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What is diabetes?
Most of the food you eat is turned into glucose for your body to use for energy. Your pancreas makes a hormone called insulin to help glucose get into the cells of your body. Your diabetes is a common life-long condition where the amount of glucose in your blood is too high as your body cannot use it properly. This is because your pancreas does not produce any or not enough insulin, or the insulin that is produced doesn’t work properly.
You are one of more than 220 million people worldwide that have one of the following types of diabetes:
Type 1 diabetes develops when the insulin-producing cells have been destroyed and the body is unable to produce any insulin. Usually it appears before the age of 40, and especially in childhood. It is treated with daily administration of insulin either by injection or pump, a healthy diet and regular physical activity. Symptoms include frequent urination, excessive thirst, extreme hunger, unusual weight loss, vision changes, fatigue and irritability. These symptoms may occur suddenly.
Type 2 diabetes develops when the body does not produce enough insulin or the insulin that is produced does not work properly. Usually it appears in people aged over 40 as a result of excess body weight and physical inactivity, though in South Asian and Black people it can appear from the age of 25. It is becoming more common in children and young people of all ethnicities. This condition is treated with a healthy diet and regular physical activity, but medication and/or insulin is often required. Symptoms may be similar to those of Type 1 diabetes (others include frequent infections, blurred vision, cuts/bruises that are slow to heal, tingling/numbness in the hands/feet, recurring skin, gum or bladder infections) but are often less marked. As a result, the disease may be diagnosed several years after onset once complications have already arisen.
Gestational diabetes is hyperglycaemia (abnormally high blood sugar levels) with onset or first recognition during pregnancy. This condition is most often diagnosed through prenatal screening rather than reported symptoms (similar to Type 2 diabetes).
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes.
Download ‘What is Diabetes?’ leaflet
Download ‘Diabetes & Pregnancy’ leaflet
Download ‘Diabetic Ketoacidosis’ leaflet
To delay the onset of type 2 diabetes and its complications, it is important to:
The main aim when treating your diabetes is to achieve blood glucose, blood pressure and blood fat levels (including cholesterol) as near to normal as possible. Other interventions include:
Download ‘Diet & Exercise’ leaflet
People with both Type 1 and Type 2 diabetes holiday all over the world, their condition certainly being no barrier. If you plan ahead and seek advice wherever necessary, you should be able to minimise any potential problems and have an enjoyable and safe trip. How you prepare for a trip will depend where you are going and what you are doing, i.e. if you are going on an active adventure you need to work out what influence extra exercise will have on your blood sugar levels.
If you generally follow a healthy, balanced diet there is no harm in experimenting with different foods whilst on holiday by making some higher fat/sugar choices from the local menu. You should let your holiday destination know in advance if there are certain foods you want. If you are traveling alone, you may like to let staff know in case you are taken unwell during your stay.
Diabetics can still take insulin with them onto an aircraft despite new security restrictions. If you are traveling you should bring a letter from your doctor explaining your need to carry syringes/injection devices and insulin for presentation to airline staff. If you encounter any problems, ask to speak to a more senior member of staff. Some GPs charge you for writing such a letter. Therefore if you travel frequently, it would be a good idea to ask your doctor to phrase the letter so that it can be used again.
Additionally a Diabetes UK Insulin user’s identity card (available from www.diabetes.org.uk) or engraved jewellery may help you verify your need to carry syringes and medication.
Airlines do bring in restrictions in emergency situations about what items can be brought onto their aircraft in hand luggage. Insulin manufacturers have always advised to avoid storing insulin in baggage which goes into the hold as travelling at altitude may freeze the baggage and damage insulin. Insulin that has to go in the hold should be placed in an airtight container (such as a flask) in the middle of your suitcase, or wrapped in bubble wrap, then in a towel and again place in the middle of your suitcase. On arrival to your destination you must examine your insulin for crystals and discard if any are found. Even if the insulin looks okay, you should test your blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged and ineffective.
Once on board some airlines, cabin crew may request that your medication be handed over for storage during the flight. For this reason you should put the insulin and syringes/needles in a separate carrier bag/hand luggage.
People with diabetes need to eat regularly to help control their blood glucose levels. Special ‘diabetic’ meals are not necessary on board planes as they are often low in carbohydrate. Thus it is recommended that diabetics select meals from the standard airline menu items and that:
In some countries, including the USA and many EU countries, blood glucose is measured in milligrams per 100 millilitres (expressed as mg %) and not in millimoles per litre (mmol/l), as it is in the UK. A blood glucose conversion chart is shown below:
Firstly check if you are going to a very hot country or on a long, hot car journey as you will need to keep your insulin cool and protected. Insulin can withstand short trips when not refrigerated but it’s the exposure to direct sunlight and extremes of heat that can deactivate it. Below is a list of bags, wallets, fridges and travel friendly accessories that will allow you to keep your insulin cool on the move:
If you are planning to drive while on holiday, ensure your licence is valid for the duration of the trip and that you are covered by your insurance policy for driving, especially when abroad.
Download ‘Diabetes & Travel, Driving’ leaflet
|Association of British Clinical Diabetologists||http://www.diabetologists-abcd.org.uk/|
|American Diabetes Association||http://www.diabetes.org/|
|International Diabetes Federation||http://www.idf.org/|
|World Health Organisation||http://www.who.int/topics/diabetes_mellitus/en/|
|Children with Diabetes||http://www.childrenwithdiabetes.com/|
|Nutritionist Resource – Diabetes||http://www.nutritionist-resource.org.uk/articles/diabetes.html|
|Drugwatch – Diabetes||https://www.drugwatch.com/diabetes/|
|Drugwatch – Diabetes Stigma||https://www.drugwatch.com/featured/diabetes-stigma/|
These sites are in no way affiliated with www.keysmart.com we provide these links for your convenience only.
Many people want their meters to have laboratory-level accuracy, which is understandable. But to do so meters would have to have much more complicated technology, which could get exceptionally expensive for both the patient and health care system. When it comes to health outcomes, experts agree that accuracy at every blood glucose level is less important than accuracy at levels for which a wrong number is most likely to cause a clinical error, for example in the hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar) regions where dosing too much or too little insulin may have an adverse effect on the user.
When people compare their glucose readings from a new meter with their previous meter, it is not unusual that the readings they get on their new meters will be different. For some, the difference is concerning, and they consider that their old meter has the right reading and their new meter must be wrong. However, variances are normal between hand held meters and are to be expected. The reason for this, is how different manufacturers calibrate their meters whilst still maintaining the high standard required for accuracy.
The Food and Drug Administration (FDA) in America and the International Organization for Standardisation (ISO) in Europe have accuracy requirements for all blood glucose monitoring system that are marketed for use by diabetics which in turn, allow for a range of readings. These standards stipulate the following.
For results at or above 100 mg/dl glucose (or 5.5mM) 95% of meter test results must be within plus or minus 15% of the actual blood glucose level that would be measured in a hospital laboratory. This means that a subject with an actual blood glucose result of 180 mg/dl (10mM) could potentially show on a meter any value from 153 mg/dl (8.5mM) to 207 mg/dl (11.4mM) and still meet the requirement of the standard. Taking the extreme cases, two meters would still be considered accurate if on the same sample of blood they displayed glucose values of 153 mg/dl and 207 mg/dl.
For results below 100 mg/dl, 95% of test results must be within plus or minus 15 points of the actual blood glucose level. The same logic applies to these glucose readings. For example, a subject with an actual blood glucose result of 70 mg/dl (3.9 mmol/L) could potentially show on a meter as any value from 55 mg/dl (3.0 mmol/L) to 85 mg/dl (4.7 mmol/L) and meet the standard. Some people are aware of this 15% variance, but think that this means that there can only be a 15% difference between the readings of two meters, rather than between a meter and a lab test.
Many people want their meters to have laboratory-level accuracy, which is understandable. But to do so, meters would have to have much more complicated technology, which could get exceptionally expensive. When it comes to health outcomes, experts agree that accuracy at every blood glucose level is less important than accuracy at levels for which a wrong number is most likely to cause a clinical error. Those are results that might encourage you to make a possibly harmful decision about not treating hypoglycaemia (low blood glucose) or dosing too much insulin for what appears to be high blood glucose. This fact is addressed in the required FDA and ISO accuracy standards to ensure that this never happens. It should also be appreciated, that meter manufacturers are required to continually assess the accuracy of their meters. In addition, many hospital and academic laboratories consistently test and publish accuracy results for commercially available blood glucose meters.
The key message for people with diabetes is that directly comparing results between meters is not best clinical practice. It may be useful for a short period of time, while becoming familiar with the new meter, but it is important to reinforce that meter readings from any meter are only indicative. The most meaningful information is to understand the trends, and what the readings mean for them and their diabetes management. This is best achieved in partnership with the health care professional.
If you have diabetes, your blood-glucose meter is a critical tool that gives you the necessary insight as to what’s going on inside your body at a given moment—an absolutely essential piece of knowledge, particularly if you use insulin.
That’s why it’s important to ensure that your meter is functioning correctly and giving you accurate readings. To verify this, start by periodically using a standard glucose solution, also known as control solution, provided by your meter’s manufacturer to test the accuracy of the results you’re getting. You generally should also use liquid control solutions if you drop your blood glucose meter, or whenever you get unusual results.
Match your reading with lab results. Take the blood glucose monitor along when you visit your doctor or have an appointment for lab work. Check your blood sugar level with your meter at the same time that blood is drawn for lab tests. Then compare your meter’s reading with the lab results. Results that are within 15 percent of the lab reading are considered accurate. If your meter isn’t working properly, contact the manufacturer of your meter and test strips and ask for a replacement. Finally, watch out for these common factors that can affect your meter readings:
Out of date test strips – Dispose of damaged or outdated test strips; lack of enzyme coverage in these can cause inaccuracies. Store your strips in their sealed container, away from heat, moisture and humidity. Be sure the strips are meant for your specific glucose meter.
Out of date Control Solution
Substances on your hands.
Temperature changes. Your meter user’s manual (or web site) will tell you the temperature range in which your meters will function correctly.
Hand washing your testing site with soap and water and proper drying is very important with new smaller-volume meters now. The tiniest amount of dirt, alcohol or other skin contaminant can significantly raise blood glucose Wet fingers mixing with blood may cause an inaccurate reading.