1. Caring for people with Diabetes
Understanding diabetes, supporting the individual and
planning care

2. Table of Contents

3. Understanding Diabetes
Diabetes is a disease in which blood glucose, or sugar
levels in the blood are too high
Glucose comes from the food you eat
Insulin is a hormone that helps the glucose get into your
cells to give them energy
Diabetes occurs as a result of :
1. Insufficient insulin production
2. No insulin production
3. Improper use of insulin
Blood stream
The total number of people with diabetes in 2010 was
around 50.8 million in India, rising to 87.0 million by 2030
A Ramachandran1, AK Das, SR Joshi, CS Yajnik, S Shah, and KM Prasanna Kumar. Current Status of Diabetes in India and Need for Novel Therapeutic Agents. [Cited on 9th January, 2011] Available from:
http://www.japi.org/june_special_issue_2010/Article_02.pdf

4. Types of Diabetes
National Institute of health. Eunice Kennedy Shriver. National Institute of Child health and human development. [Cited on 9th January, 2011] Available from:
http://www.nichd.nih.gov/health/topics/gestational_diabetes.cfm

5. Common symptoms of Diabetes
Common symptoms of diabetes include:
o Excessive urination
o Excessive thirst and hunger
o Fatigue
o Blurred vision
o Tingling in hands and feet
o Itchy dry skin
o Sores and cuts that don’t heal
or heal very slowly

6. Diagnosing Diabetes
National Diabetes Information Clearinghouse. Diagnosis of Diabetes. [Cited on 9th January, 2011] Available from: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/diagnosis.pdf

7. Diagnosing Diabetes (cont..)
Richard J. Schrot. Targeting Plasma Glucose: Preprandial Versus Postprandial. Clinical Diabetes. 2004;22: 4 169-172.
National Diabetes Information Clearinghouse. Diabetes overview [Online]. [cited 9th jan, 2011]; Available from: URL:http://www.diabetes.niddk.nih.gov/dm/pubs/overview/index.htm

8. Dangers of Diabetes
Having high blood glucose over a period of time can damage
large and small blood vessels; and nerves in the body
Damage to large blood vessels may lead to:
o Poor circulation
o Heart attack
o Strokes
Damage to small blood vessels may lead to:
o Eye disease
o Kidney disease
Damage to nerves may lead to:
o Pain
o Loss of feeling in the hands, legs and feet
o Weak muscles

9. Management of Diabetes

10. Treatment Goals
Treatment goals are :
o Control blood glucose levels
o Prevent complications
o Improve quality of life
This can be achieved by the 4 pillars of Diabetes Management

11. 4 Pillars of Diabetes Management

12. Diet and Diabetes - Nutrients
Carbohydrate: Carbohydrates are the principal sources of energy
o The carbohydrate in food is broken down to glucose which
provides energy
o Sources: Cereals, whole pulses, fruits
o Avoid: Refined food like maida-based products, sugar, honey,
jaggery and sweets
Protein: Proteins help in building & strengthening body tissues
o Sources:
Vegetarian sources – Pulses like soya beans, kidney beans, low
fat milk and milk products
Non Vegetarian sources – Fish, chicken, egg
Guidelines for the management of type 2 diabetes . [Online] . [cited January 11, 2012]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm

13. Diet and Diabetes – Nutrients (cont..)
Fat: Fat is a calorie dense nutrient providing 9 calories / gram
o Sources: Vegetable oils (groundnut oils, mustard oil, sunflower
oil etc.) butter, ghee, cheese, cream, egg yolk etc.
o Avoid: Fried foods, ghee, butter, egg yolk. Restrict oil use to 3 tsp/
day
Fibers: A part of plant foods which cannot be digested
o They help in improving blood glucose control
o Sources: Whole grains (ragi, jowhar, barley, oats etc.), whole
pulses, soybean, green leafy vegetables and fenu-greek seeds
Vitamins & Minerals: Whole fruits & vegetables are good sources
o Whole fruits are recommended in moderation (1 serving/ day),
however, very sweet fruits (mango, banana, chikoo, grapes,
custard apple) and fruit juices should be avoided
Guidelines for the management of type 2 diabetes . [Online] . [cited January 11, 2012]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm

14. Exercise / Activity and Diabetes
Type 2 Diabetes and Exercise. [cited January 11, 2012]; Available from: http://diabetes.webmd.com/guide/exercise-guidelines

15. Exercise / Activity and Diabetes (cont..)
Exercise checklist for Diabetics
Talk to your doctor about the right exercise for you
Check your blood sugar level before and after
exercising
Check your feet for blisters or sores before and after
exercising
Drink plenty of fluids before, during and after
exercising
Warm up before exercising and cool down after
exercising
Have a snack handy in case your blood sugar level
drops too low

16. Self-Monitoring of Blood Glucose (SMBG)
Evan M. Benjamin. Self-Monitoring of Blood Glucose: The Basics. Clinical Diabetes. 2002;20:1:45-47.

17. How is SMBG Done?
• Wash your hands with mild soap/ sterilize the finger with an alcohol swab. Allow it
to dry
• Insert a test strip into your Contour TS meter
• Use your lancing device on the side of your fingertip to get a drop of blood
• Gently massage your finger until a drop of blood forms

18. How is SMBG Done? (cont..)
• Hold the edge of the test strip to the drop of blood. Contour TS strip will
automatically sip in the blood drop
• Your blood glucose level will appear on the meter's display within 8 seconds
• Wipe away the blood on your finger with a sterilized cotton ball

19. SMBG use and Frequency
o Perform SMBG three or more times per day
o Adjust intensity of monitoring to intensity of insulin therapy
o Perform SMBG three or more times every day when multiple doses of
insulin are administered every day
o The exact frequency is undetermined
o Perform SMBG at a sufficient rate to reach glucose goals
o If taking insulin therapy, perform SMBG three or more times each day
o Perform SMBG three or more times each day
American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2005;28:S4–S36.

20. Pharmacological Treatment For Diabetes
Oral Anti-diabetic drugs
Guidelines for the management of type 2 diabetes . [Online] . [cited january 11, 2011]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm

21. Pharmacological Treatment For Diabetes (cont..)
Insulin therapy
Insulin therapy is an important part of diabetes treatment
Role of insulin
Regulate sugar in your bloodstream. The main job of
insulin is to keep the level of sugar in the bloodstream
within a normal range
Storage of excess glucose for energy. After a meal when
insulin levels are high — excess glucose is stored in the
liver in the form of glycogen
Mayo clinic. Diabetes. [Cited online January 25, 2012] Available from: http://www.mayoclinic.com/health/diabetes-treatment/DA00010

22. Pharmacological Treatment For Diabetes (cont..)
Types of Insulin
There are many forms of insulin to treat diabetes. They are classified by how fast
they start to work and how long their effects last
Web.MD. Types of Insulin for Diabetes Treatment. [Cited online January 25, 2012] Available from: http://diabetes.webmd.com/diabetes-types-insulin

23. Pharmacological Treatment For Diabetes (cont..)
Injection Site Selection
The needle is to be inserted at a slight angle so that the
injection is in the subcutaneous tissue
The most common injection site is the abdomen
The back of the upper arms, the upper buttocks or hips
and the outer side of the thighs are also used
These sites are the best to inject into for two reasons:
o They have a layer of fat just below the skin to
absorb the insulin
o They make it easier to inject into the subcutaneous
tissue, where insulin injection is recommended

24. Complications of Diabetes

25. Hypoglycemia (low blood sugar)
Hypoglycemia is a condition in which there is an abnormally low level of glucose
(sugar) in the blood
The amount of sugar or glucose in the blood is below 70 mg/dL
Common causes of low blood sugar include the following:
o Overmedication with insulin or anti-diabetic pills
o Use of alcohol
o Missed meals

26. Hypoglycemia (low blood sugar) (cont..)
Symptoms of Hypoglycemia

27. Hypoglycemia (low blood sugar) (cont..)
Act quickly

28. How to treat Hypoglycemia
ADA recommends the 15/15 Rule for treating low blood sugar
American Diabetes Association. The 15/15 Rule for Treating Lows. [Cited online January 25, 2012] Available from: http://community.diabetes.org/t5/Lizzy-s-Lounge/The-15-15-Rule-for-Treating-Lows/ba-p/113685

29. Hypoglycemia
The following items are quick energy sources that contain about 15 grams
of carbohydrate
o ½ cup fruit of orange, apple or grapefruit juice
o 1/3 cup grape, prune or cranberry juice
o 2 tbsp raisins
o 3-5 pieces hard candy
o 1 cup skim milk
o 1 piece bread
o 3-4 glucose tablets or 1 tube glucose gel

30. Diabetic Foot care
Foot problems in persons with diabetes are usually
the result of three primary factors:
o Neuropathy
o Poor circulation
o Decreased resistance to infection
Nerve damage can lead to loss in sensation which
in turn can cause foot injuries/ ulcers eventually
resulting in amputation if left untreated

31. Diabetic Retinopathy
Diabetic retinopathy is caused by damage to
blood vessels of the retina
If left untreated, diabetic retinopathy can
cause blindness
Symptoms of diabetic retinopathy include:
o Seeing spots or floaters in your field of
vision
o Blurred vision
o Having a dark or empty spot in the
center of your vision
o Difficulty seeing well at night

32. Diabetes and Kidney Problems
Long-standing diabetes causes changes in small
blood vessels that can damage the kidneys
This damage can result in severe kidney failure
The first symptom of kidney disease is often
fluid buildup
Other symptoms of kidney disease include:
o Loss of sleep
o Poor appetite
o Upset stomach
o Weakness
o Difficulty in concentrating
American Diabetes Association. Kidney Disease (Nephropathy) [cited January 11, 2012]; Available from: http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html

33. Diabetic Neuropathy
Diabetes damages the nerves that allows you to feel
sensations such as pain
Elevated blood glucose levels damage the blood
vessels that supply oxygen to these nerves
Symptoms of nerve damage include
o Numbness, tingling, or pain in the toes, feet, legs,
hands, arms, and fingers
o Indigestion, nausea or vomiting
o Diarrhea or constipation
o Dizziness or faintness due to a drop in blood
pressure after standing or sitting up
o Problems with urination

34. Prevention of Diabetic complications
Self-care
Diabetic complications can be prevented through tight control of blood glucose
and blood pressure
Four ways to lower your blood sugar and blood pressure are
o Losing weight o Avoiding alcohol and tobacco
o Eating less salt o Regular exercise
Drugs : Take your medications (pills and/or insulin) as prescribed by your doctor
Diet : Follow a sensible diet. Do not skip meals

35. Diabetes has a major impact on quality of life and life expectancy
There are three main types of diabetes: Type 1, Type 2 and gestational diabetes
Normal values for Fasting sugar should be below 99mg/dL and for PPBS should be
below 140 mg/dL
Four corner stones of diabetes management are diet, exercise, SMBG &
medication/ insulin
Self-monitoring of blood glucose (SMBG) has been accepted as an important
instrument to measure their blood sugar at home and achieve therapeutic goals
Diabetic complications can be prevented with healthy lifestyle and by keeping the
blood sugar under control