If you think you are injecting into the muscle, you may want to change your technique or ask your GP to prescribe shorter needles.

The steps below are a broad guide to injecting insulin.

If you plan to change your technique, check with your healthcare team, diabetic nurse or consultant for their advice.

How to perform an insulin injection

Firstly, prepare your kit.

You will need:

• An insulin pen
• Enough insulin inside to give the required dose
• A new pen needle
• A sharps disposal box for used pen needles to go into

Make sure you have your kit available at all times and if possible, inform your family as to its location.

If you suffer from a hypo, this will allow your family to act quickly.

Injecting your insulin shot

To perform your insulin injection:

• Wherever possible, wash your hands with soap and water before injecting.
• Put a new needle onto your pen.
• Remove the caps of the pen needle.
• Hold the pen upright and perform an ‘air shot’. This requires dialling up at least 2 units and pressing the plunger to expel a test shot of insulin. This helps to clear any bubbles out of the needle. If you do not get a steady stream, repeat the air shot until you do get a steady stream of insulin coming out.
• Dial up your dose.
• Pick a soft fatty area to inject. Tops of thighs, belly, bum and triceps (triceps; the top and back of the upper arm, are not always recommended for children or thinner people).
• Some people may need to raise a fold of fatty flesh slightly between your thumb and fingers. If you are unsure about whether you need to do this, ask your health team.
• Put the needle in and keep the pen steady.
• Push the plunger relatively slowly to inject the dose.
• After the dose has been injected, hold the needle in for a good 10 seconds to help insulin get delivered and prevent any of the dose escaping out.
• Ensure that the used needle bin is deposited into a sharps bin.

How to avoid pain when injecting insulin

Most injections are not painful. The chance of pain is greatly minimised by using a new needle.

Some tips to help avoid or minimise pain when injecting, include:

• Always use a new needle.
• Use a needle that is the right length. Your health team can advise you on whether you’re using the right needle length.
• Use insulin and a needle which is at room temperature.
• Push the needle in quickly when injecting.
• Try not to wiggle the needle as you’re injecting or withdrawing the needle.

Injections and bruising

You may notice a little blood leaks out after injecting.

This is not to worry about, it just means the needle has gone through a small blood vessel.

If this happens, you may notice a raised area of your skin from the blood underneath but this should ease down over the next few hours and you’ll be left with a bit of a bruise for a few days.

Rotate your injection sites to avoid ‘lumpy’ skin

If you tend to inject in the same places you may find that your flesh becomes less flexible than usual. This is called lumpy skin and means the insulin won’t be absorbed as well.

Avoid having a ‘favourite part’ of that area to inject into as this greatly increases the risk of lumpy skin. If this is the case, try injecting into surrounding areas, picking a new spot each time.

Each of the main four areas (abdomen, buttocks, outer thighs and upper arms) should give a give a good area of flesh to inject into. Using different areas of the body to inject into is insulin injection site rotation.

However, you may find you have a ‘favourite part’ of that area to inject into. If this is the case, try injecting into surrounding areas, picking a new spot each time.

One way to pick a non-lumpy area is to feel or squeeze the skin before injecting insulin If it doesn’t feel as supple as it could be, pick a different spot to inject into.

Testing your blood glucose with a blood glucose meter allows you manage your diabetes. Watch a video guide on how to test your blood glucose (sugar) levels.

For people new to diabetes, this guide to testing your blood glucose levels should get you started.

Testing your

blood sugar levels
helps you to make informed decisions about your diet, activity and, if self-adjusting insulin, dosing requirements.

Bear in mind that not all blood glucose meters are the samen, so you may need to slightly the modify the method here.

What do I need to test my blood sugar?

In order to test your blood sugar levels, you will need:

• a
  
  blood glucose meter
• a
  
  test strip
  and
• a lancing device

Some blood glucose meters may come with test strips and/or lancing devices.

If in doubt, ask your healthcare professional.

How to test your blood glucose

1. 
   Prepare
   
   your kit ready for testing.

   This should include:
   
   your meter
   
   , a
   
   test strip
   
   to hand (it may be advisable to have a spare strip to hand too), the
   
   finger pricker
   
   (lancing device), cotton wool (optional) and a
   
   monitoring diary
   
   to record the results

2. Ensure that the finger pricking device has been loaded with a
   
   new lancet
   

3. 
   Wash and dry your hands
   
   – to ensure that the result is not influenced by any sugars that may be present on your fingers

   A fuller drop of blood will be obtained if your fingers are warm, so it’s worth warming your hands up if you can. Be careful not to overheat your fingers so as not to hurt yourself.

4. Put a
   
   test strip into your meter
   
5. 
   Prick your finger
   
   with the lancing device at the sides of the finger as there are less nerve ending here than at the tips or the ‘pads’.

   Recommended finger: the World Health Organisation recommends the middle or ring fingers are used for blood glucose tests (second and third fingers). You may want to avoid using your little finger due to the skin being thin.

   You may need to squeeze your finger a little until blood appears – if you find you need to squeeze hard, try pricking a finger again.

6. When blood appears,
   
   check the meter is ready
   
   and then
   
   transfer the blood onto the test strip
   
   and wait a few seconds – most meters these days provide a result within 10 seconds and often sooner.
7. If the test is unsuccessful, repeat from step 4.
8. If the test is successful,
   
   clean any blood off
   
   your finger – with the cotton wool if necessary
9. 
   Record the result
   
   in a monitoring diary
10. 
    Dispose of the test strip
    
    and
    
    ensure that the lancet
    
    used is put into a
    
    sharps bin

Most diabetics agree that blood glucose testing can be a pain, but it is an essential part of

diabetes management

A healthy low-carb diet is a wonderful thing. Far from being protein overload, a well-followed low-carb diet is brimming with a delicious variety of

vegetable

-focused dishes.

It’s important that a healthy low-carb diet is ultimately enjoyable as this will make the lifestyle much easier to follow.

Many people that switch to a low-carb diet for health reason often wonder why they never followed the diet as they realise not only how healthy it is but how satisfying it is too.

A healthy low-carb diet should have:

• A strong instake of vegetables
• Include healthy, natural sources of fat
• A moderate amount of protein
• Low in starchy and sugary foods
• Low or very low in fruit
• Very little or no
  
  processed food
  

Vegetables

Any healthy diet should include a strong intake of vegetables and a low-carb diet is no different.

An advantage that many people find with a low-carb diet is that, because the diet involves little to no grains, it is easier to have room for larger portions of vegetables.

People on a very-low-carb

ketogenic diet

will want to stick to

non-starchy vegetables

such as leafy greens. People on a less strict diet can afford to have some

starchy vegetables

One of the keys to making a healthy diet work for you is to put care into the cooking and preparation of vegetables. With a bit of attention paid to them, vegetables will form a truly delicious part of meals.

Healthy fats

Most of the energy in a healthy low-carb diet should come from natural sources of fats including meat,

oily fish

, dairy, nuts, avocado, coconut based foods, olives, oils (including olive oil, coconut oil, other nut oils, avocado oil).

Fat

is particularly good because it provides energy in a very gradual way which can help to keep you feeling satisfied for a number of hours.

Be aware that some healthy fat sources, such as nuts and cheese, are also quite rich in protein. You may need to be aware of this if you are quite a high amount of protein and are struggling to lose weight.

A healthy low-carb diet

should not

include unhealthy fatty foods, that are also high in carbohydrate, such as pies, crisps, chips and fries, sausage rolls etc.

Protein

Protein

can come from a number of forms including fish, meat, eggs, dairy, beans, nuts, legumes and lentils.

A number of these foods are good sources of protein and fat as well.

Be aware that beans, legumes and lentils contain a fair amount of carbohydrate. If you are looking to follow a very-low-carb ketogenic diet, you will need to have very little or none of these foods.

Starchy and sugary foods

People following a very-low-carb diet will want to avoid

grains

and starchy foods altogether, however, those on a less strict low-carb diet may wish to have some grains, albeit in small portions.

People on a strict low-carb diet will want to avoid

sugary foods

wherever possible. If on a less strict diet, you may allow yourself to have small amounts of sugary foods.

Dark

chocolate

, with high cocoa content (say 85% or above), tends to be quite popular with people on low-carb diets as small portions do not contain too much carbohydrate.

Fruit

Fruit

has a relatively low focus within a low-carb diet. People following a very-low-carb diet should be very strict on fruit and either stick to small quantities of berries, that are low in carbohydrate, or avoid fruit completely.

Even those on a less strict low-carb diet will want to keep fruit intake fairly low.

It can be hard to regulate what your child buys or chooses at school, packed lunches can be helpful for ensuring they eat right at

school

Processed food

Any healthy diet should be low in

processed food

As a general rule of thumb, processed foods are energy dense and nutrient poor.

This means that whilst these foods contain relatively high amounts of calories, they won’t fill you up or provide the body with the nutrients it needs. The result is that you can eat a huge load of calories and still be hungry soon after eating these foods.

Water and salt

Keeping hydrated and having an adequate intake of salt are part of a healthy low-carb diet.

Going onto a low-carb diet can result in excreting more salt and fluid than normal and having too little salt or water can result in side effects such as headaches, leg cramps, dizziness, brain fog, constipation or feeling woozy.

Ensuring you have sufficient water and salt in your diet should minimise the risk of these side effects.

Note that salt is needed in our diet and many of the negative headlines about salt are less to do with salt itself and more about unhealthy processed foods that salt is found within.

The fact that unhealthy foods, such as crisps, fries and ready meals, have a high salt content means that salt has simply become guilty by association.

As stated, it is highly recommended to cut down on processed food.

Salt

, however, is perfectly healthy when used as part of flavouring for healthy, home prepared, low-carb meals.

When starting a low-carb diet, it is important to take salt, either in your food or in a drink of water, to minimise side effects occurring. Some people may wish to drink vegetable or bone broths as these are a good way of getting salt as well as other vitamins and minerals.

The

calculation of BMI
(Body Mass Index) was invented by Adolphe Quetelet, a Belgian mathematician born in 1796.

His proposal was that people’s weight could be deemed as relative to an ideal weight for their height.

BMI is still referred to as the Quetelet index, for which the formula is:

• 
  BMI (kg/m2)
  
  = mass (kg) / height (m)2

BMI is conducted the same way for both adults and children, however, the interpretation of the results is different.

For adults

BMI is interpreted using standard weight categories for adults over 20, which are the same for all ages of both men and women.

Once you have measured your BMI number, you can assess which weight status category you fall in with this table:

With height ranges added, the corresponding BMI ranges and weight status categories can be derived from a sample height with this table. For example, someone who is 5′ 9″ and who is 1.752m:

• 
  BMI (kg/m2)
  
  = mass (kg) / height (m)2 – which in this case is:
• 
  [BMI Range Value]
  
  = mass (kg) / 1.752m2

For children

The interpretation of BMI for children and teens is both age and sex specific, with BMI obtained using percentiles to show how a child’s BMI compares to other children of the same age and gender.

Age and gender are used to interpret BMI in children and teens because the amount of body fat changes with age and differs between boys and girls.

The following table displays BMI-for-age weight status categories and their corresponding percentiles.

BMI cut off for Asians

The relationship between BMI and body fatness differs in Asian populations, who have been found to have a higher body fat per cent at a lower BMI compared to Caucasians.

This high body fat per cent can be explained due to factors such as body build, slenderness and muscularity, which is why universal BMI cut-off points are not appropriate for Asians.

To calculate BMI for Asians, you must use this BMI cut-off table.

Your BMI is a great method of deducting your weight, but measuring your waist is also important to assess for potential risks of disease.

Carrying too much abdominal fat around your waist can lead to obesity-related diseases such as coronary heart disease,

high blood pressure
and diabetes.

Using a tape measure, there are four steps to follow to accurately measure your weight:

• Locate the top of your hip bone and the bottom of your ribs
• Take a deep breath out
• Place the tape measure between these points and pull it tight around your waist
• Read your measurement

You can assess what your waist size means by using the following:

Note

: there is a higher risk based on waist size for Asian men and women.

Sticking to natural, paleo foods and avoiding processed food will put you on a good track to following a healthy paleo diet.

As with most diets, it’s possible to follow a paleo diet in a healthy way or an unhealthy way. This guide is to help you to follow the paleo diet healthily.

For a guide to which foods are allowed on the paleo and which aren’t see our guide to

foods to eat on a paleo diet

Paleo diet basics

The focus of a paleo diet is eating low amounts of

carbohydrate

and moderate to high amounts of protein and fat. If you decide to adopt the paleo diet, it can help to alleviate your carb consumption gradually, thereby easing some of the early side effects you may experience.

Read more about the

side effects of the paleo diet

Calorie counting is not necessary on the paleo diet. While this flexibility can ease the transition into the diet, it is important not to overindulge on protein or foods with higher sugar content, such as fruit or honey.

Investment in health

Going paleo may take a bit of adjusting to at first. You may need to dedicate extra time in the kitchen at first to get used to preparing new food combinations. A bit of early effort will pay dividends later.

Because the paleo diet relies on a strong intake of foods such as meat, fish and nuts, in addition to

non-starchy vegetables

, it is not the cheapest diet available. However, if you can afford to buy good quality cuts of meat and fish, it will be a solid investment in your long-term health.

Foods that keep you satisfied

A big advantage of the paleo diet is that the foods allowed on the diet are filling foods. A good portion of meat or fish plus a large helping of non-starchy vegetables will fill you up nicely for a long time without being excessive in calories.

You might find cravings are common in the early stages of the diet. This is perfectly normal and shouldn’t last long. Eventually you should notice yourself becoming fuller as your body gets accustomed to eating healthy, natural foods.

Enjoy meat but avoid over-indulging

While meat is very filling, it’s possible to eat too much protein on the paleo diet. Eating excess meat will increase your

blood sugar levels

and can also lead to weight gain.

Sensible meal portions for most people include either one or two pork chops, a good fillet of fish or three sausages. A large mixed grill or a portion of meat that takes up most of your plate may be excessive and could lead to high blood sugar for people with diabetes, unless you exercise regularly.

How much protein is right for you will vary from person to person; the key thing is to note that there is such a thing as too much. The paleo diet is not a green light to eat meat excessively, not if you wish to stay healthy.

Keep fruit and nuts intake moderate

Fruit is a sugary food group and it’s best to stick to smaller portions of low-carb foods such as berries rather than more sugary fruits such as bananas, citrus fruits and especially figs and dates. This will help to keep blood sugar levels under control.

Read more about

which fruits contain the highest amounts of sugar

Nuts are another food which are healthy but require some moderation as they can pack a lot of calories if consumed in excess.

Fake paleo foods

Just because something is labelled ‘paleo’ does not mean it’s necessarily healthy.

There are no rules regarding which foods can label themselves as being paleo. As a result, any food manufacturer trying to take advantage of the paleo diet’s popularity can label food as paleo, regardless of whether it is or isn’t.

Some foods calling themselves ‘paleo bars’ can be high-sugar, processed snacks that are not paleo at all, so be sure to read the ingredients before choosing to buy a paleo bar.

Paleo baking

The paleo diet has become popular in recent years, but some of the true spirit of the diet is becoming eroded as people seek to bend the rules to fit modern tastes. One of these methods is with paleo baking.

Firstly, paleolithic people were not creating cakes out of nut flour and date syrup, that is for sure. Secondly, this form of baking can be very high in carbohydrate and sugar. Natural or non-refined sugars are still sugar and best avoided, or consumed only in small quantities.

You are free to try some baking but be aware that this isn’t part of the true paleo spirit. Moreover, you should make sure your carbohydrate and sugar content won’t badly affect your diabetes control.

Type 1 diabetes needs to be managed with treatment. This guide talk abouts what will happen and how your family can help.

• Children with type 1 diabetes need treatment for their whole life.
• Learning about diabetes treatment will happen with a doctor or in a hospital.
• Everyone in the family needs to learn about type 1 diabetes.
• When your brother or sister or friend has diabetes you can learn about diabetes as well, and help them to understand it.
• When a child is diagnosed with diabetes, the family need to learn:
• 
  What diabetes is
  
• How to test blood sugar levels
• How to give insulin injections
• How to exercise regularly
• How to deal with diabetes
• How to understand when blood glucose gets too high
• How to understand when blood glucose gets too low
• How to make blood glucose lower or higher

New words to remember:



Treatment, diagnosed with diabetes, test, deal with diabetes

When you get started on a pump, you should be given full training on how to use and get the most out of your new pump.

This guide therefore serves as an introduction to what’s involved in using an insulin pump for those wanting an insight into day to day usage of an insulin pump.

Setting up an insulin pump

The steps below serve as a guide to what’s involved in setting up a typical tethered insulin pump.

Fill the reservoir

This typically involves either drawing

insulin

from a vial into the reservoir or loading a new cartridge of insulin into the reservoir. It’s best to try to reduce the amount of air going into the cartridge.

Attach the infusion set

Attach the infusion set (tubing connected to a cannula) to the reservoir outlet.

Prime the pump

Priming the insulin pump is activated by pressing controls on the insulin pump which tells the pump to start moving the plunger. Priming is used to push any air out of the tubing and the reservoir

Insert the infusion set

With as much air removed from the tubing and reservoir as possible, the next step is to apply the infusion set to your body. Areas such as the abdomen (tummy), thighs, buttocks and the arms (unless very lean) are good areas to use.

Applying the infusion set involves pushing the cannula under the skin and holding it in place with an adhesive patch.

Some infusion sets can be implanted with a tool to help insert the cannula

smoothly and consistently.

Setting the basal rate of insulin

Insulin pumps don’t use

long acting insulin

, instead they constantly deliver a small amount of fast acting insulin through the day.

The basal rate can be set and changed at any time at the press of a few buttons.

Your health team will help you to set a basal rate, i.e. how much background insulin you receive each hour.

When you get used to using your pump, you should become comfortable with increasing and decreasing your basal rate to suit your needs.

Delivering boluses

Delivering a shot of insulin (bolus), to help your sugar levels cope with meals and other causes of rises in sugar levels, can also be done at the press of a few buttons.

The ease of

delivering boluses of insulin

, without needing to change needles each time or insert a needle, is one of the benefits of insulin pumps over injections.

Changing infusion sites and refilling the pump

Once set up, changing infusion sites and refilling the pump with insulin are two common tasks you will regularly (every few days or so) need to perform to keep yourself pumping.

Infusion sites need to be changed every few days to allow consistent delivery of insulin. Changing of infusion sites means taking out old infusion set and replacing it with a new infusion set.

A change of infusion site can take a few minutes and a bit of space to get organised but as you only need change the site every 2 to 3 days, it is usually easy enough to find a convenient time and place to do this.

When the pump begins running out of insulin, new insulin will need to be loaded into the pump, either by cartridge or by refilling the reservoir from an insulin vial (as applicable).

Advanced uses of an insulin pump

Another great thing about an insulin pump is that you have the chance to program in insulin doses to be delivered at certain times or up to several hours into the future.

Custom basal rates

Insulin pumps can be programmed to deliver different basal rates at different times of day. For example, you may need less insulin over night than you do upon waking in the morning, so your insulin pump can be set up to give a higher rate of insulin when you wake and a lower rate when you go to bed.

You can even suspend delivery of insulin if you need to, such as when playing sports,

to stop your sugar levels dropping too low

Custom bolus rates

Not every meal affects our

blood glucose levels

the same way and insulin pumps can be set to deliver bolus doses in specific ways to cope with the different absorption and digestion rates of different foods.

As well as delivering one up front dose of insulin,

pumps can also be set to deliver special doses

such as delivering half of the dose up front and then delivering the second half of the dose an hour or so later, which can be helpful for managing certain foods such as pizza.

What’s your vice? A large glass of wine at the end of a hard day at work? A cigarette or two before a difficult conversation you’re anxious about? A beer (or 5) to ‘relax’ at the weekend?

Some people may read these descriptions and think, “Gosh that’s not me”, while others may think the opposite, “Sounds like a typical week for men, what’s the problem?”

If you fall into the first category then feel free to stop reading now. However if you’re in the second category or your thought is, “Yes, I know that’s me and I want to change….HELP!” then keep reading.

What is compulsive behaviour?

Compulsive behaviour forms when activities such as drinking alcohol,

smoking cigarettes, shopping when you can’t afford it and overeating are carried out because you feel that you have to – not because you want to.

All of these activities can be engaged in to a greater or lesser degree and labelled as one of life’s pleasures.

However, these behaviours can also be used as a way of

handling emotions
that are difficult, unpleasant, overwhelming or distressing.

They can distract and soothe; however they rarely, if ever, heal.

Emotions and compulsive behaviour

To better understand the link between your behaviour and your emotions, the first step is to learn what emotions you are using your compulsive behaviour to deal with.

Look over the following list and see which resonate or ‘jump out’ at, it may be just one or it may be many:

• Loneliness
• Excitement
• Anxiety
• Nerves
• Boredom
• Unrest
• Grief
• Anticipation
• Doubt
• Procrastination
• Anger
• Fear
• Regret
• Disgust

What many people don’t realise is that drinking alcohol or smoking a cigarette are actually often a


symptom

of an underlying (usually emotional) problem, which then becomes a problem in and of itself.

By addressing the underlying problems, your need for these coping mechanisms will naturally decrease over time and you will have insight into yourself that will also serve you in other areas of your life.

Fill in the short questionnaire below to find out how much you are being affected. It was designed to address alcohol dependence, but you can substitute another compulsive behaviour for alcohol too. Make sure you are honest with yourself.

You may not want to be honest with those around you, but if you are not straight with yourself this is often a sign that you do have a problem with your compulsive behaviour.

The Dependence Questionnaire

If you have answer ‘yes’ to four or more of these questions, you are probably

dependent on alcohol
or the other area of compulsion. Even a single answer of ‘yes’ means you should think carefully about the control you have over alcohol.

• Does one drink tend not to satisfy you?
• Do you almost prefer to drink alone?
• Do you tend to have a drink at night to help you sleep?
• Do you tend to drink in such a way that others are not aware of how much you drink?
• When expecting to drink, would you have something you do not normally like, if that was all that available?
• Would it feel strange to leave half a glassful of drink?
• Do you have an absolute rule not to drink before a certain time of day?
• Do you often drink significantly more than you intend?
• Has anyone else ever been seriously concerned about your drinking?
• Are you worried about your drinking?

Source:

Adapted from B. Colcough, Tomorrow Will Be Different (London: Viking, 1993)

You can see how compulsive behaviour affects you

So, now you are clearer about how your compulsive behaviour affects you, how do you begin to make a change? You may have never attempted to change this area of your life before and so the whole process may feel uncertain – where is the best place to begin?

Or perhaps you have tried to change countless times before, maybe with some success, only to return to your compulsive behaviour weeks, days or even hours after making a commitment to change.

Wherever you’re starting from, it’s ok. Have permission to go easy on yourself.

Likely you’ve used these ways of coping for a long time and, in many ways, they have served you effectively, perhaps allowing you to distance yourself from difficult emotions or circumstances in life.

Look back over the list of emotions above. Think about how to begin to let yourself experience a little more of this emotion each day, before you engage in the drink or the cigarette.

Could you ‘sit’ with the feeling for 5 minutes before then engaging in the compulsive behaviour? You could aim to set a timer and track how long you can handle it for, with increasing increments of 1 minute or even 30 seconds at a time.

Support and trust is essential

Seeking support from others you trust can be so valuable – too often it is the secrecy of compulsive behaviours that keeps a hold over you and by letting go of this secrecy, you can begin to make a change. Someone you love gently asking you, “How’s it going?” can help you to stay accountable to change.

Alongside these self-help strategies, do gain some professional help. Talk to your

GP
about NHS options for quitting alcohol and cigarettes and think about considering a support group such as Alcoholics Anonymous or

NHS
Stop Smoking Services.

Be honest with yourself about your compulsive behaviour – you

can

overcome your difficulties and enjoy greater diabetes health and wellbeing.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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How many people have said to you that they’d like to change their behaviour but don’t have the motivation. People often know what they need to do for

their diabetes, but can’t seem to summon up the how.

So when I tell them, “You are one of the most motivated people I have ever seen” – they tend to stare at me in utter disbelief!

But then I explain

They are motivated to do all sorts of things in life.

Watch the latest film at the cinema. Devote some time to engaging in an enjoyable pastime or hobby. Pet their cat.

Eat a delicious meal
in the company of loved ones.

Going on holiday. I’m pretty certain there’s not a single person reading this who finds that the concept of ‘motivation’ enters their mind when they are thinking of doing these fun activities! In fact, the average person would be ready, willing and eager to get started and feel the

enjoyment that these activities bring

So the crucial difference with these things is that they are a short-term route to good feelings – which health-promoting activities such as exercising,

eating healthily
or testing your blood often aren’t in the short term.

No one feels motivated to do something if the costs seem to outweigh the benefits. Go to the gym in the evening or spend a cosy night in front of the tv with your partner? I’m sure you can see what I mean!

Tips for staying motivated

Here are my

top tips

for staying motivated with any aspect of your diabetes health care:

Making it feel effortless

The secret with motivation is to link an activity that feels like a struggle with one that naturally feels effortless.

You could: Test your blood glucose and then phone a friend you love to chat with straight after; plan your exercise so it’s immediately followed by watching your favourite TV programmen,

make the doctors appointment
you’ve been putting off for months and visit your favourite museum or gallery afterwards.

Keep imagining

Imagine, and keep imagining, how great you’ll feel once you’ve accomplished your goal, whether it be losing weight, getting to the

HBA1C level
you are aiming for or exercising more.

Having a photo, picture or object that reminds you of your goal present and available to remind you of what you’re aiming for can be so effective when you are losing motivation, either because your goal is taking too long or the results seem too slow.

Keep your inner voice kind and supportive

It’s so easy to find yourself talking to yourself in a negative way, and even worse, listening to it. Form a coping statement that you find motivating and remind yourself of it often.

Examples may be: “It this was easy then everyone would be doing it!”, “Only I can change my life. No one can do it for me”, “Change is challenging but each day I’m moving closer to my desired goal”.

Remind yourself of success

Remind yourself of successes you have achieved in the past, and how you can transfer this experience to your current goal. Keep track of all your successes in a success journal, no matter how small and in whatever area of life you like.

Examples could be: learning to drive, making a new friend or nurturing an existing relationship, learning how to use a computer, raising your child, having a successful work meeting, learning a new recipe, mastering a new skill, planning a holiday or family day out, you get the idea!

Know the difference between a lapse and a relapse

A lapse is when you go off track temporarily – these are an inevitable part of changing behaviour.

A relapse is when you allow a string of lapses to overwhelm you without taking corrective action. “All or nothing thinking” can really get in your way, either being ‘good’ or ‘not good’ when it comes to reaching your goals.

No matter how well you think you’re doing, there will always be some obstacles in your way.

Yes, you will make mistakes, but the secret is in learning from them and carrying on regardless.

Plan for success

Develop a plan for success, which incorporates rewards. Daily; or at the minimum, weekly rewards are crucial for ensuring motivation levels stay high. These rewards don’t have to cost anything – they can be naturally occurring rewards such as self-praise, time spent in an enjoyable past time, a relaxing bath, listening to your favourite music – anything that you enjoy.

Reward yourself

Alternatively, you could design ‘token system’ in return for rewards – award yourself one token for each challenging activity you engage i, and after 5 or 10 tokens (you decide) mentally exchange these tokens for a CD, a new item of clothing, some fresh flowers – again, you decide!

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Learning how to control diabetes is the aim for all of us with diabetes.

This can be done for both type 1 and type 2 diabetes with food, diet and regular blood testing.

Being armed with information will help you to control your diabetes and this guide includes specific information for controlling type 1 and

type 2 diabetes

Blood glucose testing

A blood glucose monitor is an excellent tool for managing diabetes.

Some of us will be very familiar with using a blood glucose meter but for others it will be something new.

Testing before and after meals can be a useful technique for measuring how different meals affect our sugar levels and help to improve our diet and dosage decisions.

• Read about
  
  pre meal and post meal blood glucose testing
  

What blood sugar levels should I aim for?

The NICE recommendations vary a little depending on the type of diabetes and whether you are a child or adult.

Broadly speaking, we should aim to get our blood sugar levels into a range similar to someone without diabetes – i.e. between 4 and 6 mmol/L before meals and under 7.8 mmol/L after meals.

• View the current

  blood glucose level ranges

  (as set by NICE)

Record your blood glucose levels

Recording your blood glucose levels comes highly recommended. By recording your levels you can start to build up a history of results and draw conclusions from results.

• Download a
  
  free blood glucose diary
  

Recording your blood sugar levels can help you:

• Improve dosage decisions (for people on insulin)
• Identify
  
  which foods are best for your levels
  
  – and which aren’t so good
• Learn from periods of high sugar levels – such as during illness
• See how your sugar levels are affected by exercise

Keep your motivation up

Controlling blood sugar levels requires a lot of dedication. Don’t get too upset if your blood sugar levels appear to be beating you. Take any set backs as a lesson to learn and you’ll soon be back to winning the fight over your blood sugar control.

If your sugar levels run consistently high or low,

contact your health team

who can help to set you on the right track.

Control type 1 diabetes

Type 1 diabetes requires close monitoring as blood sugar levels can be quite erratic through the day if left unchecked.

People with type 1 diabetes will usually take a combination of long acting (basal) and short acting (bolus) insulin.

• Read more on
  
  controlling type 1 diabetes
  
• Read our guide on
  
  adjusting basal and bolus insulin doses
  
• 
  Diet advice for type 1 diabetes
  
  

Control type 2 diabetes

With type 2 diabetes, one of the best ways to achieve greater control of your diabetes is through diet.

Some foods affect our blood sugar significantly more than others and so picking the

diet for type 2 diabetes

that works for you can make a big difference to your numbers and your health.

We recommend using blood glucose testing to help you to test which foods are blood glucose level friendly.

• Read more on
  
  controlling type 2 diabetes
  

Support from others

Controlling blood sugar levels is not an easy task and we all need a bit of help from time to time. The diabetes forum is an excellent source of support, providing a wealth of experience.

• 
  Join the Diabetes forum
  

Blood pressure varies through the day but your resting level should be below a specific target value.

For people with diabetes, then blood pressure target is to achieve a reading below 130/80 mmHg.

There are a number of ways in which your resting blood pressure level can be improved, without the need for blood pressure medication, which can help to reduce your risk of developing complications.

How do I test my blood pressure?

The easiest way to test your blood pressure is to use a blood pressure monitor. Most blood pressure monitors will feature an inflatable cuff – although you can also purchase blood pressure monitors liked to apps for direct reporting.

Diet

The NHS advises people to consume a smaller daily intake of sodium (salt), to help reduce blood pressure levels. The NHS advises to consume less than 6g of salt in a day.

Many of the prepared foods available, such as breads, cereals and ready meals, tend to have relatively high quantities of salt. Salt helps to provide food with flavour and takeaway foods will typically use relatively high quantities of salt to increase flavour.

With home cooked food, you can exercise more control on your salt intake. Note though that one teaspoon of salt provides the daily target of 6g of salt, so bear this in mind if you use salt in your cooking.

• Read more about healthy eating with diabetes
  

Physical activity

Physical activity is known to be beneficial for reducing blood pressure levels.

The NHS advises people undertake 2 and a half hours of moderate physical activity each week or 1 hour 15 minutes of vigorous exercise.

If you are currently not so active, the British Heart Foundation recommends building your level of exercise up from a couple of 10 minute sessions each day.

Cut down alcohol and quit smoking

Overconsumption of alcohol over a sustained period of time has been found to contribute to higher levels of blood pressure.

It can be easy for us to not be aware of when we are drinking too much.

The NHS advises us to cut down on alcohol and keeping a drinks diary can be helpful in assessing whether you are drinking too much.

The British Heart Foundation lists quitting smoking as the single most important factor in improving heart health.

Smoking damages the walls of the arteries which can lead to narrowing of the arteries and raises the risk of blood clots and heart attack.

Your GP can help you to quit with a range of options including a ‘quit kit’ and access to a local ‘stop smoking service’.

Losing weight

If you are overweight, you are more likely to have higher blood pressure. The US National Institutes of health notes that even a modest weight loss of 10 pounds (4.5 kg) can help to lower your blood pressure.

• Read more about losing weight
  

Mindfulness

Mindfulness is a technique recognised by the NHS to significantly reduce hypertension. Mindfulness is the technique of paying attentio, on purpose to the present moment.

It has been shown to be particularly effective at managing stress, reducing symptoms of depression and anxiety and is a particularly effective technique for people with diabetes as it could improve their blood glucose management, decrease their chances of suffering from diabetes burnout and due to its profound effects on blood pressure it could significantly reduce chances of developing diabetes related complications.

Mindfulness is not currently available as a treatment option for hypertension on the NHS.

• Read more on Mindfulness and Blood Pressure

Long term diabetic complications are the result of one or more parts of your body becoming damaged as a result of diabetes.

Long term complications need not be inevitable and research indicates that it is possible to minimise complications or avoid or prevent them altogether.

What are the main long term complications?

The most common long term complications of diabetes include:

• 
  Heart disease
  – known as cardiovascular disease
  
• 
  Kidney damage
  – known as nephropathy
  
• 
  Eye damage
  – known as retinopathy
  
• 
  Nerve damage
  – known as neuropathy
  
• 
  Stroke
  
• 
  Limb amputations
  – particularly lower leg amputations
  

How can I prevent these complications?

On our

complications pages
we include statistics about how common complications are.

Some of the figures may appear worryingly high.

However, the truth is that there are a lot of people who have, for one reason or another, not had the education needed to get their diabetes under control.

There are steps we can take to prevent, delay or minimise the effect of complications.

These include:

• Keeping blood sugar under control
• Getting regular physical activity
• Eating a healthy diet
• Attending all your diabetic reviews and screenings
• Cutting down or avoiding smoking
• Cutting down or avoiding alcohol

Keep your blood sugars under control

This one may come across as much easier said than done but any positive change in your control should help to improve your chances of avoiding complications.

There are a number of ways that can help with improving blood sugar control.

Testing your blood glucose, recording your test results in a

blood glucose diary
and then actively looking to understand the results tends is an important part of better controlling your diabetes.

If you are not prescribed test strips, see our guide on

access to testing strips

Diabetes education
courses are available to help people with diabetes get better control. Speak to your doctor about being put onto a course.

The Diabetes Forum is another great option, giving you the chance pick up on the many years of valuable experience of others with diabetes.

• 
  Join the Diabetes Forum

Attend reviews and screenings

Reviews and screenings are an essential part of avoiding complications. Complications are easier to treat in their earlier stages so the sooner evidence of complications can be spotted, the better your chances of a good outcome will be.

• Read more on
  
  diabetes health checks
  

As well as attending all your screenings, it’s important to report any symptoms that could be indicative of diabetic complications to your doctor.

This could include any problems with your vision, loss of sensitivity in your touch, any sensations of pain or any damage or blisters on your feet.

Avoid smoking and drinking

Smoking
and

alcohol
can increase the likelihood of complications so cutting down or quitting smoking and drinking alcohol can improve your chances of staying complication free.

Get regular physical activity

Physical activity can help to improve insulin sensitivity and is thought to have a host of other health benefits for the body.

We’re advised to get at least

two and a half hours of physical activity into our week, or at least one and a half hours of strenuous activity.

Eat a healthy diet

In picking a healthy diet to prevent complications, it’s advisable to pick fresh foods in preference to

processed food
and base meals around fruit and vegetables.

• For more healthy eating tips, read our
  
  Foods which help diabetes guide

We look at some of the options for lowering blood glucose in the short term.

High blood sugar is commonly known as hyperglycemia.

What are the signs of high blood sugar?

The classic symptoms of high blood glucose levels are:

• Feeling very thirsty
• Needing to go the toilet often
• Having a dry mouth
• Feeling tired/lethargic
• Feeling uncomfortable and irritable

Check your blood sugar

If you take medication that may cause low blood sugar (hypoglycemia), it’s highly advisable to check your blood sugar levels before you try to bring your sugar levels down.

This is just in case your blood sugar is normal or low, which can be the case in some situations.

• What should my blood glucose levels be?

Testing of blood sugar before bringing your levels down is particularly important if you take insulin.

When to call for medical advice

It is important to note that very high blood glucose levels can be dangerous and it is important to be aware of the symptoms and risk factors of the following conditions:

• Diabetic ketoacidosis – a short term complication most commonly associated with type 1 diabetes
• Hyperosmolar Hyperglycaemic State – a short term complication most commonly associated with type 2 diabetes

If you are struggling to keep your blood glucose levels under control, speak to your GP or consultant who can advise you or refer you onto a diabetes education course.

Correcting high blood sugar levels with insulin

If you take insulin, one way to reduce blood sugar is to inject insulin.

However, be careful as insulin can take 4 hours or longer to be fully absorbed, so you need to make sure you take into account how much insulin you may already have in your body that is yet to be absorbed by the blood. Insulin that is yet to be absorbed by the blood is called ‘active insulin’.

If you decide to correct with insulin, watch you don’t over correct as this can lead to hypoglycemia and can be dangerous, particularly so before bed.

Walking

Exercise can help to lower blood sugar and walking is a good way of achieving this.

It might make sense that exercising harder would have a better effect on lowering blood sugar therefore but this is not always the case as strenuous exercise can produce a stress response which causes the body to raise blood glucose levels. This response does tend to vary from person.

Drinking more water

When your blood sugar levels are running high, your body will try to flush excess sugar out of your blood through the urine. As a result, your body will need more fluids to rehydrate itself. Drinking water can help the body with flushing out some of the glucose in the blood.

Just a word of caution to be sensible with drinking water; water intoxication (which can result in death) is possible if a number of litres water are drunk in a short space of time. This is rare and quite difficult to manage but it pays to be aware of this.

Reflect on the amount of sugar in your diet

Hyperglycemia occurs when there is too much glucose in the blood.

• Low-carb diet for 12 weeks put type 2 diabetes into remission
• Low carb in type 1 diabetes improves glucose level variability, new study shows

Therefore, one way of reducing your blood glucose levels is reflecting on where sugar may be consumed in the diet. Think about any refined and processed foods that may be in your diet as these are often high in sugar. This can be achieved through a low carbohydrate diet.

Hypos are periods of low blood sugar. Although common for diabetics, a hypo can be unnerving.

With appropriate treatment the effects and length of hypos can be reduced.

Noticing you’re having a hypo

Before you can treat the hypo, you need to notice that you are low on blood sugar.

The sooner you notice hypoglycemia, the less disruptive it’s likely to be.

Typical signs of

hypoglycemia
include:

• Feeling suddenly tired or weak
• Having difficulty concentrating
• Exaggerated mood changes
• Feeling dizzy

Hypos can occur at any time, pay close attention to your blood sugar levels when exercising, playing sports or during physical activity.

Check it is a hypo by blood glucose testing

Where possible,

test your blood sugar
to ensure it is low blood sugar as some of the signs of low blood sugar may also represent higher blood sugar (such as tiredness or mood changes).

If you cannot test and are unsure if you have low or high blood glucose, it may be best to treat it as a hypo as hypoglycemia can quickly become dangerous if left untreated.

Act quickly

It is important that as soon as you notice or confirm you are hypo you treat the hypo immediately.

Immediate hypo treatment helps by:

• Preventing a severe hypo occurring
• Speeding up recovery
• Reducing the chances of
  
  losing hypo awareness

How to treat your hypo

To treat the hypo, you need to take about 15 to 20 grams of

quick acting carbohydrate

Take a quick acting source of sugar

Glucose tablets are ideal as they act very quickly and will take you out of the hypo quicker. They are also relatively easy to judge how much sugar you are taking.

Sugary drinks (Coke, Pepsi, etc)

Glucose tablets and glucose juice are ideal as they act very quickly and will take you out of the hypo as quickly as possible. They are also relatively easy to judge how much sugar you are taking.

You can also have five jelly baby sized sweets or four to five sugar lumps.

15-20g of sugar

can be found in:

• 160ml (half a 330ml can) of sugary cola or lemonade
• 200ml (a small carton) of fruit juice

Sugary drinks
can sometimes be a little more difficult to judge how much sugar you are taking but they’re still a good source of sugar in an emergency.

You may also need slower acting carbs

If your next meal is not soon, you may also need to take

15-20g

of slower acting carbohydrate to prevent a further dip in blood sugar.

15-20g of slower acting carbs can be found in:

• A slice of bread
• An apple or a banana
• A cereal bar

Check blood glucose after 15-20 minutes

Check your blood glucose levels 15-20 minutes after treating the hypo. If your blood glucose levels are below 5 mmol/l (90 mg/dl), repeat the treatment.

Treating severe hypos: seizures

When a seizure is occurring, it will not be possible for a person to take sugar. It is also not advised to feed someone when they are having a seizure as this could lead to choking.

Where possible try to ensure the person having the seizure will not hit anything and cause themselves injury.

If they are on the floor, place something soft like a pillow or article of clothing to cushion their head.

Often a seizure will pass after a few minutes and this may allow the person having the seizure to take some sugar. If the seizure persists for more than 5 minutes, call for an ambulance.

Treating severe hypos: Unconsciousness or unable to take sugar

If unconsciousness occurs or the person is unable to take sugar,

call for an ambulance

If you have a glucagon injection kit, check the glucagon is in date and administer a dose. If you have not given a

glucagon dose
before, read the instructions carefully before starting.

In some cases, unconsciousness may occur as a result of very high blood sugar levels. You can give the person a blood test to confirm, taking care to ensure their fingers are clean first.

If they have too high sugar levels, glucagon will not treat the problem but should not present a risk.