What should you aim for?

Blood sugar values in people who do not have diabetes usually run between 4 and 7, but for most people with diabetes it is almost impossible to keep all results within this range. We are usually very pleased if we can keep most results above 4, but less than 10. It is more difficult to control the diabetes in some people than others, through no fault of their own. If you have done your best, and taken the doctors advice, you should not feel guilty if the blood sugars are less than ideal. Even in the most difficult cases, a conscientious effort to maintain reasonable blood sugars will always produce better results than trying to ignore the diabetes.
You should aim to have the blood sugars as low as they can be without causing excessively frequent (or excessively severe) episodes of hypoglycaemia. Long-term complications of diabetes are virtually never seen before puberty: most doctors looking after diabetes agree that in very small children it is safer to put up with blood sugar levels which are a bit high, rather than run the risk of severe hypoglycaemia.

Controlling the blood sugar - How's it done?

Measure the blood sugar to find out whether you are getting the right amount of insulin.
When you first started on insulin, the doctor had no way of knowing how much insulin you needed - he had to guess to begin with, and after that the blood sugar levels helped to guide him towards a more suitable dose. However, as you grow, your body changes, your diet changes and your activities change. This means that the amount of insulin you need will change as well, and the blood sugar results will help to guide you about when to adjust the dose.
The most useful times to check you blood sugar are before the main meals (breakfast, lunch and tea) and before the bedtime snack. For children who have an early evening meal, a test as soon as they come home from school is more useful than a teatime test. When things are going well, one test a day will do very nicely. Try to vary the time that you do the blood tests at, so that you get some blood samples at each of the times suggested above. If the blood sugar levels are unsatisfactory, it is worth your while to do the tests a bit more often, so that you can see more quickly whether the insulin dose needs to be changed.

1. Write down the results, along with the date and time. - otherwise they will soon be forgotten and useless
2. Keep a note of any changes in your usual routine. Write down the time that any “hypos” happened at – even if you were not able to check the blood sugar. Hypos can make your next blood sugar reading unusually high, but that doesn't mean you need more insulin!
3. It’s a team thing; the young person with diabetes should sit down with a parent, once every week, to look over the results and decide whether it would be helpful to modify the current treatment.
4. We know that it can be unpleasant and inconvenient to do a lot of blood tests. If you feel a bit embarrassed that you haven't done very many blood tests, do not “invent” results - it's a waste of your time, and it may result in the doctor giving you the wrong advice.

What does the blood sugar tell you?

The blood sugar level does not tell you how much insulin you have to take for your next injection! Instead, it tells you how well your last dose of insulin worked. It also tells you how what you have just been doing, and been eating, has affected your blood sugar.

Adjusting insulin

The rules are simple - the clinic doctor will advise you at the beginning, but we hope you will get a good idea of how it is done yourself before long.

1. Always remember that insulin makes the blood sugar come down
2. Look at the blood sugar results over the last few days. If you see a single blood sugar result that you don't like the look of - don't panic! No harm is done.
3. Wait to see if a particular problem usually occurs at a particular time of day – you will have to wait for a few days to be sure. If it does, you should adjust the insulin dose. The table below will guide you about which dose of insulin to adjust. It depends on how many injections you take each day, and what time of day the problem occurs at.

How many injections do you take in a day?	What time of day is the problem?
	Before Breakfast	Before lunch	Before tea	Before bedtime snack
2 each day	Adjust the teatime dose	Adjust the morning dose	Adjust the morning dose	Adjust the teatime dose
3 each day	Adjust the bedtime dose	Adjust the morning dose	Adjust the morning dose	Adjust the teatime dose
4 each day	Adjust the long-acting insulin	Adjust the morning dose of short-acting insulin	Adjust the lunchtime dose of short-acting insulin	Adjust the teatime dose of short-acting insulin

1. sometimes you will find that you cannot sort out a high blood sugar at one time of day without causing hypoglycaemia at some other time. You may need a different insulin mix, or a more flexible insulin routine – discuss this with your diabetes team.
2. If you are ill, you will need to check the blood sugar more often, and adjust the insulin more quickly.
3. Try to avoid frequent or severe 'hypos' - these will tend to make the blood sugars more erratic.
4. If the blood sugar results are very different from one day to the next on the same dose of insulin, changing the dose will not make them more consistent! See the section on dealing with unstable blood sugar values (page 7)
5. Trying to keep to exactly the same routine every day may not make your diabetes better controlled – but it will cause boredom and rebellion. If you are concerned about how best to handle a meal out, a day out, or a holiday - discuss this with the clinic staff.

We know that perfection is not possible. Do not blame yourself if, after your best efforts things still are not quite as good as you might have hoped - and do not be too quick to blame anyone else, either. It won't help, and can even make things worse!

If the blood sugar is over 17, ask yourself - can you explain it? Perhaps you have just eaten something sweet, or just recovered from a hypo. If so, then the blood sugar will probably return to normal after a few hours. If, however, there is no obvious cause, or the blood sugar is high because you are poorly, you should check the urine for ketones.

Ketones – what are they anyway?

Most people with diabetes have heard of ketones - but many will be unsure of why they are important.
When we have not eaten for a few hours, we rely on the body's stores of sugar and fat for energy. After a few more hours the sugar stores run low. At this stage we can no longer break down fat effectively - and ketones are produced as a by-product. Everybody will produce ketones if they are starved.
If the body is under stress - during an illness or after an accident - energy is used more quickly, and ketones appear sooner.
The most severe form of starvation occurs when someone with diabetes gets too little insulin. There may be a lot of sugar in the blood - but the body cannot use it because of the shortage of insulin. The production of ketones gets out of hand, and can result in a severe illness called "ketoacidosis".

When to test for ketones

If you are well, and the blood sugars are reasonably well controlled, you do not need to worry about ketones. If you are ill, or the blood sugars are running high, you should check a urine test for ketones. Ketostix and fast-acting insulin (Actrapid; Humulin S; Humalog; or Novorapid) are an essential part of your kit. Make sure they are not out of date. Your pack of Ketostix should be replaced when it has been open for 6 months.

What to do if you find ketones in your urine

If you have a high blood sugar with ketones (more than a trace), you will need extra insulin.
Extra insulin is given as an additional injection of fast-acting insulin. The dose is one-sixth of the normal amount of insulin you take in a whole day. (for example, if you usually take 24 units in the morning and 12 units at night, the amount of insulin you take in a whole day is 36 units. You would need an extra dose of 6 units of fast-acting insulin).
If the blood sugar is still high and there are ketones in the urine after 4 hours, repeat the extra dose. (If you cannot get a urine specimen, repeat the extra dose if the blood sugar is over 18). You may have to repeat several times in a day.

• Never omit your normal insulin
• If you are ill, follow the sick-day rules
• Look out for the signs of ketoacidosis. These are
• vomiting everything you eat or drink for more than 4 hours
• abdominal pain
• heavy or rapid breathing
• dehydration.

Ketoacidosis is a medical emergency which requires hospital treatment.

Ketones - Frequently asked questions

Q How often should I check blood sugar and urine ketone tests if my child is ill, or has persistently high  blood sugars?
A We suggest testing the blood sugar 4 times a day (before breakfast, lunch, tea and supper), and urine ketones twice a day.

Q  My child is feeling ill and eating less than usual. I tested the urine and found moderate ketones. The blood sugar is less than 12, so it does not seem right to give extra insulin – what should I do?
A If the blood sugar is low, the ketones are likely to be due to lack of food rather than lack of insulin. Make sure your child is getting enough energy in their food or drink – sugary drinks may be your best bet. Keep checking blood sugars and urine ketones regularly. If the blood sugar rises above 12 and the ketone levels in the urine are not settling, give extra fast-acting insulin as described above.

Q The blood test result is very high, but there are no ketones in the urine. Should I give extra fast-acting insulin?
A Blood sugars go up and down a lot during childhood, and if you give extra insulin after a single high result, it will often be followed by hypoglycaemia. The best idea is to recheck the blood sugar after 4 hours – before the next meal. If it is still high you can give extra fast-acting insulin. The dose should be around one tenth of the amount of insulin usually given in a whole day.

Q The blood sugars have all been high for 3 days, but there are no ketones in the urine. What should I do?
A It is time to increase the doses of your usual insulin.

 

Register with
www.highland-diabetes.org.uk
for more information about ketones,
and what to do when your are ill.

 
Click Here for Flow chart for identifying and treating ketones

Mixing your insulin

If the cloudy insulin is not properly mixed the dose you are actually giving might be a lot higher or a lot lower than you think it is. The insulin vial or cartridge should be turned upside down and righted again 20 times before every injection.

Where and when to give the injection

Insulin is not absorbed reliably from injections sites which have been overused and become hard or lumpy. It may be absorbed differently from different sites - for example it will be absorbed more quickly from arms and tummy than from legs or bottom. If you are using a needle longer than 6mm and you do not pick up the skin first, the insulin may go into muscle – and start working very quickly indeed. When the blood sugars seem very irregular with no other explanation, it may be worth sticking to the same general area for a while, to see if this helps.
The best time to do an insulin injection is between 20 and 30 minutes before a meal. This prevents the blood sugar from going too high in the hour or so after the meal, and will also make hypoglycaemia before the following meal less likely. The only exception to this rule is if you are using one of the very rapid analogue insulins (Novorapid or Humalog). These should always be given immediately before you eat.

Is your pen injector working?

• Use a fresh needle for each injection – and take it off immediately after the injection (to stop insulin from leaking out)
• Before you give the injection, hold the pen with the tip pointing upwards, then dial up and eject 2 units of insulin. Repeat this until a bead of insulin appears at the end of the needle – it is your assurance that the pen is working.
• If your blood sugars are really wonky, check to make sure that the cartridge is not cracked or leaking.

Food

Very sweet foods, if eaten by themselves, will cause the blood sugar to rise very high for a short period of time. Ideally, any sweets should be included as part of a meal, so that the sugar content is absorbed more gradually, or else taken before exercise.

Trying too hard

If you make a lot of adjustments to food, insulin dose and exercise routines, the blood sugars can become completely erratic. Both the blood sugar control, and the quality of family life, will suffer. The answer is – stop fiddling! It will then be much easier to see the pattern in the blood sugar record, and you will be able to gradually adjust the insulin dose to get the best results. Stick to before mealtimes to check the blood sugars – just after a meal or snack the results are more difficult to interpret. If you think you are getting into a tangle, call the diabetic clinic team.

A hypo (short for hypoglycaemia) happens when your blood sugar falls too low. We usually reckon that blood sugars of 4 or less are "too low". Some people begin to feel hypo when the blood sugars are a bit higher than this, and some people will feel all right even when the blood sugars are lower than this (see below).

Q - How will I know that I'm hypo?

When the blood sugar falls too low, most people feel different from usual. You may feel "funny", - shaky, wobbly, or dizzy, have tingly lips or fingers, have a sore head or tummy, or feel very hungry. Other people may notice you looking pale or sweaty, or find that you are behaving oddly - either very quiet, or unusually rowdy!
These are the most common effects. Different people can have different symptoms - you will probably come to recognise your own hypo symptoms quite clearly. You may find that your symptoms change as you get older.
If you are not quite sure if you are hypo, try to check your blood sugar to find out. If, on the other hand you are out and about, or if you are in a great hurry, just carry on and treat the hypo. You won't do yourself any harm this way.
Some people feel fine even when their blood sugars are very low. This is a bit worrying, because it means that they might have a nasty hypo without getting any warning. If this happens to you, adjust your insulin to make sure that the blood sugars aren't falling into the hypoglycaemic range too often.

Q - What will make me hypo?

Exercise.   The common thing is doing more exercise than you normally do. Even shopping, or playing around the house can lower your blood sugar. Hypos due to exercise can be prevented by taking extra sweet food beforehand - the clinic staff can advise you. (After a particularly active day, blood sugars may fall during the night - see the section on exercise for further details)
Lack of food.   You can go hypo if you don't take enough carbohydrate (e.g. bread, potatoes, etc) when you eat, or if a meal or snack is late or missed altogether. If you are going to be later than usual in eating, take an extra snack to tide you over. If you are up early (or go to bed late) you will need an extra snack.
Insulin.   You can go hypo if you are taking more insulin than you need. If hypos are happening very regularly (for example, twice a week or more), or if severe hypos are occurring without obvious reason, the insulin dose may need to be altered. Contact the clinic staff if you are not confident about making the alteration yourself.

Q - What should I do if I'm Hypo?

As soon as you notice that you are hypo, you should take something sweet. (You should carry something with you at all times: dextrose sweets are particularly convenient). You could take;

• half a glass of lucozade
• three or four glucose tablets (Dextro-Energy  or Lucozade sweets)
• a full glass of ordinary cola or lemonade (not the diet varieties!)
• five or six fruit pastilles

Sit down quietly for a few minutes. If you are not feeling better after 5 or 6 minutes, take some more sugary food or drink. Once you feel better you should follow this up with something more substantial to eat, for example

• plain biscuit e.g. digestive, rich tea
• cracker /oatcake/ crispbread/ muesli bar
• toast/ sandwich
• piece of fruit
• your next meal

Never count what you have taken for a hypo as part of your next meal. Your body needed that extra sugar!

Q - What if I feel hypo during the night?

Do exactly the same as you would do during the day - i.e. take Lucozade or glucose tablets, or something similar. It is particularly important to have something more substantial to eat or drink afterwards to see you through till morning.
You may not always get warning of night-time hypos. If you have had trouble with overnight hypoglycaemia, or the bedtime and/or early morning blood sugars tend to run low, reduce the evening dose of insulin

Q - What if I have a nasty hypo?

Sometimes you get so mixed up when you are hypo that you forget that you are supposed to take sugar - if you are just sleepy, vague, or grumpy, one of your family or friends can usually persuade you to take something.
If you have a particularly nasty hypo, it can result in you becoming unconscious, or even having a 'fit'. This can be very dramatic and frightening to watch - however, even in these more severe hypos, it is extremely rare for anyone to come to any harm. Try not to panic!
If someone is unconscious or having a fit, it is not safe to give them anything by mouth. Your parents should have an injection of Glucagon at home, and know how to use it. This will bring you round in about 10 minutes or so (if there is no obvious effect after this time, they should call a doctor or an ambulance)
If a nasty hypo were to occur, but no-one knew it was happening, you would eventually come out of it yourself - but you would feel quite ill and exhausted for a while. You should try to avoid nasty hypos - and mild hypos should be treated as quickly as possible to prevent a nasty hypo from developing.

Q - How will I feel afterwards?

Usually, after a hypo, you will feel fine. Occasionally, after a nasty hypo, you will still feel quite woozy even after the blood sugar has come up to normal. This will pass.
The next blood sugar result after a hypo is often quite high -and, if you test for it, you may find ketones in the urine. This is normal. Do not take extra insulin because of it, or you may have another hypo!

Q - What else should I know?

Always carry something sweet! there is no point in having something in your 'other jacket', or upstairs when you are downstairs.
You can keep a supply of glucose sweets in any – or all – of the following places

• In you coat/trouser pocket
• In all your school bags
• Upstairs and downstairs in the house
• In the car
• In anything you take when you play outside (e.g. cycle bag, bum bag)
• In the classroom - either in your desk, or with your teacher.

(Remember to replace your 'hypo' supplies if you use them. )
It is a good ideal to tell your best friend or friends about your diabetes, so that they can help you if you become hypo.

Infections can upset the control of your diabetes, so you have to take extra care when you are unwell.  Although every infection is different, there are some "golden rules" which will mostly help you to stay out of trouble - and out of hospital!
remember:
1) People with diabetes need a regular intake of carbohydrate, even when they are ill, and even when the blood sugar is high.
2) If you are feeling sick, or if you have been sick, it is usually best to take the carbohydrate as regular sips of sugary drinks.  You will need to take a reasonable amount of unsweetened fluids as well.
3) You should not miss out your insulin. You may well need extra doses, depending on what your blood sugars are doing (see the sheet on "Dealing with high results"
3) Check the blood sugar 4 times each day (before breakfast, lunch, tea and supper) while you are unwell. Increase the insulin dose if necessary.
4) When  you are ill you should check the urine for ketones, twice a day, even if the blood sugars look all right.
If ketones ("small" or more) are present, and the blood sugar is highish (say over 12), you will need more insulin (see the sheet "Dealing with high results"). If the blood sugar is lower than this, it means you have to take more carbohydrate - and (unless you are on the verge of a 'hypo'), extra insulin as well.
5) If you are able to stick to the above advice, it will usually be possible to stay out of hospital. However, you should also know when to give up!
Hospital is the best place for you when

• all food and drink have been vomited for more than 4 hours.
• there is severe tummy pain
• the breathing is fast or unusually deep
• there is dehydration (sunken eyes, dry mouth, and the skin feels loose)

           
6) The hospital diabetes team is there to advise you. When in doubt - phone!

What to eat when you are ill

You still need to take your insulin when you are unwell, and you need to make sure that you are getting enough to eat and drink as well. You may find your usual food and drink too much to eat, or to hard to eat - for example if you have a sore throat or are feeling sick. Here are some suggestions to help you through.

Foods which are easy to swallow

• Soups
• potato and gravy
• yoghurt
• milk puddings
• porridge
• breakfast cereals
• milky drinks
• fresh fruit juice
• tinned fruit
• ice cream
• instant desserts.

If however, you feel very unwell, or have just been sick, you may need to take all your carbohydrate as liquids such as sugary squashes and fizzy drinks. You can take the fizz out (if it upsets you) by sprinkling in a little sugar and stirring vigorously.

Don't cram it down!

You may find it difficult to eat enough at a mealtime. Instead, why not spread your food and drink over several hours? For example, nibble or sip throughout the morning the quantity you would usually take for your breakfast and midmorning snack. Do the same in the afternoon and evening, with the food you would normally take at your lunch or evening meal.

Medicines

Do not worry if you need to take antibiotics or cough sweets/medicines which contain sugar. If you keep to the recommended doses, they will have little effect on your blood sugar level.

To help stop your blood sugar from falling too low :

You should eat some extra carbohydrate before the activity. For example,

• at the meal or snack just before exercise, eat an extra sandwich,  or
• immediately before exercise, eat something sweet. "Fun-size" bars (eg Mars, Milky Way, Snickers), a small carton of fresh fruit juice, or small packets of Starburst (opal fruits) or fruit pastilles are all suitable, Your dietitian can give you advice on any other sweets you may want to eat.

If you are going to be active for more than about 45 minutes, or if the exercise is very strenuous, you should top up your blood sugar by taking a sugary drink or snack halfway through. Always carry glucose tablets, or leave Lucozade near you in case you feel hypo.

Should I take less insulin?

If you are going to be active for a relatively short time (PE, swimming, fencing, or a game of football), it is best to cover this with extra carbohydrate and take your normal insulin. If you are going to be very active all day (a sponsored walk, or hill climbing) you could cut down the dose of insulin for that day. Remember that you may also need extra carbohydrate too.

Late hypoglycaemia

If you have been very active, you may find that you are prone to a low blood sugar for several hours afterwards. It is important to eat regularly, and always take a proper snack before bedtime.  If the bedtime blood sugar is lowish, you might want to take a bit more to eat than your usual.

Exercise and play

It is not just sport which can lower your blood sugar. Remember that soft play, bouncy castles, parties, discos, shopping, and even general excitement are also forms of exercise!

How much extra should I take to eat?

The amount of extra carbohydrate you need take depends on what you are going to be doing, and on how fit you are. Begin by taking a small amount of carbohydrate - for example, a fun-sized bar, or 2 digestives. You can find out if this has been the right amount by measuring your blood sugars afterwards.

• If your blood sugar is low after exercise, you will know to take more carbohydrate next time.
• If your blood sugar is high - (over 14 for example), then you will know to take less carbohydrate next time.
• If your blood sugar is between 6 and 14 then you have probably taken the right amount of extra food for that activity.

You can soon find out how much extra you need to eat for all you different activities.

Everyone needs time to recharge their batteries. The ideal way of doing this is by having a holiday, whether you choose to go to exotic places, or stay nearer home.
Supplies.   Make sure that you carry enough supplies to cover the whole trip - with spares in case of mishaps! This is especially important if you travel abroad. Carry some food and drink in case a meal is delayed.
Carrying and storing insulin.   If you are travelling by train or car, keep your insulin in the coolest place. A small thermos flask rinsed out in cold water from the tap can help in hot weather.
If you are travelling by plane, carry your insulin in hand luggage. Do not pack it in your suitcase as the hold of the plane is so cold that it may freeze your insulin, after which it will be of no use.
Accommodation.   You do not need to have access to a fridge, but again a thermos flask cooled with water may be the solution in hot climates.
Going abroad.   Depending where you are going you may pass through time zones, 'gaining' and 'losing' hours on the way there and back. You should discuss your insulin adjustment and eating plan with the consultant or specialist nurse. We can give the most detailed advice if you can tell us;

• the time of departure,
• the duration of the flight in hours, and
• the time difference between the UK and your destination.

A more detailed advice sheet is available for long distance travel.
Insurance.   Countries in the EEC have reciprocal medical cover: get form E111 from your local post office before you leave. You should have medical insurance as well - with a minimum coverage of £250,000. Make sure that the insurance company know you have diabetes. If you think you are being overcharged because you have diabetes, the British Diabetic Association may be able to recommend an alternative company.
Eating.   It may be worth speaking to your dietitian before you leave if you are going to exotic places with unfamiliar foods.
Exercise and activity.   Remember that you will not have such a regular routine as usual. Your insulin requirement may fall a bit, but it is an ideal time to relax your diet slightly. You can discuss this with your dietitian.
Innoculations.   If you need any inoculations, these should be done at least 2 weeks before you leave. This is because they can upset your diabetes for a few days.
Identification.   Immigration and customs officers take particular interest in people carrying vials and syringes, so you should be able to 'prove' that you have diabetes! The clinic doctor will provide a letter for you, or if you prefer, the British Diabetic Association will issue you with an identity card for a small charge.
Remember.   You are on holiday - but your diabetes is not! Do some tests to monitor your diabetic control, and make adjustments to keep you well during your holiday.

Everyone, young and old, likes a celebration - like birthdays, Christmas, Easter, and anniversaries.
There is no need for the hostess to produce a 'special diabetic meal' - nobody likes to be different. A few simple rules will guarantee that a good time is had by all.
On Christmas Day and birthdays, children can get so excited that they are more likely to have problems with hypoglycaemia rather than high blood sugars! Late bedtimes and early mornings all require extra snacks. High blood sugars are more of a problem in the days after Christmas - when there may be little activity and a lot of food around.
Do extra blood tests over the festive season. You may have to take extra insulin if the blood tests are running high - see the sheet on Dealing with high results

If you are going to be very active - for example, at a disco or tenpin bowling, your blood sugars may well fall and you will need to have something sweet - for example, a fizzy drink or a fun-size Mars bar.

All the experiences that we go through have an effect on us and on our families. When someone is told that their child has diabetes they will experience a mixture of emotions - relief that they know why he has been so poorly, worry about how they are going to handle the insulin, diet etc., perhaps anger that this has happened to them and wanting to know why. Your child might well have a similar mixture of feelings, and since all children are different they will express these feelings in different ways - some children will ask lots of questions, others won't, some will be upset, others seem to take it in their stride.

Talking to your child

You are the expert when it comes to your child - you know how they react to situations, and what usually helps when they are worried. In general it is usually best to answer any questions that they ask as simply and honestly as possible in words which they understand. Children are sensitive to parents’ feelings - if they pick up that you are worried they will feel that this is something to worry about. This doesn't mean that you should try to hide your feelings from your child - that wouldn't work, and in any case children learn to cope with their own feelings by watching the adults around them cope with the same feelings. Instead, if you feel that you are becoming very upset talk to someone, either in the family, a friend, or at the clinic. The staff are always happy to talk to you by yourself if you wish.

Behaviour

Sometimes one of the early signs of diabetes will have been a change in your child's behaviour, but this is very short lived and should disappear once treatment commences. However, parents often comment that their child seems different: what has usually changed is not the child's behaviour, but how the parents are reacting to him. Eating problems, sleep problems and temper tantrums are all part of normal childhood; moodiness and seeing how far you can go are part of normal adolescence and children with diabetes are just the same as any other when it comes to going through these stages. Most parents can usually work out satisfactory ways of dealing with these stages in children, but again if you feel concerned, talk it over with the staff at the clinic and they will be able to advise you, or suggest the right person to help.

Keeping your blood sugars within reasonable limits will help you to keep fit and well. The doctor, dietitian and clinic nurse are there to help you to do this.
As well as looking after the diabetes, it is also a good idea to keep fit, and to look after your general health. Here are some suggestions.

Teeth

Everyone wants a good set of teeth to last them for a lifetime. When your blood sugar is high, the saliva can be sugary too, and this might lead to tooth and gum disease. We particularly recommend that people with diabetes brush carefully and regularly, and get a regular check-up with a dentist.
Ordinary dental treatment is not a problem. If you need a general anaesthetic (that is, to be put to sleep), this is usually best done in hospital. Make sure your dentist knows that you have diabetes

Exercise

Everyone should take regular exercise. It makes you stronger and fitter, and makes you look and feel good. It also helps prevent you from putting on too much weight, and helps guard against heart disease and the like in later life. It is especially useful for people with diabetes; Insulin works better if you are fit and take regular exercise.
Different people like different kinds of exercise: some prefer competitive games, some like group activities like aerobics or keep fit, and some people prefer swimming, cycling and walking. All these kinds of exercise are good for you - find out which suits you best, and try to do it on a regular basis.

Feet

Older people, who have had diabetes for some time, can get problems with their feet. This is because the circulation can be poor, and the sensation dulled. For these reasons, it is a good idea to take particular care with your feet - and to start young.

• Make sure your shoes fit well - get your feet measured first if possible.
• Wear shoes made of canvas or leather, which allow your feet to breathe.
• Wear comfortable, absorbent socks which cushion your feet
• Don't walk around outside with no shoes or socks on
• Wash your feet regularly, and dry them carefully - especially in between the toes.
• Cut your toenails straight across (this prevents them from becoming ingrown)
• If you tend to get sweaty skin, a rub of surgical spirit followed by talcum powder can be useful.
• If you tend to have dry skin, use a moisturising cream regularly.
• Check your feet regularly for rubbed bits, broken skin, corns and verruccae. See a State-Registered Chiropodist if any of these problems occur.

Smoking

Smoking Damages Your Health.

• It causes;
• Lung Cancer,
• Chronic Bronchitis,
• Heart Disease
• Circulatory Problems
• Bad Breath (ask any non-smoker!)
• Wrinkles (it makes the skin age prematurely)
• Poverty (because it costs so much).

Smoking-related diseases are responsible for a high proportion of all premature deaths.
Smoking can be particularly harmful to people with diabetes, who are more prone to heart disease and circulatory problems than the average. Remember that tobacco is addictive. We strongly recommend that people with diabetes should not take up smoking.

Drinking alcohol

There is no reason why people with diabetes should not enjoy a drink. However, an alcoholic drink can make your blood sugar fall later in the evening. So...
If you are drinking, do not count the drink as carbohydrate in your diet. Take a carbohydrate snack in addition to your usual diet (solid food, for example a bag of crisps, is best: sugary drinks and mixers do not last long enough).
Do not miss your normal insulin dose.
If you are hypo and smell of alcohol, people will assume that you are acting funny because you are drunk - so you might not get properly looked after. It is best to hang around with people who you know, and who know about your diabetes.
Try not to overdo it!

Be prepared.

You should always carry something sugary with you - like dextrose sweets, for example - so that you can take some if you feel hypo. It is also a good idea to carry some kind of identification, so that if you are found hypo and confused, people can find out that you have diabetes, and give you something sweet to revive you.

The clinic can provide you with an identification card. Some people prefer to wear an identity bracelet or medallion, and a number of styles are available. Contact your clinic for further details.

If you have had diabetes for a long time (and particularly if the blood sugar results have persistently been a lot higher than the ideal), it can lead to a number of health problems of in later life. It is part of the clinic routine to keep an eye out for these complications of diabetes, as a lot can be done to help if they are picked up early.
In children who have diabetes and are over 12 years old, particularly those who have had diabetes for more than three years, we aim to check the following each year: 1) eyesight; 2) examination of the back of the eyes with a light; 3) blood pressure, and 4) examination of an early morning urine specimen for protein.

It is uncommon for long-term complications of diabetes to arise during childhood. If we find anything abnormal, we will let you know what we have found, and what we intend to do about it.