Why do I need to take insulin? - Staying in control www.withyoualltheway.info
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Why do I
need to take
insulin?
Staying in control
www.withyoualltheway.info
At Novo Nordisk, we are changing diabetes.
In our approach to developing treatments,
in our commitment to operate profitably and
ethically and in our search for a cure.
With you all the way is a patient
support programme created by
Novo Nordisk, providing practical
information on diabetes and its
management for children and
young adults with diabetes.
This material has been reviewed by
a panel of experts:
Lead Diabetes Specialist Nurse –
Nicola Lewis, UK
Paediatric Endocrinologists –
Prof Thomas Danne, Germany
and Dr Nandu Thalange, UK
Why do I
need to take
insulin every
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
day?
or nurse if you have any questions or
concerns about managing your diabetes.
1
It is important that you take insulin every day to maintain
control of your diabetes.1
As your pancreas is no longer able to make insulin, your body
is unable to transport glucose from the blood to other cells
in the body that need it for energy.1
Taking insulin, either by injection or by using a pump, helps
to regulate your blood glucose levels.1 If you are receiving
injections, you will need to inject insulin several times a day.
Some people have a fixed insulin dose with meals and some
vary the amount of insulin according to carbohydrate intake
(usually called ‘carb counting’). Whether you have a regular
fixed dose, or you count carbs, you should also adjust your
insulin dose according to your blood glucose level and
physical activity.
Your insulin needs will change as you grow and develop,
so you will have your insulin regimen reassessed regularly.2
2
Sometimes you may forget to take your ALEKSEY EVSTRATOV,
Russia
insulin at the normal time. This will cause Aleksey has type 1 diabetes
your blood glucose to increase.
You should discuss with your doctor or
nurse what to do if you forget a dose,
so you have a plan in place.
When your blood glucose is too high,
you may notice some of the following
signs and symptoms:1
Feeling hungry
Feeling very thirsty
Feeling tired or exhausted
Frequent urination
Blurred vision
What if I
forget to
take my
3
insulin?
Diabetic DKA can be confirmed by testing ketone
levels in your blood or urine using testing
ketoacidosis strips. You should check for ketones if
your blood glucose is high, particularly
(DKA) if you are unwell.
If hyperglycaemia is left untreated, it may If you have any of the signs of
lead to a life-threatening condition called DKA, tell your parents or teacher
diabetic ketoacidosis (DKA). immediately or contact your doctor/
nurse directly as you may need to
DKA happens when there is a lack of go to hospital. DKA is a medical
insulin circulating in the blood, which emergency – it is important to take
causes the body to start breaking down it seriously.
fats for energy, producing chemicals
called ‘ketones’.
Signs of DKA include:1
Nausea and vomiting
Stomach pain
Fruity odour on your breath
(‘ketones’) – often described
as similar to nail polish remover
Rapid breathing
Dehydration (e.g. dry tongue, passing
urine less frequently)
Increased blood glucose levels
4
What will happen if I stop These tests – urine and blood tests,
eye checks and foot examinations –
taking insulin? give important early warning signs of
problems at a stage when they can be
Some days you may feel like you want to skip injections, treated. Remember, with good control
but you should be aware that skipping insulin can have you can live a normal, healthy life.
serious consequences.
Without adequate insulin your blood glucose levels will
increase. High blood glucose (hyperglycaemia) can make
Taking control
you feel unwell and can lead to DKA and other problems of diabetes
like infections, as well as increasing your chance of
long-term complications. It is important to learn how to manage your
diabetes and how to balance your food intake,
insulin dosing and physical activity.4
Risk of long-term problems Maintaining good glucose control
can help to prevent complications
Poor glucose control over time can increase the risk of
in the future.3
long-term complications.3 Prolonged high blood glucose
levels have been shown to increase the risk of problems
with your feet, eyes, kidneys, nervous system or heart.1
Good control will prevent you developing complications
for many years.
Your doctor or nurse will look out for signs of
complications at your routine check-ups.
5
Goals
You are given a higher glucose target at bedtime to reduce
your risk of hypoglycaemia at night. However, it is also
important that your blood glucose levels are not too high
at bedtime. If you are aiming for a blood glucose level
over 10 mmol/L (180 mg/dL) because you are worried Long-term goals that you should be
about hypoglycaemia, you should talk to your diabetes aiming for are:5
care team – they can advise you on how to stay
Before a meal – levels should be
in control.
between 4.0 and 8.0 mmol/L
Don’t worry if you don’t reach these goals straight (72–144 mg/dL)
away. It can take a long time to get your diabetes 2 hours after a meal levels should
under control, and your insulin needs will change be no more than 10.0 mmol/L
during your teenage years. Once you have finished (180 mg/dL). One way to help you hit
growing (girls around 15 and boys around 17), your glucose target after meals is to
you may need less insulin. make sure you are injecting on time –
ideally, just before you eat
At bedtime levels should be between
7.0 mmol/L and 10.0 mmol/L
(126–180 mg/dL)
Lars Myhrer,
Norway
Talk to your doctor or nurse about your
Lars has type 1 diabetes
progress and what you can do to get closer
to these goals.
6
Staying in
control of
your diabetes
Learning to manage your diabetes will help you to balance
your blood glucose levels and can help to avoid hypoglycaemia
and hyperglycaemia. Your doctor or nurse will teach you how
to manage your diabetes.
7
Tips6
Check your blood glucose regularly Learn how to recognise signs of hypoglycaemia
– This will help to track your blood glucose levels and and hyperglycaemia
make adjustments if necessary – Know what you need to do if they happen
– People who test themselves four or more times a day
usually have better blood glucose control than people Try to exercise regularly and adjust your insulin or have
who test less frequently a snack when exercising
– Keep a record of your progress to help you – This can help to prevent hypoglycaemia
manage your insulin, and pick out times which
are a problem, such as after exercise or before Stick to your meal plans
your evening meal. Your diabetes care team can – Don’t skip meals as this can lead to hypoglycaemia
look at the patterns of glucose results and help
you get your insulin doses right Don’t skip insulin doses
– T his can lead to hyperglycaemia and
diabetic ketoacidosis
8
Hypoglycaemia is not a pleasant experience and you
may worry about it happening in front of other people.
However, keeping blood glucose levels too high is dangerous
in the long-run as it increases your risk of infection, diabetic
ketoacidosis and long-term complications.
Should I aim for
higher blood
glucose levels
to avoid
hypoglycaemia?
If you have any questions or concerns, speak to your doctor or nurse.
9Sude IĞdır,
Turkey
Sude has type 1 diabetes
References
1. NIH Medline Plus Library. Type 1 diabetes.
Available at: www.nlm.nih.gov/
medlineplus/ency/article/000305.htm
Accessed October 2012.
2. Silverstein J et al. Care of children and
adolescents with type 1 diabetes. Diabetes
Care 2005; 28(1): 186–212.
3. Rewers MP et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Assessment and monitoring of glycemic
control in children and adolescents with
diabetes. Pediatr Diabetes 2009;
10(Suppl. 12): 100–117.
4. Smart C et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Nutritional management in children and
adolescents with diabetes. Pediatr Diabetes
2009; 10(Suppl. 12): 100–117.
5. Diabetes UK. Children and diabetes. Available
at: www.diabetes.org.uk/information-for-
parents/ Accessed October 2012.
6. NIH Medline Plus Library. Managing your
blood sugar. Available at: www.nlm.nih.
gov/medlineplus/ency/patientinstructions/
000086.htm Accessed October 2012.
7. Novo Nordisk website. Available at:
www.novonordisk.com
Accessed October 2012.
10About Novo Nordisk
This information was developed by Novo Nordisk, Since then Novo Nordisk has grown to become a
a global healthcare company specialising in the world leader in the provision of diabetes products
care of people with diabetes. and support for patients of all ages.7
Novo Nordisk was started up almost 90 years ago We fully understand the challenges that children
by a Danish couple with a passion for changing with diabetes face and are working together with
diabetes. August Krogh was a professor at the parents, schools and healthcare professionals to
University of Copenhagen and Nobel Prize winner improve the care of children with diabetes, as they
and his wife Marie, a doctor and researcher into grow up and develop.
metabolic diseases, suffered from type 2 diabetes.
They learned of insulin being developed in Canada For more information about Novo Nordisk,
and were determined to ensure access to insulin please visit: www.novonordisk.com
for everyone with diabetes, hence in 1923
Novo Nordisk was born.
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
or nurse if you have any questions or
concerns about managing your diabetes.
APROM ID#4599; approval date: December 2012.
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S.
Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark
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