Living Well. with diabetes. Refreshing diabetes management. Helping all people live healthy lives

Transcription

1 Living Well with diabetes Helping all people live healthy lives Refreshing diabetes management

2 Contents 4 Injecting correctly ensuring the right technique What is under the surface of your skin and how to hit the right spot when you inject 6 Injection site rotation why it is really important How to rotate injection sites and where to inject 8 Feeling Great, Looking Great lipos and how to avoid them The do s and dont s to help you reduce the risk of developing lumps and bumps from lipos 10 Sharp thinking why using a new needle each time is important 13 Deliciously tempting treats simple recipes to enjoy Apricot Oat Munchies Summer Berry Crepes Did you know: Olympic rower Sir Steve Redgrave has diabetes. 2 Diabetes management refresher guide

3 Getting it right We all know what it s like. We learn something new, do it the right way for a while and then, without realising it, we slip into bad habits. Whether it s driving or exercise or even the way we look after ourselves, we have all done it. Often, all we need is a little reminder to get us back into the good habits that we once had. This booklet is just that a refresher on the basics of looking after yourself with the way you manage your diabetes. Injecting insulin or incretin hormone can be a pain (sometimes literally) but doing it the right way can make all the difference to the way you feel day to day. This guide and your diabetes nurse will help you look after yourself and feel as well as you can. And because life is about enjoying yourself, we have developed some delicious recipe ideas that can be a treat for you and your whole family. Enjoy!

4 Doing injections correctly it s more than just skin deep Skin layer don t inject into here! Subcutaneous tissue layer inject into here Muscle layer don t inject into here! You have been injecting yourself for some time but did you know that it matters where and how you inject? We will talk more about where to inject later, but for now it s important to remember the rights and wrongs of injecting, and to remind yourself of the right technique. what is under the surface To start with, let s look at what is under the skin. What we call the skin is actually made up of three layers. The top, thin layer is known as the epidermis this is the bit you can actually see. Underneath that is the dermis, which is where hair roots, nerve endings, sweat glands and blood vessels sit. Broadly the thickness of the first 2 layers is the same for everybody, whatever size you are, and is generally about 2mm thick on average. This covers a layer of fatty tissue known as subcutaneous tissue, which we all have and which sits on top of our muscles. When you inject, it is the subcutaneous tissue layer that you are aiming for, and not the muscle layer or dermis. 4 Diabetes management refresher guide

5 Did you know: Skin is on average only 2mm thick, which is why short needles are often recommended to patients. why the subcutaneous layer is important We all know that different materials absorb things at different rates and it is the same for the different layers of your skin. Insulin needs to be absorbed steadily to work properly and subcutaneous tissue is the best layer to do this. This ensures that the insulin is released into your body smoothly, helping to regulate your blood glucose levels evenly. If the needle goes deeper, the injection goes into the muscle. Unlike subcutaneous tissue, muscle absorbs insulin rapidly, which could cause a hypo this is why you should not inject in the muscle layer (that and the fact that it hurts a bit more too). how to hit the right spot So we know you need to inject into the subcutaneous layer. For most people, using a short (e.g. 5mm) needle is ideal to make sure the end of the needle is in the subcutaneous layer and doesn t go deeper reaching the muscle layer. Others (e.g. using an 8mm) may need to inject into a skin fold to help you hit the right spot your nurse will be able to advise you on the most appropriate technique for you based on your needle length. And remember, leave the needle in for at least 10 seconds after you have pressed the plunger to make sure that all of the insulin is injected properly.

6 Rotation, rotation, rotation it really makes a BIG difference As you can imagine, every time you stick a needle into your skin you cause a tiny bit of damage. It s important to let this damage heal, which it does quickly as long as you don t keep injecting in the same place all the time. That is why you are always advised to rotate your injection sites. what areas you can inject into You no doubt have one or two favourite areas that you inject into, however there are three areas that generally could be used for injecting: thighs, abdomen and buttocks. You need to be able to reach them easily, and be comfortable making your injection there. Talk to your nurse or doctor about the sites that are best for you and try to get into the habit of using these sites. Note: the arms can be used as an injection site if advised by your nurse 6 Diabetes management refresher guide

7 Did you know: Even though the injection site has less influence on the absorption rate of analogue insulin, it is still important to rotate sites to avoid lipos. why you need to rotate sites The main reason for rotating between and within sites is to make sure you don t keep injecting in the same spot each time. Here s why: The speed of insulin absorption varies from site to site. So it s important to develop a pattern where you are injecting in different sites throughout the day. Doing this helps you control your blood glucose levels If you inject in the same spot regularly the tissue beneath may harden a condition known as lipohypertrophy (or lipos as they are often called) Lipos can cause serious problems. Not only do they not look good (and can grow over time to be quite large), more importantly lipos affect the way that insulin is absorbed. This in turn will affect the control of your blood glucose with the result that you won t feel as well as you should. how to rotate the rules Rule 1 Always ROTATE between sites consistently. Always inject in the same area at the same time of the day. Let s say you need 3 injections a day. You might start with a morning injection in your arm. Then a lunchtime injection in your abdomen. And lastly an evening injection in your thigh or buttock. It is equally important to alternate between the left and right sides e.g. left thigh, right thigh. Rule 2 DON T inject in exactly the same point each time. When it s time to use an area to inject again, choose a different spot within the area. If you imagine a grid drawn on the skin, you re aiming to move on a finger s width from the last injection point, like the illustration shown above. Note: if you already have a lipo you need to allow the tissue to recover. Stop injecting into the lipo, rotate and don t reuse. If you see or feel a lipo developing, talk to your nurse, they can help you.

8 Feeling Great, Looking Great Lipos the facts and how to avoid them It s very easy to forget, what with everything else that is going on, that the needle on the end of your pen is a vital part of your treatment. Pen needles are now designed to be single use only for example single-use needles are now much thinner than they used to be, to try and make injecting less painful, and they also have a lubricant to help when injecting but this wears-off. Some people leave their single-use needles on all day and some even only change their single-use needle when the insulin cartridge needs changing every week or so. We all know there are times when you run out or don t have a new needle with you. However, it is really important that you do use a new singleuse needle each time you inject. There are lots of reasons for this but avoiding lipos is one of the main ones. what are they and how to spot them Lipos (or lipohypertrophy) are lumps and bumps that can form under your skin. While a lot of people who inject get lipos, you really can avoid them with good injection technique. They can appear anywhere that you inject your insulin and you need to know how to look for them. It is important to regularly examine the sites where you inject. Look for any lumps, swelling or redness and feel for any irregularity or hardening of the skin. It s easier to look for them when you are undressed, standing up and relaxed. You can always ask your doctor or nurse to explain how to examine your own injection sites. 8 Diabetes management refresher guide Example of Lipos

9 Do these things and you greatly improve your chances of avoiding lipos. And not only will that make you feel great, but you will look great too! why you should avoid lipos Well, apart from the fact that they can be unsightly and uncomfortable, they also affect the way insulin is absorbed. Absorption of insulin injected into a lipo is erratic and unpredictable. Erratic absorption means that your blood glucose levels are not as controlled as they should be, which means that you do not feel as well as you could and that you are more likely to get complications. Also it has been shown that injecting into non lipo tissue can reduce your insulin requirements by up to 50%*. how to avoid lipos Research carried out in 2007 * showed that: 79.7% of people who used a new needle at every injection didn t have lipos 100% of those who only changed their needles when they replaced their cartridge had lipos While you can t guarantee that you won t get lipos, you can greatly improve your chances if you: Change injection sites Rotate within injection sites Use a new needle each time you inject * B. Varder and S. Kizilci (2007)

10 Sharp Thinking it s all about bubbles While avoiding lipos is one of the main reasons you should always use a new needle, there are other reasons why you should avoid leaving the needle on the pen between injections. Insulin can leak out Insulin such as pre-mixed insulin (e.g. 30/70) contains two types of insulin (short or rapid acting and intermediate acting insulin). The short/rapid acting insulin is much more fluid and leaks more readily from the open passage created by leaving a needle attached. This leakage changes the relative concentration of the insulin mixture. This means that you are not getting the correct mixture you need, which will negatively impact your glucose control. Air bubbles form in the insulin cartridge If you leave the needle on your insulin pen in between uses, air will get into the insulin cartridge. While the air itself won t hurt you, research* has shown that air in the cartridge can have a dramatic impact on how long it can take for the insulin to be delivered during an injection. With no excess air in the cartridge, almost all of the insulin is delivered within 10 seconds of pressing the plunger on the pen (which is why you are told to keep the needle in for 10 seconds). However, this can reduce to only 37% if there is more air in the cartridge (which can happen if the needle is left on for even only a couple of days). *B. Ginsberg, J. Parkes and C. Sparacino (1994) 10 Diabetes management refresher guide

11 This means that you are not getting the full dose of insulin. Instead it is still coming out of the needle after you have pulled it out of your skin. You may have seen this yourself. When this happens, your blood glucose will not be as controlled as you would hope and you won t feel as well as you should. Did you know: If you leave your needle attached to your pen, your body might only be getting 37% of the required dose of insulin.

12 Sharp Thinking Summary Hopefully this booklet has been helpful and can act as a reminder for you when it comes to looking after yourself. Remember...Keep an eye out for lipos forming. Look and feel for any lumps forming. If you find a lipo, don t inject into it as it affects how your insulin is absorbed....always rotate your injection sites. This is one of the simplest ways of avoiding unsightly lipos forming. If you are not sure, ask your doctor or nurse to show you how best to rotate between and within sites....always use a new single-use needle. Research has shown that needles used more than once increase the chance of a lipo forming, so it really does make sense to use a new needle each time. Blunt needles hurt! A new needle is sharp and enters the skin easily. But if you use it more than once, the end becomes blunt and the lubricant which helps the needle go smoothly into and out of your skin, is worn off. Needles used more than once can clog between injections. Insulin can form crystals in used needles. If you re-use the needle it may get blocked, making it more difficult and painful to inject. New needles are sterile. Each time a new single-use needle is opened, it s sterile. That means there are no bacteria present when you use it (which has to be a good thing!). 12 Diabetes management refresher guide

13 Tempting Treats Recipes Ideas We believe that it is important to enjoy life, so we have teamed up with a leading chef to bring you some delicious treats for you and your family. These recipes have been designed to be easy to do at home, so that you can spend time having fun, and then enjoying as an after dinner pud. Relax and enjoy!

14 Apricot Oat Munchies Takes: 60 mins Makes: 12 squares Per apricot oat square 174 calories 34g carbohydrates Ingredients: cut into chunks 250g ready-to-eat apricots + 70g crystallised ginger 400ml orange juice 200g porridge oats 3 x 15ml sps muscavado sugar 30g sunflower seeds or chopped walnuts Make: Place the apricots and orange juice in a pan and bring to the boil, then simmer for 25 mins until most of the juice is absorbed. Using a hand-held blender or food processor blend the apricots briefly until you have a rough puree. Preheat the oven to 180 C/Gas 4 Line the base of a rectangular baking tray (250mm x 170mm) with baking parchment. Add the ginger, oats, sugar and sunflower seeds (or walnuts, if using) to the apricots and stir to combine. Spoon into the tray and press down evenly. Bake: for mins until lightly brown and firm to the touch. Allow to cool for 10mins then cut into squares, and allow to cool completely before turning out.

15 Summer Berry Crepes Takes: 45 mins Makes: 8 crepes Per crepe 123 calories 20g carbohydrates Ingredients: 110g wholemeal flour 15g wheatgerm pinch of salt 225g skimmed milk 2 x eggs a few drops of vanilla essence grapeseed oil, to grease pan 100g blueberries 200g stawberries, halved 200g raspberries (+ 200g for coulis) ground cinnamon Make: Combine the flour, salt and wheatgerm in a large bowl. Whisk the milk, eggs and vanilla essence together. Make a well in the centre of the flour and gradually pour in the milk and eggs, whisking until smooth. Allow batter to stand for 30 mins. Meanwhile combine the fruit with a pinch of cinnamon and set aside. To make the coulis, rinse the 200g raspberries in water, place in a pan and heat gently until softened. Pass through a sieve. Crepes: To make the crepes, pour a thin layer of batter into a hot greased crepe or frying pan, tipping to spread it evenly over the base. Cook for about 1 min, toss and cook for a further min. Repeat with remaining batter. Divide the fruit evenly between the crepes, drizzle with the coulis and fold into quarters. Serve, with cream or a pinch of cinnamon.

16 Useful information. Facts, resources, help. BD Medical Diabetes Care Practical advice and resources. Diabetes UK & Diabetes Federation of Ireland The leading UK and Irish charities helping people with diabetes, providing information, (including diabetes identity cards) and supporting reasearch. Diabetes UK: T: +44 (0) E: Diabetes UK Careline: T: +44 (0) , Monday-Friday, 9am-5pm E: Diabetes Federation of Ireland: T: E: info@diabetes.ie Helpline: Driving and diabetes If you re diagnosed with diabetes, you MUST notify the DVLA (in the UK) or Department of Transport (Ireland). After completing a form you ll be issued with a licence valid for 1-3 years. You must inform your motor insurance company. UK: T: +44 (0) Drivers Abroad: +44 (0) E: drivers.dvla@gtnet.gov.uk ROI: T: Local: E: info@transport.ie Your healthcare team contact details: Names: Helping all people live healthy lives Tel: BD and BD Logo are trademarks of Becton, Dickinson and Company BD. All other brands are trademarks of their respective owners. Becton, Dickenson U.K. Limited. Registered in England: Registered Office: The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford, Oxfordshire OX4 4DQ. BDDC September B. Vardar and S. Kızılcı (2007). Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Research and Clinical Practice 77: B. Ginsberg, J. Parkes and C. Sparacino (1994). The kinetics of insulin administration by insulin pens. Hormone and Metabolic Research. 26: BD Medical - Diabetes Care Edmund Halley Road Oxford Science Park Oxford OX4 4DQ Tel: +44 (0) Fax: +44 (0)