24 Hour Support. Telephone Available 24 hours a day, 7 days a week

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2 Contents Page What is SHAIRE? 1 What is basal-bolus regimen? 2 Why do I need a basal-bolus regimen? 3 How does basal insulin work? 3 How does rapid-acting insulin work? 4 How often should I test my Blood Sugar? 4 What is involved in Carbohydrate Counting? 5 What else will I learn? 5 What are the next steps? 6 Helpful words 7 Further information 8 24 hour support 9 My contacts 9 24 Hour Support Sanofi-aventis Insulin Support Programme Telephone Available 24 hours a day, 7 days a week Novo Nordisk Helpline Hours of operation The helpline is staffed from hrs Mon-Fri hrs at weekends and public holidays All calls are charged at a local rate and no other cost is incurred by the caller. Eli Lilly Customer Care: hrs My Contacts The information in this booklet is not intended to replace the advice of you diabetes nurse or doctor

3 Further Information Diabetes UK Suite 8 Bridgewood House Newforge Business Park Newforge Lane Belfast BT9 6NW Tel Driving and Diabetes Diabetes information website with a range of online tools such as an online monitoring diary and calendar to help manage your diabetes What is SHAIRE SHAIRE is based on an education programme called DAFNE (Dose Adjustment For Normal Eating), which has been shown to improve control and quality of life in people with Type 1 Diabetes. The SHAIRE programme is run over one day and is led by the Diabetes Specialist Nurses and Dietitian. The SHAIRE programme allows you the freedom to choose whatever type or amount of carbohydrate you wish to eat by teaching you how to adjust your insulin and maintain good sugar (glucose) levels. You will also be able to change the timing of meals and snacks to allow greater flexibility. The SHAIRE approach requires you to take more time to learn about the foods that you eat; where carbohydrate comes from and how much carbohydrate there is in certain foods. DVLNI Check address You will also need to look at the doses of insulin taken and the blood sugar responses to meals so that you can work out a dose of insulin per serving of carbohydrate You will gradually become very familiar with the foods you normally eat so that the process of adjusting insulin doses becomes second nature. SHAIRE allows you to eat normally and gives more flexibility (whilst on your insulin regimen)

4 What is a basal-bolus regimen? Long acting (also known as basal) insulin is usually combined with a rapid acting (also known as bolus) insulin. Your bolus insulin will be taken with each meal of the day. The combination of a basal and a mealtime insulin is known as a basal-bolus regimen. Key point: A combined programme of a long-acting insulin and a rapid-acting insulin is known as a basal-bolus insulin regimen. Helpful words Background insulin Basal insulin Basal-bolus regimen Bolus insulin Carbohydrate (CHO) Hyperglycaemia Hypoglycaemia Long acting insulin Peakless Rapid-acting insulin Regimen Continous insulin production by the normal pancreas Long-acting insulin, resembling the continous background insulin normally produced by the pancreas. A combined programme of longacting and a rapid-acting insulin. Rapid-acting insulin Found in foods containing sugars and starches which, when digested, cause a rise in blood sugar levels. Insulin mobilises this sugar into the body s cells to provide them with energy High blood glucose Low blood glucose (<4mmol/l). Hypo is a common term for hypoglycaemia Injected insulin that carries on working for up to 24 hours Steady and continous with no peaks and troughs Insulin that works for a very short time and can be injected just before meals, immediately afterwards, or even when eating. Treatment programme

5 What are the next steps? Do you think this education programme is for you? If yes: Please make an appointment for our next available slot before you leave the clinic or contact your Diabetes Specialist Nurse. Time: Date: Place: Why do I need a basal-bolus regimen? Your doctor has prescribed a long-acting insulin as part of your new insulin programme (sometimes known as a regimen). A basal-bolus regimen allows you to be more flexible with your eating times, whilst maintaining your blood sugar levels. Good blood glucose control reduces the risk of complications from diabetes such as eye, foot, kidney and heart problems. How does basal insulin work? Your long-acting (basal) insulin is like the background insulin normally producecd by the pancreas. It helps you control your blood glucose level over 24 hours so you only need to inject it once a day. Long-acting (basal) insulin is sometimes known as peakless insulin because the insulin level in the blood stays quite constant. You should adjust your basal insulin according to your fasting blood sugar level. Key points: you should inject a basal insulin once a day. A basal insulin works for 24 hours. Type of Insulin Example Rapid acting Longacting NovoRapid (insulin aspart), Humalog (insulin lispro): Apidra (insulin glulisine) Absorbed very rapidly, lasts only a few hours. Aims to control mealtime blood sugar level. Levemir (insulin detemir), Lantus (insulin glargine): More slowly absorbed. Designed to provide a background level of insulin throughout day and night

6 How does rapid-acting insulin work? Every meal that contains carbohydrate will require a dose of rapid-acting insulin to cover your mealtime rise in blood sugar. This is called bolus insulin. Your rapid-acting insulin will either be Humalog, NovoRapid or Apidra. These insulins allow flexibility in meal times when incorporating carbohydrate counting and adjusting doses. During the SHAIRE education session the action of these insulins, timing and doses will be discussed further. Key Point: you should adjust your bolus insulin according to the carbohydrate in your meal. How often should I test my Blood Sugar? You will need to test your blood sugar at least four times per day to achieve optimal control. What is involved in Carbohydrate Counting? Carbohydrate (CHO) is the main nutrient that affects your blood sugar level. You will be taught how to identify the CHO sources in your diet and be able to work out how much CHO you are eating or drinking. The CHO amount allows you to work out how much insulin you will require to cover that meal. You will be given an insulin to CHO ratio to help you do this. CHO counting not only gives you more choice and flexibility with the type and amount of food you eat but also can help you maintain your blood sugar levels within your target ranges. Key Point: CHO counting helps you to match your insulin dose to the amount of CHO you eat more accurately, resulting in better blood glucose management. What else will I learn? Other topics covered during the education session will include managing your diabetes and: Driving Hypoglycaemia Alcohol Eating out Exercise Sick day rules Learning and sharing your diabetes experiences in a small group. Key point: Lifestyle issues will be discussed.