Managing Treatment

Vaccinations

Keep your vaccines up to date.

High blood sugar can weaken your immune system, which makes routine vaccines more important than ever. Ask your doctor about:

  • Flu vaccine. An annual flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu.
  • Pneumonia vaccine. Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you’re age 65 or older, you may need a five-year booster shot.
  • Hepatitis B vaccine. The Centers for Disease Control and Prevention (CDC) currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult aged 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you’re age 60 or older and have diabetes and haven’t previously received the vaccine, talk to your doctor about the whether it’s right for you.
  • Other vaccines. Stay up to date with your tetanus shot and its 10-year boosters. Depending on the circumstances, your doctor may recommend other vaccines as well.

Foot Treatment

Begin taking good care of your feet today. Set a time every day to check your feet.

Check your feet on a daily basis. Look at your bare feet for red spots, cuts, swelling, and blisters. If you can’t see the bottoms of your feet, use a mirror or ask someone to help.

Wash your feet daily. Wash your feet in lukewarm water once a day. Dry them gently, especially between the toes. Use a pumice stone to gently rub the skin where calluses easily form. Sprinkle talcum powder or cornstarch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft.

Don’t remove calluses or other foot lesions yourself. To avoid injury to your skin, don’t use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Don’t use chemical wart removers. See your doctor or foot specialist (podiatrist) for removal of any of these lesions.

Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.

If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.

Wear shoes and socks at all times. Never walk barefoot.

Wear clean, dry socks. Wear socks made of fibers that pull (wick) sweat away from your skin, such as cotton and special acrylic fibers — not nylon. Avoid socks with tight elastic bands that reduce circulation, as well as thick bulky socks that often fit poorly and irritate your skin.

Buy shoes that fit properly. Buy comfortable shoes that do not fit tightly and that provide support and cushioning for the heel, arch and ball of the foot. Avoid high heels or narrow shoes that crowd your toes. If one foot is bigger than the other, buy shoes in the larger size. Your doctor may recommend specially designed shoes (orthopedic shoes) that fit the exact shape of your feet, provide cushioning and evenly distribute weight on your feet.

Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.

Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for five minutes, two or three times a day. Don’t cross your legs for long periods of time.

Don’t smoke. Smoking impairs circulation and reduces the amount of oxygen in the blood. These circulatory problems can result in more severe wounds and poor healing. Talk to your doctor if you need help to quit smoking.

Schedule regular foot checkups. Your doctor or podiatrist can inspect your feet for early signs of nerve damage, poor circulation or other foot problems. Schedule foot exams at least once a year or more often if recommended by your doctor.

Take foot injuries seriously. Contact your doctor if you have a foot sore that doesn’t begin to heal within a few days or other persistent problems with your feet. Your doctor will inspect your feet to make a diagnosis and prescribe the appropriate course of treatment

Preventing long-term conditions

Preventing long-term conditions – Your own help is needed

Don’t smoke

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage, and kidney disease. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

Keep your blood pressure and cholesterol under control.

Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.

Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Sometimes medication is needed, too.

Schedule yearly physicals and regular eye exams.

Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

How to correctly manage medication intake

Medication non-compliance is the failure to take drugs on time in the dosages prescribed. It’s a common problem. According to an April 2011 Mayo Clinic Proceedings article, only about half of those who are prescribed medication take it exactly as prescribed.

There are many reasons you might not take your medication as prescribed. They include not understanding medical terms, not being involved in the medical decision making, poor communication on the part of your health care provider, your doctor having an incomplete medical history, limited finances or access to health care, complex medication regimens, cultural barriers, memory issues, health beliefs or misconceptions and many others. It’s a complex issue with no single solution.

So then what can be done? What can you do?

First, ask questions. You have the right to understand your own medical program. Consider inviting a family member or friend to your appointments in order to assist with understanding instructions.

A lot people tend to forget to take their medication. Taking medication is a behavior, and all behaviors can be changed, although change isn’t always easy. Consider tools designed to help — such as medication organizers, dispensers, pill box timers, alarms and written schedules or calendars.

Preparing for your next Doctor appointment

Prepare for your next Appointment

Here’s some information to help you get ready for your next appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance. This will likely include restricting your diet, if you need to complete a fasting blood sugar test.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated.
  • Write down key personal information, including major stresses or recent life changes. If you’re monitoring your glucose levels at home, bring a record of the glucose results, detailing the dates and times of testing.
  • Take a family member or friend, if possible. Someone who accompanies you can help you remember information you need.
  • Write down questions to ask your doctor. Ask about aspects of your diabetes management you’re unclear about.
  • Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you’re there.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

  • Are the symptoms I’m having related to my diabetes or another condition?
  • What else can I do to protect my health?
  • What are other options to manage my diabetes?
  • I have other health conditions. How can I best manage these conditions together?
  • Should I see another specialist, such as a dietitian or diabetes educator?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don’t hesitate to ask any other questions you have.

Insulin Safety

For many people with diabetes, injecting two types of insulin is a daily requirement. Giving yourself your injections can become so much a part of your routine that you can do it without thinking — which can lead to errors.

To increase insulin safety and avoid taking the wrong insulin:

  • Pause and double-check that you’re taking the correct insulin.
  • Label insulin vials or pens with different-colored tape, so that you can differentiate between them. For example, use red tape for short-acting insulin and yellow tape for long-acting insulin.

If you accidentally give yourself the wrong insulin:

  • Call your local emergency number.
  • Test your blood sugar frequently until help arrives. Eat or drink a fast-acting carbohydrate to maintain a blood sugar within your goal range.

In preparation for such issues, it’s a good idea to always carry a simple sugar source with you, such as glucose tablets, juice, regular soda or hard candy.

Injecting Insulin

How to inject insulin?

The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin.

It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body.

To prepare your insulin injection correctly:

  • Wash your hands with soap and water.
  • Before every injection you should shoot 1 to 2 units into the air until you see a drop on the tip of the needle. This way  you make sure that the pen is functioning. In case there is no insulin coming out of the pen, it might be that the cartridge is empty, the needle is clogged or that the piston position is not correct.
  • If you are using intermediate insulin, mix the insulin by rolling the pen slowly  between your hands at least 20 times. Never shake the pen vigorously (hard).
  • Do not use the insulin if it looks lumpy or grainy, seems unusually thick or seems to be even a little discolored.

Do not use the insulin if it contains crystals.

Regular insulin (short-acting) should be used only if it is clear and colorless

  • Adjust the right dose of insulin with the dosage knob
  • Chose the optimal injection site: abdomen, outer thighs or buttocks.

At the abdomen the insulin ill be absorbed the fastest. The area around the navel (around 8 cm surrounding the navel) should not be used. Insulin that is injected into the thigh or the buttocks will be absorbed slower. Talk to your doctor to see which injection site to use.

  • Avoid areas with scarring (old surgery sites) or moles because the tough tissue may not absorb insulin well
  • Gently pinch your skin with your free hand to avoid any damage of the vessels or muscles.
  • Do not inject insulin through clothes.
  • Always inject the length of the needle either straight or slightly diagonal into fatty tissue.
  • Do not pull the needle instantly out. Leave it at least 10 seconds in to make sure that the insulin is distributed.
  • After each injection change the injection site.
  • Use the needle of the pen only once. If you use the needle too often it can cause tissue changes which will prevent the absorption of insulin.

Leaving an insulin needle attached to an insulin pen can lead to unintentional air entering into the insulin pen. If unintentional air enters into the insulin pen, it can contribute to air bubbles accumulating within the insulin and pen and ultimately improper dosing of insulin.  It could also lead to insulin contamination.

To make sure that insulin is correctly distributed

  • Use the right needles depending on your fatty tissue. For the optimal injection the length of the needle is important. Needles are available for children, skinny, and normal as well as more corpulent people with diabetes.
  • Always use the same body region at the same time of the day (e.g. morning the abdomen, evening the thigh) otherwise there may occur variations in the blood sugar levels

Changes in dose—your doctor may change the first dose of the day. A change in the first dose of the day might change your blood sugar later in the day or change the amount of insulin you should use in other doses later that day. That is why your doctor should know any time your dose changes, even temporarily, unless you have been told otherwise.

On sick days—when you become sick with a cold, fever, or the flu, you need to take your usual insulin dose, even if you feel too ill to eat. This is especially true if you have nausea, vomiting, or diarrhea. Infection usually increases your need for insulin. Call your doctor for specific instructions. Continue taking your insulin and try to stay on your regular meal plan. However, if you have trouble eating solid food, drink fruit juices, non-diet soft drinks, or clear soups, or eat small amounts of bland foods. A dietitian or your doctor can give you a list of foods and the amounts to use for sick days. Test your blood sugar level at least every 4 hours while you are awake and check your urine for ketones. If ketones are present, call your doctor at once. If you have severe or prolonged vomiting, check with your doctor. Even when you start feeling better, let your doctor know how you are doing.

Storage

Store in the refrigerator. Do not freeze.

Store your insulin in the refrigerator, in an insulated case or cooler with a freezable gel pack, or use a cooling wallet. Cooling wallets are available through many diabetes supply companies and keep insulin vials, pens and pumps cool at a safe temperature without the need for refrigeration or ice. The wallets have a liner filled with crystals. The liner is immersed in cold water for 10-15 minutes, and placed back into the wallet, along with the insulin. It works by relying on the process of evaporation for cooling, can keep insulin cool for up to 48 hours, and is reusable

Unopened bottles of insulin should be refrigerated until needed and may be used until the printed expiration date on the label. Insulin should never be frozen. Remove the insulin from the refrigerator and allow it to reach room temperature before injecting it.

An insulin bottle in use may be kept at room temperature for up to 1 month. Insulin that has been kept at room temperature for longer than a month should be thrown away.

Storing pre-filled syringes in the refrigerator with the needle pointed up reduces problems that can occur, such as crystals forming in the needle and blocking it up.

Never freeze insulin or expose it to extremely hot temperatures or direct sunlight. Never leave it in your car. Never place it directly on ice or an ice pack.

Throw away insulin that is discolored or contains solid particles.

Remember, after opening a vial of insulin or starting a new insulin pen, the insulin loses its potency and should be thrown away after a certain number of days, depending on the manufacturer’s guidelines. Generally, most vials of insulin are good for 28 days after opening with the exception of Levemir (detemir), which is good for 42 days. Other pens are good for 10, 14, 28 or 42 days. Check the medication insert.

What about insulin pumps?

Heat can make proteins like insulin harden, which increases the potential for infusion set occlusions (blockage). If you live in a hot climate and especially if you work outdoors, you may need to pay closer attention to how the heat can affect your insulin. Using a pump wallet could be another option for people concerned about the effects of heat on their insulin. Also, make sure that the infusion set tubing is tucked in your clothing and not hanging out and exposed to the light and or heat.