diabetes for canadians for dummies, 3rd edition

Table of Contents

Introduction ................................................................. 1About This Book .............................................................................................. 1

Conventions Used in This Book ..................................................................... 2

What You Don’t Have to Read ........................................................................ 2

Foolish Assumptions ....................................................................................... 3

How This Book Is Organized .......................................................................... 3

Part I: Dealing with the Diagnosis of Diabetes ................................... 3

Part II: How Diabetes Can Affect Your Body....................................... 3

Part III: Rule Your Diabetes: Don’t Let It Rule You ............................ 4

Part IV: Particular Patients and Special Circumstances ................... 4

Part V: The Part of Tens ........................................................................ 4

Part VI: Appendixes ............................................................................... 4

Icons Used in This Book ................................................................................. 5

Part I: Dealing with the Diagnosis of Diabetes ................ 7

Chapter 1: Membership in a Club You Didn’t Ask to Join. . . . . . . . . . . .9

Figuring Out What Diabetes Is ....................................................................... 9

You’re Not Alone ........................................................................................... 10

Handling the News ......................................................................................... 11

The Impact of Your Diabetes

on Your Relationships .............................................................................. 12

Looking at the impact of your diabetes on your

relationships with your family ....................................................... 12


relationships with your friends ...................................................... 13


relationships with your workmates ............................................... 14

Juggling Your Diabetes and Your “Real Life” ............................................. 15

Juggling your diabetes and your family life ...................................... 15

Juggling your diabetes and your work life ........................................ 16

Putting Your Energies into Your Diabetes ................................................. 17

Feeling guilty with your diabetes ....................................................... 17

Feeling frustrated with your diabetes ............................................... 18

Coping with diabetes ........................................................................... 18

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Diabetes For Canadians For Dummies, 3rd Edition xivChapter 2: You and Your Blood Glucose . . . . . . . . . . . . . . . . . . . . . . . . .21

What Is Glucose? ............................................................................................ 21

Diagnosing Diabetes ...................................................................................... 22

How High Blood Glucose Makes You Feel .................................................. 24

Understanding how your body handles blood glucose .................. 24

Examining symptoms caused by high blood glucose ..................... 25

Controlling Your Blood Glucose .................................................................. 27

What You Can Do If You Lose Control of Your Blood Glucose ................ 27

Chapter 3: Discovering the Cause of Your Diabetes . . . . . . . . . . . . . . .29

How Your Organs Make Music ..................................................................... 29

Presenting your pancreas ................................................................... 30

Looking at your liver ........................................................................... 31

Going on about your gut ..................................................................... 32

Mentioning your muscles ................................................................... 32

Chewing the fat .................................................................................... 32

Being brainy .......................................................................................... 33

Playing a beautiful melody ................................................................. 33

What Happens When Your Organs Hit the Wrong Notes? ....................... 34

Insulin resistance ................................................................................. 35

Insulin defi ciency ................................................................................. 35

Defective incretin action ..................................................................... 36

Chapter 4: Looking at the Different Types of Diabetes . . . . . . . . . . . . .39

Type 1 Diabetes and You .............................................................................. 40

Identifying the symptoms of type 1 diabetes ................................... 41

Investigating the causes of type 1 diabetes ...................................... 42

Latent autoimmune diabetes of adults ............................................. 44

Preventing type 1 diabetes ................................................................. 45

Type 2 Diabetes and You .............................................................................. 45

Identifying the symptoms of type 2 diabetes ................................... 47

Investigating the causes of type 2 diabetes ...................................... 49

Screening for type 2 diabetes ............................................................. 50

Preventing type 2 diabetes ................................................................. 51

Key Differences between Type 1 and Type 2 Diabetes ............................. 53

Gestational and Pregestational Diabetes and You .................................... 54

The Metabolic Syndrome and You .............................................................. 54

Prediabetes and You ..................................................................................... 55

Recognizing Other Types of Diabetes ......................................................... 57

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xv Table of Contents

Part II: How Diabetes Can Affect Your Body ................. 59

Chapter 5: Handling Low and High Blood Glucose Emergencies . . . .61

Understanding Hypoglycemia (Low Blood Glucose) ................................ 61

Looking at the symptoms of hypoglycemia...................................... 63

Considering the causes of hypoglycemia ......................................... 66

Treating hypoglycemia ....................................................................... 67

Preventing hypoglycemia ................................................................... 71

Coping with hypoglycemia unawareness ......................................... 74

Dealing with Ketoacidosis ............................................................................ 75

Exploring how ketoacidosis develops ............................................... 75

Investigating the symptoms of ketoacidosis .................................... 76

Understanding the causes of ketoacidosis ....................................... 77

Treating ketoacidosis .......................................................................... 77

Preventing ketoacidosis ...................................................................... 78

Hyperosmolar Hyperglycemic State ........................................................... 79

Identifying the symptoms of the hyperosmolar

hyperglycemic state ......................................................................... 80

Examining the causes of the hyperosmolar hyperglycemic state ... 81

Treating the hyperosmolar hyperglycemic state ............................ 81

Preventing the hyperosmolar hyperglycemic state ........................ 81

Chapter 6: As Time Goes By: Handling Long-Term Complications . . .83

Complications Aren’t Inevitable .................................................................. 83

Categorizing Long-Term Complications ..................................................... 84

Coronary Artery Disease and Cerebrovascular Disease .......................... 86

Preventing a heart attack or stroke ................................................... 87

Quitting smoking .................................................................................. 88

Peripheral Arterial Disease .......................................................................... 89

The Lowdown on High Blood Pressure ............................................. 90

Abnormal Cholesterol and Triglyceride Levels (Dyslipidemia) .............. 91

Looking at healthy cholesterol levels ............................................... 93

Keeping your lipids under control..................................................... 94

Eye Disease ..................................................................................................... 95

Retinopathy .......................................................................................... 95

Cataracts ............................................................................................... 98

Glaucoma .............................................................................................. 98

Resources to help you if you are blind or visually impaired ......... 98

Kidney Disease ............................................................................................... 99

Diagnosing diabetes kidney damage ............................................... 100

Treating diabetes kidney damage .................................................... 101

Neuropathy (Nerve Damage) ..................................................................... 102

Peripheral neuropathy ...................................................................... 103

Autonomic neuropathy ..................................................................... 105

Other types of neuropathy ............................................................... 105

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Diabetes For Canadians For Dummies, 3rd Edition xviPreventing Pneumonia ................................................................................ 106

Mental Health Problems ............................................................................. 106

Depression .......................................................................................... 107

Dementia ............................................................................................. 107

Digestive Disorders: Problems of the Stomach, Intestines, and Liver .... 107

Gastroparesis ..................................................................................... 108

Diarrhea .............................................................................................. 108

Celiac disease ..................................................................................... 108

Liver disease ....................................................................................... 109

Foot Disease in Diabetes ............................................................................. 109

Protecting your feet ........................................................................... 110

Skin Disease in Diabetes ............................................................................. 113

Musculoskeletal Problems (Muscles, Joints, and Such) ......................... 114

Thyroid Disease and Diabetes ................................................................... 115

Gum Disease in Diabetes ............................................................................ 116

Erectile Dysfunction Due to Diabetes ....................................................... 116

Why the spirit may be willing, but the penis isn’t ......................... 116

How to improve erectile dysfunction .............................................. 117

Dealing with Female Sexual Problems Related to Diabetes ................... 119

Chapter 7: Diabetes and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . .121

Gestational Diabetes ................................................................................... 121

Exploring the causes of gestational diabetes ................................. 122

Diagnosing gestational diabetes ...................................................... 122

Determining if you are at high risk for gestational diabetes ........ 124

Treating gestational diabetes ........................................................... 125

Monitoring gestational diabetes ...................................................... 128

Understanding the potential complications for the mother ........ 129

Considering the potential complications for the baby ................. 130

Knowing what to do after you’ve had your baby .......................... 130

Pregestational Diabetes (Pregnancy in Women with

Type 1 or Type 2 Diabetes) .................................................................... 132

Knowing what can happen to the mom .......................................... 133

Knowing what can happen to the fetus and baby ......................... 134

Reviewing things to do before you get pregnant ........................... 134

Managing your health while you are pregnant .............................. 137

Knowing what to expect during labour and delivery .................... 139

Handling your diabetes for the fi rst few months after

having your baby ........................................................................... 141

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xvii Table of Contents

Part III: Rule Your Diabetes: Don’t Let It Rule You ...... 143

Chapter 8: Meet Your Diabetes Team. . . . . . . . . . . . . . . . . . . . . . . . . . .145

You Are the Captain of the Team .............................................................. 146

The Family Physician: Your Coach ............................................................ 148

The Diabetes Specialist: Your General Manager ..................................... 149

The Diabetes Educator: Your Trainer ....................................................... 150

The Dietitian: Your Energizer ..................................................................... 151

The Eye Specialist: Your Cameraperson .................................................. 152

The Pharmacist: Your Equipment Manager ............................................. 153

The Foot Doctor: Your Sole Mate .............................................................. 154

The Dentist: Your Opening Act .................................................................. 155

Your Family and Friends: Your Fans and Cheerleaders ......................... 155

Chapter 9: Monitoring and Understanding Your Blood Glucose Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157

Understanding the Importance of Measuring Your

Blood Glucose Levels .............................................................................. 158

Determining if Your Blood Glucose Is in Control .................................... 159

Testing with a Blood Glucose Meter ......................................................... 160

Reviewing the supplies you need .................................................... 160

Performing a test with a blood glucose meter ............................... 161

Knowing how often to test your blood glucose ............................. 162

Looking at when you should test your blood glucose .................. 165

Choosing a Blood Glucose Meter ..................................................... 166

Recording Your Results .............................................................................. 171

Discovering Your Blood Glucose Targets ................................................ 175

Interpreting Your Blood Glucose Results ................................................. 176

When your before-breakfast readings are high

(and other readings good) ............................................................ 176

When your after-meal readings are high

(and other readings good) ............................................................ 177

When all your readings are elevated ............................................... 178

When you are having too many lows .............................................. 179

When your readings have no pattern .............................................. 180

Testing for Longer-Term Blood Glucose Control with the A1C Test .... 184

Learning the importance of your A1C ............................................. 184

Understanding your A1C result........................................................ 186

Looking at why your A1C and your blood glucose

readings don’t fi t ............................................................................ 187

Using a Continuous Glucose Monitoring System .................................... 190

Understanding continuous glucose monitoring ............................ 190

Checking out the benefi ts of continuous glucose monitoring ..... 193

Looking at the drawbacks of continuous glucose monitoring ..... 197

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Diabetes For Canadians For Dummies, 3rd Edition xviiiChapter 10: You Are What You Eat: Staying Healthy with Good Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201

The Key Ingredients .................................................................................... 202

Carbohydrates.................................................................................... 203

Proteins ............................................................................................... 208

Fats ...................................................................................................... 209

Getting Enough Vitamins, Minerals, and Water ....................................... 211

Counting Alcohol as Part of Your Diet ...................................................... 213

Non-nutritive Sweeteners ........................................................................... 214

Looking at Other Dietary Strategies .......................................................... 215

Eating Out ..................................................................................................... 216

Weighty Issues ............................................................................................. 218

Weight-loss challenges ...................................................................... 218

The best strategy for losing weight ................................................. 219

Portion control for weight loss ........................................................ 220

Medication therapy for losing weight ............................................. 220

Surgery for weight loss (bariatric surgery) .................................... 220

Behaviour modifi cation ..................................................................... 221

Coping with Eating Disorders .................................................................... 223

Chapter 11: Exercising Your Way to Good Health . . . . . . . . . . . . . . . .225

How Exercise Can Improve Your Diabetes Health .................................. 226

Finding the Right Type of Exercise ............................................................ 227

Cardiovascular exercise and you..................................................... 228

Resistance exercise and you ............................................................ 231

Taking Precautions Before You Start Exercising ..................................... 232

Exercising if You Are Taking Antihyperglycemic Medication ............... 233

Finding a Supervised Exercise Program ................................................... 235

Chapter 12: Controlling Your Blood Glucose with Non-insulin Antihyperglycemic Medications and Alternative Therapies. . . . . . .237

To Take or Not to Take: That Is the Antihyperglycemic

Medication Question ............................................................................... 238

Choosing the right medication for you ........................................... 239

Understanding how antihyperglycemic medications work .......... 240

Investigating the Types of Antihyperglycemic Medications .................. 241

Metformin ........................................................................................... 241

Sulfonylureas ...................................................................................... 243

Meglitinides ........................................................................................ 243

Thiazolidinediones ............................................................................ 244

Alpha-glucosidase inhibitors ............................................................ 245

DPP-4 inhibitors ................................................................................. 246

GLP-1 analogues ................................................................................. 247

Other antihyperglycemic medications............................................ 249

Using Antihyperglycemic Medication Effectively: The CDA-

Recommended Approach to Treating Type 2 Diabetes ...................... 251

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xix Table of Contents

As Time Goes By: Antihyperglycemic Medications,

Type 2 Diabetes and You ........................................................................ 253

Complementary and Alternative Therapies ............................................. 255

Cautions concerning CAMs .............................................................. 255

Looking at some types of CAMS ....................................................... 256

Chapter 13: Using Insulin Effectively . . . . . . . . . . . . . . . . . . . . . . . . . . .259

What Is Insulin? ............................................................................................ 260

Looking at the Types of Insulin .................................................................. 260

Understanding Insulin Terminology ......................................................... 263

Rapid-acting insulin ........................................................................... 264

Regular insulin.................................................................................... 265

Intermediate-acting insulin ............................................................... 265

Long-acting insulin ............................................................................. 266

Premixed insulin ................................................................................ 267

Inhaled insulin .................................................................................... 268

Animal insulins ................................................................................... 268

Type 1 Diabetes and Insulin Therapy ....................................................... 268

Type 2 Diabetes and Insulin Therapy ....................................................... 269

Debunking Insulin Myths ............................................................................ 270

How to Give Insulin ..................................................................................... 272

Using an insulin pen .......................................................................... 272

Using an insulin pump ....................................................................... 274

Caring for Your Insulin ................................................................................ 282

Adjusting Your Insulin Dose ....................................................................... 283

Adjusting your insulin dose to lower your fasting

blood glucose ................................................................................. 285

Adjusting your insulin dose to avoid overnight hypoglycemia ... 285

Adjusting your insulin dose to improve elevated

after-meal blood glucose levels .................................................... 286

Carbohydrate Counting .............................................................................. 287

Travelling with Your Insulin ....................................................................... 290

Breezing through the border ............................................................ 290

Adjusting your doses between time zones ..................................... 291

Part IV: Particular Patients and Special Circumstances .............................................. 293

Chapter 14: Your Child Has Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . .295

Your Baby or Toddler Has Type 1 Diabetes ............................................ 296

Diagnosing type 1 diabetes in a baby or toddler ........................... 296

Blood glucose targets for your baby or toddler

with type 1 diabetes ....................................................................... 296

Managing your baby or toddler’s type 1 diabetes ......................... 297

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Diabetes For Canadians For Dummies, 3rd Edition xxYour Primary School-Aged Child Has Type 1 Diabetes ........................... 298

Blood glucose targets for a primary school-aged child ................ 299

Meeting with primary school teachers and administrators ......... 300

Your Adolescent Has Type 1 Diabetes ...................................................... 301

Your Young Adult Child Has Type 1 Diabetes ......................................... 303

Transitioning Care: Moving from Pediatric to Adult

Diabetes Specialist Care .......................................................................... 304

Sick Day Solutions for Your Child with Type 1 Diabetes ........................ 306

Screening Tests for Organ Injury in Children and

Adolescents with Type 1 Diabetes......................................................... 307

Summer Camps for Children with Type 1 Diabetes ................................ 308

Your Child Has Type 2 Diabetes ................................................................ 309

Your Child Has MODY ................................................................................. 311

Chapter 15: Diabetes in Special Groups: The Elderly and Aboriginal Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313

Diabetes and the Elderly ............................................................................. 313

Diagnosing diabetes in the elderly .................................................. 314

Evaluating intellectual functioning .................................................. 315

Dealing with eye problems ............................................................... 315

Coping with urinary and sexual problems ..................................... 315

Monitoring foot problems ................................................................. 316

Considering treatment for high blood glucose .............................. 317

Diabetes and Aboriginal Peoples ............................................................... 320

Considering the extent of the problem ........................................... 320

Screening for diabetes for Aboriginal peoples ............................... 321

Looking at how Aboriginal peoples are combatting the problem.... 321

Chapter 16: Special Circumstances: Employment, Insurance, Safe Driving, and Preparing for Disaster . . . . . . . . . . . . . . . . . . . . . . . .323

Employing Both You and Your Rights ...................................................... 323

Fighting for your rights ..................................................................... 324

Affecting your ability to work ........................................................... 325

Exploring your avenues of recourse ............................................... 326

Insuring Your Health ................................................................................... 327

Life insurance ..................................................................................... 328

Disability insurance ........................................................................... 328

Travel insurance ................................................................................ 328

Driving When You Have Diabetes .............................................................. 329

Determining if you’re medically fi t to drive .................................... 329

Taking necessary precautions ......................................................... 329

Applying for a commercial licence .................................................. 330

Keeping your driver’s licence .......................................................... 332

Regaining your driver’s licence........................................................ 333

Preparing for When Disaster Strikes ......................................................... 333

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xxi Table of Contents

Part V: The Part of Tens ............................................ 335

Chapter 17: Ten Ways to Stay Healthy and Avoid Complications . . .337

Learn for Life ................................................................................................ 338

Eat Earnestly ................................................................................................ 339

Exercise Enthusiastically ............................................................................ 339

Give the Heave-Ho to Harmful Habits ....................................................... 340

Controlling Your Numbers: Optimizing Your Blood Glucose,

Blood Pressure, Cholesterol, and Kidney Function ............................. 340

Blood glucose levels .......................................................................... 341

Cholesterol ......................................................................................... 341

Blood pressure ................................................................................... 342

Kidney function .................................................................................. 342

See Your Eye Doctor ................................................................................... 342

Fuss Over Your Feet .................................................................................... 342

Master Your Medicines ............................................................................... 343

Help Your Doctor Help You ........................................................................ 344

Don’t Try to Do It Alone .............................................................................. 344

Chapter 18: Ten Frequently Asked Questions about Diabetes. . . . . .345

Why Are My Blood Glucose Levels Higher When I Get Up

in the Morning than When I Go to Bed? ................................................ 345

Why Are My Blood Glucose Levels All Over the Place? ......................... 346

Why Are My Blood Glucose Levels Getting Worse as Time Goes By? .... 347

What’s the Difference between an A1C Level and a Blood

Glucose Level? .......................................................................................... 347

I Used to Be on Pills, but Now I’m on Insulin. Does that Mean I’ve

Developed Type 1 Diabetes? .................................................................. 348

When You’re on Insulin, You’re on It Forever, Right? ............................ 348

I’m Watching My Diet, So Why Is My Cholesterol Level High? .............. 348

Why Do I Need Blood Pressure Pills If My Blood Pressure Is Good? .... 349

How Can I Get My Doctor to Be More Communicative? ......................... 349

Will I Always Have Diabetes? ..................................................................... 350

Part VI: Appendixes .................................................. 353

Appendix A: The Food Group System . . . . . . . . . . . . . . . . . . . . . . . . . . .355

Grains and Starches .................................................................................... 356

Fruits ............................................................................................................. 357

Milk and Alternatives .................................................................................. 359

Other Choices (sweet foods and snacks) ................................................. 360

Vegetables .................................................................................................... 360

Meat and Alternatives ................................................................................. 361

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Diabetes For Canadians For Dummies, 3rd Edition xxiiFats ................................................................................................................ 363

Free Foods .................................................................................................... 364

Using “Beyond the Basics” to Create a Nutrition Plan ............................ 364

Appendix B: Straight Goods on a Tangled Web: Diabetes Websites Worth Visiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . .367

Ian’s and Alan’s Websites ........................................................................... 368

General Sites ................................................................................................. 368

Recipe Websites for People with Diabetes ............................................... 369

Appendix C: Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .371

Index ....................................................................... 381

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Chapter 1

Membership in a Club You Didn’t Ask to Join

In This Chapter▶ Understanding what diabetes is

▶ Knowing you’re not alone

▶ Dealing with the news that you have diabetes

▶ Looking at the impact of diabetes on your relationships

▶ Fitting diabetes management into your busy life

▶ Coping with diabetes

As a person with diabetes, you already know that diabetes isn’t “just a

sugar problem.” In fact, the moment you were told you had diabetes,

many different thoughts may have run through your mind. You have feelings,

and you have your own personal story. You’re not the same person as your

next-door neighbour or your sister or your friend, and your diabetes and the

way you respond to its challenges are unique to you.

And unless you live alone on a desert island, your diabetes doesn’t affect just

you. Your family, friends, and co-workers are influenced by your diabetes and

by their desire to help you.

In this chapter we consider how you might feel after you first find out you

have diabetes, and we also look at some coping strategies to help you deal

with this unwelcome news.

Figuring Out What Diabetes IsBecause we spend so much time discussing diabetes in this book, we want

to start by defining the condition. Diabetes is a metabolic disorder (a problem

with the body’s internal chemistry) characterized by the presence of high

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10 Part I: Dealing with the Diagnosis of Diabetes

blood glucose because the pancreas is unable to make enough insulin hor-

mone or because the insulin the pancreas makes is not working properly, or

both. (We take a closer look at glucose in Chapter 2.)

That may be the technically correct definition of diabetes, but to leave it at

that would be akin to defining Paris as “a city with a metal tower located in

France.” France does indeed have a metal tower — and diabetes does indeed

have high blood glucose — but to limit your perspective to such simple defi-

nitions would be to miss out on so, so much. Diabetes isn’t just a sugar prob-

lem; it’s a whole body problem. But fortunately this is a problem with many

available ways to tackle it head on.

Diabetes is actually the short form for diabetes mellitus. The Romans noticed

that the urine of certain people was mellitus, the Latin word for “sweet.” The

Greeks noticed that when people with sweet urine drank, fluids came out in

the urine almost as fast as they went in the mouth, like a siphon. They called

this by the Greek word for “siphon” — diabetes. Hence “diabetes mellitus.”

Nonetheless, we think the essence of diabetes is much better captured by the

17th-century definition of diabetes: “the pissing evil.” Talk about calling it the

way you see it!

You may have done some searching in books or on the Internet and come

across another form of diabetes called diabetes insipidus. This term refers

to an entirely different condition than diabetes mellitus. The only thing they

have in common is a tendency to pass lots of urine. And now that we’ve clari-

fied that, you won’t see diabetes insipidus mentioned again in this book.

You’re Not AloneIt seems unimaginable, but the number of people worldwide living with diabe-

tes has risen from an estimated 30 million in 1985 to a mind boggling 366 mil-

lion in 2011 and, by 2030, it is predicted 552 million people will be living with

diabetes. In Canada, currently over 2.5 million people are living with diabe-

tes. Clearly, as the title of this section says, you are most definitely not alone.

Hardly a day goes by when a person with diabetes isn’t in the news. Even

better, so far as we’re concerned, is that their diabetes is not part of the

news. Clearly the media and society in general have come to recognize that

living with diabetes is, in and of itself, not the newsworthy part of most sto-

ries. We couldn’t have found a better example of this than the 2009 appoint-

ment of Sonia Sotomayor to the US Supreme Court. Nearly all the news

stories spoke of her intelligence and education and hard work and abilities.

Her having diabetes was hardly mentioned. And those stories that did men-

tion it did so in passing. Diabetes didn’t — and doesn’t — define her life.


11 Chapter 1: Membership in a Club You Didn’t Ask to Join

It is not hard to find other examples of people living with diabetes who have

achieved the loftiest of goals. Sebastien Sasseville (www.sebinspires.com)

did so quite literally when he successfully climbed Mount Everest. And Gary

Hall Junior is one of the most successful athletes in Olympic history with a

bucketful of medals to his credit. Ian remembers meeting John Chick when

John was playing with the CFL’s Saskatchewan Roughriders (he now plays

in the NFL). (Ian never felt so small in his life than he did that day, standing

beside the towering athlete!) John is a past winner of the CFL Most Outstanding

Defensive Player award. All these amazing individuals have diabetes.

Away from the sports arena, Ernest Hemingway, Thomas Edison, Jack Benny,

Elizabeth Taylor, Drew Carey, and — Ian’s all-time favourite piece of diabetes

lore — Elvis Presley have all lived with diabetes.

You may not have spoken to Stephen Steele, but he has quite possibly

spoken to you. Stephen is a commercial pilot with a major Canadian airline.

And if you’ve ever had the bad luck to be on some sinking vessel off the

Atlantic coast, the hero who plucked you from the ocean may have been

none other than Major Chuck Grenkow, a Medal of Bravery-winning former

Canadian Forces pilot and aircraft commander, who performed search and

rescue operations with the Canadian military. Oh, by the way, they both

have diabetes.

Diabetes is a common disease, so it’s bound to occur in some very uncom-

mon people. But you don’t have to be famous to be considered exceptional.

Indeed, every day of the week in our practices we see special people, people

who have diabetes yet look after families, work in automotive plants or office

buildings, write exams, go to movies, and do their best to live life to the

fullest — people, perhaps, just like you.

The point is, diabetes shouldn’t define your life. You’re the same person

the day after you found out you had diabetes as you were the day before.

But you’ve been given an additional challenge to contend with. Diabetes

shouldn’t stop you from doing what you want to do with your life. Certainly,

it does complicate things in some ways. But if you follow the principles of

good diabetes care that we discuss in this book, you may actually be health-

ier than people without diabetes who smoke, overeat, under-exercise, or

engage in other unhealthy activities.

Handling the NewsIf you are like most people, you were likely quite shocked when you were first

told you had diabetes. Nobody wants to have diabetes and your first thought

may well have been, “How can this be?” But, alas, it did come to be and you



have had to deal with it ever since. You may have had your share of emo-

tional ups and downs in coming to terms with your diabetes. For each person

with this condition the journey toward acceptance is unique.

Hopefully, you not only came to accept your diabetes diagnosis, but also

shared the news with your family and other people close to you. Having

diabetes isn’t something to be ashamed of, and it isn’t something that you

should have to hide from anyone. Your diabetes isn’t your fault. You didn’t

want to have diabetes. You didn’t try to get diabetes. And no one can catch it

from you.

The Impact of Your Diabetes on Your Relationships

Everyone is involved in relationships with others. These might be family

relationships, relationships with friends or workmates or, with some other

people. And although living with diabetes needn’t be front and centre in your

interactions with people, it needn’t be a secret either. In this section we look

at how having diabetes may affect your relationships.

Looking at the impact of your diabetes on your relationships with your familyIf one person in a family has diabetes, then, in a sense, everyone in the family

has diabetes. Or at least has to live with it and deal with it.

If you’ve recently been diagnosed with diabetes, your family likely has had

as many questions as you. What is diabetes? How can it affect you? How is it

treated? Will you be okay? Some of the answers are simple. Some are com-

plicated. (To help answer their questions we’d suggest you let your family

members borrow this book from you and read it, too.) The fact your family

is asking these questions isn’t, of course, to play J. Edgar Hoover on you.

Rather, it is simply a reflection of their concern and caring.

Ultimately, your diabetes is, well, your diabetes, and you need to take owner-

ship of it. It is — and always will be — your decision about how you eat, if

and how you exercise, if you test your blood glucose levels, attend doctors’

appointments, and so forth. But all of this will be easier if you see your family

as partners in your journey with diabetes. This may not, however, always be

easy or straightforward.



Here are some ways you can help maintain positive, mentoring family

relationships:

✓ Don’t keep your feelings about your diabetes to yourself. Let your

family members know if your diabetes is getting you down. Let them

know if you are feeling positive about how things are going.

✓ Feel free to test your blood glucose and, if you’re giving insulin, inject this in front of family members. You’re the one doing it; it’s a far lesser

deal for someone else to watch when you’re doing it. (And even at that, it

will soon become routine enough to your family that they won’t

even notice.)

✓ Remember that your blood glucose results are yours. You only need to

share the numbers if you want to. (We discuss this further later in this

chapter.)

✓ Make grocery shopping a collective experience and share your knowl-edge about healthy food with your family members. Indeed, you can

help ensure the whole family is eating healthfully because, as we dis-

cover in Chapter 10, a “diabetic diet” is, basically, a healthy eating diet.

✓ Make exercising a family experience. As we look at in Chapter 11,

diabetes loves exercise and should be a regular part of your existence.

But it should also be a part of everyone’s existence, whether or not they

have diabetes.

✓ If you feel you’d like a supportive “extra set of ears” when you see a member of your health care team, bring a sufficiently mature family member with you to your appointment. This is especially helpful for

appointments with your diabetes educator or dietitian. (We discuss the

members and roles of the diabetes health care team in Chapter 8.)

✓ Remember that your family cares about you and wants to help you. This is especially important when helping you in an emergency situa-

tion. Teach your family members what to do if ever you should need

their help to treat a bad episode of low blood glucose. We discuss this in

detail in Chapter 5.

Looking at the impact of your diabetes on your relationships with your friendsYour friends are your friends for a reason. Maybe you share the same inter-

ests in music or sports or hobbies, or perhaps you share opposite sides of

the same picket fence. Whatever the case, your diabetes needn’t interfere

with your relationships with your friends. If anything, it can strengthen



friendships and even foster developing new relationships. Indeed, we know

many people living with diabetes who developed friendships because of their diabetes. For example, they met new friends at meetings of the CDA

(Canadian Diabetes Association) or JDRF (Juvenile Diabetes Research

Foundation) or at local diabetes support groups.

Here are a couple of ways that diabetes may affect your friendships:

✓ As with family (see the preceding section), your friends care about you. Therefore, if you want to share your thoughts or feelings about

your diabetes with your friends, do so. And if you need to test your

blood glucose or you need to give yourself an injection of insulin, don’t

feel obliged to do this in private. (You’re welcome to, of course, but we

hope you won’t feel you have to.)

✓ Keep right on doing the same activities with your friends that you’ve always done. You may have to modify to some degree the way in which

you do the activities, but your friends won’t mind. For example, if you

like to bike, because of your diabetes you may need to sometimes

stop to check your blood glucose or to take some extra fluid to keep

hydrated. Your friends will likely enjoy the excuse to rest; Ian sure does

when he bikes with his friends who have diabetes!

We never recommend drinking alcohol to excess. But it is a fact of life —

especially among teenagers and young adults — that overindulging with

friends may happen. If you and your friends like to drink together and you’ve

had more than your share, make sure your friends know the difference

between being drunk and having low blood glucose. If ever your friends are

unsure if you’re drunk or having low blood glucose — especially if you are get-

ting sleepy or confused and are unable to check your blood glucose — then

your friends should call 9-1-1. We discuss the treatment of low blood glucose

in Chapter 5.

Looking at the impact of your diabetes on your relationships with your workmatesAlthough we encourage you to share the fact of your diabetes (and its impact

on you) with your family and friends, it’s not quite as straightforward with

your workmates.

Of course, some of your workmates may also be your friends; people you

play hockey with, have over for a barbeque, and so forth. For these par-

ticular workplace relationships our advice is the same as in the preceding

section about friends. Most of your workmates, however, are probably not



your friends. They’re more likely to be people that you work with, but do not

socialize with much, if at all. Regarding these relationships and your diabe-

tes, we suggest the following:

✓ Be as open or as closed about your diabetes as you wish. If you want

to share the fact of your diabetes, feel free to do so. If you want to keep

it private, do that. It is no one else’s business unless you want it to be.

(Exceptions do apply, however. For example, if you have a job in which

you can be endangered or can endanger others if you have a diabetes

emergency, you may be obliged to let your workplace know you have

diabetes.)

✓ If you are on medication — particularly insulin — that can cause your blood glucose level to go low, and especially if you have previously experienced bad episodes of hypoglycemia that required someone to assist you, try to find at least one workmate you can confide in and who can help you out if you run into a bad low. Show this person where

you keep your diabetes emergency supplies (such as dextrose tablets

or juice). Also keep a glucagon kit at work (we discuss glucagon kits in

Chapter 5) and teach your trusted workmate when and how to use it.

Juggling Your Diabetes and Your “Real Life”

Most people these days feel like they are constantly run off their feet. They

juggle work (in or out of the home) and family life. They run here, run there,

and try to squeeze in time for friends, sports, hobbies, volunteering, and so

on. This never-ending rush of activity, often accompanied by stress, leaves

very little time or energy for anything else. Oh, but wait, you have diabetes.

How in the world are you going to fit managing your diabetes into your life?

We look at that in this section.

Juggling your diabetes and your family lifeMany of Ian’s patients — especially the mothers of young children — tell

us that they are so busy looking after their family that they have no time or

energy to look after themselves. Time and again we see young women who

manage their diabetes beautifully leading up to and during pregnancy, only to

see it go off the rails when the realities of having a newborn (then infant then

toddler. . .) are added to the mix. Whether you are the mother of a youngster



or the father of a teenager or live in some other sort of family relationship,

you likely find that sometimes family commitments get in the way of paying

close attention to your diabetes. That makes perfect sense. However, your

diabetes isn’t going away and you have to deal with it. Here are some tips you

may find helpful for juggling your diabetes and your family life:

✓ Involve your family in your diabetes. Take your kids grocery shopping

(okay, sure, it will double the time it takes . . . maybe don’t do this every

time), have your child help you write down your blood glucose readings,

and so on.

✓ Exercise with your family. Make it a collective experience. Or go out for

a walk after you’ve dropped your kids off at hockey or soccer practice.

✓ Make time for yourself. Looking after your own health isn’t selfish.

Quite the opposite: Keeping yourself healthy is one of the very best things you can do for your whole family.

Juggling your diabetes and your work lifeDepending on your occupation and where you work, time constraints or

other challenges can make looking after your diabetes difficult while on the

job. Table 1-1 illustrates some examples of these challenges and possible

options available to help. (In Chapter 16 we look in detail at diabetes, employ-

ment issues, and your rights.)

Table 1-1 Dealing with Challenges at Work

If Your Work . . . We Recommend You . . .Provides no or insufficient breaks for eating, blood glucose testing, or inject-ing insulin

Speak to your employer. It is your legal right to be given sufficient time to per-form these health-related tasks.

Makes it impossible to do fingerstick blood glucose tests because your hands are always dirty or greasy

Talk to your pharmacist about alterna-tive-site blood glucose meters that allow you to test your blood glucose from, for example, your forearm. (We discuss this topic in more detail in Chapter 9.)

Does not have a discrete place for you to give your insulin and you’re not comfort-able injecting yourself in front of others

Speak to your diabetes specialist or diabetes educator about discrete ways to give your insulin.

Is in a hot environment and you do not have access to a fridge to store your insulin

Bring an insulated container to work in which to keep your insulin. (We discuss insulin storage in Chapter 13.)



Putting Your Energies into Your DiabetesLiving with diabetes is a time-consuming, energy-demanding, unceasing com-

mitment. Diabetes doesn’t take holidays, breaks, or any time off. Indeed,

living with diabetes can sometimes feel like a full-time job. So if ever anyone

has the audacity to tell you that your diabetes is no big deal, ask them if they

want to try having diabetes for a while! Anyhow, the fact remains that you do

have diabetes, it’s not going away, and you have to invest time and energy to

keep yourself healthy. This isn’t easy, but it is essential.

How much energy goes into managing your diabetes? Well, you need to

invest energy into choosing the right foods and preparing them in the right

way. You need to check your blood glucose and take your medicines. You

need to attend appointments with doctors and nurses and dietitians and

other health care professionals. You need to visit the pharmacy regularly

and you need to do lab tests and go for eye exams and check your feet. And

you need to put physical energy into expending energy; that is, exercising.

And you need to do all this in addition to doing everything else that goes

on in your life. To effectively juggle and manage all these many things is, for

most people, simply going to be impossible at times and something will, for a

time, slip through the cracks. This is perfectly understandable, but for many

people leads to feelings of guilt. We discuss this next.

Feeling guilty with your diabetesGiven what we say in the preceding sections, sometimes you’ll find that you

simply can’t muster all the energy you need, and something has to give. If

you’ve been living with diabetes for a while, you probably can recall different

times when you let your diabetes slide. Perhaps you didn’t eat as healthfully

as you knew you should, or you tested your blood less often, or you stopped

exercising. If so, we hope you didn’t feel guilty about it. Or at least kept your

guilt to a minimum. It is perfectly normal to have stages where your energy

feels sapped and looking after your diabetes seems like more effort than you

can muster. The key is to recognize that although this is both understandable

and normal, you need to get back on track — preferably sooner than later.

Your diabetes demands it and you deserve it. And as for feelings of guilt,

don’t beat yourself up over what you think you should’ve done better in the

past; instead think about how you’re going to better manage your diabetes

in the future. Just like driving a car, you should be spending a lot more time

looking forward than in your rear-view mirror.

We provide coping tips later in this chapter.



Feeling frustrated with your diabetesThe fact that you have diabetes doesn’t change day-to-day, but lots of other

things do. We’re talking changes in the workplace, stresses at home, short-

term illnesses, travel, and so forth. And that, in turn, will impact on your dia-

betes and in particular on your blood glucose control. It can be frustrating,

indeed, when factors often beyond your control adversely impact your diabe-

tes. Longer-term changes can also impact on your diabetes and lead to feelings

of frustration. For example, perhaps you have developed arthritis and cannot

exercise as much. Or, as typically happens if you have type 2 diabetes, the

medications that were working just fine at first start to work less well.

Faced with all these changes that affect your glucose control, you may feel

like you’re trying to hit a moving target. Actually, it’s not like trying to hit a

moving target. It is trying to hit a moving target! Everything can seem to be

going well, your blood glucose levels in check, your diet on track, your daily

walks a well-honed ritual, then, Wham! A few holiday dinners or a sprained

ankle or a bout of bronchitis or trouble at the office, and all of a sudden your

blood glucose levels are up. Or pills that were working well start to be inef-

fective, and your blood glucose levels are on the rise. Or the insulin dose

you give seems to work beautifully one day, and poorly the next. Feeling

frustrated? Who wouldn’t! Although your diabetes isn’t going away, coping

strategies can help you deal with the frustrations that diabetes presents. We

look at this topic in the very next section. (As for bringing your glucose levels

back in check, we discuss this in Chapters 10 to 13.)

Coping with diabetesWhether you’ve had diabetes for ten days or ten years (or much longer), some-

times you will feel frustrated, discouraged, or simply fed up with dealing with

it. This is perfectly understandable. Diabetes is a full-time job that you didn’t

apply for and would rather not have been hired for, thank you very much.

If your diabetes is getting you down, you can do a whole host of things to

help lift yourself out of the doldrums. Here are some options:

✓ Don’t deny your feelings. They are not unjustified and in any event,

your feelings are your feelings.

✓ Don’t bottle up your emotions. Share your feelings with those that are

close to you, especially your family.

✓ Seek support. Participate in a support group (whether virtual or

in-the-flesh).



✓ Don’t be too hard on yourself if your blood glucose levels are not as good or as consistent as they should be. Perfect blood glucose control

is not possible given that we have imperfect therapy. (Speaking of which,

one of Ian’s dictums is that the word “perfect” and the word “diabetes”

should never be used in the same sentence.)

✓ Think positively. Focus on your successes (be they eating a healthy

meal, going out for a walk, and so on) and pat yourself on the back

more often.

✓ Exercise regularly. If you’re feeling stressed and tired and burnt out with

your diabetes, the idea of exercising may be the furthest thing from your

mind. But exercise can hugely improve one’s energy level and well-being.

✓ Speak to your doctor about how you’re feeling. Discuss temporarily

lightening some of your diabetes workload. For example, ask if for a

period of time you can safely test your blood glucose less often. Or, if

you’re on four times daily insulin, ask if you can safely, temporarily,

switch to a different insulin that is given twice per day.

✓ Know that help is available. Your doctor, depending on your specific

situation, may recommend antidepressant medication or other forms of

psychological support.

Feeling at wits’ end with diabetes is common enough that an entire book is

devoted to the subject. Diabetes Burnout by Dr. William Polonsky is an excel-

lent resource to help you cope.

Diabetes etiquetteIf you have diabetes, you’ve probably run into situations where people have offered you well-intentioned, but unsolicited and unhelpful advice. (We love the term for these people — especially those who question your food choices when you’re in the cafeteria lineup or at a restaurant: the diabetes police!) The Behavioral Diabetes Institute (BDI; www.behavioraldiabetesinstitute.org) has developed etiquette cards for people with diabetes to give out to others (who don’t have diabetes). With the BDI’s kind permission, here’s what the card says:

1. DON’T offer unsolicited advice about my eating or other aspects of diabetes. You may mean well, but giving advice about some-one’s personal habits, especially when it is not requested, isn’t very nice. Besides, many of the popularly held beliefs about diabetes (“you should just stop eating sugar”) are out of date or just plain wrong.

2. DO realize and appreciate that diabetes is hard work. Diabetes management is a full-time job that I didn’t apply for, didn’t want and can’t quit. It Involves thinking about what, when, and

(continued)



(continued)

how much I eat, while also factoring in exer-cise, medication, stress, blood sugar monitor-ing, and so much more — each and every day.

3. DON’T tell me horror stories about your grandmother or other people with diabetes you have heard about. Diabetes is scary enough, and stories like these are not reassuring! Besides, we now know that with good manage-ment, odds are good you can live a long, healthy and happy life with diabetes.

4. DO offer to join me in making healthy lifestyle changes. Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!

5. DON’T look so horrified when I check my blood sugars or give myself an injection. It is not a lot of fun for me either. Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes it much harder for me.

6. DO ask how you might be helpful. If you want to be supportive, there may be lots of little things I would probably appreciate your help with. However, what I really need may be very different than what you think I need, so please ask first.

7. DON’T offer thoughtless reassurances. When you first learn about my diabetes, you may want to reassure me by saying things like, “Hey, it could be worse; you could have cancer!” This won’t make me feel better. And the implicit mes-sage seems to be that diabetes is no big deal. However, diabetes (like cancer) IS a big deal.

8. DO be supportive of my efforts for self-care. Help me set up an environment for success by supporting healthy food choices. Please honor my decision to decline a particular food, even when you really want me to try it. You are most helpful when you are not being a source of unnecessary temptation.

9. DON’T peek at or comment on my blood glucose numbers without asking me first. These numbers are private unless I choose to share them. It is normal to have numbers that are sometimes too low or too high. Your unsolicited comments about these numbers can add to the disappointment, frustration and anger I already feel.

10. DO offer your love and encouragement. As I work hard to manage diabetes successfully, sometimes just knowing that you care can be very helpful and motivating.


Index

• A •Aboriginal peoples and diabetes

overview, 320–321

prevention and treatment, 321–322

screening schedule, 321

A1C

blood glucose readings not matching,

187–189

defi ned, 371

diagnosing diabetes, A1C level as

criteria for, 22–23

importance of, 184–186

monitoring, 146

overview, 184

pregnancy, testing during, 138

readings, understanding your, 186–187

reporting, new methods of, 185

target readings, 187

acanthosis nigricans, 113

acarbose, 52, 245, 371

accepting your diabetes, 11–12

ACCU-CHEK Spirit Combo (Roche), 275

ACE inhibitor, 371

ACR (albumin/creatinine ratio), 100

acromegaly, 57

actos. See pioglitazone

adolescents with diabetes, 301–303

adult-onset diabetes. See type 2 diabetes

aerobic exercise. See cardiovascular

exercise

airline security and traveling with

insulin, 290–291

albumin, 100

alcohol

hypoglycemia, avoiding overuse of

alcohol as method of preventing,

72–73

moderation in drinking, 340

overview, 213–214

alpha-glucosidase inhibitors, 245–246

alternate therapies. See CAMs

amaryl. See glimepiride

American Diabetes Association (ADA)

website, 368, 369

American Foundation for the Blind, 99

amino acids, 371

amylin, 31, 33

analgesics (pain relievers) for nerve

damage, 104

animal insulin, 268

anorexia nervosa, 223

antibodies, 371

antihyperglycemic medications

alpha-glucosidase inhibitors, 245–246

bromocriptine, 249

CDA-recommended approach to

treating type 2 diabetes with, 251–253

choosing, 239

colesevelam, 249

defi ned, 371

DPP-4 inhibitors, 246–247

GLP-1 analogues, 247–249

how it works, 240

long-term treatment, 253–254

meglitinides, 243–244

metformin, 241–242

orlistat, 249

31_9781118399569-bindex.indd 38131_9781118399569-bindex.indd 381 3/21/13 9:52 AM3/21/13 9:52 AM

382 Diabetes For Canadians For Dummies, 3rd Edition

antihyperglycemic medications (continued)

pramlintide, 249

reasons for not taking, 238

reasons to take, 239

SGLT-2 inhibitors, 250

sulfonylureas, 243

thiazolidinediones (TZDs), 244–245

types of, 241–250

anxiety as symptom of hypoglycemia, 64

apidra. See glulisine

apolipoprotein B, 92, 93

ARB, 371

arterial circulatory disease, 85

Ask NOAH about Diabetes (website), 368

aspart insulin, 264, 371

aspartame, 215

atherosclerosis, 48, 85, 371

atorvastatin, 94, 95

autoimmune disorder, 42, 372

autonomic neuropathy (nerve damage),

105, 372

autonomic symptoms of hypoglycemia,

63, 64–65

avandia. See rosiglitazone

average blood glucose, 186–187

• B •babies with diabetes, 296–298

balanitis, 48

Banting, Dr. Frederick (Nobel Prize

winner), 37

bariatric surgery, 220–221

basal-bolus insulin therapy, 263–264,

268–269, 270, 275, 372

basal insulin, 263–264, 268–269, 292, 372

bedtime snack as method of prevention

of hypoglycemia, 72

Behavioral Diabetes Institute (BDI),

19, 368

behaviour modifi cation for weight

reduction, 221–222

Belviq, 220

Benny, Jack (actor), 11

Best, Charles H. (Nobel Prize winner), 37

beta blockers, 73, 75

beta cell, 30, 372

Beyond the Basics: Meal Planning for

Healthy Eating, Diabetes Prevention

and Management, 355, 356

biguanides, 242

bile acid binding resins, 94

birth defects, 134

bladder malfunction, 105

blind or visually impaired persons,

resources for, 98–99

blinded CGM. See professional CGM

Blindness Resource Center, 99

Bliss, Michael (The Discovery of Insulin),

37

blood, donating, 289

blood glucose

average, 186–187

macrovascular complications, reducing

high blood glucose to prevent, 86

peripheral neuropathy, effect on, 104

unsolicited comments on your

numbers, 20

blood glucose meter

alternative sites, ability to test from,

169

calibration, 169

choosing, 166, 168–171

defi ned, 372

diagnosis of diabetes from, avoid

making a, 23

display readability and features, 169

download capabilities, 170

esthetics and ergonomics, 168

iPhone compatibility, 170


383383 Index

ketone testing ability, 170

manufacturers, 171

mealtime insulin doses, help

calculating, 169–170

multiple test strips, ability to hold, 170

overview, 160–161

patterns, ability to interpret blood

glucose, 169

with speech capability, 99

using, 161–162

blood glucose monitoring

with A1C test, 184–189

for elderly people, 317–320

erratic blood glucose levels, possible

causes of, 181–184

frequency of testing, 162–165

high readings all the time, 178–179

high two-hour after-meal readings,

177–178

hypoglycemia, setting higher blood

glucose targets as method of

preventing, 73

importance of, 158–159

interpreting your results, 176–184

ketoacidosis, preventing, 78

methods of, 159–160

overview, 146

during pregnancy, 138

recording your results, 171–175

sharing results, 13

target readings, 175–176

testing and reaching your target

levels, 341

when to test your blood glucose,

165–167

blood pressure

low blood pressure when standing, 105

lowering, 342

monitoring, 146–147

blot hemorrhages, 95

Blumer, Ian (Understanding Prescription

Drugs For Canadians For

Dummies), 73

blurred vision

blood glucose and, 25, 26

type 1 diabetes symptom, 41


body mass index (BMI), 52, 372

bolus insulin, 264, 268, 292, 372

brain’s role in glucose regulation, 33

breastfeeding, 131, 141

brittle diabetes, 183–184

bromocriptine, 249

bronze diabetes, 57

bruising, 113

bulimia nervosa, 223

byetta. See exenatide

• C •CAD (coronary artery disease), 85–88

calcium, 212

calorie, 203

The Calorie King Calorie, Fat &

Carbohydrate Counter (Family

Health), 288

CAMs (complementary or alternative

therapies)

chromium, 256

cinnamon, 257

evaluating, 255–256

fenugreek, 257

garlic, 257

ginkgo, 257

ginseng, 257

gymnema sylvestre, 257

overview, 255

Canadian Council of the Blind, 99



Canadian Diabetes Association (CDA)

antihyperglycemic medications,

recommended approach to treating

type 2 diabetes with, 251–253

blood glucose targets, recommendation

of, 175

Clinical Practice Guidelines, 1, 62, 123

Eating Well with Canada’s Food

Guide, 202

food group system, 355–366, 374

heart attack and stroke prevention

strategies, 87

statins, recommendation of, 94

type 2 diabetes screening for at risk

people, recommendation of, 47, 50

website, 368, 369

Canadian National Institute for the Blind

(CNIB), 99

CANRISK (Canadian Diabetes Risk

Questionnaire), 51

capsaicin, 104

carbohydrate

defi ned, 372

fi bre, 207

glycemic index (GI), 205–207

overview, 22, 203–205

role of, 204

carbohydrate counting, 152, 207,

287–289, 372

cardiovascular disease, 85

cardiovascular exercise

moderate, 230

overview, 228–229

recommended amount of, 230–231

starting, 229–230

vigorous, 230

Carey, Drew (actor), 11

carpal tunnel syndrome, 105, 114

cataract, 98, 372

catheter method of insulin delivery, 274

causes

hypoglycemia, 66–67

type 1 diabetes, 42–43


CDA. See Canadian Diabetes Association

CDE (certifi ed diabetes educator), 150

celiac disease, 108–109, 182

Celiac Disease For Dummies (Crowe), 109

cerebrovascular disease, 48, 50, 85–88

CGM (continuous glucose monitoring)

advantages of, 193–197

components, 190–191

disadvantages of, 197–199

hypoglycemia, as method of

preventing, 73

overview, 190–193

professional, 190, 193, 196–197

real-time, 190–193, 194–196

receiver (display), 193

sensor, 193

transmitter, 193

Charles H. Best Diabetes Centre, 301

chemical exposure as cause of type 1

diabetes, 43

Chick, John (athlete), 11

children with diabetes

adolescents, 301–303

babies, 296–298

MODY (maturity onset diabetes of the

young), 311

primary school children, 298–301

screening tests for organ injury, 307–308

sick day solutions, 306–307

summer camps for, 308–309

toddlers, 296–298

transition from pediatric to adult

diabetes specialist care, 304–306


young adult children, 303

Children with Diabetes (website), 369


385385 Index

cholesterol

defi ned, 372

overview, 209–210

reducing, 341

cholestyramine, 94

chromium, 256

Chromosome 20, HNF-4alpha. See MODY

Cialis, 118

cinnamon, 257

claudication, 89

Clement, Dr. Maureen (family

physician), 150

CNIB (Canadian National Institute for the

Blind), 99

colesevelam, 94, 249

Collip, J. B. (Nobel Prize winner), 37

commercial driver’s licence, 330–331

complementary or alternative therapies.

See CAMs

confusion as symptom of

hypoglycemia, 65

congenital anomaly, 134

consciousness, loss of, 65

continuous glucose monitoring. See CGM

continuous glucose monitoring system,

373

continuous subcutaneous insulin

infusion therapy (CSII), 275

controlling your blood glucose

corrective action for, 27–28

lose control of your blood glucose,

what to do if you, 27–28

overview, 27

coping with diabetes, 18–19

coronary artery disease, 50

coronary heart disease, 48, 85

correction factor, 289

corrective action for controlling your

blood glucose, 27–28

cow’s milk as cause of type 1 diabetes,

early exposure to, 43

creatinine, 100, 373

Crestor, 94, 95

criteria for diagnosing diabetes, 22–23

Crowe, Dr. Sheila (Celiac Disease For

Dummies), 109

cure for diabetes, progress for, 351

Cushing’s syndrome, 57

• D •DASH (Dietary Approaches to Stop

Hypertension), 215

dawn phenomenon, 177, 285, 346, 373

degludec, 373

delivery of large baby as risk factor for

type 2 diabetes, 50

dementia, 107, 315

dentist, 155

depression, 107

detemir, 373

Dex4 tablets for mild/moderate

hypoglycemia, 67–68

Dexcom CGMS, 191–192

diabeta. See glyburide

diabetes

accepting your, 11–12

coping with, 18–19

etiquette, 19–20

family, impact of your diabetes on your

relationships with your, 12–13

friends, impact of your diabetes on

your relationships with your, 13–14

frustration with managing your, 18

guilt over not doing better managing

your, 17

increase in, 10

managing, energy needed for, 17

number of people living with, 10

overview, 9–10

sharing news of your, 12

types of, 57

workmates, impact of your diabetes on




Diabetes Burnout (Polonsky), 19

diabetes education centres, 151

diabetes educator, 150–151, 235

Diabetes in the Workplace: A Guide for

Employers and Employees, 327

diabetes insipidus, 10

diabetes mellitus, 10, 373

Diabetes Monitor (website), 368

diabetes nurse educators, 151

diabetes specialist, 149–150

Diabetic Gourmet Magazine (website), 369

diabetic hand syndrome, 115

diabetic ketoacidosis. See ketoacidosis

diabetologist, 373

diagnosing diabetes

A1C level as criteria for, 22–23

criteria for, 22–23

in elderly people, 314

fasting blood glucose level as criteria

for, 22–23

glucose tolerance test as criteria for,

22–23

history of, 21

overview, 21, 22–23

random blood glucose level as criteria

for, 22–23

dialysis, 102, 373

diamicron. See gliclazide

diarrhea, 108

diet

alcohol, 213–214

carbohydrates, 203–207

DASH (Dietary Approaches to Stop

Hypertension), 215

eating out, 216–217


fats, 209–211

food group system, nutrition plan

created with, 364–366

gestational diabetes treated with, 126

importance of following a healthy, 339

Mediterranean, 215

minerals, 212

non-nutritive sweeteners, 214–215

overview, 202–203

plan, 181

during pregnancy, 138

proteins, 208–209

sugar, 204

vegan, 215

vegetarian, 215

vitamins, 211–212

water, 213

Dietary Approaches to Stop

Hypertension (DASH), 215

dietitians. See registered dietitians

digestive disorders, 108–109

disability insurance, 328

disaster preparation, 333–334

The Discovery of Insulin (Bliss), 37

discrimination, employment, 323–324,

326–327

disposable pens for insulin delivery,

272–273

Disraeli, Benjamin (British prime

minister), 43

dizziness as symptom of

hypoglycemia, 65

doctor. See also specifi c types of doctors

duty to report patients unsafe to

drive, 332

working with your, 344

donating blood, 289

dose, adjusting your insulin, 283–287

dot hemorrhages, 95

double diabetes, 36

DPP-4 inhibitors, 246–247, 320, 373

Dr. Rubin (website), 368

driving when you have diabetes

commercial licence, 330–331

losing your licence, avoiding, 332–333

medically fi t to drive, determining if

you are, 329


387387 Index

physician’s duty to report patients

unsafe to drive, 332

precautions, 329–330

reinstating your licence, 333

drowsiness as symptom of

hypoglycemia, 65

Drucker, Dr. Daniel (research

scientist), 32

drug availability in countries other than

Canada, 250

drug-induced diabetes, 57, 58

drunk, difference between having low

blood glucose and being, 14

dysesthesiae, 103

dyslipidemia, 373

• E •eating disorders, 223

eating out, 216–217

Eating Well with Canada’s Food

Guide, 202

ED (erectile dysfunction), 116–119

Edison, Thomas (inventor), 11

eGFR (estimated glomerular fi ltration

rate), 100–101

elderly people and diabetes

blood glucose control, 317–320

diagnosis, 314

elderly defi ned, 313

exercise, 318

eye problems, 315

foot problems, 316

intellectual function evaluation, 315

medication, 319–320

nutrition, 317–318

overview, 313–314

sexual dysfunction, 316

urinary problems, 315

elevated blood glucose, extreme.

See HHS

employment

discrimination, 323–324, 326–327

job interviews, 325

legal protections, 324–325

recourse against discrimination,

326–327

safety-sensitive positions, 325–326

endocrine function, 30

endocrinologist, 149, 373

estimated average glucose, 185

etiquette, diabetes, 19–20

exenatide, 247, 373

exercise

advantages of, 226–227

cardiovascular, 227, 228–231

checking with doctor before starting a

program of, 232–233

daily exercise, importance of, 339

for elderly people, 318

with family members, 13

fl exibility, 227

gestational diabetes treated with, 126

hypoglycemia, exercise plan as method

of preventing, 72

regular, 19

resistance, 227, 231–232

supervised exercise programs, 235

types of, 227–228

exercise stress test, 232

extra-ocular muscle palsy, 106

eye disease

cataracts, 98


glaucoma, 98

overview, 95

retinopathy, 95–98

eye doctor, 152–153, 342

ezetimibe, 94

Ezetrol, 94



• F •family

biological fi rst-degree relative with

type 2

diabetes as risk factor for type 2

diabetes, 50

exercising with your, 16

health care team, as part of, 155–156

impact of your diabetes on your

relationships with your, 12–13

involvement, importance of, 16, 344

juggling your diabetes and your family

life, 15–16

yourself, making time for, 16

family physician, 148–149, 150, 235

FAQs (frequently asked questions)

“How can I get my doctor to be more

communicative?”, 349–350

“I used to be on pills, but now I’m

on insulin. Does that mean I’ve

developed type 1 diabetes?”, 348

“I’m watching my diet, so why is my

cholesterol level high?”, 348

“What’s the difference between an A1C

level and a blood glucose level?”, 347

“When you’re on insulin, you’re on it

forever, right?”, 348

“Why are my blood glucose levels all

over the place?”, 346

“Why are my blood glucose levels

getting worse as time goes by?”, 347

“Why are my blood glucose levels

higher when I get up in the morning

than when I go to bed?”, 345–346

“Why do I need blood pressure pills if

my blood pressure is good?”, 349

“Will I always have diabetes?”, 350–351

fasting, 22

fasting blood glucose

diagnosing diabetes, as criteria for,

22–23

insulin dose adjusted to lower your,

285

fat carried in midsection, 52, 55

fatigue

high blood glucose symptom, 26



fats

cholesterol, 209–210

defi ned, 373

food group system, category in, 363

monounsaturated, 210

omega-3 fatty acids, 210

overview, 209

polyunsaturated, 210

saturated, 210

trans fatty acids, 210–211

unsaturated, 210

feet. See also foot disease

maintaining your, 342–343

numbness of feet as type 2 diabetes

symptom, 48

female sexual dysfunction, 119–120

fenofi brate, 97

fenugreek, 257

fi brate, 94

fi bre, 207, 373

First Nations peoples. See Aboriginal

peoples

fl exibility exercise, 227

folic acid, 137

Food and Diabetes (Yasui and Hatton), 299

food group system

defi ned, 374

fats, 363

free foods, 364

fruits, 357–359

grains and starches, 356–357

meat and alternatives, 361–362

milk and alternatives, 359

nutrition plan created with, 364–366

other choices (sweet foods and

snacks), 360

overview, 355–356

sample menus, 364–366

vegetables, 360–361


389389 Index

foot disease


overview, 109

protecting your feet, 110–112

foot doctor, 154–155

free foods, 364

frequently asked questions. See FAQs

friends as part of your health care team,

155–156

frozen shoulder, 115

fructosamine level, testing, 160

fructose, 22, 374

fruits, 357–359

fruity breath

ketoacidosis symptom, 76


frustration with managing your

diabetes, 18

• G •garlic, 257

gastric bypass, 221

gastroparesis, 108, 182, 264, 374

GDM. See gestational diabetes

genetic risk for type 2 diabetes, 49

gestational diabetes

after baby is born, 130–132

causes, 122

defi ned, 374

diagnosing, 122–124, 125

monitoring, 128

one-step approach to diagnosing, 124

overview, 121–122

potential complications

for baby, 130

for mother, 129

risk for, determining, 124–125

treating, 125–127

two-step approach to diagnosing, 123

type 2 diabetes, risk factor for, 50

GFR (glomerular fi ltration rate), 100–101

GI (glycemic index), 205–207, 375

gingivitis, 115, 155

ginkgo, 257

ginseng, 257

glargine, 374

glaucoma, 98

gliclazide, 243, 374

glimepiride, 243, 374

GLP-1 analogues, 247–249, 374

glucagon

defi ned, 374

hypoglycemia, as treatment of, 69–71

overview, 31, 33

glucagon kit, 69–70

Glucobay. See acarbose

GlucoNorm. See repaglinide

glucose, 2, 21–22, 374

glucose tolerance test, 22–23, 374

glulisine insulin, 264, 374

glumetza, 374

glyburide, 243, 374

glycemic index (GI), 205–207, 375

glycogen, 375

glycohemoglobin. See A1C

glycosylated hemoglobin. See A1C

grains and starches, 356–357

Grenkow, Chuck (former Canadian

Forces pilot), 11

grocery shopping with family

members, 13

GTT (glucose tolerance test), 131

guilt over not doing better managing

your diabetes, 17

gum disease, 115, 155

gymnema sylvestre, 257

• H •Hall, Gary Junior (athlete), 11

handling and storage of insulin, 282–283

hardening of the arteries. See

atherosclerosis

Hatton, Doreen (Food and Diabetes), 299

HDL (high-density lipoprotein), 92, 375



health care team

defi ned, 375

dentist, 155

diabetes educator, 150–151

diabetes specialist, 149–150

eye doctor, 152–153

family and friends, 13, 155–156

family physician, 148–149

foot doctor, 154–155

pharmacist, 153–154

questioning your, 147–148

registered dietitians, 151–152

scheduling visits to members of

your, 147

your responsibilities, 146–148

health maintenance tips

blood glucose levels, testing and

reaching your target, 341

blood pressure, lowering your, 342

cholesterol, reducing your, 341

diet, following a healthy, 339

doctor, working with your, 344

drinking moderately, 340

exercise, daily, 339

eye doctor, visiting your, 342

family involvement, importance of, 344

feet, maintaining your, 342–343

kidney function, monitoring, 342

learning everything you can about

diabetes, 338

medication, taking proper, 343–344

numbers, importance of knowing your,

340–342

smoking, quitting, 340

heart attack

prediabetes as risk for, 56

preventing, 87–88

risk for, determining, 147

heart disease, 48, 232

heart rate, abnormal, 105

helpful, ways to be, 20

Hemingway, Ernest (writer), 11

hemochromatosis, 57

hemoglobin, 347

hemoglobin A1C. See A1C

HHS (hyperosmolar hyperglycemic

state)

causes of, 81

defi ned, 375

overview, 79–80

prevention of, 81–82

symptoms of, 80–81

treatment of, 81

high blood glucose, symptoms caused

by, 25–26

high blood pressure (hypertension),

90–91, 133, 232

high-density lipoprotein (HDL), 92, 375

high-risk population member as risk

factor for type 2 diabetes, 50

history of diagnosing diabetes, 21

honeymoon phase, 287, 375

hormonal disease-induced diabetes, 57

hormones, 24, 30–31. See also insulin

horror stories, 20

hospitalization

for HHS, 80

ketoacidosis, treatment of, 77–78

humalog insulin. See Lispro insulin

hunger


hypoglycemia symptom, 64, 65


hyperglycemia

after baby is born, 131

defi ned, 375

and exercise, 232–234

overview, 36, 297

hyperosmolar hyperglycemic state.

See HHS

hyperthyroidism, 57, 115

hypoglycemia (low blood glucose)

baby, after having a, 141–142

baby developing, 130


391391 Index

causes of, 66–67

defi ned, 62, 375

and exercise, 232–234, 233–234

mild, 63

moderate, 63

overly frequent, 179–180

overview, 61–62, 297

pregestational diabetes and risk of, 133


repeated hypoglycemia, 74

severe, 63, 64

severity of, 63

symptoms of

autonomic, 63, 64–65

neuroglycopenic, 63, 65–66

overview, 63–64

treatment of

glucagon as, 69–71

mild hypoglycemia, 67–68

moderate hypoglycemia, 67–68

overview, 67

severe hypoglycemia, 69–71

hypoglycemia unawareness, 74–75

hypothyroidism, 115

Hypurin NPH insulin, 268

Hypurin Regular insulin, 268

• I •impaired fasting glucose (IFG), 375

impaired glucose tolerance (IGT), 375

incretin mimetic, 375

incretins, 32, 36, 375

infants with diabetes, 296–298

infusion set malfunctions causing

ketoacidosis, 78

inhaled insulin, 268

inheritance of type 1 diabetes, 43

insoluble fi bre, 207

insulin

animal, 268

basal, 263–264, 268–269, 292, 372

bolus, 264, 268, 292, 372

defective insulin as cause of

ketoacidosis, 77

defi ned, 376

discovery of, 37

dose, adjusting your, 283–287

for elderly people, 320

gestational diabetes treated with,

126–127

hypoglycemia

insulin as cause of, 66

switching type of insulin you are

taking as method of preventing, 72

inhaled, 268

intermediate-acting, 263, 265–266

ketoacidosis

fresh insulin used as method of

preventing, 78

low insulin doses as cause of, 77

missing insulin doses as cause of, 77

taking insulin as method of

preventing, 78

long-acting, 263, 266–267

myths about, 270–271

overview, 24, 260

pregnancy, adjusting during, 138–139

premixed, 263, 267, 270

rapid-acting, 263, 264, 291

regular, 265

short-acting, 263

storage and handling, 282–283

terminology, 263–264

traveling with, 290–292

types of, 260–263

insulin defi ciency, 35–36

insulin delivery

with catheter, 274

with jet injection device, 274

overview, 272

with pen devices, 272–273

with pump, 274–282



insulin dependent diabetes. See type 1

diabetes

Insulin for Life, 132, 260

insulin injection

family members, in front of, 13

friends, in front of, 14

reaction to, 20

insulin reaction, 66, 376

insulin resistance, 35, 49, 376

insulin sensitivity factor, 289

insulin shock, 66

insulin therapy

basal-bolus, 263–264, 268–269, 270,

275, 372

with carbohydrate counting, 287–289

and exercise, 234

inconsistent blood glucose readings,

182–184

intensifi ed, 275

pump therapy, 270

for type 1 diabetes, 268–269


insurance

disability, 328

life, 328

overview, 327

travel, 328

intellectual function evaluation for

elderly people, 315

intensifi ed insulin therapy. See basal-

bolus insulin therapy

intensive diabetes management, 376

intermediate-acting insulin, 263, 265–266

intermittent claudication, 89

internists, 149–150

interpreting your blood glucose results

high before-breakfast readings, 176–177

high readings all the time, 178–179

high two-hour after-meal readings,

177–178

hypoglycemia, overly frequent, 179–180

inconsistent readings, 180–184

overview, 176

intestine, role in glucose regulation of, 32

Inuit peoples. See Aboriginal peoples

islet cells, 30, 376

• J •januvia. See sitagliptin

JDRF (Juvenile Diabetes Research

Foundation), 14

jet injection device for insulin

delivery, 274

job interviews, 325

juice for mild/moderate hypoglycemia,

67–68

juvenile-onset diabetes. See type 1

diabetes

• K •ketoacidosis

causes of, 77

defi ned, 376

overview, 40, 75


symptoms of, 76

treatment of, 77–78

ketone

defi ned, 376

overview, 41, 128

when to test for, 76

kidney disease

diagnosing, 100–101

overview, 99

treating, 101–102

kidney failure, 100

kidney function

monitoring, 342

worsening of, 133

kilocalorie, 203

kilojoules, 203

Kimball, Charlie (race car driver), 194


393393 Index

• L •labour and delivery, 139–141

lactic acidosis, 242

LADA (latent autoimmune diabetes of

adults), 44

lancet, 160, 376

lancet holder, 161

lantus. See glargine

laparoscopic banding, 221

laser treatment, 376

lateral femoral cutaneous nerve

syndrome, 106

LDL (low-density lipoprotein),

92, 93, 94, 377

learning everything you can about

diabetes, 338

legal protection for employment, 324–325

Levemir insulin, 266–267

Levitra, 118

life insurance, 328

lifestyle treatment plan, 51–52, 146

Lilly Diabetes Journey Awards, 288

linagliptin, 247, 376

lipid levels, monitoring, 147

lipids, 91–95

Lipitor, 94, 95

lipohypertrophy, 113, 183, 283, 376

liraglutide, 247, 377

lispro insulin, 264, 377

liver disease, 109

liver’s role in glucose regulation, 31–32

logbooks, maintaining, 171–175

long-acting insulin, 263, 266–267, 376

long-term complications

abnormal cholesterol and triglyceride

levels (dyslipidemia), 91–95

CAD (coronary artery disease),

85, 86–89

cardiovascular disease, 85

categories of, 84–85

cerebrovascular disease, 85, 86–89

digestive disorders, 108–109


eye disease, 95–99

female sexual dysfunction, 119–120

foot disease, 109–112

gum disease, 115

high blood pressure, 90–91

kidney disease, 99–102

macrovascular complications, 84–86

mental health issues, 107

microvascular complications, 84, 86

musculoskeletal problems, 114–115

neuropathy (nerve damage), 102–106

overview, 83–84

PAD (peripheral arterial disease),

85, 89–90

skin disease, 113–114

thyroid disease, 115


longstanding diabetes as cause of

hypoglycemia unawareness, 74

losing your licence, avoiding, 332–333

low blood glucose. See hypoglycemia

low blood pressure when standing, 105

low-density lipoprotein (LDL),

92, 93, 94, 377

• M •Macleod, Dr. John (Nobel Prize

winner), 37

macrosomia, 50, 130, 377

macrovascular complications

overview, 84–85

reducing high blood glucose to

prevent, 86

macrovascular syndrome, 377

macula, 95

macular edema, 95

managing your diabetes, energy needed

for, 17



McDonald-Blumer, Heather

(Understanding Prescription Drugs For

Canadians For Dummies), 73

meals

after-meal blood glucose levels, insulin

dose adjusted to improve, 286–287

after you’ve eaten, organs role in

glucose regulation, 33–34

high before-breakfast blood glucose

readings, 176–177

missing or delaying meals as cause of

hypoglycemia, 71

meat and alternatives, 361–362

medical alert bracelets/necklaces, 63

medical assistance, when to seek, 28

medical care team. See health care team

medically fi t to drive, determining if you

are, 329

medication. See also antihyperglycemic

medications

bringing all your medication to medical

appointments, 147


for erectile dysfunction, 118

exercise and medication therapy, 233

for high cholesterol, 94–95

for high triglycerides, 94

hypoglycemia

medication impairing your ability to

recognize, 75

reviewing your non-diabetes

medications with your physician as

method of preventing, 73

importance of taking proper, 343–344

for nerve damage, 104

for weight reduction, 220

Mediterranean, 215

MedLinePlus Drug Information

(website), 368

Medtronic, 191–192

Medtronic CGMS, 195

meglitinides, 66–67, 243–244

Mendosa, David (medical writer), 369

menstrual cycle, 182

mental health issues, 107

metabolic syndrome, 54–55, 377

metabolism, 377

metformin, 52, 241–242, 319, 377

Métis peoples. See Aboriginal peoples

microalbuminuria, 100, 377

microaneurysms, 95

microvascular complications

defi ned, 377

overview, 84

reducing high blood glucose to

prevent, 86

mild hypoglycemia (low blood glucose),

63, 67–68

milk and alternatives, 359

milligrams per decilitre (mg/dL), 23

minerals, 212

mini-dose glucagon, 297, 300

MiniMed Paradigm Veo (Medtronic), 275

miscarriage, 134

missing or delaying meals as cause of

hypoglycemia, 71

mmol/L (millimoles per litre), 2

moderate cardiovascular exercise, 230

moderate hypoglycemia (low blood

glucose), 63, 67–68

MODY (maturity onset diabetes of the

young), 57, 311

monounsaturated fat, 210, 377

multivitamins, 137

muscles’ role in glucose regulation, 32

musculoskeletal problems, 114–115

myths about insulin, 270–271

• N •nail infections, 113–114

nateglinide, 244, 377

natural health products. See CAMs

Natural Health Products Regulations, 256


395395 Index

nausea, vomiting, and abdominal pain as

symptom of ketoacidosis, 76

necrobiosis lipoidica diabeticorum, 114

neovascularization, 95, 377

nephropathy, 50, 377

neuroglycopenic symptoms of

hypoglycemia (low blood glucose),

63, 65–66

neuropathy (nerve damage)

autonomic, 105

defi ned, 377

overview, 102–103

peripheral, 103–104

types of, 105–106

niacin, 94

non-HDL cholesterol, 92, 93

non-insulin antihyperglycemic

medication, 377

non-insulin dependent diabetes.

See type 2 diabetes

non-nutritive sweeteners, 214–215

non-proliferative retinopathy, 95

non-visceral fat, 33

Novo Nordisk Half Century Award

Program, 288

NovoRapid (aspart) insulin, 127, 264

NPH insulin, 126, 265–266, 378

numbers, importance of knowing your,

340–342

nurse educators, 151

nutrition. See diet

nutrition food labels, 217

• O •omega-3 fatty acids, 210, 378

OneTouch Ping (Animas), 275

onglyza. See saxagliptin

Online Diabetes Resources by David

Mendosa (website), 369

open sores on your feet, 110, 113

ophthalmologist, 97, 378

optometrists, 97

oral antidiabetic agents. See

antihyperglycemic medications

oral hypoglycemic agent, 378

Oral-lyn insulin, 268

organs’ role in glucose regulation

after you’ve eaten, 33–34

brain, 33

fat, 32–33

intestine, 32

liver, 31–32

muscles, 32

overview, 29–30

pancreas, 30–31, 33–34

when you haven’t recently eaten, 34

orlistat, 249

orthotics, 154

Our Diabetes (website), 368

overnight hypoglycemia

children, reducing risk for, 299

insulin dose adjusted to avoid, 285–286

overweight, determining if you are, 52

oxygen free radicals exposure as cause

of type 1 diabetes, 43

• P •PAD (peripheral arterial disease),

48, 50, 85, 89–90

palpitations as symptom of

hypoglycemia, 64, 65

pancreas

beta cell, 30

defi ned, 378

diabetes caused from damage to, 57

endocrine function, 30

exocrine function, 30

glucose regulation, 30–31, 33–34

hormones produced by, 30–31

islet cells, 30

overview, 24, 30

pancreatitis, 57, 93



patch pumps, 275, 277, 281

PDE5 (phosphodiesterase type 5)

inhibitors, 118, 119

pen devices for insulin delivery

for blind or visually impaired people, 99

disposable pens, 272–273

overview, 272–274

refi llable pens, 272–273

perfection, not striving for, 19

peripheral arterial disease. See PAD

peripheral neuropathy (nerve damage),

103–104, 233, 378

personal CGM. See real-time CGM

pharmacist, 153–154

pheochromocytoma, 57

physical limitations and exercise, 233

pioglitazone, 244, 378

A Place for All: A Guide to Creating an

Inclusive Workplace, 325

placenta, 122

plaque, 85

pneumonia, 106

podiatrist, 378

Polonsky, William (Diabetes Burnout), 19

polydipsia, 378

polyunsaturated fat, 210, 378

polyuria, 378

portion control for weight reduction, 220

positive thinking, 19

post-prandial, 378

postpartum thyroiditis, 142

pramlintide, 249

pre-prandial, 378

precautions for driving when you have

diabetes, 329–330

prediabetes

criteria for, 56

defi ned, 378

overview, 55

risks of, 56–57

type 2 diabetes, as risk for, 50, 56

prednisone, 58

pregestational diabetes

after having your baby, managing your

diabetes, 141–142

overview, 54, 132–133

pregnancy, managing your health

during, 137–139

before pregnancy, review of what to do,

134–137

risks

for baby, 134

for fetus, 134

for mother, 133

pregnancy

after having your baby, managing your

diabetes, 141–142

gestational diabetes, 121–132

labour and delivery, 139–141

managing your health during, 137–139

pregestational diabetes, 132–142

premixed insulin, 263, 267, 270

prepackaged foods, 217

Presley, Elvis (singer), 11

preventative strategies

Aboriginal peoples and diabetes,

321–322

hypoglycemia (low blood glucose),

71–74

type 1 diabetes, 45


primary school children with diabetes,

298–301

professional CGM, 190, 193, 196–197

proliferative retinopathy, 95

protein, 208–209, 378

Public Health Agency of Canada, 51

pump for insulin delivery

defective delivery of insulin as cause of

ketoacidosis, 77

insulin pump defi ned, 376

during labour and delivery, 140

malfunctions causing ketoacidosis, 78

overview, 270, 274–282


397397 Index

• Q •Qsymia, 220

quitting smoking, 88–89

• R •random blood glucose level as criteria

for diagnosing diabetes, 22–23

rapid-acting insulin, 127, 263, 264,

291, 378

rapid breathing as symptom of

ketoacidosis, 76

real-time CGM, 190–193, 194–196

recourse against discrimination in

workplace, 326–327

refi llable pens for insulin delivery,

272–273

registered dietitians, 151–152

regular insulin, 265, 378

reinstating your licence, 333

relationships, impact of your diabetes on

your, 12–15

repaglinide, 244, 379

repeated hypoglycemia, 74

resistance exercise, 227, 231–232

responsibilities for your health, your

day-to-day, 146–148

restaurant meals, 216–217

retina, 379

retinal detachment, 95

retinopathy

defi ned, 379

non-proliferative, 95

overview, 50, 95–96, 133

preventing, 96–97

proliferative, 95

screening for, 97–98

retrograde ejaculation, 116

rosiglitazone, 244, 379

rosuvastatin, 94, 95

• S •safety-sensitive positions, 325–326

sample menus, 364–366

Sasseville, Sebastien (mountain

climber), 11

saturated fat, 210, 379

Saudek, Dr. Christopher (previous

president of American Diabetes

Association), 150

saxagliptin, 247, 379

scheduling visits to members of your

health care team, 147

screening

Aboriginal peoples and diabetes, 321

for organ injury, 307–308


secondary prevention strategies for

type 1 diabetes, 45

seizures as symptom of hypoglycemia, 65

severe hypoglycemia (low blood

glucose)

overview, 63, 64

treatment, 69–71

sexual dysfunction


elderly people, 316

female, 119–120

SGLT-2 inhibitors, 250

sharing news of your diabetes, 12

sharps container, 161

short-acting insulin, 263

shoulder dystocia, 130

Sigal, Dr. Ron (researcher), 231

sitagliptin, 246, 379

skin disease, 113–114

smoking

PAD, infl uence on, 90

pregnancy, effect on, 137

quitting, importance of, 88–89, 340

sodium, 212



soluble fi bre, 207

somogyi phenomenon (effect), 286, 379

sores on feet, 112

Sotomayor, Sonia (US Supreme Court

judge), 10

Standards of Care for Students with Type 1

Diabetes in Schools, 301

starlix. See nateglinide

statin, 94, 379

Steele, Stephen (pilot), 11

storage and handling of insulin, 282–283

stress, 182

stroke


preventing, 87–88

risk for, determining, 147

sucrose, 22

sugar, 204

sugar alcohols, 215

sulfonylureas, 66, 243, 319, 379

summer camps for children with

diabetes, 308–309

supervised exercise programs, 235

supportive, being, 20

surgery for weight reduction, 220–221

sweating, 64, 65, 105

sweet foods and snacks, 360

sweet urine, 36

sweeteners, non-nutritive, 214–215

symptoms

HHS (hyperosmolar hyperglycemic

state), 80–81

hypoglycemia, 63–66, 72

type 1 diabetes, 41


• T •Taylor, Elizabeth (actor), 11

test strip, 161

thiazolidinedione, 244–245, 379

thickened skin, 114

thirst



Thompson, Leonard (test subject for

insulin), 37

thyroid disease, 115

time zones, adjusting your insulin doses

between, 291–292

toddlers with diabetes, 296–298

Toronto insulin. See regular insulin

total cholesterol, 92

total cholesterol/HDL ratio, 92

toxemia, 133

trajenta. See linagliptin

trans fatty acids, 210–211, 379

travel insurance, 328

traveling with insulin, 290–292

treatment. See specifi c treatments

trembling as symptom of

hypoglycemia, 64

tresiba. See degludec

Tresiba insulin, 266

TrialNet5, 4

triglycerides, 55, 92, 93, 94, 379

tube-requiring insulin pumps,

276–277, 281

type 1 diabetes

adolescents, 301–303

babies with, 296–298

causes of

chemicals, exposure to certain, 43

cow’s milk, early exposure to, 43

overview, 42–43

oxygen free radicals, exposure to, 43

viral infection triggering abnormal

immune system response, 42

virus damaging pancreas by directly

attacking it, 43

double diabetes, 36

inheritance of, 43


399399 Index

insulin therapy, 268–269


adults), 44

overview, 34, 40

preventative strategies, 45

primary school children with, 298–301

retinopathy screening, 97

symptoms, 41

toddlers with, 296–298

type 2 diabetes compared, 53–54

young adult children, 303

type 2 diabetes

causes, 49–50

children with diabetes, 309–311

described, 35

frequency of testing

when being treated with insulin,

164–165

when not being treated with insulin,

163–164

genetic risk for, 49

insulin defi ciency, 35–36

insulin resistance, 35, 49

insulin therapy, 269–270


adults) compared, 44

lifestyle therapy for, 51–52


overview, 45–47


preventing, 51–53

retinopathy screening, 98

risk factors, 50–51

screening for, 50–51

screening someone who had

gestational diabetes for, 131

symptoms, 47–48

type 1 diabetes compared, 53–54

TZD. See thiazolidinedione

• U •ulcers of the foot, 110, 113

Understanding Prescription Drugs For

Canadians For Dummies (Blumer and

McDonald-Blumer), 73, 320

unsaturated fats, 210

unsolicited advice, 19

urination

elderly people and problems with, 315



• V •vaccinations for pneumonia, 106

vaginal infections as symptom of high

blood glucose, 26

vascular disease risk factors as risk

factor for type 2 diabetes, 50

vegan diet, 215

vegetables, 360–361

vegetarian diet, 215

Vegetarian Resource Group (website), 369

Viagra, 118

vigorous cardiovascular exercise, 230

viral infection triggering abnormal

immune system response as cause of

type 1 diabetes, 42

virus damaging pancreas by directly

attacking it as cause of type 1

diabetes, 43

visceral fat, 33

vision changes as symptom of

hypoglycemia, 65

visually impaired or blind persons,

resources for, 98–99

vitamins, 211–212

vitiligo, 114

vitrectomy, 97



• W •waist circumference, measuring your, 52

water, 213

websites

American Diabetes Association (ADA),

368, 369

Ask NOAH about Diabetes, 368

Behavioral Diabetes Institute, 368

Canadian Diabetes Association (CDA),

368, 369

Children with Diabetes, 369

Diabetes Monitor, 368

Diabetic Gourmet Magazine, 369

Dr. Rubin, 368

MedLinePlus Drug Information, 368

Online Diabetes Resources by David

Mendosa, 369

Our Diabetes, 368

Vegetarian Resource Group, 369

weight

BMI (body mass index), 52

overweight, determining if you are, 52

weight loss


overview, 36



weight reduction

advantages of, 218

with behaviour modifi cation, 221–222

best strategy for, 219

challenges, 218–219

medication therapy for, 220

overview, 218

portion control, 220

surgery for, 220–221

weight training, 231

weightlifting, 231

work

blood glucose testing at, 16

challenges at work, dealing with, 16

insulin, storing and injecting, 16

schedule, 182

workmates, impact of your diabetes on


wound healing, slow, 48

• X •xanthomata, 114

Xenical, 220

• Y •Yasui, Doreen (Food and Diabetes), 299

yeast infections, 48

young adult children with diabetes, 303


diabetes for canadians for dummies, 3rd edition

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