Diabetic (Charcot) Foot

How does Diabetes Affect Your Body?

High blood sugar levels can affect your entire body. Many people with high blood glucose levels may initially feel normal and not realise that the high blood glucose level is silently doing damage.

Diabetes is a chronic condition that can impact other functions of the body including the: Feet, Toes and Skin

What is Diabetes?

Diabetes is a condition characterised by high levels of glucose (or sugar) in the blood. When a person has a high blood sugar level they are said to be hyperglycaemic.

Glucose is essential for providing the body with energy. The body converts many of the foods that we eat into glucose. A hormone called insulin is required to transfer glucose from the bloodstream to the body’s cells.

If you suspect or know you have diabetes it is important to speak with your doctor to seek testing and advice on how to best manage your diabetes.

What is the Cause of Diabetes?

Diabetes occurs when there is not enough insulin to help get the glucose out of the bloodstream and into the body’s cells.

All types of diabetes lead to high blood glucose levels. The most common are Type 2 Diabetes Mellitus, Type 1 Diabetes Mellitus and Gestational Diabetes Mellitus. Each diabetes type has a different cause. (please see “What are the types of diabetes”). 

 High blood glucose levels usually occur because:
  • The pancreas is unable to produce any or enough insulin. This happens in Type 1 Diabetes Mellitus
OR
  • The body’s cells are resistant to the action of insulin (insulin resistance). This occurs in Type 2 Diabetes Mellitus

What Part does the Pancreas Play in Diabetes?

The pancreas is a leaf-shaped gland located behind the stomach. It is responsible for the production of insulin, which is the hormone that helps regulate blood glucose levels.

After a meal, the blood glucose level rises, causing the pancreas to normally release insulin into the blood. In a healthy person, the insulin allows the body’s cells to absorb glucose so it can be used as energy. When there is enough insulin, the blood sugar levels stay in the normal range. 

For people living with diabetes, there are two main reasons why the blood sugar levels are high. This is because either:
  1. Little or no insulin is produced by the pancreas, or
  2. The body’s cells are resistant to the action of insulin. 
This results in glucose being unable to enter the cells and therefore we see increased blood glucose levels (sometimes known as hyperglycaemia).

What are the Types of Diabetes?

Type 1 Diabetes Mellitus:

Type 1 Diabetes Mellitus is caused by an autoimmune condition, where a person’s own immune system attacks the cells of the pancreas which produce insulin. This leads to very low levels of insulin. Its onset is often sudden and without warning. There is currently no way of preventing it and no cure. People living with Type 1 Diabetes Mellitus do not produce any insulin and need insulin treatment to survive. This insulin can be given either by multiple injections per day or via an insulin pump.

Type 1 Diabetes accounts for around 10% of all diagnosed cases of diabetes.

People living with Type 1 Diabetes Mellitus can lead a normal, long and healthy life with the right support of family, friends, medical team along with medications, insulin and new technology.

Another term for Type 1 Diabetes Mellitus is Juvenile Diabetes – however adults can also develop Type 1 Diabetes Mellitus.

Type 2 Diabetes Mellitus:

Type 2 Diabetes Mellitus is caused by the inability of the pancreas to produce enough insulin and/or the body’s cells being resistant to the action of insulin. It is the most common type and accounts for around 85-90% of all diagnoses of diabetes.

Type 2 diabetes is a condition that gradually progresses over time.

While there is no cure for the condition, it can be managed. People with Type 2 diabetes can lead normal, healthy and happy lives.
 
Lifestyle changes, such as exercising and improving your diet, are effective ways to treat Type 2 Diabetes Mellitus. People with Type 2 Diabetes Mellitus may also need medications to treat their condition depending on the severity of the condition. Along with lifestyle changes the medications may be a combination of tablets and/or injections.

MODY (Maturity Onset Diabetes of the Young):

MODY is caused by a single abnormal gene. It accounts for approximately 1-2% of all diabetes diagnoses and is caused by a genetic mutation that is often passed down in families.It is a rare form of diabetes that is different to Type 1 and Type 2 Diabetes Mellitus.

People with MODY are often diagnosed before the age of 25.

The treatment is often tablets or sometimes a combination of tablets and insulin injections.

Secondary Diabetes Mellitus:

Secondary diabetes occurs when the pancreas is damaged and unable to make insulin. Sometimes it is referred to as Type 3 Diabetes Mellitus.

Secondary diabetes is most commonly caused by pancreatitis or inflammation of the pancreas. Examples of common causes of secondary diabetes mellitus include:
  • Pancreatitis
  • Haemochromatosis
  • Cystic fibrosis
  • Trauma to the pancreas
  • Pancreas surgery such as pancreatectomy
  • Pancreatic agenesis
  • Pancreatic cancer

Gestational Diabetes Mellitus:

Gestational diabetes is diabetes that first appears during pregnancy.

Approximately 12-14% of pregnant women will develop the condition around the 24th to 28th week of pregnancy.

It is important to remember that sometimes women who have no risk factors may develop Gestational diabetes. Therefore, all women should be tested for the condition between the 26th to 28th week of pregnancy or earlier if you have multiple risk factors for the condition.  

Gestational diabetes needs to be monitored closely by the health care team as poorly controlled blood glucose levels can have severe impacts on both the health of the mother and baby.

Gestational diabetes is often managed simply with changes to diet and exercise, however some women may require tablets, insulin injections or both.

Once women with gestational diabetes give birth, the diabetes should go away. However, women who have had gestational diabetes are at greater risk for developing Type 2 Diabetes Mellitus in the future and require lifelong screening.

Risk Factors for Developing Type 1 Diabetes

  • Anyone can get Type 1 diabetes - it does not discriminate. People who have a family history of diabetes eg. a parent or sibling with type 1 diabetes or genetic predisposition are at increased risk of type 1 diabetes.  
  • Sometime triggers like infections can make people more at risk to autoimmune conditions like Type 1 Diabetes Mellitus

Risk Factors for Developing Type 2 Diabetes

There are many factors which may put a person at increased risk of developing this condition. Some of these include:
  • Family history of diabetes
  • Being overweight or obese
  • Being over 45 years old
  • Genetics, especially people from some cultural backgrounds (Aboriginal and Torres Strait Islander, Pacific Islander, Indian and Chinese)
  • Women who have previously had Gestational diabetes while pregnant.
  • Unhealthy diet
  • Sedentary lifestyle
  • Having high blood pressure
  • Having abnormal cholesterol levels in blood

Risk Factors for Developing Secondary Diabetes

  • Pancreatitis
  • Pancreas surgery or removal of the pancreas
  • Medical conditions that can be associated with damage to the pancreas such as cystic fibrosis 

Risk Factors for Developing Gestational Diabetes

Only pregnant women can develop gestational diabetes. The risk factors include:
  • Being over the age of 40
  • Having a mother or sister with a history of Type 2 or Gestational diabetes
  • Being overweight or rapidly gaining excessive weight in the first trimester of pregnancy
  • Cultural background (Aboriginal or Torres Strait Islander, Melanesian, Polynesian, Chinese, Southeast Asian, Middle Eastern or Indian)
  • History of Polycystic Ovarian Syndrome
  • Gestational diabetes in previous pregnancies
  • History of large birth weight (greater than 4.5kg) in previous pregnancies.

How Often should I See My Doctor to Assess My Risk of Diabetes?

Everyone over the age of 40 should be screened for diabetes every three years using a risk calculator like AUSDRISK.

Aboriginal and Torres Strait Islander people should begin having AUSDRISK assessments from the age of 18.

You can calculate your risk using the AUSDRISK score and answering 10 simple questions - https://www.diabetesaustralia.com.au/risk-calculator
Did you know?
Half a million Australians could have Type 2 Diabetes Mellitus but don’t know it!

What are the Symptoms of Diabetes?

The main symptoms of Type 2 Diabetes Mellitus are:
  • Increased thirst and drinking
  • Hunger
  • Frequent urination
  • Tiredness
  • Increased infections
  • Blurry vision
  • Dark pigmentation in certain parts of the body
  • Some people may have no symptoms at all and not know they have diabetes 
The main symptoms of Type 1 Diabetes Mellitus are the 4 T’s:
  • Thirst (feeling thirsty and needing to drink more fluids)
  • Toilet (needing to urinate more frequently)
  • Thinner (weight loss)
  • Tired
As insulin production declines, a patient may develop:
  • Stomach pain
  • Vomiting
  • Become very ill
Whatever the type of diabetes if there is sustained, uncontrolled high blood sugar (hyperglycaemia) it can damage the heart, blood vessels, eyes, kidneys and nerves. If you are at risk, see your doctor early to prevent this damage from happening.
Diabetes complications start before diagnosis
  •  If you have risk factors for diabetes do not delay seeing your doctor
  •  As many as half of all people diagnosed with diabetes already have developed one or more diabetes related complications
You can find more about diabetes by watching this video clip

Diagnostic Tests for Type 2 Diabetes

There are different ways for your doctor to diagnose diabetes
  • Fasting (pre-meal) blood glucose level more than 7.0 mmol/L
  • Random blood glucose level more than 11.1 mmol/L
  • Glycated haemoglobin (HbA1c) more than 48 mmol/mol (6.5%; on two separate occasions)
Other tests used to determine a patient's type of diabetes, stage, progression, treatment pathways or effective diabetes management are:

Urine Test:

This is done to check for the presence of protein, glucose or ketones in the urine. Presence of glucose in the urine is highly suggestive of diabetes. Presence of protein in the urine can suggest the kidneys are damaged or “leaky” and may be a sign of renal failure.

HbA1c Test:

HbA1c is a measure of how much glucose is stuck to the red cells and gives an average of all your blood sugar levels over the last three months.

Target HbA1c is usually individualised for each patient:
  • For most people living with diabetes the target HbA1c is ideally less than 7% (53 mmol/mol) to reduce the chance of long term diabetes complications.
  • For young people or women planning pregnancy the target HbA1c may be lower at around 6.5% (48 mmol/mol) or less.

Oral Glucose Tolerance Test:

This is done to confirm Type 2 Diabetes and Gestational Diabetes Mellitus.

Following an overnight fast, your blood is tested for glucose. This is compared with periodic blood tests taken for the next two hours after drinking a special sugar drink.

It measures how quickly glucose can be cleared from the blood.

Fasting Blood Sugar Test:

  • The blood sugar level is tested after an overnight fast.
  • Levels of 5.5mmol/L to 6.9 mmol/L is inferred as pre-diabetes
  • Levels more than 6.9mmol/L on two or more separate tests on different days indicates diabetes.

Random Blood Sugar Test:

  • Blood is tested at a random time of the day for glucose levels. For example, this may be after a meal.
  • Blood glucose levels of 11.1 mmol/L or higher indicates diabetes.
Watch this video find out why it is important to detect diabetes early

Treatments for Type 2 Diabetes

There is no such thing as ‘mild’ diabetes. All types of diabetes are serious and require life long follow up and management in combination with a healthy lifestyle and often medications.

Management of Type 2 Diabetes is with lifestyle changes and often medications.
Watch this video to find out more about managing type 2 diabetes

Lifestyle Changes

  • Healthy eating
  • Increased physical activity
  • Healthy body weight
  • Quitting smoking

Medication

Along with healthy eating, weight control, increased physical activity and diabetes education, medications are needed for some people. Medications can be taken either orally or as injections.

Examples of classes of medications that may be used include:
  • Biguanides (Metformin)
  • Sulfonylurea
  • Thiazolidinedione
  • DPP-4 inhibitor
  • SGLT-2 inhibitor
  • GLP-1 agonist
  • Insulin
Each of the different class of medications has different levels of efficacy, side-effects, impact on weight loss, varying costs and risks of hypoglycaemia.In Australia most, but not all, of the medications used for treating diabetes are subsidised by the government PBS (Pharmaceutical Benefits Scheme). Visiting an endocrinologist can help to individualise the right management plan for you.

How Often do I Need to Check My Blood Sugar Level if I am on Insulin?

If you are on insulin, routine self-monitoring of your blood glucose is recommended. 

The type of insulin you are on and the type of diabetes that you have will determine how often you will need to check your glucose level. It may include checking your blood glucose:
  • Before food
  • Before going to bed
  • Before driving
  • Before exercise 
  • If you think you have symptoms of a low blood glucose level (hypoglycaemia)
  • Or a combination of these
You will need to check with your doctor to find out what is best for you and how often you need to check.

How Often do I Need to Check My Blood Sugar Level if I am on Tablets (not Insulin)?

If you are on tablets that do not cause hypoglycaemia you may not need to routinely monitor your blood sugar level. Instead your doctor may organise routine HbA1c levels to measure your 3 monthly average glucose level.

What should My Target Blood Glucose Level be?

The ideal target for everyone with diabetes will vary. Talk to your doctor about what the right targets should be for you. In general targets for blood glucose levels are:
  • Fasting blood glucose level of 4-7 mmol/L
  • Post meal blood glucose level of 6–10 mmol/L  
Blood glucose levels should be individualised. If you are young or planning pregnancy lower blood sugar levels may be recommended. For some people, such as those with cancer or dementia, higher blood sugar levels may be ok.

With the right treatment you can prevent diabetes causing complications.
Facts and Figures:
  • 60% of Australians with type 2 diabetes will experience some form of diabetes related eye disease within 20 years of developing diabetes.
  • Diabetes is the leading cause of end stage kidney disease.
  • Around 65% of all cardiovascular disease related deaths in Australia occur in people with diabetes or prediabetes.

How can You Reduce Your Risk of Diabetes Complications?

There are three important ways to reduce your risk of developing long term, irreversible diabetes complications:
  1. Aiming for optimal blood glucose control
  2. Aiming for a blood pressure of less than 140/90 mmHg
  3. Regular screening tests to pick up early changes before any damage has occurred.

What Screening Tests do You Need if You Live with Type 2 Diabetes Mellitus?

Regular screening tests can reduce your risk of long term diabetes related complications.Your diabetes care plan or annual cycle of care will include regular tests and screening:

Feet & Nerves

Routine foot checks with GP or podiatrist. If there is numbness or diabetic neuropathy than you will need to take special care of your feet.
  • Inspect your feet regularly.
  • Wash, dry and look at your feet every day, especially between your toes.
  • Always wear well fitting shoes.
  • See you doctor early if you develop an ulcer or signs of an infection such as redness or swelling. 
  • You may need to have scans to check blood flow in the feet or see a surgeon if you have wounds on your legs or feet that won’t heal.

Management of Type 1 Diabetes

The management of Type 1 Diabetes involves a combination of
  • Insulin by multiple daily injections or insulin pump
  • Exercise
  • Healthy diet
  • Regular blood sugar measurements.
People living with Type 1 Diabetes need regular specialist care as their medical needs change and to screen for potential diabetes related complications. Activities and illness also affect their treatments.

Insulin Treatment in Type 1 Diabetes

Insulin is essential for people with type 1 diabetes as the body produces little or no insulin. Without insulin, people with type 1 diabetes cannot survive. Whether you have an insulin pump or give multiple daily insulin injections, it is recommended that you:
  • Monitor your blood glucose levels regularly
  • Bolus for insulin if your blood glucose level is high
  • Bolus for insulin if you are eating carbohydrate containing foods
  • Learn to carbohydrate count so you can match the amount of insulin given with the amount of carbohydrate in the food
  • Adjust your insulin doses depending on activities such as exercise or work and illness
  • See your GP and endocrinologist routinely
  • Have routine screening for diabetes complications
Success requires work and effort. If you are willing to work at it, you will see the rewards!

Types of Insulin Used in Type 1 Diabetes

There are two main types of insulin.

Basal insulin

Basal insulin is also known as background insulin. This mimics the body’s natural steady release of insulin. When basal insulin is given it is absorbed slowly and gives the body a steady, low level of insulin to manage blood glucose.

Examples of basal insulin include Lantus (insulin glargine) and Levemir (insulin detemir). Alternatively, giving small continuous amounts of quick acting insulin via an insulin pump acts as basal insulin.

Quick Acting Insulin

A bolus of quick acting insulin is taken to cover the rise in blood sugar with food and/or if blood sugar levels are high. This mimics the body’s large peaks in insulin that are normally released in response to food or a high blood glucose level.

Quick acting insulins can be given via:
  • Pens
  • Needle and syringe
  • As a bolus via a insulin pump
Examples of quick acting insulin include Humalog (Lispro), Novorapid (Aspart) or Apidra (Glulisine).

Quick acting insulin is usually best taken 10-15 minutes before a meal. This is so that the insulin is “kicking in” and reaching its peak effect as you are about to digest the meal.

How Long does Insulin Last?

Depending on which type of insulin and how much insulin you take will determine how long an insulin will last.

Common insulin profiles include:
Rapid-acting insulin
Short-acting insulin
Intermediate-acting human insulin
Long-acting insulin
Pre-mixed Insulin
Onset
10-20 minutes
30 minutes
1.5 hours
1-2 hours
10-20 minutes
Peak
1-3 hours
2.5-5 hours
4-12 hours
3-14 hours
1-4 hours
Duration
3-5 hours
8 hours
24 hours
18 to 24+ hours
24 hours
Knowing how long your insulin lasts is important. You should avoid taking repeated doses of quick acting insulin before they have had time to “kick in” or you can cause “stacking” of insulin. Hypoglycemia or a lower blood glucose level can occur if you “stack” multiple doses of insulin. Instead you should allow 2 or 3 hours for your quick acting insulin to reach its peak before giving a second dose of quick acting insulin.

What if Diabetes is Untreated?

If left untreated, blood sugar can reach abnormally high levels leading to a condition called hyperglycaemia.

Uncontrolled diabetes can result in complications such as damage to
  • Eyes (leading to blindness)
  • Kidneys (leading to renal failure)
  • Heart (leading to heart disease or heart attack)
  • Brain (leading to stroke)
  • Nerves (leading to loss of sensitivity in various parts of the body)
  • Blood vessels (leading to poor blood flow to the feet, which can make them susceptible to poorly healing cuts and blisters. This could lead to amputation)
With the right management high blood glucose levels can be avoided and the damage from diabetes complications can be prevented.
Knowing how long your insulin lasts is important. You should avoid taking repeated doses of quick acting insulin before they have had time to “kick in” or you can cause “stacking” of insulin. Hypoglycemia or a lower blood glucose level can occur if you “stack” multiple doses of insulin. Instead you should allow 2 or 3 hours for your quick acting insulin to reach its peak before giving a second dose of quick acting insulin.

What is an Insulin Pump?

An insulin pump is a portable device used to deliver insulin.It is small enough to be placed in a pocket or on a belt. It is connected to a narrow tube that is attached to a cannula which is inserted under the skin to deliver the insulin.

How does the Insulin Pump Work?

Insulin pumps deliver short-acting insulin 24 hours a day. You can use buttons on the insulin pump to control the dose.
Insulin doses are divided into:
  • Basal insulin: Insulin that can be continuously delivered throughout the day and night.
  • Bolus insulin: A larger amount of insulin that is given to cover carbohydrates during meals.
  • Correctional insulin: Given if your glucose is high for any reason.

How do I Get an Insulin Pump and Start Using It?

Before starting an insulin pump it is important to consider the advantages and disadvantages of an insulin pump. Talking with your endocrinologist can be helpful to decide an insulin pump is right for you. Your doctor will work with you using either multiple daily insulin injections or an insulin pump to ensure that you can reach your goals with your diabetes.

A lot of time is needed to learn about the pump and your diabetes, especially in the beginning. All this important information is usually provided prior to starting the pump and at an insulin pump start up. Insulin pump start-ups (and upgrades) are done either as a short hospital admission or in an outpatient clinic.

Advantages of an Insulin Pump

Insulin Pumps are recommended for the following reasons:
  • Eliminates the need for regular injections
  • One needle every 3 days (instead of 4-6 needles every day)
  • Fewer variations in blood glucose levels
  • Easier & more convenient delivery of insulin bolus
  • Increased flexibility regarding when and what you eat
  • Eliminates the unpredictability of intermediate and long-acting insulin
  • Reduces the need to consume a large amount of carbohydrates in order to exercise.
  • Increased accuracy of insulin delivery 
  • Ability to give very small doses of insulin
  • Able to set alarms to remind you to check your blood glucose or bolus your insulin
  • Decreases your risk of hypoglycaemia during exercise without worsening diabetes control

Disadvantages of an Insulin Pump

Insulin pumps may not be selected for the following reasons:
  • Need to learn how to carbohydrate count prior to using a pump
  • Sometimes more skin problems or reaction to tape or adhesives
  • May cause weight gain
  • May be expensive
  • May be bothersome as you are attached to the pump all the time
  • May require a full day for training to use the pump
  • Requires willingness to keep in regular contact with your diabetes educator or endocrinologist for review and adjustment of pump settings.
  • The insulin pump must be worn all the time, but can be removed for short periods when showering, swimming or playing contact sports.
  • In rare cases, diabetic ketoacidosis may occur if the tube comes out and no insulin is received for hours.

How Much does an Insulin Pump Cost in Australia?

In Australia the full cost of insulin pumps are not covered by medicare or the NDSS. Without private health insurance, insulin pumps cost between $5000-$10 000+. 

Some private health insurance companies subsidise the cost of an insulin pump. Insulin pump consumables such as pump sets and lines are an ongoing cost for the patient and are not usually covered by private health insurance, NDSS or medicare.

As with all technology, insulin pumps do not last forever. Usually people will need a new pump every 2-4 years. You will need to speak to your diabetes educator or endocrinologist about a pump upgrade.

If you choose multiple daily injections with a pen or an insulin pump you will still have ongoing costs of insulin. In Australia insulin is subsidised by the government via the PBS (Pharmaceutical Benefits Scheme).

Checklist Before Starting an Insulin Pump

  • Willingness to learn about new pump technology 
  • Attend more frequent appointments when starting the insulin pump
  • Learn to carbohydrate count or participate in a DAFNE course
  • See a diabetes educator
  • Be willing to check blood glucose levels multiple times per day
  • Have an understanding of costs of insulin pump 
  • Consider taking out private health insurance

Which Insulin Pump should I Choose?

Different brands of insulin pumps are available in Australia and overseas.
The various brands of insulin pump differ in:
  • Features
  • Cost
  • Colour
  • Battery life
  • Screen size
  • Software
  • Tubing and consumables
  • Warranty
  • Water resistance  
  • Continuous glucose monitoring connectivity
  • Extra features such as a remote control
The available pumps and upgrades in Australia are always changing. The choice of pumps is yours. We can help you decide which is right for your needs. 

Your endocrinologist does not get any commission if you do or do not purchase an insulin pump – the only reward is seeing you living well with your diabetes!

How Often should I Check My Blood Glucose Level if I have Type 1 Diabetes Mellitus?

Knowing your blood glucose level can help you decide how much insulin to take. It is recommended to check your blood glucose level:
  • Before driving 
  • Before eating or giving insulin
  • Before exercising
  • Before going to bed
  • If you think you are having a “hypo” (low blood glucose)

What is Continuous Glucose Monitoring?

Continuous glucose monitoring systems (CGMS) give a continuous readout of the glucose levels in the body's tissues. The glucose in the tissues closely reflects the amount of glucose in the blood stream.

How is Continuous Glucose Monitoring Done?

A sensor about the size of a strand of hair is inserted under the skin and into the fat. This is similar to inserting an insulin needle or pump needle. The sensor is held in place by adhesive tape.

It stays in place for 5 to 14 days depending on the brand.

The sensor measures the glucose level and transmits the results either to an insulin pump or a CGMS transmitter. The user can find out in real time what their glucose level is at any stage.

Sometimes finger prick blood glucose levels will still be needed multiple times per day to calibrate the system.

How does Continuous Glucose Monitoring System Benefit Patients?

  • Provides a complete picture at all times of glucose levels 
  • Enables user to adjust insulin dose depending on trends
  • Enables diabetes team and patient to find out what is happening and analysing when and why blood glucose levels may be changing.
  • Most CGM’s have alarm systems that tell you when you are getting close to the limits you have pre-set for high and low blood glucose levels.
  • Some CGM’s can talk to the insulin pump and help avoid hypoglycemia

What do I do if I have Diabetes and I have a Low Blood Sugar Level?

A low BGL or hypoglycemia is a blood sugar less than 4 mmol.

Some people may or may not have symptoms if they are having a hypo. If you think you are having a hypo or have a low blood sugar level check your blood glucose level. (If you can’t check your BGL, treat it as a hypo, just in case.)

After you have recovered from your hypoglycemic event try and think what things may have caused your low blood sugar so that you can try and avoid it in the future. Hypoglycaemia can be caused by one or a number of events, such as:
  • Too much insulin 
  • Too much of glucose lowering diabetes tablets
  • Delaying or missing a meal
  • Not eating enough carbohydrate
  • Unplanned physical activity
  • More strenuous exercise than usual
  • Drinking alcohol
It is an emergency if the person is hypoglycaemic and is unconscious, drowsy or unable to swallow. Do not give them any food or drink by mouth. Treat as follows:
  1. Place them on their side making sure their airway is clear
  2. Give an injection of Glucagon if available and you are trained to give it
  3. Phone for an ambulance (Dial 000) 
  4. Wait with them until the ambulance arrives

Top Tips for Exercising with Type 1 Diabetes

  • Have more carbohydrate before the exercise
  • Have less insulin before and/or after exercising
  • Change the type of activity or take the type of activity you are doing into account when you are planning on the types of food you will eat and how much insulin you will give
  • Check your blood glucose level more often

What Routine Screening is Recommended for People Living with Type 1 Diabetes?

By having regular screening tests, you can reduce your risk of long term diabetes related complications.

Your diabetes care plan or annual cycle of care should include regular tests such as:
  • Eye check with your optometrist or ophthalmologist
  • Checking your feet with GP or podiatrist
  • Blood pressure monitoring
  • Kidney checks with blood and urine tests

What do I do if I have Type 1 Diabetes and Become Sick or Unwell?

Everyone with type 1 diabetes mellitus should have a sick day plan so that you can avoid developing life threatening diabetic ketoacidosis (DKA). When you are unwell it is important to:
  • Monitoring your blood sugar more frequently
  • Check your blood or urine ketones
  • Take extra insulin corrections if your blood sugar is high
  • Drinking lots of water if possible
  • Never stop taking your background or basal insulin
You need to go to hospital if you:
  • Have blood or urine ketones that are not lowering despite insulin 
  • Have persistent vomiting
  • Have persistent hypoglycaemia
  • Become drowsy or confused
  • Develop fast or unusual breathing
  • Develop abdominal pain
  • Are unsure what is wrong
  • The people who are caring for you are not sure what to do or are exhausted

What do I do if I have Type 1 Diabetes and Want to Travel?

  • Get travel insurance prior to booking your holiday– Some companies have HbA1c requirements
  • If you are an Australian citizen consider travelling to countries with reciprocal health agreement such as New Zealand, United Kingdom, Republic of Ireland, Sweden, Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway
  • Think about which country you are travelling to. What access to health care you may require?
  • Think about who you are travelling with. Do they have the information and skills to help you if required or do they need further education?
  • Think about what you will do with time zone changes – remember you always need to have insulin on board to avoid becoming unwell with DKA
  • Calculate what insulin you need and take 20% more as spare
  • Take a spare glucose meter- One that uses the same strips
  • See you doctor before in case you need other medications:
    • What if you get “Bali belly” or gastro?
    • Do you have medications to take if you are vomiting?
    • Do you need travel immunisations?
  • Make sure you pack everything you need
    • Travel letter (+PDF digital copy)
    • Take a list of medications (+PDF digital copy)
    • Sick day plan (+PDF digital copy)
    • Food & hypo treatment
    • Insulin pump failure action plan and spare insulin needles/pens
    • Pack your insulin in your hand luggage. Don’t pack insulin in stowed luggage as it will freeze in the hull of the plane

What if Diabetes is Untreated?

If left untreated, blood sugar can reach abnormally high levels leading to a condition called hyperglycaemia.

Uncontrolled diabetes can result in complications such as damage to
  • Eyes (leading to blindness)
  • Kidneys (leading to renal failure)
  • Heart (leading to heart disease or heart attack)
  • Brain (leading to stroke)
  • Nerves (leading to loss of sensitivity in various parts of the body)
  • Blood vessels (leading to poor blood flow to the feet, which can make them susceptible to poorly healing cuts and blisters. This could lead to amputation)
With the right management high blood glucose levels can be avoided and the damage from diabetes complications can be prevented.
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