My name is Diana Noller from the Medical Team at Sanofi, U.S., and I ll be your host today. I

Transcription

1 sanofi aventis U.S. LLC. All rights reserved. [Script] Hello, and welcome to, "A Helping Hand for Mealtime., a video designed to help you learn more about managing diabetes with a focus on the insulin that your doctor or HCP may prescribe to be taken at mealtime. My name is Diana Noller from the Medical Team at Sanofi, U.S., and I ll be your host today. I am a Registered Nurse and a Certified Diabetes Educator, or CDE. CDEs are skilled and trained healthcare professionals certified by the National Certification Board for Diabetes Educators. While working on your blood sugar can be a challenge, you re taking an important step by watching this video. We ll cover a lot of helpful topics. When it comes to your own personal diabetes treatment plan, always remember to consult with your own healthcare provider as individual needs vary. This training is about 30 minutes long. You can re play this video at any time, and view the sections that are most important to you. Let s get started! 1

2 Today we ll talk about blood sugar, healthy meal planning, and adding your mealtime insulin to your diabetes treatment plan. 2

3 One of the most important things you can do to manage your diabetes is to keep your blood sugar levels within your target ranges. The guidelines shown here are from the American Diabetes Association, or ADA, the leading nonprofit organization for providing diabetes research and information in the United States. The guidelines recommended for most adults with diabetes are fasting or before meal plasma glucose of mg/dl and after meal plasma glucose of less than 180 mg/ dl. This should be measured 1 to 2 hours after starting a meal. Plasma glucose is the blood sugar check that you do yourself throughout the day, at the times recommended by your healthcare provider. While some meters report blood sugar in whole blood, most that are currently on the market report a plasma adjusted value. This is important to know, because values differ between the two measurements. Also, you should know that these recommendations are based on treatment goals for most adults with diabetes. Your healthcare provider may have different blood sugar targets for you, so be sure to follow his or her guidelines. 3

4 [Script ] Now that we ve covered blood sugar level recommendations, we ll look at how to recognize the symptoms of high and low blood sugar levels, what can cause them, and what to do if your blood sugar levels are too high or low. Common symptoms of high blood sugar include frequent urination, increased thirst, increased hunger, blurred vision, fatigue, weight loss, frequent infections, slow healing cuts or sores, and tingling or numbness in the feet or hands. But you may have high blood sugar without any symptoms, so checking your blood sugar is important! 4

5 If you have diabetes, too much food, usually carbohydrates, can cause high blood sugar. But food is not the only cause of high blood sugar. Too little physical activity, too little diabetes medication, interaction with other medications such as steroids, and stress or illness can also cause blood sugar levels to rise above target ranges. 5

6 If you have high blood sugar, you ll want to work with your healthcare provider to adjust your meal plan and/or physical activity routine. Talk to your healthcare provider about adjusting your medications. Also, find out what your healthcare provider considers to be very high blood sugar for you, so that you ll know at what point to take emergency action. 6

7 Common symptoms of low blood sugar include shakiness, hunger, confusion, dizziness, tingling sensations around the mouth, sudden moodiness or behavior changes, clumsy or jerky movements, pale skin color, seizure, sweating, and headache. But you may have low blood sugar without any symptoms, so checking your blood sugar is important! 7

8 If you have diabetes, low blood sugar may be the result of too little food, too much physical activity, too much diabetes medication, other medications, and alcohol. When you experience either extreme high or low blood sugar it s important to understand what may have caused it so that you can better manage that situation in the future. 8

9 If you have low blood sugar, you should eat 15 to 20 grams of fast acting carbohydrate, contained in foods such as 3 or 4 Glucose Tablets or 4 ounces or half a cup of juice or 6 ounces of regular (not diet) soda. Then wait 15 minutes and check your blood sugar again. Repeat until your blood sugar is within range and follow up with a snack or meal. 9

10 It s important to check your blood sugar levels every day. Most people can check their blood sugar levels at home. The ADA recommends that people receiving multiple insulin injections check their blood sugar levels 3 or more times a day. Your healthcare provider can help you decide how often you should check your blood sugar levels. It s also a good idea to keep a record of your levels in a blood sugar log and look for extremes. Bring it with you to your visits with your healthcare provider. This will help you both keep track of your progress. 10

11 In addition to regular blood sugar monitoring, an A1C test is needed to give you and your healthcare provider a picture of your average blood sugar control over the past 2 to 3 months. A1C is a reflection of your average blood glucose and is impacted by fasting or before meal glucose as well as postmeal blood glucose. It s important that your healthcare provider performs this test 2 to 4 times per year, depending on how well your blood sugar is controlled. Make sure to ask your healthcare provider about your results. 11

12 The ADA recommends an A1C of less than 7%, which is right for most adults with diabetes; however, your healthcare provider may have a different goal for you, so be sure to discuss this with him or her for a more individualized target. 12

13 When you have diabetes, it s important that you understand the relationship between food and blood sugar. The carbohydrate in food makes blood sugar levels go up. The more carbohydrates you eat, the more your blood sugar levels go up. Likewise, if you eat less, you can expect your blood sugar levels to be lower. Also, it s important that you always include a source of protein and fat to balance out your meal. 13

14 [Script ] Some people find it helpful to plan their meals ahead of time. A simple and popular method for diabetes meal planning is the Plate Method. Let s take a closer look at this method now. 14

15 Using this method, you would divide your plate (using a 9 inch plate) into sections. Different types of food get put on each section of the plate. The picture on the right shows some examples of food you can put on each section of your plate. Let s start with vegetables. Non starchy vegetables go on one half of your plate. Examples of non starchy vegetables include spinach, carrots, broccoli, lettuce, tomatoes, and peppers. This may be more vegetables than you usually eat. However, by increasing the amount of vegetables you eat, you are bringing your meals back into balance and adding fiber, vitamins, and minerals you might have been missing. It may be best to pick more than one type of vegetable rather than to fill half your plate with only one vegetable. You can get tired of even your favorite vegetables that way. Next, save a quarter of your plate for breads, grains, or starches. Examples are whole grain breads, such as whole wheat or rye, rice, pasta, cooked beans, green peas, potatoes, and corn. The remaining quarter of your plate should be used for lean meats, eggs, fish, or other lowfat protein sources. Examples include chicken or turkey without the skin, lean cuts of beef and pork, low fat cheese, and fish such as tuna, salmon, and catfish. You can also add an 8 oz cup of low fat milk, 6 oz container of light yogurt, or a 1/2 cup serving of fruit but be sure to balance out the rest of your carbohydrates for that meal so that your blood sugar levels stay within target. 15

16 Healthy meal planning may help you reduce the risk of high and low blood sugar levels, reach or maintain a healthy weight, and decrease your risk of heart disease and stroke. 16

17 [Script ] To help you make healthy meal choices, it s also important to understand the relationship between blood sugar and carbohydrates. Carbohydrates, which include sugars, starches, and the digestible part of fiber, are broken down by the body into simple sugars, including glucose. Insulin allows your cells to use this sugar as energy. However, if your body is not producing enough insulin, your blood sugar isn t used properly. Your total carbohydrate intake has the strongest impact on postmeal blood sugar levels. So if you have diabetes, the more carbohydrates you eat, the more insulin you will need to make sure your blood sugar levels remain within your target ranges. 17

18 [Script ] To help control the amount of carbohydrates you are having, learn to recognize the serving sizes for different types of foods. For people with diabetes, a serving is a portion that contains 15 grams of carbohydrates. Some examples of diabetes servings are: A half cup of oatmeal ¾ of a cup of plain fat free yogurt 1 small piece of fresh fruit (4 oz) 1 cup of soup ½ cup of black beans, and 1 slice of bread Keep in mind that the body doesn t process all carbohydrates the same way or at the same speed. Carbohydrates differ based on the amount of starch, sugar, and fiber contained in the food. 18

19 In order to control the amount of carbohydrates you eat, you will need to keep track of daily servings. A single serving of carbohydrates is generally considered equal to 15 grams. Most men can set a goal of 4 5 carbohydrate servings per meal, or grams, whereas women can aim for 3 4 carbohydrate servings per meal, or grams. 19

20 [Script ] There are different tools for carbohydrate counting. Hand guides are one tool you may find useful. A fist is equal to a half cup. The top of your thumb is equal to 1 teaspoon. Your entire thumb is equal to 1 tablespoon, and the palm of your hand is equal to 3 ounces of meat. 20

21 Nutrition labels are another tool for carbohydrate counting, and one of the best sources for information on grams of carbohydrate. They also define a serving size, which is very important and often surprising. The grams of sugar and fiber are counted as part of the grams of total carbohydrate. Let s look at the three steps for using a Nutrition Facts label: Step 1 is looking at the Serving Size : Look at the serving size on the label. All the numbers in the Nutrition Facts box are based on this serving size. Sometimes there is more than 1 serving in the package Step 2 is looking at the Total Carbohydrate : Look at the grams of total carbohydrate. Remember, it is the carbohydrate in food that raises your blood sugar the most. The grams of total carbohydrate include the grams of sugar. Focus on the number of grams of total carbohydrate Fiber is a carbohydrate that the body does not completely break down into sugar. Choose foods that are higher in fiber whenever possible In a meal plan for people with diabetes, one carbohydrate serving contains 15 grams of carbohydrate. You should talk to your healthcare provider about the number of carbohydrate servings that are right for you And Step 3 is looking at the Total Fat : Look at the grams of total fat in the label serving. Choose lower fat foods most often. 21

22 Looking at the different types of insulin, we see that rapid acting insulin starts to work in about 5 minutes after injection and continues to work for 2 to 4 hours. Short acting insulin begins to work within 30 minutes after injection and continues working for up to 6 hours. Intermediate acting insulin usually begins to work in 2 to 4 hours after it s injected and continues to work for about 12 to 18 hours. And long acting insulin begins to work in 2 to 4 hours after injection and can work for 24 hours. Sometimes, a mixture of two insulins in predetermined proportions combining an intermediate acting and a rapid or short acting insulin in one dose is used. This type of mixture is called premix. Many types of premixed insulins are available. It s important to know that exercise, diet, and other diabetes treatments are all part of diabetes therapy. You should speak with your healthcare provider to understand the appropriate treatment for managing your blood sugar. 22

23 Let s take a closer look at rapid acting insulin. Every time you eat, your blood sugar goes up. A long acting insulin alone may not be able to control those mealtime blood sugar spikes. Your HCP may recommend using a rapid acting insulin to help control blood sugar at mealtimes. 23

24 Now let s take a look at Apidra, an insulin analog taken at mealtime, which your healthcare provider may have prescribed for you. Here is the Indications and Usage information from Apidra s prescribing information leaflet. You can also access all of the Important Safety Information and full prescribing information through the links alongside this video. Indications and Usage for Apidra Prescription Apidra is an insulin for adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes to improve blood sugar control. Apidra given by subcutaneous injection is usually used with a longer acting insulin. When used as a mealtime insulin, Apidra should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra may be infused subcutaneously using external insulin infusion pumps. Important Safety Information for Apidra Do not use Apidra during a low blood sugar reaction (hypoglycemia) or if you are allergic to any of the ingredients in Apidra. 24

25 Apidra works like the insulin the body makes at mealtimes. When added to the right balance of diet, exercise, and other diabetes medications, Apidra is effective at lowering mealtime blood sugar levels. There are a number of points of Important Safety Information for Apidra Do not share needles, insulin pens or syringes with others. You must test your blood sugar levels while using insulin, such as Apidra. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Apidra must only be used if the solution is clear and colorless with no particles visible. Now let s take a look at how Apidra works to help control blood sugar. 25

26 So how is Apidra used as a part of a treatment plan to help control blood sugar levels? Apidra should normally be taken with a longer acting insulin. As a rapid acting insulin, Apidra gives you the extra help you may need to manage the blood sugar spikes that happen when you eat. Here are some additional points of Important Safety Information for Apidra Apidra, when given by injection under the skin, should not be mixed with insulins other than NPH. Do not mix Apidra with any insulin when used in the pump or for intravenous administration. 26

27 Apidra is as effective as other mealtime insulins at controlling your blood sugar levels and offers you dosing flexibility. Apidra is the only mealtime insulin approved for you to take 15 minutes before or within 20 minutes after starting a meal. The next Important Safety Information for Apidra pertains to side effects. The most common side effect of insulin, including Apidra, is low blood sugar (hypoglycemia), which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision. Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include low blood potassium, injection site reactions, such as changes in fat tissue at the injection site, and allergic reactions, such as itching and rash. Less common, but potentially more serious or life threatening, is generalized allergy to insulin, including anaphylactic reactions. 27

28 The most common side effect of insulin, including Apidra, is low blood sugar (hypoglycemia), which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision. Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include low blood potassium, injection site reactions, such as changes in fat tissue at the injection site, and allergic reactions, such as itching and rash. Less common, but potentially more serious or life threatening, is generalized allergy to insulin, including anaphylactic reactions. 28

29 Sometimes it s hard to eat on schedule. Meals get delayed for all kinds of reasons. Restaurants can be late bringing your food, surprise interruptions at work or home can delay meals, or a busy family schedule can take over. With Apidra, being able to dose after your meal begins gives you more options it means you don t have to worry about your meal being delayed, which could possibly lead to a low blood sugar reaction. Apidra is the only mealtime insulin approved for you to take 15 minutes before or within 20 minutes after starting a meal. Here is some additional Important Safety Information for Apidra Do not use Apidra during a low blood sugar reaction (hypoglycemia) or if you are allergic to any of the ingredients in Apidra. 29

30 Sometimes people end up eating more than they want to because they have already taken their mealtime insulin. Dosing after your meal may help prevent you from having to eat to balance your dose. Whereas some mealtime insulins require strict eating schedules which can include dosing up to 30 minutes before your meal begins, Apidra is one of the rapid acting insulins approved by the Food and Drug Administration to take after your meal begins. A few additional points of Important Safety Information for Apidra Do not share needles, insulin pens or syringes with others. You must test your blood sugar levels while using insulin, such as Apidra. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Apidra must only be used if the solution is clear and colorless with no particles visible. 30

31 An easy to use option for Apidra administration is the Apidra SoloSTAR pen, a disposable insulin pen prefilled with Apidra. It s important to note that needles and the Apidra SoloSTAR pen itself must not be shared. And, remember, Apidra should normally be taken with a long acting insulin. You may take Apidra in this SoloStar pen, by using a vial and syringe, or in an insulin pump. You can find links to injection instructions and videos on the same page where you found this video, and review the information that matches how you may take Apidra. Important Safety Information for Apidra SoloSTAR Apidra SoloSTAR is a disposable prefilled insulin pen. Please talk to your healthcare provider about proper injection techniques and follow instructions in the Instruction Leaflet that accompanies the pen. 31

32 [Script ] We re coming to the end of our video. Thanks for watching! Remember, you can re watch this video at anytime. You can also watch the instructional videos about injecting using the SoloSTAR pen, or using a vial and syringe, or information about using Apidra in an insulin pump. Before we finish, let s take another look at the Important Safety Information for Apidra. Do not use Apidra during a low blood sugar reaction (hypoglycemia) or if you are allergic to any of the ingredients in Apidra Do not share needles, insulin pens or syringes with others. You must test your blood sugar levels while using insulin, such as Apidra. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Apidra must only be used if the solution is clear and colorless with no particles visible. Apidra, when given by injection under the skin, should not be mixed with insulins other than NPH. Do not mix Apidra with any insulin when used in the pump or for intravenous administration. 32

33 The most common side effect of insulin, including Apidra, is low blood sugar (hypoglycemia), which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision. Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include low blood potassium, injection site reactions, such as changes in fat tissue at the injection site, and allergic reactions, such as itching and rash. Less common, but potentially more serious or life threatening, is generalized allergy to insulin, including anaphylactic reactions. 33

34 Tell your doctor about other medicines, especially ones commonly called TZDs (thiazolidinediones), and supplements you are taking because they can change the way insulin works. Before starting Apidra, tell your doctor about all your medical conditions including if you have liver or kidney problems, are pregnant or planning to become pregnant, or are breast feeding or planning to breast feed. If you have heart failure or other heart problems, it may get worse while you take TZDs with Apidra. Apidra SoloSTAR is a disposable prefilled insulin pen. Please talk to your healthcare provider about proper injection techniques and follow instructions in the Instruction Leaflet that accompanies the pen. 34

35 It is important to always follow the instructions provided with your Apidra prescription for use with an external insulin infusion pump. These instructions may differ from the instructions that accompany your insulin infusion pump. Failure to follow the Apidra specific instructions may lead to serious side effects. You must change the infusion set (reservoir, tubing, and catheter), and the Apidra in the pump reservoir at least every 48 hours. Do not mix Apidra with any insulin when used in the pump and do not dilute Apidra. 35

36 If the pump or infusion set does not work right or in case of handling errors, you may not get the right amount of insulin. This can cause low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), high amounts of sugar and ketones in your blood (ketosis) or a build up of acid in your blood because your body is breaking down fat instead of sugar (diabetic ketoacidosis). It is important to have another way to inject Apidra in case the pump does not work. Apidra has not been studied in children with type 2 diabetes or in children younger than 4 years of age with type 1 diabetes. In a clinical study of children with type 1 diabetes, there was a higher rate of severe symptomatic hypoglycemia in the two treatment groups (Apidra or insulin lispro) compared to adult trials with type 1 diabetes. You can re play this video at any time, and view the sections that are most important to you. It is always available on the Apidra website, along with specific videos on how to inject Apidra using a pen, a vial and syringe, and instructions for using Apidra in an insulin pump. I'm glad that you were able to join us for today s education session. Education is an important part of controlling your diabetes, and after watching today s presentation, you've learned about healthy meal planning, the role of Apidra in controlling blood sugar, and how to use the Apidra SoloSTAR pen and vial and syringe. Thank you for watching and have a great day! 36