/dl

Risk for Diabetes Refer to healthcare provider & educate.

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OBJECTIVE #3

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. APPRAISE IF THE CLIENT NEEDS TO BE REFERRED

2. UNDERSTAND YOUR ROLE IN DIABETIC SCREENING

3. DESCRIBE TREATMENT AND TESTING TO IDENTIFY DIABETES (BASIC)

4. UNDERSTAND HOW TO DISCUSS HIGH BLOOD SUGARS WITH CLIENTS

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DIAGNOSIS AND TREATMENT IS NOT OUR JOB

OUR JOB IS TO SCREEN…..PASS OR REFER!!!!

ALL READINGS THAT ARE EITHER ABOVE OR BELOW

THE NORMAL RANGE MUST BE REFERRED.

Before a medical provider can diagnose diabetes or pre-diabetes, a complete history and

physical exam must be completed. One abnormal test is not enough. The test should be

confirmed with a repeated test, performed on another day. Blood glucose levels over

100mg/dl are not normal.

HOW TO DISCUSS RESULTS WITH CLIENTS

NORMAL RANGE (with diabetes in family)

This is only a snap shot and should be done on a regular basis.

Give literature.

HIGH NORMAL (Pre-diabetic)

This is the time to discuss diet and exercise as being important for

prevention. Also, recommend that they make an appointment with their

medical doctor who may wish to carry out further testing.

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WHAT DO WE TELL CLIENTS WITH HIGH READINGS ???

Always ask the clients to tell the receptionist who makes their

appointment what their screening number was.

This is the reason that we give them the cards after the screening.

BG 200-299

Need to be referred to their health care provider as soon as possible. Repeat

screening if requested.

BG 300-399

Need to be referred as soon as they can make an appointment.

Suggest they tell the office personnel when they call of the reading.

Repeat screening.

BG 400-499

Contact their physician immediately.

Refer Emergency room or clinic

Repeat screening.

Ask if someone can drive them?

IF diabetic, did they take their meds?

How are they feeling?

BG 500-“Hi” on Meter

HIGH ON THE METER MEANS IT CAN NOT BE READ!!! IT IS OVER 600

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Person should not be driving

Have them call family or friends, EMT or 911 immediately

WE CAN NOT FORCE A PATIENT TO GO TO THE HOSPITAL BUT

WRITE IN THE COMMENT SECTION THAT THEY REFUSED

ADA’S GUIDELINES FOR THE DIAGNOSIS OF DIABETES

1. Hemoglobin A1C greater than 6.5% with symptoms or repeated on a different day.

(This is one area everyone does not agree on. Some endocrinologists believe patients over

5.7 should be treated as diabetics.)

THIS IS THE GOLD STANDARD

The Hemoglobin A1C (A1C) test was developed to monitor the patient’s level of glucose

control. Some glucose is stuck to the hemoglobin in the blood during the lifetime of

RBC (red blood cells), about 120 days. By testing AIC, it is possible to estimate levels of blood

glucose during the last three months. In 2010, A1C became a diagnostic as well as

monitoring test. Currently is it is the standard test for control, and, often for diagnosis.

2. Symptoms of polyuria, polydipsia, and/or unexplained weight loss with a plasma

glucose level over 200mg/dl regardless of time of day.

3. The Glucose Tolerance Test (Rarely used)

4. Fasting Plasma Glucose (Fasting Blood Sugar)

• For diagnosis, fasting is defined as no caloric intake for at least 8 hours.

• Some physicians diagnose diabetes with several positive tests.

Insulin tests evaluate how much insulin the pancreas is producing. This is one way of

distinguishing type 1 from type 2 diabetes (especially in children or young adults). Type 2

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diabetics would have high levels of insulin and glucose whereas the type 1 Diabetic would

have a high glucose and low or no insulin level.

Urine testing is used to test for ketones, not for glucose.

TREATMENT

Diabetes is serious. If left untreated it can lead to heart disease, stroke, blindness,

amputation and even death. The first step after diagnosis is education. Your health care

provider is your primary resource. There are many Diabetic Clinics located in the local

major medical centers and hospitals. The treatment plan may include:

• Medication: (Whether or not you need medication depends on type of diabetes,

symptoms, blood glucose )

• Oral Medication: Many types of oral diabetic medication such as Metformin work in

different ways to lower blood glucose. They work the best when you follow your

recommended meal plan and regular exercise program.

• Insulin is not a cure. When injected into a diabetic, insulin produces the following

effects: normal storage of glycogen in the liver and muscle tissue, reduction in blood

glucose by facilitating metabolism of glucose, disappearance of ketosis and

hyperlipemia, prevention of excessive breakdown of protein, and increased

respiratory quotient.

Insulin preparations are divided into three categories according to how quickly they act,

their potency, and duration following subcutaneous (SC) administration. The three types

are: fast, intermediate, and long acting.

• Type 1 diabetics must take insulin.

• Type 2 diabetics usually are treated with life style and/or, oral medication. Type 2

may also require insulin if they have ketones or ketoacidosis and as the diabetes

progresses. Many type 2 diabetics are on multiple medications as they all work

differently. Some require insulin.

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OBJECTIVE #4

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. DISCUSS BASIC LIFESTYLE CHANGES

2. SUCCESSFUL SELF MANAGEMENT

3. UNDERSTAND A BASIC HEALTHY DIET

4. LEARN HOW TO READ A LABEL

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LIFESTYLE CHANGES

There is no “diabetic diet”. See a dietician to learn how food affects your blood glucose.

• Change eating habits to include smaller portions with less fats and carbohydrates.

• Eating a balanced diet

• Regular exercise program

• Maintaining a healthy weight

• Not smoking

• Regular visits to health care provider

• Regular visits to dentist

• Eye and foot exams yearly

REGULAR SCREENING OF BLOOD GLUCOSE HAS BEEN PROVEN TO BE THE MOST

IMPORTANT PART OF DIABETES CONTROL.

SUCCESSFUL SELF-MANAGEMENT OF DIABETES

The Stanford University's Chronic Disease Self-Management Program suggests an

educational process that involves the use of the following tools to help control diabetes:

1. Blood sugar testing at home

2. Lifestyle changes

3. Relieve high stress levels

4. Make short term plans

5. Monitor progress on a weekly basis

6. Make changes in plan of action when needed.

7. Develop a support system

8. Regular Doctor Visits and testing.

People cannot be made to do these things. Individuals have to take responsibility

for themselves.

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NUTRITION

WHAT IS A HEALTHY DIET?

The ADA emphasizes six main food groups: grains, meat and poultry, dairy, fruits,

vegetables, and oils. For the average adult, the current recommendation is to follow the

“food plate”. A smaller plate and 1/3 carbohydrates, 1/3 vegetables,

and 1/3 protein.

A well balanced diet includes food from each of the food groups. It has a place for

discretionary calories such as those from sweets, used in moderation. It emphasizes fruits,

vegetables, whole grains, and fat-free or low-fat milk and milk products. A healthy diet

includes poultry, fish, beans, eggs, and nuts, and is low in saturated fats, trans-fats. Each of

these groups provides essential vitamins and minerals as well as protein or energy for a

healthy body.

Every diabetic has different needs and must monitor what causes issues and high

blood sugars and adjust diet to meet the requirements laid out by the medical

advisors.

What Are Proteins?

Protein supplies amino acids, which build, repair and maintain body tissues like muscle.

Proteins contain four (4) calories per gram. Protein is contained in foods such as eggs, meat,

milk, fish, beans, cheese, and nuts.

What Are Carbohydrates?

Carbohydrates are the body's main source of energy. They are either complex

carbohydrates or starches like wild rice, potatoes, whole grains or simple sugars. They

provide three (3) calories per gram.

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It is very important when reading labels to remember that the first ingredient in the

“Carbohydrate” section is the amount of fiber. Many sources of carbohydrate, such as

“white rice”, have had the fiber portion removed.

What Are Fats?

Fats supply energy, transport nutrients and are used by your cells. All fats provide nine (9)

calories per gram, double other nutrient sources. There are healthy fats such as olive oil,

canola oil, and avocado oil.

What Are Calories?

Calories are required for energy to fuel the body. The calories we eat must be balanced with

the calories used in daily activities and exercise. For an example of how little extra we need

to eat to gain weight: if we eat 100 more calories a day than can be used, one pound per

month will be gained. In older folks it will be more.

Fruits

Fruits contain vitamins and minerals. They can be fresh, cooked, frozen, whole or diced.

Two to four servings a day are recommended for most people, but limit the choice from fruit

juices as they can fill up the quota of calories (it takes many oranges to make one glass of

juice!!) One should eat at least one vitamin C food a day, which includes citrus fruit,

strawberries, kiwi fruit, guava and papaya. But some diabetics have issues with fruits. So

again, careful monitoring of blood sugar will help you decide what works and what does

not.

Vegetables

Vegetables are a great source of vitamins and fiber. One should eat 3-5 servings per day.

Dark green vegetables like broccoli and orange vegetables like carrots are great finger

foods. They are high in vitamin A and should be eaten daily.

Keeping Vitamins in Vegetable

There is a wide variation in the amount of vitamins stored in vegetables. It depends on the

age of the vegetable, shape, and method of cooking. Cooking can destroy many vitamins.

The shorter time a vegetable or fruit is exposed to air, heat, and water the more vitamins

are preserved.

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Nutrients are best maintained in this order of cooking: microwave steaming (best),

microwave boiling, and then steaming, and least maintained by boiling. Raw is the best,

except for tomatoes.

Calcium Rich Foods

Fat-free or low-fat dairy products such as milk, cheese, and yogurt are important in a

healthy diet. One should eat 2-4 servings per day.

Whole Grains

Whole grains contain all the nutrients and fiber in the grain, and are a good source of

carbohydrates. Half of one's daily grain choices should be whole grains. These can include

whole wheat bread, whole wheat cereals, oats and cornmeal. Remember read the label.

Lean Protein

Choose lean meats like skinless poultry and fish. Keep protein lean by baking, broiling, or

grilling meats. Peas, beans, nuts, and seeds are also good sources of protein and add variety.

GLYCEMIC INDEX AT A GLANCE

• Beans and their relatives (lentils and peas) are always low GI.

• Green leafy vegetables can also be considered low GI (although they have so little

starch that their GIs typically have not been calculated).

• Nearly all fruits have a low GI. Yes, they are sweet, but most will not raise blood sugar

very quickly. Two exceptions: watermelon and pineapple have a higher GI than other

fruits.

• Pasta is a low GI food.

• Barley, bulgur, and parboiled (converted) rice all have a low GI value.

• Pumpernickel and rye breads have a low GI value, while wheat varieties such as

bagels, white bread, and even whole wheat bread have a higher GI.

• Yams and sweet potatoes are low-GI foods in contrast to baking potatoes, which are

high GI.

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• Among breakfast cereals, oatmeal and bran cereals are low GI while most cold cereals

are high GI.

NET CARBS

� Take the Carbs count off the label

� Take the fiber underneath it

� Minus the fiber from the carbs

� (Carbs – fiber = Net carbs)

GLYCEMIC LOAD AT A GLANCE

Glycemic load takes into account the glycemic index of a food and the amount eaten.

Obviously, a food with a high glycemic index will have less of an impact on blood glucose if

only a small amount of that food was eaten versus eating a lot of it. In fact, eating a small

amount of a high glycemic index food can have less of an impact on blood glucose than

eating a lot of food with a low glycemic index. The glycemic load of a carbohydrate is equal

to its glycemic index times the grams eaten divided by 100. Glycemic load charts are readily

available on the internet. I like the one published by Harvard Medical School.

ALTERNATIVE SWEETENERS

Alternative sweeteners are products that can be used in place of sugar.

• Saccharin (Sweet-Low) is about 400 times as sweet as sugar.

• Aspartame (Equal) is about 200 times as sweet as sugar. It is not safe for patients with

PKU (phenylketonuria). Aspartame can't be used for cooking, as it breaks down when

heated.

• Acesulfame-K contains natural flavors extracted from fruit.

• Sucralose (Splenda) is a good choice for cooking or baking

• Fructose (fruit sugar) is naturally found in fruit, but it is not calorie free like the

artificial sweeteners. It is a carbohydrate that is broken down by the body more

slowly than other sugars. Fructose is counted as a carbohydrate on a meal plan.

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• Stevia (Sweet Life) is a fiber that is natural (with no artificial chemicals), and has no

calories.

HOW TO READ NUTRITION LABELS

This is an important topic for anyone on any type of diet. The nutritional labels today are

based on 2000 calories per day - typically young adult (male) needs (This was established

1979). But it is important to remember actual caloric and nutritional requirements vary by

age, weight, gender, activity levels, and metabolism (which is seldom mentioned). As we

get older we need fewer calories. Labels will be taking a major change in the next year.

Please read on the new cases as they are published.

1. Serving Size

The nutrition label always lists a serving size (make sure to read the measurement). The

serving size is usually in cups, number of pieces, or number of grams or ounces. This is the

only true way you can actually see how much you are eating. Remember, everything else on

that label is based on the serving size.

Examples:

Serving size is 1 cup (228 g)

Servings per container is 2

Therefore, if one eats 2 cups one is eating 2 servings so everything is doubled on the label.

2. Calories

Example:

Amount per serving

Calories 250 Calories of fat 110

The number of calories in a single serving is listed at the top left of the nutritional label.

Calories are a measurement of how much energy one gets from one serving of this food.

Therefore, if you eat two portions of the food you would double the calories and fat calories.

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Fat calories are important if you are watching the fat intake of your diet. In this example

almost half of the calories are fat calories, which means this is a moderately high fat food.

This is important when watching cardiac health problems.

3. Nutrients (that appear on the label) that need to be limited

Example:

Daily % Value

Total fat 12g 18%

Saturated fat 8g 15%

Trans fat 3g ????

Cholesterol 30mg 10%

Sodium 470mg 20%

Carbohydrate 31g 10%

These are important when learning to watch diet for prevention of or monitoring of any

health related problem. Eating extra fat, saturated fat, transfat, cholesterol, or sodium may

increase the risk of certain chronic conditions such as heart and kidney disease, cancer, and

hypertension. A recent study has indicated we eat a weeks’ worth of salt each day.

Nutritionists and health professionals recommend eating a balanced diet with as little

saturated fat, trans fat, and cholesterol as possible.

4. Nutrients, vitamins, and minerals necessary in a healthy diet

According to the RDA, most people do not get enough dietary fiber, vitamin A, vitamin C,

calcium, and iron in their daily lives.

The daily value % (%DV) is also based on a 2000-calorie diet. The %DV must be on all

labels in the US. This was established in 1979 and is for a working (active) male.

The recommendation of fat in the daily adult diet (2000 calories) is less than 65 grams.

High fat=20% or more Moderate fat=5% or less

For all nutrients: 5% or less is considered low and 20% or more is considered high.

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OBJECTIVE #5

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND THE COMPLICATIONS OF DIABETES

2. DESCRIBE DIABETIC RETINOPATHY (BASIC)

3. APPRECIATE THE IMPORTANCE OF A1C IN A DIABETIC

4. UNDERSTAND CHILDHOOD OBESITY AND THE PROBLEMS

ASSOCIATED WITH THIS CONDITION

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COMPLICATIONS CAUSED BY DIABETES

Blindness, amputation, heart attacks can all be complications of diabetes. Diabetes is a

disease of complications, many of which are preventable. Complications do not have to be

part of living with diabetes. Complications can be prevented by controlling diabetes with

diet, medication, exercise and regular medical checkups. Research has demonstrated that

complications occur when the blood glucose levels remain over 140 mg/dl.

Signs of some of the complications include:

MICROVASCULAR COMPLICATIONS:

These complications affect blood vessels, creating problems for eyes

(Retinopathy), nerves (Neuropathy), and kidneys (Nephropathy).

Diabetic Retinopathy

This is the leading cause of blindness is the US, with between 12,000 and 24,000 (2007 data)

new cases each year. Current literature says that 30% of diabetics will have diabetic

Retinopathy. Therefore this is a major eye condition that needs to be checked yearly. Also,

other eye conditions in a diabetic are accelerated such as Cataracts, Glaucoma, and Macular

Degeneration all occur earlier then in the non-diabetic population.

Kidneys – Nephropathy DIABETES IS THE LEADING CAUSE OF RENAL FAILURE.

This develops when the nephrons – the cluster of blood vessels in the kidneys that filter out

waste from the body- lose their filtering capacity. To assess kidney health, doctors check

the urine for a protein called albumin, which is normally retained in the body but can leak

out if the nephrons are damaged. Micro-albuminuria – the diagnosis for small leakage

levels- can progress to proteinuria and finally to overt diabetic nephropathy. In severe

cases, the kidneys can fail, leading to a need for dialysis or kidney transplant, or severe diet

restrictions.

Neuropathy

Neuropathy affects the body’s nerves, often manifesting as leg and foot problems. Common

symptoms of neuropathy include tingling, numbness, and pain. The pain can become

excruciating but some experience no pain at all. Lack of sensation can lead to untended

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wounds, which especially problematic because wound deterioration and infection can lead

to amputation.

MACRO-VASCULAR COMPLICATIONS

Macro-vascular affects the larger blood vessels causing complications in the heart and

brain.

Cardiovascular Disease (CVD)

CVD is the most common cause of death for people with both type 1 and type 2 diabetes.

CVD is generally caused by a process called atherosclerosis, the narrowing of arteries, which

can lead to a heart attack. Diabetics are highest risk of having heart disease.

Strokes

Strokes are like heart attacks but in the brain. They occur when the blood can no longer feed

the brain. Either an obstruction, like a blood clot, or a break in a blood vessels that leads to

the brain can stop the flow of blood.

Serious Gum Disease

People with diabetes are twice as likely to develop serious gum disease. Good oral hygiene

is your best defense.

Critical in prevention of diabetic complications are regular medical visits, blood

glucose monitoring and following the doctor’s directions for the medications which

may be prescribed.

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GOALS FOR GLYCEMIC CONTROL

Patients with diabetes should have clear targets for glucose control. Glucose targets should

be individualized by your health care provider. The current ranges recommended by the

ADA, which are currently being re-evaluated, are:

Fasting plasma glucose 90-130 mg/dl

A1C <6.7%

UNDERSTANDING HEMOGLOBIN A1C

The Hemoglobin A1C (A1C) test was developed to monitor the patient’s level of diabetes

control. Some of the blood glucose sticks to the hemoglobin in the blood during the lifetime

of RBC (red blood cells), about 120 days. By testing AIC, it is possible to estimate AVERAGE

levels of blood glucose in last three months. In 2010, A1C became a diagnostic as well as

monitoring test. Currently is it is the standard test for control, and, often for diagnosis.

The diagnostic levels for A1C

• Normal below 5.7%

• Pre-Diabetes 5.7%-6.4%

• Diabetes 6.5% or higher

The range for fasting glucose is 70mg/dl-100mg/dl

• Normal below 100mg/dl

• Pre-Diabetic 101-119mg/dl

• Diabetic 120mg/dl or higher.

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CHILDHOOD OBESITY/DIABETES IN CHILDREN

Children and adolescents who are overweight are more likely to remain overweight, to

develop obesity as adults, and to suffer health consequences, including the following:

• Excess insulin

• Metabolic syndrome

• Type 2 diabetes

• Heart disease

• Liver disease

• Obstructive sleep apnea

• Orthopedic problems

• Depression

All of the above combined conditions have the potential to be reversed with weight loss,

physical activity, and healthier eating habits. One of the major problems associated with

excess weight is an increase in insulin production. Children today weigh 15% more than

they did 10 years ago at the same age. This has been improving with the change in the

school diet, removal of vending machines with soda and sweets, and adding physical

activities to school hours. A lot more work needs to be done to reduce childhood weight

issues.+

Type 2 Diabetes in Children

Recently there has been a major increase in type 2 diabetes among children. Seventeen

percent (17%) of today's children are overweight. Scientific research has related this

weight increase to lifestyle changes such as consumption of more fast foods and sedentary

habits like watching more TV and playing video and computer games.

Adolescents with type 2 diabetes are also typically overweight, eat fast food and have little

exercise. The pancreas produces insulin, but the body cells can't use the insulin

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(Aka insulin resistance). This problem worsens with weight gain, but it is improved with

weight loss and exercise.

Principles of Treatment for Type 2 Diabetes in Young People

• Change diet to include smaller portions with less fat and carbohydrates.

• Regular exercise that involves walking, jogging, and team sports.

• Talk with the school to help them understand the need to have healthy food in the

cafeteria for both prevention of diabetes and more appropriate food choices for

Diabetics, and to help them understand the need for regular exercise during school

hours.

• Treating newly diagnosed type 2 diabetics with insulin is common,

especially if they had ketones or ketoacidosis when diagnosed.

• Oral anti-diabetic agents such as Metformin can be effective for treating

type 2 diabetes in young people (most use them).

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OBJECTIVE #6

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND DIABETIC RETINOPATHY

2. UNDERSTAND RETINA SCREENER TRAINING

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UNDERSTANDING DIABETIC RETINOPATHY

The retina is the light sensitive layer of the eye that allows us to see. Retinopathy is a general term meaning the retina is abnormal. Diabetic retinopathy means the retina is abnormal, and that the abnormality was caused by diabetes. High blood sugar can cause retinal blood vessels to become abnormal. Retinal blood vessels can start to develop leaks, allowing fluid or blood to accumulate in the retina. This in turn can cause deterioration of vision. This stage is considered non-proliferative diabetic retinopathy. If non proliferative diabetic retinopathy persists, and/or blood sugar is not well controlled, the blood vessels can become blocked. This means that blood can no longer deliver oxygen to vital retinal tissues. In response, the eye can cause new blood vessels to grow. Unfortunately, these new blood vessels (neovascularization) proliferate and can cause more harm than they help. This is termed proliferative diabetic retinopathy. Over time, the abnormal blood vessels can contract and cause a retinal detachment, or a hemorrhage in the eye, causing the eye to fill with blood. People with diabetes (Type 1 and Type 2) should have annual (yearly) retinal examinations. This allows clinicians to detect diabetic retinopathy early, and possibly prevent eye complications. These eye exams can be achieved either by dilating the pupils with eye drops and having an examination by an optometrist or ophthalmologist, or by having pictures taken of the retina by a camera. The Florida Lions Diabetic Retinopathy Foundation is able to take digital pictures of the retina, and send those pictures to be interpreted by an ophthalmologist, who makes recommendations on the next course of action based on what the they see in the digital pictures. This may drastically decrease the amount of diabetics who convert from Non-proliferative to proliferative diabetic retinopathy. By having the digital pictures and a blood sugar measurement (blood glucose or A1C), the patient is able to be sent to a specialist (endocrinologist and eye doctor) for further evaluation and treatment. Adapted from: For My Patient: Diabetic Retinopathy. Retina Research Fund, San Francisco. 2003. ISBN 0960810234.

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RETINA SCREENER TRAINING

Since the process of Retinopathy screening is more complex, where proper technique and

reproducible quality are critical in order to be successful, we have initiated a three phase

training program to achieve the status of Certified Retinopathy Screener. Additionally,

we conduct monthly Zoom (internet conference call meetings) for our Retina team to

discuss, trouble shoot, and keep informed as to the latest developments in the program.

TO BECOME A CERTIFIED RETINOPATHY SCREENER, YOU MUST FIRST BE A

CERTIFIED BLOOD GLUCOSE SCREENER AND DO THE FOLLOWING:

• Screen ten (10) clients under the direct supervision of a Certified Retinopathy

Screener Trainer. 100% of the images must be gradable (by the retina physician)

• Screen an additional ten (10) clients with the trainer available to assist, who will

check on quality of the images, before sending them to the cloud for physician grading

and diagnosis. Again 100% of the images must be gradable to move on to the final

step.

• Work independently at a screening event, with at least 10 clients and have at least

95% gradable images.

• Participation in zoom meetings is a requirement of the certification process and

continued participation in the Diabetic Retinopathy program.

If you are interested in becoming a certified retinopathy screener, check out the Lions

program on diabetic retinopathy at www.fldrf.org. You could also contact one of the

retinopathy screeners in your club and/or Lion Norma Callahan. They will tell you what to

do next.

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OBJECTIVE #7

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. UNDERSTAND THE IMPORTANCE OF THE CONSENT FORM

2. DEMONSTRATE HOW TO COMPLETE THE CONSENT FORM

3. DISCUSS THE MOST COMMON ERRORS COMPLETING THE FORMS

4. UNDERSTAND HOW TO RETURN FORMS

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FORMS

BEFORE SCREENING A CLIENT

CONSENT FORM: NEVER TOUCH A CLIENT WITHOUT FIRST HAVING A CONSENT

FORM SIGNED BY THE CLIENT, OR IN SOME CASES BY A PARENT OR GUARDIAN.

MAKE CERTAIN THE CLIENT UNDERSTANDS WHAT THE SCREENING PROCEDURE IS

FOR. MAKE CERTAIN THE CLIENT UNDERSTANDS THAT WE DO NOT DIAGNOSE. WE

SCREEN. FAILURE TO ACT ONLY AFTER HAVING A SIGNED CONSENT FORM WILL

MAKE YOU SUBJECT TO CIVIL AND/OR CRIMINAL CONSEQUENCES.

BEFORE USING FORMS AT A SCREENING EVENT, CHECK THE WEBSITE TO

MAKE SURE THAT YOU ARE USING THE MOST CURRENT REVISION.

CHECKING CONSENT FORMS. We are required to completely fill out the forms we use in order to publish our findings in medical journals and in order to search for more grant funds. We MUST ask the participant: “When was your last dilated eye exam” If they are not sure, you can write a long time, but never leave blank. It is the screener’s responsibility to ask any question not answered. Take your time, look and make sure the consent form is omplete, including name, location and date.

IMMEDIATELY AFTER THE SCREENING EVENT

A report must be returned along with all of the original consent forms. The report must contain the name of ALL CERTIFIED SCREENERS involved in the screening and the club they belong to as well. We are offering free recertification for all Lions who have screened in the prior six months. To qualify, their screening activity must be documented in the report and returned with their names CLEARLY WRITTEN on consent forms.

IF THE REPORT AND CONSENT FORMS ARE NOT RETURNED, NO FURTHER SUPPLIES

WILL BE SENT.

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OBJECTIVE #8

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. REPORTING REQUIREMENTS

2. MAKING ARRANGEMENTS FOR SCREENING

3. ARRANGE SETTING UP FOR SCREENING

4. IDENTIFY THE EQUIPMENT/SUPPLIES REQUIRED

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REPORTING REQUIREMENTS

This is one of the most important jobs. We purchase our supplies so we must have the data as soon as possible in a timely manner. You and your team will not be issued any further supplies until the last report and form have been returned. Every form is reviewed and the data charted. If an error is made, the team leader will be contacted and will be given the name of the screener. The screener is responsible for referrals. It is important that time is taken to ensure that the forms are completed A form will be included with the equipment and is available on line on our website.

PLEASE ONLY USE THE CURRENT VERSION LISTED ON THE WEBSITE

WWW.DAFMD35.ORG

THE INFORMATION REQUIRED BY OUR GRANTS CHANGE OVER TIME AND

THE LATEST FORMAT INCLUDES ALL THE INFORMATION NEEDED NOW. We want not just the results, but also how the Lions feel about the project. Did they feel they had enough training and were ready to do the project? Also, note any problems and potential solutions to pass this information on to the other Lions. We are all one team, looking to help each other on this important project.

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SCREENING ARRANGEMENTS

1. If you are going into a new area that you are not familiar with, make sure to check out

the area and the physical layout before starting.

2. Make sure that you have the phone and cell numbers of the person who is responsible for the site or event where you are going to screen and that they have yours.

3. Assure that all contingencies are covered, such as storms, rain and other events. What

is a cancellation and how are you notified?

4. Have a complete list of phone and email contacts of all your co-workers. Remind your co-workers 7 days in advance, and get their confirmation that they plan to work. Make sure that they know what the schedule will be, the location, and directions. Schedule back-up help and the time that they can work.

5. Remind everyone again the night before. Many events have been difficult and understaffed due to Lions forgetting to call in and telling that they are sick.

6. Always check that co-workers have the address and directions. Don’t assume that one can find the screening place without directions.

7. Find out how many are expected to be screened that day and make a schedule.

8. When planning for the glucose screening, it is critical to have a rough count so as to have enough supplies and equipment.

9. The Foundation provides ONLY the meters, strips, lancets, post cards, and

brochures. All other supplies and equipment are the responsibility of the club sponsoring the event. (gloves, sanitizer, cotton balls, wipes, etc)

Always check the dates on your strips. Use the old ones first. Strips are dated on

the container.

SUPPLIES NEED TO BE ORDERED AT LEAST TWO WEEKS BEFORE AN EVENT, using the scheduling form (found on dafmd35.org website) and MUST INCLUDE the mailing address to which the supplies are to be sent.

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SETTING-UP

Look at the location. If located inside, is there a separate area to counsel the person after the screening? If not, be creative. Talking to participants about their screenings is an important part of the Diabetes Awareness Project. We need to educate them as to what are good results, encourage them to follow-up care, as well as encourage people to be screened. Do they need to see a doctor or clinic? Also to hand out literature even just a bookmark that promotes the screening program. You should all have access to our new brochures, one promoting Blood Glucose and Retinopathy screening, another about the MD-35 entities. Please have the contact information for the County Health Departments, as well as other sliding-scale, or free clinics, in your county and those around you, if you are screening in an area with many other counties close to the location. The table for screening needs to be wiped down with Clorox wipes and dried off. Equipment should be kept out of sight and only what is actually used being out in the open. Place cotton balls, and lancets in a cup, or plastic container. Place strip container and meters on table. Be sure to keep test strip container closed after removing each strip. Keep un-opened supplies off the table, in the storage bag. When setting up, it is important that the banner be displayed. Also, if supplies have been donated by a company or pharmacy, as we currently have in some locations, make sure that you have a sign to acknowledge their generosity and thank them. We are required to do visual acuity screening as part of our grant requirements, so be sure to have an area where blood glucose participants have a ten foot separation from the eye chart. Remember to document this on the consent form for every Blood Glucose screening client. (refusal needs to be documented) If your club is also doing vision screening (not to be confused with visual acuity screening done by the Blood Glucose team), do not sit next to each other. Too much noise may be confusing and the client may not get the full understanding of your teaching about diabetes or importance of the result of the screening. Set up at different tables.

The Consent Form should be signed by the person being screened. If a child is being screened, the consent needs to be signed by the adult accompanying them. If a person is sight impaired, this will also need to be witnessed.

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EQUIPMENT

1. Glucose meters - WE ONLY USE METRIX METERS

2. Screening strips 3. Non-Latex Gloves (med, large and extra-large) (club provides) 4. Lancets (encased only) 5. Consent forms 6. Post Cards 7. List of County Health Departments, as well as other sliding scale, or free

clinics, by county 8. Literature 9. Banner 10. Hand cleaner sanitizer (club provides) 11. Lion literature 12. Paper towels 13. Trash bags 14. Clorox or Lysol wipes for the table 15. Cotton balls, cotton rounds, or squares 16. Pens 17. Clip Boards 18. Eye Chart

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OBJECTIVE #9

AT THE END OF THIS UNIT, YOU WILL B E ABLE TO DO THE FOLLOWING:

1. CONDUCT A DIABETES SCREENING EVENT

2. SUCCESSFULLY REFER AND COUNSEL THE CLIENT

3. DELIVER LITERATURE WHIS IS APPROPRIATE FOR THE FINDINGS

4. SCREENING IN SCHOOLS

5. DO A FINGER STICK ON A CHILD

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SCREENING PROCEDURE Be sure to have the consent form filled out completely, as we work on grants and publish our results for LCIF. It is critical that the county the patient lives in is completed in case we need to refer. We need the last dilated eye exam as we are looking to adding this to our project screening. It is the job of the first person to make sure the form is filled and signed. Make sure the client is comfortable and seated. If it is cold, have them rub their hands together as this brings blood to the finger tips, or have them place the hand to be used under their arm pit. WE NEVER TOUCH THE PARTICIPANT WITHOUT A SIGNATURE. Ask: “WHEN DID YOU EAT LAST? “This is with sugar or real food in it. Black coffee, tea, water, and diet drinks are not included in food for this screening. (This is important as there is a table to use if the person is not fasting.) Then look at the time and calculate how many hours (Fasting, One Hour, Two Hours). Tell each screening client that all of their personal information will be kept strictly confidential according to the requirements in the federal law titled: Health Insurance Portability and Accountability Act of 1996. OVER THREE HOURS SINCE EATING IS CONSIDERED FASTING

Mark this on the consent form and the post card. The post card should also be dated as should the consent form. NO ID IS REQUIRED!! Make sure there are no sores or cuts. Screeners will put on gloves (both hands), address the client by name and look at them! Ask which finger they would like to use for the screening or have you been screened before? Place the test strip in before cleaning the finger or sticking the client. (Important: This way you do not get any of the hand cleaner on the strip which will give you an error message.) Then place a little hand cleaner on the cotton ball and clean the finger to be used and dry off with the other side of the cotton ball. You do not want to get the strip wet from the cleaner. All the current meters will wait for you (5 mins). When you place the strip in the meter, the screen lights up and displays a drop of blood. (The METRIX meters will click). Prick the finger and just touch the drop (bubble)of blood (the strip acts like a siphon). Get the blood into strip and insert the strip into the meter. You will hear a click and the time starts running. Hand the client a cotton ball. If error message pull the strip out, and replace with another one. BUT GIVE THE METER TIME TO CYCLE UNTIL THE ORIGNAL SCREEN IS

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DISPLAYED WITH THE INDICATOR IT IS READY/ You rarely must re-stick the patient just milk the finger. Since the lancet is encased, it can be thrown away in the normal trash inside your glove. Then, wait for reading. Put the reading on the consent form and then the patient’s post card. Before you remove your gloves, remove the strip and place in the glove with the cotton ball and lancet and strip using handover hand technique. ONE PAIR OF GLOVES ONE PARTICIPANT! Dispose of them in the trash.

DO NOT HANDLE BLOOD AT ALL WITHOUT GLOVES ON.

Explain the results to the client, quietly and friendly. If there is a very high value, remain calm and explain that it is important for them to seek medical attention as soon as possible. If it is just a little high, ask: “When did you see your doctor last? “ Ask: “Do you have a doctor or clinic?” Tell them this would be good time to make another appointment and that they may need a complete blood test carried out as

THIS IS ONLY A SCREENING. It is only a snapshot in time Refer to end of manual for best explanation to discuss results with patients. If they do not have a doctor or clinic, ask what county they are in, and give them either the health department referral phone number or other sliding scale clinics in your area. It is mportant to draw up this list and have with you along with the contact information. This is the time that we refer all clients who do not have blood sugars within the ideal range. It is important even on diabetic patients. We are only screening. We refer when either the high or lower blood sugar values are not in the ideal values on the screening sheet and post card. Mark their post card referral if one is made [Even if the client says they are not going to follow-up]. ANY VALUE THAT IS NOT ON THE POST CARD [EITHER HIGH OR LOW] REQUIRES A

REFERRAL.

IF THE VALUE OF YOUR SCREENING IS ON THE CARD CIRCLE IT.

THE CIRCLE BRINGS THEIR ATTENTION TO THE LOCATION OF THEIR READING

VALUE ON THE CARD.

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REFERRING AND COUNSELING

When setting up, be aware of how to interface with the client for counseling, and make comfortable arrangements for this. As part of the new confidentiality law (HIPPA) we cannot discuss the results of the screening with others around. Therefore, either have the person doing the discussion facing out and the client facing toward the wall or less populated area. It is best that the person who does the screening do the discussion, as they already have a relationship with the participant. Never be rushed. It is critical that you have as much time as is necessary. If the screener thinks or feels that someone else would do a better job do ask that another screener to help. This may be true with very high unexpected values, especially in undiagnosed diabetics. You need to be able to talk privately and not have to shout at the client regarding his or her results. Often, you will find they have questions and want us to help them understand. This is a great time to hand them our literature. Make sure if you are referring a bi-lingual patient that he understands or get a Lion who speaks his native language to help. It is always best to have more than one screener. This way screening can continue, while the discussion with the client is going on. It is highly recommended that you screen each other when first starting to remind everyone of how to use the meters and lancets. Have a brief meeting before starting screening to remind all of the workers about the meters they are using and how to screen. WE ARE

USING ONLY METRIX METERS. DO NOT LEAVE STRIPS IN THE SUN OR HEAT. THEY ARE SENSITIVE over 90o or cold below 55o. CLOSE THE TOP OF THE BOTTLE AND REMOVE ONLY THE STRIP YOU ARE USING. Dampness, (aka fog) will also make the strip give you an error message. If your paper is curling, it is too damp to test. VERY IMPORTANT: USE

ONLY METRIX TEST STRIPS - THEY CAN NOT BE INTERCHANGED.

Even if all your Certified Screeners are diabetic, it is important to have a short meeting to assure that each screened client gets the best results with the minimum amount of redoes. Look at the lancet and remember gentle twist (360) (COMPETE CIRCLE) and pull. Do not touch the trigger until ready to screen. Set up early as you may be able to screen other groups that are present before the start of the event. Remember it is okay to have your family come and be screened. We strongly encourage that the Lions screen each other. NOT

THEMSELVES.

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If you are doing a Blood Glucose screening: ALWAYS WEAR GLOVES!! Since we do not wear them when self-testing ourselves, it is critical to discuss and remind each time. We are required to WEAR GLOVES ON BOTH HANDS, NEVER ONE GLOVE.

One pair per client and ALWAYS CHANGE GLOVES after you complete each screening. We never wear our Lions vests when doing the screening. Wear either your foundation shirt, your club shirt, or a plain shirt. NEVER THE VEST when conducting the screening. Vests is okay for those signing the clients up , but not the screeners. Vests are not washed after each wearing and many have many pins, therefore they are not the cleanest article of clothing. If you receive a value of “HI” that means it cannot be read by the meter, as it is above the 600 value. THIS IS AN EMERGENCY! Ask if the client has family or someone to take them to a clinic or emergency room.

THIS PERSON SHOULD NOT BE DRIVING.

If the client is diabetic, you always look before screening, and ask when you get the results “is this within your normal range?” This opens up the discussion and sets up discussion of BS numbers. Re-screening – if a client asks to be re-screened, do so. Either have them wait and have them walk around a little and come back or even use the other meter. This way they really appreciate how serious the situation is and often respond very positively. (Remember, all meters have a degree of error so no two will be exactly the same.) You can use the same form and just write in second screening and time since they ate. Remember we are doing a service. NEVER STICK A CLIENT MORE THAN TWICE. ASK SOMEONE ELSE. NEVER RUN A DEMO AGAINST THEIR METER AS THIS IS A WASTE OF SUPPLIES AND TIME.

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SCREENING IN SCHOOLS When we go into a school, one of the best approaches would be to ask to speak at a PTA meeting and, using the information data, explain the high incidence of type 2 diabetes in young children and adolescents. Consent forms are critical and getting the school to agree to give a time and place to conduct this project. Once we have started, the forms are sent home with a cover letter. Children are screened during a pre-planned time with the assistance of the teachers. It is best to screen during a school event as you will also have access to parents and can get a signed consent form immediately. One of the most successful events have been at “welcome back to school” events. We have been able to screen both parents and children at one sitting.

HOW TO DO A FINGER STICK ON A CHILD

1. Have the parents hold the child if young. Distract the child and promise a sticker!!! Prepare meter and screen strip per earlier directions. Do not discuss just do it!!!

2. Choose the spot where you are going to do the finger stick. Wash the child’s hands with gel (very quickly)

3. Place the finger-pricking device (lancet) on the finger. Press the release mechanism and squeeze out a drop of blood.

4. Place the blood as directed in the instructions, on the meter strip. 5. Wait for the results and record them on the client’s sheet. 6. If in a school we give the results to the school assistants with the students name on it,

or to the school nurse.

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OBJECTIVE #10

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. SUCCESSFULLY ORDER AND REORDER SUPPLIES

2. DEMONSTRATE COMPETENCY IN USE OF LANCETS AND METER

3. UNDERSTAND WHAT TO DO IN AN EMERGENCY

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ORDERING SUPPLIES To get new supplies, the forms from your last screening must have been completely and accurately filled out. Furthermore, they must have been returned to Norma and received by Norma at least two (2) weeks prior to needing the new supplies. Your Screening Team Leader is responsible for getting the data back to Lion Norma Callahan, PDG at PO Box 1407, DeLand, Florida 32721. Remember, all supplies must be ordered at least two weeks before they are needed. In addition, your screening team members must be currently certified. If the team has not done in a screening in the past 6 months, they must be recertified before supplies can be ordered for them.

COMPETENCY IN THE USE OF LANCETS AND METERS

METERS - All meters are heat and cold sensitive.

DO NOT LEAVE IN THE CAR OVERNIGHT. DO NOT PLACE IN YOUR COOLER

EITHER, AS THE STRIPS WILL NOT WORK.

The range for the temperature is 55 to 90 F.

TESTING STRIPS - REMEMBER to put the strip in the meter before cleaning the patient’s finger for screening, this way the strip does not get the alcohol on it and give you an error message. Make sure the finger you are screening has been dried off as this too will give you an error message. LANCETS - WE ONLY USE ENCASED LANCETS ALL OTHERS ARE NOT TO BE USED

Gentle is important. This is plastic. These lancets can be disposed of in the trash as they are encased and have no PUNCTURE DEVICE visible or chance to get stuck. The new lancets which are baby blue with white tips are the gentle ones, the very bright yellow or sometimes pink are for hands that have tough skin, aka farm workers and gardeners. Twist the tip off 360 degrees (COMPETE CIRCLE). Place your fingers on the edge of the white plunger carefully place up against the skin and trigger. These are best used for soft hands (aka females) and children. On anyone that works outside or has tough skin these will not work very well. It is suggested that you use your DARKER lancets, the

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gray/blue or bright colored twists off, for these participants. The new version of these gray and blue are yellow and blue. They are just the same. ALL LANCETS ARE ONE TIME USE ONLY. THEY WILL NOT WORK A SECOND TIME. Should you trigger a lancet accidently, it will not work. Throw away and use another.

METER ACCURACY - SCREENING VS TESTING

We provide a valuable service to participants in our community Blood Sugar screenings but they are just that…screenings. The diagnosis and treatment of people screening high, or low, is a complex process which is the job of a Physician, not the Lions, and we must always resist the temptation to

comment, regardless of our professional or personal knowledge of diabetes and hypoglycemia. Handheld blood glucose meters are not always 100 percent accurate when screening blood sugar. The use of one meter (METRIX METER ONLY) helps to minimize variation, although there can be a variance of up to 8% or more with the same client. Our readings are just a snapshot in time and not testing, for diabetes or hypoglycemia. We only refer a participant for follow-up care. Testing takes place in a Physician-Patient relationship, using more sophisticated diagnostic tools than a personal blood glucose meter. If handheld blood glucose meters were always as accurate at checking blood sugar levels as the much bigger, much more expensive analyzers that hospitals and labs use, then hospitals and labs would use the small, personal blood sugar meters. Keep up the good community outreach and service that we provide.

Deland FL 32721. Pack up all remaining screening equipment making note of what has been used. If anything is not working correctly please label so it can be fixed or replaced. Ensure all waste material is secured and put in the proper places for disposal.

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Has a brief discussion on how everyone feels about their work, what was learned and did all get the expected results?

Give the name of the screener on the forms. The screener is responsible for referrals. It is important that time is taken to ensure that the forms are completed

RECERTIFICATION

We require yearly recertification for our blood sugar screeners to remind them of

new forms, equipment, and changes in the procedure. We also catch errors or things

we want to change in the screening areas. This is why we ask the organizers to attend

the training as well, as often they bring new potential issues or better ideas for

working in their given area.

Currently if you have screened and the forms have been returned with a report with

the names and clubs on it: RECERTIFICATION IS FREE FOR THOSE SCREENERS WHO

HAVE SCREENED WITHIN 6 MONTHS. AFTER THE 6 MONTHS SCREENERS SHOULD

RETAKE THE CLASS.

Lions are subject to the requirements of the Federal regulations known as HIPAA:

Health Insurance Portability and Accountability Act. This law requires that the

personal information of all of our clients be kept completely confidential. Results can

be discussed, but the identity of the client associated with those results must never

be associated with those results. Failure to do so can make the guilty lions and the

Lions association subject to severe civil and criminal penalties. It is highly

recommended that at least two people in each Lions club that does screenings (at

least the team leader and the club President (aka King Lion)) take the online HIPAA

training class.

EXPECTATIONS

You will soon find out where not to screen and when not to screen. At sites that are purely informational, tell people when we will be screening in their area and hand out flyers. If we are screening with food around, we must try to get setup prior to the food or their access to the food. Currently we have great local support from Public Health groups who are inviting us to attend many health-related meetings. We are also working at hospitals, health fairs. WE DO NOT PAY FOR BOOTHS. IF your club wishes to donate the cost of a booth that is fine but the Lions Diabetes Awareness Foundation of MD 35, is a 501(c)3 and does not get involved in these fees.

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OBJECTIVE #11

AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING:

1. DISCUSS RESULTS WITH CLIENTS

2. HANDLE EMERGENCIES

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HOW TO DISCUSS RESULTS WITH CLIENTS

If in the normal range (with diabetes in family) – this is only a snap shot and should be done on a regular basis. Give literature. High normal (pre-diabetic) – This is the time to discuss the importance of diet and exercise for prevention of diabetes. Also, recommend that they make an appointment with their medical doctor who may wish to carry out further testing. High above 120 (fasting) – Need to be referred to their medical doctor. Make sure to ask if they have one. If not, refer them to the county public health department. Above 200 – 299 - Need to be referred to their medical doctor as soon as possible. Above 300 – 399 - They need to be referred as soon as they can make an appointment. You may want to repeat this screening. Above 400 – 499 – Need to be referred to a clinic or emergency room. You may want to repeat this screening. Above 500 – 599 - THIS IS SERIOUS AND NEEDS TO BE SEEN THAT DAY.

Re-screening will reinforce that this is not an error. Refer to emergency room and/or contact their doctor.

“Hi” = EMERGENCY AND VERY SERIOUS.

INDIVIDUAL NEEDS TO GO TO THE EMERGENCY ROOM

NO DRIVING

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WHAT TO DO IN EMERGENCIES

First, never do anything that you do not understand or have the training to do. But

here are a few basics:

Some feel shaking and confused and tell you they have low blood sugar. If able, go

ahead and test their blood. If it is a diabetic – give them a soda that contains sugar –

but not the whole drink as it will go too high. They may have glucose tablets in their

bag. If they do not respond get an EMT or call 911.

If the person is dizzy and pale – lay them down or have them sit down with their head

between their legs.

If the person is having a seizure, get them on the ground and on their side. Do not put

a spoon in their mouth. Again, call 911.

If someone gets cut, apply pressure for a few minutes. Check bleeding has stopped.

Use a band aid or a dressing if available.

Falls – check to make sure that they are okay, (Not passed out or dizzy). If dizzy, have

them stay where they are or get them down. If just stumped or tripped, did they cut

themselves or break anything? If not sure call 911.

If someone has a heart attack or chest pain or signs of a stroke – call 911 the sooner

they are treated the better their chance of full recovery.

IF YOU ARE NOT TRAINED, ONLY DO WHAT YOU CAN. YOU ARE NOT EXPECTED TO DO

ANYTHNG BUT CALL 911.

Make sure, when calling 911, that you remember to tell them your location and what

is going on. They may direct you to do others things while you are waiting for the

EMT. Remember not all cell phones have GPS systems.

Remember: better to be safe than sorry.

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APPENDIX

ANATOMY OF THE ENDOCRINE SYSTEM

There are two major systems (nervous and endocrine) that help the body to maintain

homeostasis. Homeostasis is the state of normal internal functions. Homeostasis is

maintained by the nervous system using nerve impulses to transmit messages and by the

endocrine system using hormones it secretes into the blood system.

There are nine major glands that secrete hormones: 1) Pineal, 2) Pituitary, 3) Thyroid,

4) Parathyroid, 5) Thymus, 6) Pancreas, 7) Adrenal, 8) Ovaries, and 9) Testes. The first 7

will be covered individually in the following sections. The complexity and

interrelationships among the glands are too extensive to be covered in this presentation.

The purpose is for general information and to help you realize that the body has many

interactions and no system or organ works alone.

Pancreas: The pancreas is part of two systems--the endocrine system and the digestive

system. The majority of the pancreatic cells are involved in producing enzymes for the

body’s digestive function. The pancreas also plays an equally vital role in the endocrine

system because it produces insulin and glucagon.

The pancreas will be considered in great detail due to its major effects with regard to

diabetes. The pancreas affects 1) bones, 2) muscles, 3) gamete production as well as

hormonal activities of the ovaries and testes, 4) mammary glands, 5) growth and activity of

the thyroid gland, and 6) the activity of the cortex of the adrenal gland.

Besides enzymes, the pancreas produces both insulin and glucagon that are concerned with

blood sugar (glucose) levels.

When blood sugar levels are too high, insulin decreases it by speeding the transport of

glucose into body cells. The released insulin then works to keep the blood glucose at an

optimal level. Glucagon, by contrast, affects low blood glucose levels. It stimulates the liver

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to break down glycogen stores to glucose and releases it into the blood to be used by body

cells.

Pineal Gland: The pineal gland secretes melatonin, which is more abundant at night to

help us sleep, and less abundant during the day so that we remain awake. Melatonin is only

released when it is dark and is inhibited with light.

Sleep is very important part of our health. We need a minimum of 5 hours of solid sleep.

Pituitary Gland: Often called the master gland of the body, the pituitary gland secretes a

variety of hormones, including: 1) growth, 2) luteinizing (LH), 3) follicle stimulating (FSH),

4) prolactin (PRL), 5) thyrotropin (TSH), and 6) adrenocorticotropic (ACTH).

Thyroid Gland: Its major function is to control the rate of body metabolism. Metabolism is

the sum of all physical and chemical changes that take place within the human body.

Parathyroid Gland: The parathyroid gland maintains blood calcium levels.

Thymus Gland: The thymus gland is large in infants but decreases in size as one ages. It

produces white blood cells that attack virus-infected cells and/or tumors.

Adrenal Glands: The adrenal glands release epinephrine and norepinephrine that produce

the 'fight-or-flight' response to stressors. Some sex hormones are also produced by the

adrenals.

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GLOSSARY

Acanthosis Nigricans - The insulin can cause excess pigment to be deposited in the creases

of the skin. Acanthosis Nigricans is the outward sign that a child is developing insulin

resistance. A dark velvety pigment develops increases of the skin usually the neck. Excess

insulin stimulates the body to produce more pigment or color to the skin. It is often

mistaken for poor hygiene

AIC3 – This is also known as the HbA1c. The A1C is an average measurement of blood sugar

over the past 90 days. This provides a long term picture. Diabetics’ A1C of 7% or lower is

considered good control. Most Americans diabetics are at 9%.

Acesulfame-K – Sweetener that provides negligible energy.

Acetone – Produced when there is an excess of ketones in the blood. Acetone can be smelled

on the breath when the level is raised. (Sweet smell)

Acidosis – Shifting of the pH in the blood towards being acidic.

Adrenaline – Stress hormones from the adrenal glands that increase the blood glucose level.

Adrenal glands – Small organs situated above the kidneys that produce a number of

different hormones, including adrenaline and cortisol.

Adrenergic symptoms – Bodily symptoms of hypoglycemia caused mainly by adrenalin.

Albuminuria – Proteinuria - A larger amount of albumin in the urine than the traces of

albumin found with micro-albuminuria. A sign of permanent kidney damage.

Aldose reductase inhibitors. – Drugs that can treat nerve damage caused by diabetes.

Alpha cells- Cells in the Islets of Langerhans of the pancreas that produce the hormone

glucagon.

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Amino acid – Protein building blocks.

Amnesia –loss of memory.

Amylase – An enzyme that is produced in the saliva and the pancreas. Amylase breaks down

the starch in the food.

Antibody – Produced by the immune system to destroy viruses and bacteria.

Atherosclerosis – Hardening, narrowing, and eventually blocking of the blood vessels.

Aspartame – Sweetener that provides negligible energy.

Autoimmune – Sometimes things go wrong with immune defense and the cells of one’s own

body are attacked.

Basal insulin – a low level of insulin that covers the body’s need for insulin between meals

and during the night. The insulin is given as intermediate or long-acting insulin or in a

pump.

Basal rate – With an insulin pump, allows doses of basal insulin to be infused every hour of

the day and night.

Beta Cells – Cells in the Islets of Langerhans of the pancreas that produces the hormone

insulin.

Blood glucose level – The level of glucose in the blood

Blood sugar measurements: In the US the blood sugar levels are expressed in terms of

milligram per deciliter (abbreviated mg/dl) British countries use a metric system and these

measurements are expressed in milli-moles per liter (abbreviated mmol/L).

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Brittle Diabetes – Diabetes with very unstable blood glucose (rapid swings up and down)

that prevents the person from living a normal life. (Type 1)

Capillary blood – Capillaries are the very fine blood vessels between arteries and veins

through which the blood delivers oxygen to the tissues. Blood test from fingers uses

capillary blood.

Carbohydrates – All compounds that are made up of different types of sugar, such as cane

and beet sugar, grape sugar, syrup, starch and cellulose.

Cataract – Clouding of the lens in the eye.

Cellulose – Glucose molecules in long chains, present in many plants. Cannot be broken

down in the intestines.

Cyclosporin A – A cytotoxic drug that has been used to stop the (auto) immune process at

the onset of diabetes.

Celiac Disease – Illness where the person cannot tolerate “gluten” a substance found in

wheat, barley, and rye. Although oats do not contain gluten, processed oats are often

contaminated with gluten during processing.

Coma – unconsciousness. A coma can occur in people with diabetes when the glucose is very

low (insulin coma) or very high (diabetic coma).

Catabolic process – breaking down process

C-peptide – “Connecting peptide”, a protein produced together with insulin in the beta cells.

By measuring C-peptide, the residual insulin production of the pancreas can be estimated.

Cortisol – Stress hormone that is produced in the adrenal gland.

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Counter-regulation – The body’s defense against low levels of blood glucose. The extraction

of the counter-regulating hormones (glucagon’s, adrenaline, growth hormone and cortisol)

increases when the blood glucose level falls too low.

CSII – Continuous subcutaneous insulin infusion, treatment with insulin pump.

Cyclamate – Sweetener that does not provide any energy.

Dawn Phenomenon – The growth hormone level rises during the night, causing the blood

glucose level to rise early in the morning.

Depot effect – Part of the insulin that is injected is stored in the fat tissue as a depot (a ”spare

tank” of insulin). The longer the action of the insulin, the larger the depot will be.

Dextrose – Pure glucose.

Diabetic coma – Severe ketoacidosis that has led to unconsciousness.

Diabetes ketones – Ketones that are produced when the cells in the body are starving for

glucose due to the lack of insulin. The blood glucose level is high.

Dialysis – the process of extracting harmful substances from the blood when the kidneys do

not work properly.

Direct – acting insulin – Term used in some countries for rapid-acting insulin.

DNA – (Deoxyribonucleic acid) Genetic code inside the chromosomes. It is made of DNA.

Enzyme – Protein that cleaves or makes chemical bonds.

Fasting blood glucose – Blood glucose test taken before eating in the morning. In a person

without diabetes, the plasma glucose results would not normally be higher than 100 mg/dl

(5.6 mmol/l).

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Fatty acids – Substances produced when fat is broken down in the body.

Fluorescein angiography – Special type of X-ray technique to visualize the retinal blood

vessels in the back of the eye.

Fructosamine – Blood test that measures how much glucose that is bound to proteins

(mainly albumin) in the blood. Gives a measure of the average blood glucose level during

the last 2-3 weeks.

Fructose – A type of sugar molecule

Gastroparesis – slower stomach emptying caused by diabetes complications (neuropathy).

Galactose – A type of sugar molecule. A lactose sugar molecule in milk consists of one

molecule of galactose linked to one molecule of glucose.

Gestational Diabetes – Diabetes discovered during pregnancy. The symptoms usually

disappear after childbirth, but the woman has an increased risk of acquiring type 2 diabetes

later on in life.

Glucagon – Hormone that raises the blood glucose level. Glucagon is produced in the alpha

cells in the Islets of Langerhans of the pancreas.

Gluconeogensis – production of sugar molecules (glucose) in the liver.

Glucose – A type of sugar molecule.

Glucose Tolerance test – Test to diagnosis early stages of diabetes. Tells how much the

blood glucose level rises after orally ingested (OGTT) or intravenously given (IVGTT)

glucose.

Gluten –A type of protein that makes dough sticky. Found in wheat, rye and barley.

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Glycemic Index – A method to classify carbohydrates and foods according to how they affect

the blood glucose level. Abbreviated as GI.

Glycogen – Glucose is stored as glycogen in the liver and muscles. The glucose molecules

are connected in long chains.

Glycogenolysis – The breakdown of the glycogen store in liver or muscles.

Glycosylated hemoglobin – A1C

Growth Hormone – Hormone that is produced in the pituitary gland. Increased growth is

the most important effect. It also increases the blood glucose level.

HbA1c – A1C

Honeymoon phase – remission phase

Hormone – Protein compound that is produced in one of the glands in the body and targets

organs or tissues through the blood. Hormones work as “keys” to influence the cells in the

body to perform different functions.

Hyperglycemia – High blood glucose level.

Hyper-insulinism – High level of insulin in the blood.

Hypoglycemia – Too low a level of blood glucose. Usually defined as a blood glucose level

below 3-3.5mmol/I (55-65 mg/dl)

ICA – Islets cell antibodies. Antibodies directed against the Islets of Langerhans. Indicates

an attack by the immune system on the islet cells.

IDDM – Insulin Dependent Diabetes Mellitus, former name for type 1 diabetes.

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Implantable insulin pump – Insulin pump that is implanted under the skin in the

subcutaneous tissue. Infused insulin flows through a thin tubing into the abdominal (intra-

peritoneal) cavity. Use of his type of insulin pump is rare and has been largely discontinued.

Insulin – Hormone produced in the pancreas beta cells. Lowers the blood glucose level by

“opening the door” of the cells to the entrance of glucose.

Insulin is a (building) hormone. Its function is to remove glucose from the blood stream

and deliver it to cells to make fuel, or store it. An excess amount of insulin makes it harder

to lose weight which is a catabolic process. As weight increases, resistance to insulin can

occur, and the body produces more insulin to compensate. The insulin can cause excess

pigment to be deposited in the creases of the skin. This is Acanthosis Nigricans.

Insulin antibodies – Antibodies in the blood that bind insulin. The insulin that is bound has

no function.

Indwelling catheter (Insuflon) An aid to lessen the pain when injecting insulin. It consist of

a soft Teflon catheter which is inserted into the subcutaneous tissues.

Insulin Analogs – Newer types of insulin where the structure of insulin molecules has been

changed to make the insulin action quicker (Novolog/NovoRapid, Humalog, Apidra) or

slower (Lantus, Levemir).

Insulin Coma – Unconsciousness caused by severe hypoglycemia.

Insulin Depot – same as depot effect.

Insulin Pump – Insulin is infused into the subcutaneous tissue through thin tubing

continuously during day and night. Pre-meal doses are taken by pressing a button on the

pump.

Insulin receptor – Structure on the cell surface to which insulin binds. Initiates the signal

that opens the cell membrane for glucose transport.

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Insulin resistance – decreased insulin sensitivity – A higher level of insulin than is needed

to obtain the same blood glucose lowering effect.

Intermediate-acting insulin – Insulin that has an effective time action of 8-12 hours,

corresponding to normal night.

Islets of Langerhans – small islets in the pancreas with cells that produce insulin (beta cells)

and glucagon (alpha cells.)

Jet injector – Injection without a needle. A thin jet of liquid is propelled using a very high

pressure and penetrates the skin.

Juvenile Diabetes – Diabetes in childhood or adolescence.

Ketoacidosis – The blood turns acidic from a high level of ketones when there is a deficiency

of insulin. Can develop into diabetic coma.

Ketones – Fat is broken down to fatty acids when cells are starving due to lack of glucose.

The fatty acids are transformed into ketones in the liver. This can occur when there is a lack

of insulin or when there is a lack of food.

Ketosis – increased amounts of ketones in the blood.

Kg – kilogram, 1kg = 2.2 lbs.

Lactose – Milk sugar

LADA – Latent autoimmune diabetes in the adult. Onset of type 1 diabetes after the age of

35, usually without dramatic diabetic symptoms.

Latent phase – time during which a disease does not have symptoms.

Lente insulin – Insulin made intermediate or long –acting with a mixture of zinc.

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Lipodystrophy – Cavity in the subcutaneous tissue that can be caused by immunologic

reaction to insulin. Usually at site if injection.

Long acting insulin – Insulin with a very prolonged action, up to 24 hours.

Macroangiopathy – Diabetes complications in the large blood vessels (arteriosclerosis,

cardiovascular disease).

Metabolic syndrome – (also called Syndrome X and Insulin Resistance Syndrome X) -A

group of syndromes that increase the chances of developing type II diabetes and heart

disease.

Microalbuminuria – small amounts of protein in the urine. The first sign of kidney damage,

(nephropathy) caused by many years of high blood glucose levels. Microalbuminuria is

reversible if the blood glucose control is improved.

Microaneurysm – Small protuberance on the retinal blood vessels. The first sign of eye

damage caused by many years of high blood glucose out of control.

Microangiopathy – Diabetes complications in the small blood vessels (eyes, kidneys,

nerves.)

MODY – Maturity Onset Diabetes of the Young. A special kind of diabetes that is inherited.

Multiple injection treatment – Treatment with injections of short or rapid-acting insulin

before meals and intermediate or long-acting insulin to cover the night. When using rapid-

acting insulin for meals, one will need basal insulin during the day as well.

Nasal insulin – Insulin in aerosol form that is given via the nose.

Necrobiosis lipoidica diabeticorum – A special type of skin lesion that can be seen in

individuals with diabetes.

Nephropathy – Kidney damage caused by many years of high blood glucose levels.

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Neuroglycopenic symptoms – Symptoms of brain dysfunction caused by a low blood glucose

level.

Neuropathy – Nerve damage caused by many years of high blood glucose levels.

NIDDM – Non-Insulin Dependent Diabetes Mellitus, former name of type 2 diabetes.

NPH – insulin – Insulin made intermediate-acting.

Pancreas – An organ in the abdominal cavity that produces digestive enzymes (released into

the intestines) and different hormones (released directly into the blood.)

Pituitary Gland – Small gland situated in the brain where many of the most important

hormones in the body are produced.

Plasma glucose – A way of measuring the glucose content in the blood stream. Plasma

glucose values are approximately 11-15% higher than whole blood glucose values. Check

which type of reading your meter displays.

Pre-meal injection – Injection with short or rapid- acting insulin prior to a meal.

Prevalence – The total number of existing cases of a disease at a given time.

Prospective study – A study that investigates what happens from now and onwards when

giving a certain treatment. This is the best method of conducting a study of the effect of a

new treatment.

Protamine – A protein from salmon that is added to lengthen the action time of insulin. NPH

insulin is based on this method.

Proteinuria – Protein in the urine due to permanent kidney damage (nephropathy) as result

of high blood glucose levels for many years.

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Pylorus – the lower sphincter (opening) of the stomach into the small intestine.

Rapid-acting insulin – Insulin analogs (NovoLog/NovoRapid, Humalog, Apidra) with a much

quicker action than regular short-acting insulin. In some countries these are called ultra-

rapid insulin, in others, direct acting insulin.

Receptor – A special structure on the cell surface that fits with a hormone. The hormone

(“the key”) must fit into the receptor for it to mediate its effect on the cell.

Rebound phenomenon – After a hypoglycemic episode, the blood glucose may rise to high

levels. This is caused both by the secretion of counteracting hormones (counter regulation)

and by eating too much when feeling hypoglycemic.

Regression – Psychological term to describe when a person has retreated to an earlier stage

of psychological development. An independent teenager who is hospitalized will often

become more dependent and react as if he/she were several year younger.

Remission phase – Also called the honeymoon phase. The need for insulin will often be

lowered during the months after the onset of diabetes due to an increase of the residual

insulin produced in the pancreas.

Renal Threshold – If the blood glucose level is above this level, glucose will show up in the

urine when tested.

Retinopathy – eye damage caused by many years of high blood glucose levels.

Retrospective study – A study that looks backwards in time to investigate what happened

because of a certain treatment. Compare with prospective study.

Saccharin – Sweetener that does not provide any energy.

Sensor – Device to continuously measure blood glucose.

Short-acting insulin – Soluble insulin without additives.

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Somogyi phenomenon – A special type of night rebound phenomenon with high blood

glucose level in the morning.

Sorbitol – sugar alcohol, a sweetener that gives energy.

Starch – Complex carbohydrates found in potatoes, corn, rice, wheat and many other

vegetables.

Starvation ketones – Ketones that are produced when the cells starve due to low blood

glucose level. Caused by not eating enough food containing carbohydrates.

Subcutaneous – in the fatty tissue under the skin.

Sucrose – Cane or beet sugar, brown sugar, table sugar, powered sugar, invert sugar.

Each sucrose molecule is composed of one molecule of glucose linked to one molecule of

fructose.

Type 1 Diabetes – Previously called Insulin–Dependent Diabetes Mellitus (IDDM) Diabetes

that needs to be treated with insulin from the onset. It is caused by a failure of the pancreas

to produce insulin.

Type 2 – Previously called Non-Insulin –Dependent Diabetes Mellitus (NIDDM).

Diabetes that initially can be treated with diet and oral drugs. It is caused by an increased

resistance to the insulin produced by the pancreas.

U – Short for international units of insulin. Also short for Ultralent in Humulin U.

Unawareness of hypoglycemia – a hypoglycemic episode without having had warning

symptoms associated with decreasing blood glucose.

Uremia – Urine poisoning when the body cannot get rid of its waste products. End stage of

nephropathy.

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Venous blood test – Test taken by puncturing a blood vessel (vein).

REFERENCES FOR DIABETES

1. The Type II Diabetes Source Book by David Drum and Terry Zierenberg, published by

Lowell House 1997

2. The Type 2 Diabetes Sourcebook (third edition), David Drum and Terry Zierenberg,

McGraw Hill 2006

3. 2008 Current Medical Diagnosis and Treatment by Stephen MCPhee, Maxine Papadakis,

published by McGraw Medical 2008

4. Dr. Neal Barnard’s Program for Reversing Diabetes by Neal Barnard, MD published by

Rodale 2007

5. American Diabetes Association Complete Guide to Diabetes (Fourth Edition) Bantam

Books 2006

6. The Family Guide to Fighting Fat – A Patents’ Guide to handling Obesity and Eating

Issues – Texas Children’s Hospital published by S Martin’s Griffin 2007

7. Anatomic’s Body Atlas by Thunder Bay Press 2006

8. Guide to Raising a Child with Diabetes second edition by Linda M. Siminerio and Jean

Betschart published by American Diabetes Association 2000

9. Everything Patents’ Guide to Children with Juvenile Diabetes by Moira McCarthy

published Juvenile Diabetes foundation 2007

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10. Type 1 Diabetes – a guide for children, adolescents, young Adults, and their

caregivers – by Ragner Hanas published by Marlowe & Company 2005

11. Conquering Diabetes – A cutting-edge Comprehensive Program for Prevention and

treatment by Anne Peters published by Hudson Street Press 2005

12. A Revolutionary Plan : Take Charge of Your Diabetes by Sarfraz Zaidi published by

Dacapo Life Long 2007

13. The Human Body Book – an illustrated guide to structure, function and disorders –

By Steve Parker published by DK 2007

14. Diabetes on your Own Terms by Janis Roszler published by The Marlowe and

Company 2007

15. Web Links:

1 .CDC Diabetes Public Health Resource

2 Diabetes-Mayo Clinic.com

3. Diabetes Joslin Clinic.com

4. ADA