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How to Talk to Your Doctor

Whether you’ve been living with diabetes for years or you’re newly diagnosed, communicating with your healthcare team is one of the best things you can do. If you’re nervous about opening up to your doctor or pharmacist, there are some good reasons to conquer these fears. Less communication leads to measurable increases in stress, anxiety, and possible depression. It also leads, inevitably, to less frequent and less successful diabetes management.1 Since communicating with your healthcare providers is proven to be good for your health, here are some guidelines for starting the conversation and keeping it going. Know who’s on your healthcare team If you don’t already know the people involved in your healthcare team, get to know them. They could include: Primary care provider Pharmacist Nurse or certified diabetes educator Dietitian Endocrinologist Eye doctor Therapist Podiatrist Personal trainer You may not need to see everyone on this list, but it is a good idea to know who to turn to when you have specific questions. You have a say in your healthcare The most important member of your healthcare team is you! Other than doing what it takes to manage diabetes day to day, this also means that you have a say in your treatment. In fact, your healthcare provider should explain your diagnosis and all of your treatment options to you so that you can make an informed decision with regard to your health. The World Health Organization provides a great overview of informed consent, including which treatments require written consent (like surgery) and what you should expect to happen during the informed consent process.2 How much do you want to know? Sometimes the medical details can be overwhelming or intimidating. If you would rather not know these details right away, feel free to tell your doctor or pharmacist. Just make sure you find a comfortable balance between what you want to know and what you need to know to successfully manage your diabetes. If knowing every clinical detail puts your mind at ease and makes you feel more in control, tell your doctor this, too. Know what to discuss and ask about You will likely have general questions you’d like to ask your healthcare provider when you see them – new symptoms, any changes to your treatment, etc. It’s best to get those out of the way first. Make sure you also ask questions about sensitive topics or any other issue that is important to you. And if you’ve decided to add alternative medicines or treatments to your regimen, be open and honest with your team. These conversations are for a good cause: your health! Do you know about your medical tests? It’s important to take the medical tests your healthcare provider requests, but make sure you ask questions about them too. Some questions to ask: Is there anything you need to do before the test? What will the test measure? How will the test results influence your treatment? Are there risks to taking the test? How and when will you be informed about the results? Know what to do before and after your appointment If you know there are issues you need to discuss with your healthcare provider, organise your thoughts ahead of time. Jotting them down and bringing the list of questions to the appointment can keep the meeting on track and make you feel confident that you’re getting the information you need. After your appointment, don’t hesitate to follow up if you have questions about your treatment. For example, if you received test results that you don’t understand, make a phone call. Problems talking to your healthcare provider? Yes, doctors are busy, but they are there to serve you and there is no reason for you to delay or forego getting the information you need about your health. If you can’t seem to get a clear answer from your doctor on an issue, try saying, “I don’t understand [this topic]. Can you take a few minutes to explain it to me?” If your healthcare provider can’t make the time for a conversation, offer to make an appointment for a phone call to discuss your concerns. An “advocate”, a friend or family member who understands more about diabetes can also help by going to medical appointments with you. Never give up on getting the knowledge you need.

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Diabetes Basics

Understanding the basics of diabetes is the first step in gaining control of your health. Let’s look at what causes diabetes, some of the common symptoms, the benefits of healthy living, and what to do if you’ve just been diagnosed. What is diabetes? Diabetes is a chronic condition. Your blood sugar levels are controlled by insulin, a hormone produced by your pancreas. When you eat, food gets broken down and glucose enters your bloodstream. Insulin takes the glucose out of your bloodstream and allows it to enter your cells, where it is broken down and turned into energy. If you have diabetes, either you don’t have enough insulin or the insulin you do have doesn’t work to get the glucose out of your blood and into your cells. This is how your blood sugar ends up going higher than it should (hyperglycaemia).1 3 main types of diabetes With type 1 diabetes, your pancreas doesn’t make insulin at all. With type 2 diabetes, your pancreas doesn’t make enough insulin, or the insulin doesn’t work correctly. Gestational diabetes is a temporary condition, when a woman’s insulin is less effective during pregnancy. Common symptoms of diabetes The onset of type 1 diabetes usually happens quickly, and symptoms may be intense. Symptoms of type 2 diabetes are usually mild (or even not there at all), and appear over time. Common symptoms of both types include:2 Frequent urination Excessive thirst Increased hunger Weight loss Tiredness Lack of interest and concentration A tingling sensation or numbness in the hands or feet Blurred vision Frequent infections Slow-healing wounds Vomiting and stomach pain, often mistaken as the flu (however, it is very common to get the flu before being diagnosed, as diabetes is an auto-immune disease) If you haven’t been diagnosed with diabetes and show any of these symptoms, talk to your doctor . How does low blood sugar happen? Low blood sugar (hypoglycaemia) generally occurs when your blood sugar level drops below 3.9 mmol/L (70 mg/dl) It happens when there is too much insulin or diabetes medication in your body, if you need to eat, if you are extremely active, or if you drink too much alcohol. Everyone reacts differently to low blood sugar, but common symptoms include:3 Shakiness, weakness or chills Irritability or confusion Dizziness or nausea Blurred vision or headaches Seizures or unconsciousness If you have low blood sugar, treat it according to your healthcare provider’s instructions. In general, though, try to eat 15 grams of glucose or carbohydrates, retest your blood sugar after 15 minutes, and if you’re still low, repeat. Newly diagnosed? Here’s what to do now It’s never easy to be handed a diabetes diagnosis. You may wonder, “Why is this happening?” and may fear the unknown. It’s common to blame yourself and worry about what others will think of you. What’s most important is that you acknowledge all of your emotions as they come and go, resolve to deal with them, and understand that you are not alone. The first step in taking control of your health after a diagnosis is making an appointment with your primary healthcare provider (or endocrinologist or diabetes nurse, etc.), and finding out everything you can about your diabetes. To start, you should find out: If you are type 1 or type 2 How to test your own blood sugar and how often to test How to operate a blood glucose meter How to understand your test results How to treat your diabetes What kind of exercise is right for you What changes to make to your diet Other health issues you have that affect your diabetes treatment Who else you can see for information Once you know this, you can create an entire treatment plan with your doctor, and make a follow-up appointment. Eating and drinking Thinking about the food you eat and making healthier choices is one of the most important ways you can control your blood sugar. Counting carbohydrates, eating healthy fats (monounsaturated, polyunsaturated, or omega-3), getting enough protein and fibre – these are the keys to a healthy diabetes diet. Don’t forget to factor in your drinks when managing your blood sugar. Water, unsweetened tea or coffee, or low-calorie drinks are best. Avoid fruit juice or sugary sodas (unless you’re treating a bout of low blood sugar). Limit alcoholic drinks to 1 per day for women, 2 for men. Why testing your own blood sugar is important The results of your blood sugar level tests tell you how food, exercise, or other factors like stress are affecting your blood glucose. If you test regularly, you’ll begin to see patterns – highs and lows – and will be able to make changes to your daily routine that will improve your health over time.

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Self-Monitoring of Blood Glucose (SMBG)

By self-monitoring your blood glucose you can measure how your body handles different types of food, exercise, medication, stress and illness. Your blood glucose result may prompt you to eat a snack, take more insulin or go for a walk. Self-monitoring can also alert you to a blood glucose level that is too high or too low, which requires special treatment. Self-monitoring is also known as Structured Testing which means testing at the right times, in the right situations, and frequently enough to generate useful information.   Controlling your blood glucose level is a very important part of managing diabetes. Regularly testing your blood glucose helps measure the effectiveness of your meal plan, physical activity and medications.   The results of self-monitoring can help guide you and your healthcare team to adjust the many parts of your therapy. Always consult with your Healthcare Professional to agree on a Structured Testing plan for you!   How to Test: A smart way to test your blood sugar is as easy as connecting the dots! The Accu-Chek® 360° View 3-day profile tool is an easy-to-use tool that helps you and your doctor see how well your blood sugar is under control. You can see the effect of your meals on your blood sugar, and how well your diabetes therapy is working.1   Click here to access / download the Accu-Chek 360 View 3-day profile tool. Show the tool to your Healthcare Provider if you need help filling it in.   Accu-Chek® Testing in Pairs tool The easy-before-and-after tool to help you discover that what you do affects your blood glucose.   Click here to access / download the Accu-Chek Testing in Pairs tool. Show the tool to your Healthcare Provider if you need help filling it in.   Guidelines supporting structured testing •IDF Guideline on self-monitoring of blood glucose in non-insulin treated type 2 diabetes: http://www.idf.org/guidelines/self-monitoring •The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes: http://www.semdsa.org.za/images/2012_SEMDSA_Guideline_July_FINAL.pdf •Standards of Medical Care in Diabetes – 2016: http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf   Always remember when testing to follow these basic steps2: Wash and dry your hands. Using warm water may help increase the blood flow to your fingertips Follow the instructions included with your lancing device to get a drop of blood— which normally include shaking your hands below the wrist or gently squeezing your finger a few times to help Apply the blood drop to the test strip as directed Wait a few seconds to view your results Dispose of the lancet and test strip in the proper manner  

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Eating Healthy with Diabetes

You don’t have to sacrifice your target blood sugar levels to enjoy some of your favourite foods. Here’s how to eat healthy with diabetes, whether you’re cooking at home or eating in a restaurant. Carbohydrates and your blood sugar Carbohydrates are sugars. They break down in the body to create glucose, a major source of energy. Counting the carbs you eat at every meal and pairing them with the correct dosage of insulin can keep your blood sugar level closer to normal range.1 It also allows you to eat a wider variety of foods. In fact, your diet can accommodate any food in moderation, so you don’t have to give up the food you love. Carb counting tools from Accu-Chek Diabetes superfoods Many foods are on the good-for-you list, but these are extra healthy for people with diabetes, because they have a lower glycaemic index or net carbs and help stabilise your blood sugar.2 Beans give you plenty of fibre in only ½ a cup, the same amount of protein in 28 grams of meat. Plus, they’re a good source of magnesium and potassium. Dark green, leafy vegetables give you a powerful dose of fibre, protein, vitamins, and minerals with hardly any calories or carbs. Citrus fruits are known for their generous amounts of vitamin C and fibre. Sweet potatoes give you more healthy fibre, antioxidants and vitamin A than white potatoes. Berries are packed with antioxidants, fibre and vitamins. Tomatoes, like citrus, are an amazing, low-carb source of vitamins C and E, and iron. Salmon, or any fish high in omega-3 fatty acids, can lower your triglycerides and blood pressure, and reduce inflammation. This is one of those “good fats”. Whole grains have all the folate, omega-3s, magnesium, chromium, fibre and potassium that white bread loses in processing. Raw nuts are quite possibly the perfect snack, since they’re full of healthy fats and fibre. Fat-free dairy is an important source of vitamin D. Plain, unsweetened yoghurt, in particular, has the added benefit of probiotic bacteria which keeps your intestines healthy and helps your immune system. Portion control Even if you’re an old pro at counting carbs, it’s worth a reminder to take portion sizes into account. If you’re cooking at home, using a food scale and measuring cups can save you a lot of worry. This way, you’ll know exactly how many carbs you’re eating, instead of approximately how many. Over the course of a day, these little inaccuracies can really throw off your carb count. If you don’t have a scale or measuring cup handy, here are some fairly accurate approximations: 1 serving of meat should be 85 grams, about the size of a deck of cards. 1 cup or 225 grams is about the size of a small fist. (250ml) 1 cupped hand is approximately ½ a cup or 115 grams. (125ml) The tip of your thumb, from the first knuckle up, is about 5 ml. When at a restaurant: At an all-you-can-eat buffet, start with salad or veggies, and then save your 2nd trip for a small piece of meat and a carb. Split a main course or dessert with someone else. Get a starter or a salad (dressing on the side) instead of a main course. Get a take-away box at the beginning of the meal and put ½ of your meal in it for later. For some more tips on healthy eating download the handy Accu-Chek® Portion Plate here. How your blood glucose meter helps By monitoring your blood sugar yourself, you can make changes to what you are about to eat or how much insulin to dose. Several Accu-Chek® products like the, Accu-Chek® Combo insulin pump, or the Accu-Chek® Connect system have built-in bolus advisors, which calculate your insulin dose based on your latest blood test result and the number of carbs you’re about to eat. Technology like this allows you to enjoy your meal without worrying about the maths. Over time, you may find that you create healthier and more manageable habits, stay on target, and reduce your risk of developing other health problems later.

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Future Diabetes Treatment

Diabetes care has come a long way in just a few decades – after all, the first insulin pump was introduced in 1963, and finger-prick tests for personal blood glucose monitoring have only been around since the mid-1980s. So what's next? In development: Automating insulin delivery – the artificial pancreas Taking insulin pumping to the next level, an artificial pancreas is being tested that combines a continuous glucose monitor, insulin pump and glucagon pump (should blood glucose go too low), all managed by a smartphone app. The goal is to monitor your blood glucose and adjust your insulin throughout the day; http://sites.bu.edu/bionicpancreas/ Much smaller and more contained (and unlikely to be ready for many years), a patch that senses blood glucose levels and delivers insulin automatically is also in the works.1 Now: Connecting with your blood glucose – and your doctor New ways to track blood glucose data and connect with your healthcare team can greatly simplify diabetes control. Smartphone apps and websites offer a variety of ways to streamline data management, however, researchers in Norway have found that the greatest potential lies in a few key features:2 Seamless data transfer from the meter to the app eliminates the need for manual entry and reduces the risk of human error Automatic data sharing with a parent or caregiver enable peace of mind while their loved ones manage blood glucose away from home Diaries that integrate with electronic health records aid discussions at doctors' appointments The Accu-Chek® Connect system offers many of these features, including data management tools, a clinically proven bolus advisor3 for accurately calculating mealtime insulin and the ability to save photos of meals to support carb counting discussions with your healthcare provider. There's even more on the horizon Ideas are in development to sense acetone in the body, a biomarker associated with blood glucose. Engineers at the University of Michigan in the United States are testing a wearable vapour sensor that can "smell" high blood gluose.4 Research is underway to develop a test that measures blood glucose by analysing the user's breath.5 Temporary tattoos that monitor blood glucose levels may also be available someday, once developers figure out how to get their readings to the user.6 Today and every day: Remembering the basics Eating well, staying active and getting enough sleep may not sound new or exciting, yet they remain the foundation of successful diabetes management and healthy living. So, while advanced technology has a great deal to offer in the world of diabetes care, it's important not to lose sight of the proven low-tech and no-tech solutions, too. Remember, it's your future. Commit to your health every day, and your efforts will pay off throughout your lifetime.

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