Symptoms may include
Increased thirst, passing a lot of urine, large amounts of sugar and ketones in the urine, loss of appetite, feeling and being sick, lack of energy, blurred eyesight

Managing high blood sugars
Don't panic! It is normal for blood sugars to go up and down during the day. Monitor your blood glucose more frequently. Increase fluid intakes such as water or sugar free drinks. If you have persistently high blood glucose levels check for ketones in your blood or urine, and contact your diabetes team for advice

When you are ill your body becomes more resistant to insulin. This means your blood glucose levels can go up (even if you are not eating). You therefore need to test your blood glucose levels regularly as well as checking for ketones (by testing your urine or blood) to see if you need more insulin. Even though you won’t feel like it, it is vital you monitor your diabetes to prevent diabetic ketoacidosis developing and prevent you needing to be admitted to hospital

1. Never stop taking your insulin even if you do not feel well and cannot eat. Your body needs insulin in order to transform the glucose supplied by the food you eat into the energy source your body's cells need. However even if you don't eat, your body will produce glucose from its stores. If you stop your insulin you may then become ill, or even seriously ill. Your dose might need to be adjusted while you are sick. If you are unsure how to do this, consult your healthcare professional
   
   
2. Measure your blood glucose level more frequently, at least 4 times a day, and adjust your insulin dose if necessary. Your blood sugar will rise during illness, especially with fever, so be prepared to increase your insulin dose as needed. Once you get better your insulin sensitivity will come back. You will then need to decrease your dose as soon as you see your blood glucose values coming back into the normal range
   
   
3. Try to drink plenty of liquids such as water or sugar-free drinks. At least 3 to 4 litres should be sipped through the day if possible. Hyperglycaemia (high blood glucose) occurs more frequently during illness causing you to pass more urine, so that you can easily become dehydrated. Illness is often associated with fever which accelerates fluid loss
   
   
4. If you don't feel like eating solid food, try alternatives like milk, soup, cereals, ice cream, pudding, fruit juice, or normal drinks. Have something every hour throughout the day. This will help to ensure that you are still taking your full carbohydrate allowance, balancing the insulin and helping to prevent the problem of vomiting which can sometimes occur if a full meal is eaten. Try keeping an emergency store of these alternatives for use only when you are feeling ill. Each of the following brings around 10g of carbohydrates:
   100mI of natural fruit juice, 100ml of cola, 150ml of lemonade or similar fizzy drink, 200ml of milk, 200ml of thickened soup, 1 plain yoghurt, 1 diet fruit yoghurt, 1 scoop of ice cream, 50ml of Lucozade, 2 teaspoons of drinking chocolate powder made with a mug of milk, 2 tablespoons of squash/cordial in 1 glass of water, milk pudding. If you cannot keep anything down suck on ordinary sweets. Remember sugary cough medicines and lozenges are best avoided - sugar free alternatives are available
   
   
5. Test your blood for ketones frequently as it will give you the first warning of a lack of insulin
   
   
6. The following need urgent medical advice: vomiting, diarrhoea, ketones in urine, abdominal pain, control remains poor, acetone smell on breath
   

Contact your diabetes clinic or your GP if: you are unsure about what to do, you are vomiting, you don't improve quickly (24hrs), your blood glucose level remains high or, adversely low, you are worried

Even though illness is not something you can plan in advance, try to be prepared and ask your doctor or diabetes nurse about what to do if you become ill. MOST IMPORTANTLY, NEVER STOP TAKING YOUR INSULIN UNDER ANY CIRCUMSTANCES AND ENSURE YOU HAVE KETONE TESTING EQUIPMENT THAT IS IN DATE

More information about management of diabetes when ill

Minor illness - urine ketones negative or trace or blood ketones <1.5

• Sip sugar free fluids
• Test blood glucose levels 4-6 hourly
• Have usual background insulin and quick acting insulin to carbohydrate ratio if eating
• Use corrective doses of quick acting insulin (1 unit will generally reduce blood glucose levels by 2-3 mmols/l)
• Corrections may need to be slightly larger as high blood glucose levels can cause insulin resistance
• May still need correction doses of quick acting insulin if not eating
• May only require background insulin if not eating and blood glucose levels in target

Severe illness - urine ketones +/++ or blood ketones 1.5-3

• Sip sugar free fluids
• Test blood glucose and ketones every 2 hours
• Have 10% of total daily dose as quick acting insulin every 2 hours plus usual quick acting insulin to carbohydrate ratio if eating
• Always have background insulin

Severe illness - urine ketones +++/++++ or blood ketones >3

• Sip sugar free fluids
• Test blood glucose and ketones every 2 hours
• Have 20% of total daily dose as quick acting insulin every 2 hours plus usual quick acting insulin to carbohydrate ratio if eating
• Always have background insulin
  

Feeling unwell - Test Blood Glucose & Ketones
Minor Illness		Severe Illness
Sip sugar Free Fluids at least l00mls an hour		Sip sugar Free Fluids at least l00mls an hour
Test Blood Glucose & Ketones every 4-6 hours		Test Blood Glucose & Ketones every 2-4 hours
Usual Quick Acting : Carbohydrate ratio if eating Use correctives (may find you need larger Quick Acting doses to reduce blood glucose) May only need background insulin if not eating May need Quick Acting correctives even if not eating Usual background insulin but may need to increase by 1-2 units if unwell for more than a day		Calculate total daily dose from previous day
		Urine Ketones +/++ Blood Ketones 1.5-3 mmol/l Give 10% of total daily dose as quick acting insulin every 2 hours PLUS usual Quick Acting:Carbohydrate ratio if eating PLUS usual background insulin		Urine Ketones +++/++++ Blood Ketones >3 mmol/l Give 20% of total daily dose as quick acting insulin every 2 hours PLUS usual Quick Acting:Carbohydrate ratio if eating PLUS usual background insulin
If you are continuously vomiting and are unable to keep fluids down, or are unable to control your blood glucose levels then you must contact the hospital as an emergency

Table source: LTHT June 2011

As you know, keeping your diabetes in good control is the key to staying healthy. You check your blood glucose levels at different times of the day to make sure your diabetes plan is working. These tests tell you what your blood glucose level is at that moment, which is very helpful. However, your blood glucose levels change a lot over the course of a day. Although self-testing frequently is a good way to manage your diabetes, it ALONE does not give you the whole picture

There is another test that can tell you your average blood glucose for the past 2 to 3 months. This test is called a Haemoglobin A1. You may hear a few different names for this test, including: HbA1c, Glycohaemoglobin, A1C

What is Haemoglobin?
Haemoglobin is a protein inside your red blood cells. It is the part of the red blood cell that carries oxygen from your lungs to the rest of your body. Haemoglobin also carries glucose, because glucose can stick to all kinds of proteins in your body. Once glucose sticks to haemoglobin, it is stuck there for the life of the red blood cell, about 3 or 4 months. The more glucose there is in your blood, the more will end up stuck to the haemoglobin

What does the HbA1c measure?
HbA1c is a measure of how much glucose is stuck to your haemoglobin. Your HbA1c reading tells you and your healthcare team what your average blood glucose level has been for the past 2 or 3 months. If you have lots of glucose in your blood and your average blood glucose has been high for the past few months, then your HbA1c will be high. The HbA1c test allows you to see how good your control has really been. You should talk to your healthcare team about your daily blood glucose tests and your HbA1c

How does my HbA1c reading compare to my daily blood glucose levels?

This chart is an example of how blood glucose compares to HbA1c. The numbers in this chart are for non-pregnant adults. “Take action” depends on your own plan, and your action steps should be discussed with your healthcare team. Some labs use different ways to test and have a different normal range. Talk to your healthcare team about your results

How can HbA1c testing help me?
An HbA1c higher than 7.4% is a warning sign that your diabetes is out of control. If your haemoglobin HbA1c is high, your healthcare team may change your diabetes plan to help control your blood glucose better. Changes in your plan are expected from time to time and will help bring your HbA1c closer to normal. When your HbA1c is close to normal, you know you are doing all you can to stay healthy

Research shows that good blood glucose control does lower your risk of developing major diabetes related health problems including heart disease, stroke, kidney disease, eye disease, nerve damage, amputations, and circulation problems. By keeping your blood glucose close to normal, you will stop or delay the damage high blood glucose does to blood vessels and nerves. You can prevent the complications of diabetes

Where do I go for an HbA1c test?
Some doctors can do an HbA1 in their office by taking a blood drop from a finger prick. You can wait for the results and discuss them right away. You can also go to the lab for this test but will have to return at a later date to discuss the result with your doctor.

How often should I have an HbA1c test?
The ACE and AACE recommend that anyone with diabetes should have an HbA1c done every 6 months for people at or below the target of 7.4%, and every 3 months for those above7.4% or changing therapy. If you inject insulin, you should have this test done every 3 months. Two major studies have shown the importance of good blood glucose control and the relationship of the HbA1c to diabetes complications:

The first was the Diabetes Control and Complications Trial (DCCT). In this study, patients with type 1 diabetes had an HbA1c every month. This gave the healthcare team useful information to change treatment plans. In this study, patients who had close to normal HbA1c were in better health and had fewer cases of eye disease, kidney disease and nerve damage

The other study was called the United Kingdom Prospective Diabetes Study (UKPDS). This was a study done with patients with type 2 diabetes. People who had good blood glucose control were in better health in this study, too

Both of these studies show that the hard work it takes to control your blood glucose is worth it. Your healthcare team will help you take good care of your blood glucose. They will tell you how often you should have an HbA1c test performed

Source for this section: Bayer Healthcare

GLYCAEMIC INDEX

The Glycaemic Index (GI) is a ranking of carbohydrate foods based on their immediate effect on blood sugar levels. Carbohydrate foods that break down quickly during digestion have a higher GI value because they quickly cause a higher rise in blood sugar. In comparison, carbohydrates that breakdown slowly, release glucose more gradually into the bloodstream and have low GI values

As well as improving your blood sugar levels, diets that contain a greater proportion of lower GI carbohydrates have been shown to be more satisfying, can help with weight loss and improve blood cholesterol levels.
Remember that the glycaemic effect is seen when you compare foods with the same (grammes) of carbohydrate

The most important part of ‘Carbohydrate Counting’ is to calculate the TOTAL amount of carbohydrate in a meal, regardless of type and adjust the insulin dose accordingly. The effect of the glycaemic index is not as obvious when patients are taking fast acting insulin before meals. But, if you find that your blood sugar response is different to that expected, you may want to consider whether the glycaemix index of food eaten was particularly different. For example, you may get a lower blood sugar response after eating a portion of pasta compared to a jacket potato (same grammes of carbohydrate)

The table below shows typical carbohydrate foods and lists them in order of their glycaemic effect with the foods on the right having the lowest GI, i.e. more likely to cause a smaller rise in the blood sugar level

You can download a 5MB PowerPoint presentation on Carbohydrate Counting

Source for this section: Royal Bournemouth Hospital

SHARPS DISPOSAL

Unfortunately we are no longer able to accept your full sharps bins, instead you can take them to these pharmacies:

ALCOHOL & DRUG IMPLICATIONS

Alcohol
For the majority of students alcohol is a routine part of their life at University, and a diagnosis of Diabetes doesn't automatically mean that alcohol is a no go area

• Never drink on an empty stomach
• The sugar in some alcoholic drinks may cause your blood glucose to initially rise
• Have a carbohydrate snack after drinking even if your blood glucose appears high
  
• Drinks with a high alcohol content are more likely to cause hypos
• Alcohol in excessive levels may distort your ability to sense when your blood glucose levels are too high or too low
  
• Be aware that low alcohol or alcohol free drinks usually have a much higher sugar content
• If you are taking insulin or diabetes medicines a few hours after the alcohol it may cause hypos
• Never drink and drive - alcohol can cause a severe hypo and can affect your blood glucose into the next day
• Ensure your friends know what to do if you have a hypo

Drugs
As most people will realise the use of illegal drugs carries health risks, but patients with diabetes should be aware that the effect of drugs become much more unpredictable, and in some circumstances life-threatening

• Any drug use may distort your ability to sense when your blood glucose levels are too high or too low
• Speed, Ecstasy, and cocaine all suppress the appetite, which combined with dancing can cause a severe hypo
• Cannabis stimulates the appetite, and excessive food intake could raise your blood sugar level
• Cannabis can make people feel out of it, which could cause you to forget to take insulin/medication
• It is OK to say no to drink and drugs - not everyone drinks to excess or takes drugs!
• Ensure your friends know what to do if you have a hypo

HEALTHY EATING

You can take a look at the following (general advice) pages on our web site:

• Healthy Eating For Students
  
• Healthy Eating
• Avoiding Food Poisoning

DRIVERS WITH DIABETES MELLITUS

From September 2010 the minimum medical standards in the new EC Directive came into force

This means that a Group 2 driver with diabetes receiving treatment with a sulphonylurea or glinide (or insulin) who has had an episode of disabling hypoglycaemia (requiring the assistance of another person) within the preceding 12 months should be advised to stop driving and notify DVLA

A Group 1 (car/motorcycle) driver with diabetes who has had more than one episode of disabling hypoglycaemia (requiring the assistance of another person) within the preceding 12 months should also be advised not to drive and to notify DVLA

WEB SITES

When you select one of the links below you will open the new site in this existing window. You can hit the Back button in your Internet browser to return here, or select this site from the Address drop-down list

• www.bbc.co.uk/health/conditions/diabetes/index.shtml BBC Diabetes home page
• www.abbottdiabetescare.co.uk Freestyle and Optium exceed meters and general information
• www.lifescan.co.uk One Touch Meters and some general information and useful links
• www.accu-chek.co.uk Meters and some general information
• www.ascensia.co.uk Bayer Healthcare - Contour and Breeze meters and general information
• www.bddiabetes.co.uk Needles and general information
• www.disetronic.com Information about Insulin pumps
• www.minimed.com Information about Insulin pumps
• www.diabeteswellness.net General information relating to living with Diabetes
• www.diabeticretinopathy.org.uk General information relating to living with Diabetes
• www.lilly.co.uk Follow - conditions, Diabetes - range of self help leaflets
• www.leedsteachinghospitals.com/sites/diabetes Carbohydrate counting tables and general information
• www.diabetesleeds.org.uk general information
• www.changingdiabetes.co.uk Novonordisk web site
• www.diabetes-healthnet.ac.uk/leaflets/main.htm Tayside Regional Diabetes Network
• www.patient.co.uk Information relating to a wide range of health/disease and medication issues
• www.diabetes.org.uk Diabetes UK web site
• www.yorkshirediabetes.com Comprehensive site covering general information and all equipment
• www.iddtinternational.org Insulin Dependent Diabetes Trust
• www.jdrf.org.uk Juvenile Diabetes Research Foundation
• www.xpert-diabetes.org.uk Structured education programme for self management
• www.goodtogoinsurance.com/Travel insurance for Diabetics and other conditions
• www.DiabeticTravel.co.uk Travel insurance for Diabetics
• www.DiabeticLife.co.uk Life insurance for Diabetics

Note: Novo Nordisk operate an out-of-hours emergency diabetes HELPLINE for people with diabetes, who use their products. Telephone 0845 600 5055

Source for sections unless specified separately: LSMP