TCS Wellness Articles

What is diabetes mellitus?

Diabetes mellitus is a disease that prevents your body from properly using the energy from the food you eat. Diabetes occurs in one of the following situations:

• The pancreas (an organ behind your stomach) produces little insulin or no insulin at all. (Insulin is a naturally occurring hormone, produced by the beta cells of the pancreas, which helps the body use sugar for energy.)
• The pancreas makes insulin, but the insulin made does not work as it should. This condition is called insulin resistance.

There are two main types of diabetes:

• Type 1 diabetes or juvenile (insulin dependent) diabetes is usually diagnosed before the age of 30. In this type, the pancreas produces little or no insulin.
• Type 2 diabetes (non-insulin-dependent) is usually diagnosed after the age of 40. In this type, the insulin is either produced in insufficient amounts and/or cannot be used by the body to control blood sugar levels.

The most common signs and symptoms of diabetes are:

• Increased urination.
• Increased thirst.
• Increased appetite.
• Fatigue and weakness.

What do you need to know?

Anti-diabetic pills:

• Take your anti-diabetic pills regularly as prescribed by your physician.
• Do not stop the medication on your own without contacting your physician
• If you obtain a normal blood sugar reading (80 - 120mg/dl), your blood sugar is under control and you need to continue with the medication, diet and exercise.
• If your blood sugar is often low, (that is below 70mg/dl) or often high (that is above 200mg/dl), you need to contact your physician.

Insulin:

• Store insulin vials in the refrigerator if prescribed.
• Check the label on the bottle (type of insulin, expirydate).
• Roll gently the insulin vials of intermediate and long acting insulin to ensure that all sediment is mixed into the liquid.
• Do not administer cold insulin, warm it by rotating the filled syringe between the hands.
• Wash your hands thoroughly and dry them. Clean the cap of the insulin vial with an antiseptic swab.
• Rotate the vial of insulin between your hands to mix the insulin. If crystals remain in the bottom, it means the insulin is not good for use.
• Draw an amount of air equal to the amount of the dose of insulin that you require, up into the syringe.
• With the insulin vial upright, plunge the needle through the rubber cap, pushing air into the vial, then turn the insulin vial upside down and carefully draw the correct dose of insulin.

For mixing insulin:

• Read instructions and consult your physician, pharmacist or nurse.
• Withdraw short acting insulin first then intermediate or long acting insulin second to avoid contamination of short acting insulin.
• Draw air into your syringe equal to the amount of long or intermediate acting insulin and inject the air in the vial, then withdraw the needle and leave the vial aside.
• Inject air into your short acting insulin vial in the same manner but do not withdraw the needle.
• Turn the bottle upside down, withdraw the short acting dose of insulin into the syringe, remove the needle, and insert it in the bottle of long or intermediate acting insulin then withdraw the correct amount of insulin. The fluid should always cover the bevel of the needle.

Injection sites:

• Use the upper arms, the thighs and the abdomen for insulin injections.
• Rotate sites to prevent tissue damage and to aid in absorption.
• Take the next injection at least 2cm apart from the previous one, and then change to another area when the whole area has been used.
• Clean the site with alcohol where you intend to inject, and then pinch the skin between the thumb and forefinger of one hand.
• Hold the syringe by its barrel in the other hand; insert the needle quickly at a 45° angle (90° angle around the umbilicus) into the tissue lying under the skin, depending on needle length and the amount of subcutaneous tissue at the site.
• Press the plunger all the way down to inject all the insulin.
• Withdraw the needle quickly while placing an antiseptic swab gently over site. Apply a light pressure to the site.

Activity:

• Follow regular daily exercises.
• Be involved in moderate levels of activity (jogging, walking …).
• Follow a specific exercise plan that is mutually decided upon by the physician and you to fit into daily activities and to prescribe the proper diet and adequate insulin as necessary.
• Exercise at the same time every day.
• Check blood glucose before beginning to exercise.
• Do not perform exercise when insulin or oral antidiabetic agent is at its peak of action.

Diet:

• Learn how to follow a calculated diet as ordered.
• Eat three or more regularly spaced meals each day, especially before the insulin dose.
• Know the caloric value of foods frequently eaten.
• Avoid concentrated sweets, salts, and foods high in cholesterol.
• Follow a weight control diet, to keep your weight at normal level.
• Use artificial sweeteners in moderation.
• Take an extra snack before exercise.

Blood sugar test
1. A blood sugar test measures the amount of sugar, or glucose, in the blood.
2. The results can help doctors diagnose diabetes, and help people with diabetes manage their condition. You can take a blood sugar test at home with a glucose meter. Or it can be done through a blood draw at your doctor’s office

When should you take your blood sugar?

You and your healthcare team will determine when you should check your blood sugar based on your current health, age and level of activity, as well as the time of day and other factors. They may suggest that you test your blood sugar at any of the following times:

• Before each meal.
• 1 or 2 hours after a meal.
• Before a bedtime snack.
• In the middle of the night.
• Before physical activity, to see if you need a snack.
• During and after physical activity.
• If you think your blood sugar might be too high, too low or falling.
• When you're sick or under stress.

The chart below gives you an idea of where your blood sugar level should be throughout the day. Your ideal blood sugar range may be different from another person's and will change throughout the day.

Time of Test	Ideal for Adults With Diabetes
Before meals	70-130 mg/dL
After meals	Less than 180 mg/dL

How Do you Check?

1. After washing your hands, insert a test strip into your meter.
2. Use your lancing device on the side of your fingertip to get a drop of blood.
3. Touch and hold the edge of the test strip to the drop of blood and wait for the result.
4. Your blood glucose level will appear on the meter's display.

Note: All meters are slightly different, so always refer to your user's manual for specific instructions. Other tips for checking:

• With some meters, you can also use your forearm, thigh or fleshy part of your hand.
• There are spring-loaded lancing devices that make sticking yourself less painful.
• If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.

Considerations:

• Quit smoking.
• Do an eye check up once a year and consult your doctor for any vision problems. Diabetes might affect the eye without symptoms.
• Keep an identification card saying “I am diabetic”.
• Watch out for symptoms of hypoglycemia (low blood sugar) such as sweating, trembling, irritability, tingling of lips and tongue or fingers, hunger and mental confusion.
• Carry with you at all times some sugar or candy to eat when you suspect hypoglycemia.
• Try to find out the cause of the hypoglycemic attack and consult your physician. It may be due to insulin overdose, over exercise or little eating.
• Watch out for conditions that are acute complications of diabetes mellitus (diabetic ketoacidosis, hyperosmolar hyperglycemia) manifested by the following symptoms: thirst, loss of appetite, fatigue, abdominal pain, nausea and vomiting.
• Test your blood sugar as ordered by your physician.
• Watch for any infection:
  a) High temperature (may indicate bladder, kidney and skin infection…).
  b) Sores in your mouth.
  c) Changes in color or sensation in your fingertips or toes.
  
• Do blood tests as ordered to detect any complications such as disease of the kidneys (neuropathy).
• Wash your feet daily, dry them thoroughly and inspect them for lesions. Foot ulcers are a common complication of diabetes.
• Apply a non medicated moisturizing cream on your feet to prevent dryness and cracking. Do not apply cream in between the toes.
• Use only warm water in washing. Do not use hot water. Test the water with your hand to check its temperature before using It.
• Wear comfortable shoes, do not wear tight shoes, and never stay barefoot.
• Cut nails straight not deep into the corners.
• Report to your physician immediately any sign of hypoglycemia (low blood sugar level that is below 70mg/dl) ketoacidosis, eye problems, mental disturbances, and foot problems.
• Avoid injuries. Cuts may not heal easily.
• Perform personal hygiene daily to avoid urinary tract infection.

Does my Insurance Policy cover diabetes treatment?

Yes. According to CCHI unified Policy terms and conditions, health insurance policies in Saudi Arabia cover the treatment of diabetes.

Please Click Here to access the Unified CCHI Policy Wordings.

References:

“Diabetes Mellitus.” Checking Your Blood Glucose, 4 Aug. 2016.
“Diabetes Mellitus.” Diabetes , 31 July 2014.
“Diabetes Mellitus.” How and When to Test Your Blood Sugar With Diabetes, 15 Mar. 2017.
“Diabetes Mellitus.” Diabetes Mellitus: An Overview, 4 July 2017.