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HELPING YOU MANAGE TYPE 2 DIABETES

FIND THE RIGHT BALANCE

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CONTENTSAbout this guide 3

What is diabetes? 4

Diagnosing type 2 diabetes 8

Why do I need a Type 2 Diabetes Action Plan? 9

Managing type 2 diabetes 10

Monitoring and controlling your blood glucose 12

Reducing risk factors with self-management 18

Medications for type 2 diabetes 21

Preventing and managing complications of type 2 diabetes 25

Other considerations when managing type 2 diabetes 28

The Type 2 Diabetes Action Plan and Health Medication Record 30

Further information 35

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ABOUT THIS GUIDEThis guide offers practical advice, current research and information to help people living with type 2 diabetes. It may also be a useful resource for family and friends who want to know more about diabetes and how they can help.

Inside this guide, you’ll find the following:

° Information about diabetes and how to help reduce its impact on your health and everyday life

° A Type 2 Diabetes Action Plan that you can prepare together with your doctor (found at the back of this guide)

Take this guide with you when you next visit your doctor so you can get started on making your own Diabetes Action Plan together.

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WHAT IS DIABETES?Diabetes is one of Australia’s most common and fastest growing chronic conditions. It affects over 4 percent of Australians (around 1 million people) and many of us don’t even know we have it.

When you have diabetes your body can’t use glucose (a form of sugar) in the way it’s meant to, due to problems with insulin. Insulin is a hormone made in the pancreas (a gland found behind your stomach) and it helps the body absorb and convert glucose in the food you eat so it can be used as energy.

If you don’t have enough insulin, or if your body can’t use it properly, glucose can build up in the blood and lead to serious health problems.

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The liver and surrounding structures

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Types of diabetesThere are three main types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes (diabetes in pregnancy).

Type-1 diabetesPreviously known as insulin-dependent diabetes mellitus (IDDM), this is a lifelong condition where the body doesn’t have enough insulin because the cells in the pancreas that produce insulin are destroyed or don’t work. About 1 in 10 Australians living with diabetes have type 1 diabetes and as it usually has an earlier onset, it accounts for 90 percent of childhood and adolescent diabetes.

Symptoms can include excessive thirst, passing excessive urine, weight loss and ketones (an acid produced when your body uses up fat) in the urine. The causes of type 1 diabetes are unknown, but it has a strong link to family history of diabetes and it’s possible it may be triggered by a virus or other autoimmune disease.

Type 2 diabetesPreviously known as non-insulin dependent diabetes mellitus (NIDDM), this is a lifelong condition where the body stops responding to insulin effectively (insulin resistance). So no matter how much insulin your pancreas produces it’s insufficient to control blood glucose levels. Developing insulin resistance is often the result of being overweight but there can also be other factors, including genetics.

Type 2 diabetes affects 9 in 10 Australians living with diabetes. Although more common in people over 40, type 2 diabetes increasingly occurs in younger people, even children. Many people with type 2 diabetes have no or very mild symptoms that go unnoticed for years and it’s often only discovered accidentally at routine medical check-ups or screenings.

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You’re more likely to develop type 2 diabetes if you:

° are overweight or obese

° don’t exercise very often

° have a family history of type 2 diabetes

° smoke

° drink alcohol excessively

° are of Aboriginal and Torres Strait islander background

° are over 40

° have high blood pressure or have had a heart attack or stroke

° have polycystic ovary syndrome (PCOS) and are overweight

° are taking certain types of medications (such as an antipsychotic)

° have impaired glucose tolerance.

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Gestational diabetes is diabetes that a mother develops during pregnancy. Gestational diabetes often goes away after the baby is born. However, it can come back with subsequent pregnancies and it increases the mother’s risk of developing type 2 diabetes.

During pregnancy, the placenta produces hormones that help the baby grow and develop, but the hormones can also affect the action of the insulin. In response, the body has to produce more insulin — women need two or three times more insulin than normal while they are pregnant. However, if the body isn’t able to produce this much insulin, or becomes resistant to the action of insulin, blood glucose levels rise to higher than normal levels, leading to gestational diabetes. All pregnant women are screened in Australia for gestational diabetes between 26 and 28 weeks gestation.

The most common effect of unmanaged gestational diabetes on the unborn baby is that extra glucose from the mother is transferred to the baby and stored as fat. A larger baby may increase the risk of problems with delivery and during the period just after birth. Well-managed blood glucose levels can lower the risk of these problems. Your doctor, obstetrician and/or a specialist in gestational diabetes can help, along with a dietitian and diabetes educator.

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DIAGNOSING TYPE 2 DIABETESIf you think you have or may be at risk of developing diabetes, visit your GP. Your GP can carry out a test, such as the Australian type 2 diabetes risk assessment tool (AUSDRISK), with questions to evaluate your individual risk factors for type 2 diabetes. They may also ask about your symptoms, examine you and ask about your medical history.

You may also be asked to have a blood test to measure the level of glucose in your blood. This might be a fasting glucose test, which is taken after you haven’t eaten for at least eight hours, or a random glucose test done at any time. Generally, a diagnosis of diabetes requires a fasting blood sugar level ≥ 7 mmol/L or a random blood sugar level ≥ 11.1 mmol/L.

If your GP can’t make a definite diagnosis after these tests, you may have an oral glucose tolerance test (OGTT). This measures how your blood glucose level changes over time after you swallow a sugary drink, having fasted overnight. Generally, diabetes is likely if your blood sugar level is ≥ 11.1 mmol/L two hours after you have the sugary drink.

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WHY DO I NEED A TYPE 2 DIABETES ACTION PLAN?Good management and control of diabetes can minimise the serious complications of this disease. While there is no cure for diabetes as yet, we do know that maintaining healthy lifestyle habits, having regular check-ups, and using medicines when necessary can help manage and control many of the effects of diabetes — which is what this guide is all about.

Developing a written Action Plan together with your doctor to record your medication, self-management skills and any health checks required can help you monitor your symptoms and manage your diabetes.

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MANAGING TYPE 2 DIABETESThe aim for anyone living with type 2 diabetes is to manage their condition for a better quality and longer life. This generally involves:

° relieving symptoms and preventing short-term complications of fluctuating blood glucose levels

° keeping blood glucose levels as consistently close to an ideal range as possible

° reducing risk factors to help prevent or manage chronic complications such as heart attack, stroke, mental health issues, nerve damage and vision loss.

A typical diabetes management plan to help achieve this includes:

° measuring blood glucose levels, blood pressure, and cholesterol levels to meet treatment targets;

° a healthy eating plan, regular exercise and other healthy lifestyle habits;

° self-management skills to cope with significant changes in blood glucose levels;

° oral medication and/or insulin where required; and

° monitoring and treatment for complications.

Any successful plan to help you manage diabetes needs to take into account your personal preferences, objective and priorities alongside factors such as your age, other health conditions you may have and your current mental wellbeing.

The following information is to let you know more about what’s involved in the day-to-day management of diabetes, what complications it may cause and most importantly, how you can lower the risks of them occurring.

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Your diabetes management teamIt’s been shown that having a team of healthcare professionals can be a great help in guiding and empowering people living with diabetes to manage their condition. This team often includes a:

° GP — often the first point of contact who can help you co-ordinate your care

° Diabetes educator — helps increase your knowledge and skills across all aspects of your diabetes management, particularly in the early days after a diagnosis

° Dietitian — helps you understand and implement changes to your lifestyle habits to follow a healthy eating plan and regular exercise program to reach and maintain a healthy weight.

° Endocrinologist — a specialist physician working with your GP to help with complicated problems related to diabetes

° Pharmacist — provides information and advice on your prescribed and over-the-counter medications

° Optometrist/ophthalmologist — eye health professionals who regularly check your eyes for any signs of damage to help reduce the risk of complications

° Podiatrist — help regularly check you for any signs of foot and lower limb problems, which often involves nerve and circulation damage in people living with diabetes.

Some people may also need referrals to healthcare professionals to look after other aspects of their diabetes management when required, such as oral health professionals, mental health professionals and exercise professionals.

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MONITORING AND CONTROLLING YOUR BLOOD GLUCOSE LEVELSFor people living with type 2 diabetes, it’s important to control the blood glucose level within an ideal range. Poorly controlled glucose can have serious long-term consequences on your health and wellbeing.

You may not always be able to tell if your blood glucose is too high (hyperglycemia) or too low (hypoglycemia) just by how you feel. For this reason, it’s important to know how to test your blood glucose levels with a portable blood glucose meter. Regularly monitoring your blood glucose levels helps you and your doctor identify the best management strategy for your diabetes. It also allows you to work out how different factors — such as illness, stress, diet and exercise — can affect your blood glucose levels.

When and how often you need to test your blood glucose depends on your individual situation. Your doctor will recommend a suitable schedule for you. It’s likely you’ll also need to monitor your blood glucose levels more frequently when you’re stressed or sick, if you’ve been significantly more or less active, if you’ve changed your eating habits, if there’s been a change in your medication, and if you’re experiencing symptoms of low or high blood glucose levels.

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In addition, your doctor is likely to test your glycosylated haemoglobin (HbA1c) levels. This can help determine how well your diabetes is managed over the previous 10–12 weeks. Current guidelines recommend that you aim for an HbA1c that is 53mmol/mol or lower, although this target may vary depending on your individual circumstance. Previously, HbA1c was reported as a percentage, and 53mmol/mol is equivalent to 7% in the old unit of measurement. The closer your HbA1c level is to the target, the more successful your chance of reducing or preventing complications.

It’s recommended your HbA1c levels be tested every 3 months to help determine the success of your diabetes management and any required changes to your treatment.

HyperglycaemiaHyperglycaemia occurs when blood glucose levels are considered too high. If your blood glucose is consistently too high, it can cause damage to your nerves, blood vessels and other body organs.

Generally, target blood glucose levels for people living with type 2 diabetes are:

° 4.0 — 8.0 mmol/L before meals

° 4.0 — 10.0 mmol/L two hours after starting meals

It’s important to discuss with your healthcare professionals what target range is best for you.

Ideally, blood glucose should be tested first thing in the morning before eating and two hours after a meal on a regular basis.

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High levels of blood glucose can be caused by:

° missing any oral diabetes medication or insulin you may be taking, or your medication needs to be reviewed to make sure it’s still appropriate for your diet and activity

° other medications such as corticosteroids (often used to treat arthritis or asthma)

° changing your eating patterns

° being less active than usual

° an illness or infection

Signs and symptoms of hyperglycaemia include:

° excessive thirst

° dry, itchy skin

° frequent urination

° pain and tingling in legs and feet

° tiredness

° headaches

° vision problems, such as blurring

° increased susceptibility to infections such as thrush.

Discuss with your GP and/or your diabetes educator about the best steps to take if you find you have hyperglycaemia.

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HypoglycaemiaHypoglycaemia (‘hypo’) occurs when blood glucose levels are too low (less than 3.5 mmol/L). If your blood glucose is too low, it can lead to tiredness, numbness in your fingers and around your lips, loss of consciousness and even death.

Low levels of blood glucose can be caused by:

° not having enough food or waiting too long between meals or snacks, especially if you’re taking diabetes medication or insulin

° exercising without eating adequate carbohydrates to fuel your activity

° adjusting your diabetes medication or the dose

° drinking too much alcohol and drinking on an empty stomach.

Signs and symptoms of hypoglycaemia include:

° light-headedness or dizziness

° sweating

° shaking

° numbness of the lips and/or fingers

° irritability

° lack of concentration, not being able to think clearly

° fainting.

If you have any of these symptoms, try to check your blood glucose immediately. It’s important to treat hypoglycaemia quickly as it may get worse and lead to fitting and loss of consciousness.

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If your blood glucose is low, eat or drink a quick-acting carbohydrate (‘hypo’) food to put sugar back into your body. ‘Hypo’ foods contain about 15g of carbohydrates that are quickly absorbed into your body to help restore blood glucose levels to normal:

° glucose tablets equivalent to 15 grams of carbohydrate

° six or seven jelly beans

° half a can of regular soft drink (not diet or sugar free)

° three teaspoons of sugar or honey

° half a glass of fruit juice.

Wait 10–15 minutes and then re-check your blood glucose level. If it is still low, eat another ‘hypo’ food then wait another 10–15 minutes before checking your blood glucose level again. If it has still not returned to normal, call your doctor straight away for further instructions.

If your blood glucose returns to normal after eating, stop drinking and eating ‘hypo’ foods even if you still feel some symptoms of low blood glucose and start planning ahead for your next meal. If your next meal is within 20 minutes, wait and eat your meal at the normal time. If your next meal is more than 20 minutes away, eat a small snack of longer-acting carbohydrate, then eat your meal at the normal time.

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Longer-acting carbohydrates are absorbed slower into the body and help regulate your blood glucose levels over time:

° one sandwich

° one glass of milk

° one piece of fruit

° two or three dried apricots, figs or other dried fruit

° one tub of low fat yogurt

° six small dry biscuits with cheese.

Keep ‘hypo’ and longer-acting carbohydrate foods at hand (car, desk, handbag, pocket) so you can access them quickly. Make sure your family, friends and co-workers know you have diabetes and where your ‘hypo’ foods are kept so they can help you if you experience hypoglycaemia.

If a person with type 2 diabetes is unable to swallow, drowsy or unconscious, this is an emergency. Call 000 for an ambulance and do not give them any food or drink.

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REDUCING RISK FACTORS WITH SELF-MANAGEMENT TECHNIQUESMore than half of the people living with type 2 diabetes can control their blood glucose levels to within an ideal range by looking after eating and exercise habits, which in turn helps them to reach and maintain a healthy weight. These healthy lifestyle habits can also help reduce the risk of diabetes complications.

Diet and nutritionGenerally, healthy eating for people with diabetes is no different to that recommended for everyone. You should not need to prepare separate meals or buy special foods.

However, people living with diabetes need to pay particular attention to the quantity and quality of the carbohydrate-containing foods they eat as it affects how blood glucose levels rise after a meal. Too large a serve can mean too large a rise. It’s best to have regular and appropriately-sized meals to spread carbohydrate intake evenly throughout the day. Try and eat predominantly high-fibre, low glycaemic index (GI) foods such as oats, muesli, dense grainy breads, beans and lentils, whole fruits and low-fat milk. Low GI foods are broken down into glucose and absorbed more slowly to release glucose gradually into the blood stream over a longer period of time. This can help stabilise your blood glucose levels as well as helping you feel fuller for longer to help maintain a healthy weight.

People living with diabetes can have some sugar in their diet (eg one teaspoon of sugar in a cup of tea or an occasional slice of cake containing sugar). However, it’s best to avoid or limit consumption of foods and beverages that are high in sugar as these can contribute to poor blood glucose control as well as weight problems. Tap water is the best drink for hydration, and you can occasionally have artificially-sweetened (diet) drinks as an alternative to sugary drinks like soft drink, cordial and fruit juice.

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Lower your total fat intake, particularly your saturated fat intake, and reduce the amount of salt you eat as well. This is to help lower your cholesterol and blood pressure levels, which are risk factors for heart- and blood vessel- related complications of diabetes.

Physical activityPhysical activity can significantly improve your glucose control and also help you reach and maintain a healthy weight. When you do physical activity your muscles usually burn glucose for energy. This means while you are exercising your glucose levels decrease, and it also helps improve your body’s ability to control glucose levels in the long-run.

Try to be active every single day — that doesn’t necessarily mean going to the gym or running (although it’s great if you can manage it). Even moderate-intensity aerobic exercise such as brisk walking for at least 30 minutes a day can gives you health benefits. You can even divide this into three lots of ten minutes if that’s easier. Garden, ride a bike, play with the children, walk the dog — just get moving. Some activity is better than none and more is better than a little.

Strength training has also been shown to be beneficial for glucose control as it helps build more lean muscle. This acts as a ‘dam’, a place where glucose can be stored in the form of glycogen. In addition to storing glucose, increased lean muscle mass increases your body’s use of glucose.

Talk to your GP before beginning a new exercise program, especially if you’ve been leading an inactive or mostly inactive lifestyle, are pregnant, are overweight, have heart disease or a family history of heart disease or any other major health concerns.

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Healthy weightIf you are overweight or obese, see your doctor to help with a sensible weight loss program. Research suggests losing 5–10 percent body weight is an appropriate medium-term goal to help improve blood glucose control. Losing excess body weight can also help you reduce your blood pressure and cholesterol levels and keep within ideal ranges to lower your risk of complications.

SmokingYou probably already know that smoking is harmful to your health. One way it can harm your health is by increasing your risk of developing type 2 diabetes. And if you already have diabetes, it can make managing the condition more difficult by increasing your chances of serious complications including heart disease, stroke, kidney disease, nerve damage, foot problems and eye problems.

Reducing the amount you smoke — or even better, giving up — can really help prevent diabetes or prevent complications. If you’ve tried to quit smoking before without long-term success, don’t be too hard on yourself. Sometimes it takes multiple attempts. Each try gets you closer to reaching your goal and in the meantime, you have reduced the total number of cigarettes you’ll have in your lifetime. Talk to your doctor or pharmacist about ways to make giving up smoking a reality.

AlcoholPeople living with type 2 diabetes need to limit their alcohol intake — alcohol is high in kilojoules and it’s often served with mixers that can also be high in sugars, and may raise blood glucose levels. Excessive drinking can also increase your risk of high blood pressure and heart disease.

Talk to your doctor about what level of drinking is appropriate for you. If you do choose to drink, keep to recommended levels (no more than two standard drinks a day for adults), avoid sweet wines and beers, and choose sugar-free mixers where possible.

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MEDICATIONS FOR TYPE 2 DIABETES Following a healthy eating plan and a regular activity program is important for maintaining your long-term good health and wellbeing. If your blood glucose is still not well controlled after a 2–3 month trial of healthy eating and exercise, your doctor may also recommend certain medication to control your glucose levels. Medication is only one part of an overall management picture and should not be substituted for healthy living habits.

Oral medications that work to lower blood glucose levels, boost your insulin levels or both are generally used to treat type 2 diabetes. They may be used on their own, in conjunction with each other, or with insulin.

Insulin injections are needed when the body doesn’t produce enough insulin to control blood glucose levels. People living with type 1 diabetes require insulin while people living with type 2 diabetes may require insulin if their glucose levels are not controlled by other medications, a healthy eating plan and exercise.

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Below is some information on medications. You should only take medications as prescribed by your doctor. Be sure to always check with your doctor and pharmacist prior to taking any medications as they may cause side effects. If you’re experiencing side effects or symptoms, contact your doctor or pharmacist as soon as possible. You may also have to be careful about mixing your medication/s with other medications and/or alcohol. If you are unsure about any of the medications you’ve been prescribed, you should ask your doctor for more information.

Metformin works by reducing the amount of glucose produced by the liver and increasing the uptake of glucose by cells to reduce the level of glucose in the bloodstream. Metformin is considered the first-line of treatment for people living with type 2 diabetes. It’s particularly suitable for those who are overweight because it’s less likely to cause weight gain problems compared to other anti-diabetic agents. It has also been shown to reduce the risk of death and other complications related to diabetes. However, it’s not suitable for those with kidney failure, and should be used with caution in those with liver or heart disease.

Sulphonylureas are a class of anti-diabetic agent sometimes added to treatment when maximum tolerated doses of metformin are not enough to bring blood glucose levels to within normal range. Sulphonylureas work by stimulating the production of insulin by the pancreas. They may also have a beneficial effect of improving the sensitivity of the body’s tissues to the action of insulin. There can be unwanted side effects of weight gain and hypoglycaemia.

Acarbose is sometimes prescribed with metformin or sulphonylureas. It helps slow the digestion of carbohydrates in the small intestine to reduce the absorption of glucose into the bloodstream. It’s best

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taken at the start of a meal so it can work on reducing blood glucose after eating. It needs to be introduced gradually to reduce side effects of flatulence and diarrhoea, and care needs to be taken in people who have kidney impairment or gastrointestinal (stomach and bowel) disease.

Glitinides may be a good alternative for people who have an allergy to sulphonylureas. They work by stimulating the pancreas to produce a surge of insulin just after eating. They are sometimes prescribed in addition to metformin tablets or insulin therapy.

Thiazolidinediones, also known as glitazones, work by increasing the sensitivity of the body’s tissues to the action of insulin, rather than stimulating insulin secretion. This allows glucose to be used more efficiently. It also reduces how much glucose your liver makes. It’s usually prescribed in combination with metformin and/or sulphonylureas. People are recommended to have their liver function tested before starting these medications as they can have unwanted side effects of liver toxicity and weight gain. They can also increase the risk of heart failure by causing fluid retention, and are not recommended for use in combination with insulin.

Incretin enhancers and incretin mimetics are newer medications that work on incretin hormones that stimulate insulin release from the pancreas after glucose is consumed. Currently available incretin enhancers stop an enzyme from breaking down incretin. It can be used in combination with metformin, glitazones or sulphonylureas. The currently available incretin mimetic is given by injection in combination with metformin and/or sulphonylureas. It can also help with the feeling of being full after a meal so it can help with weight loss, but it may cause gastrointestinal side effects such as loss of appetite and nausea, particularly at the start of treatment.

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InsulinIt is not unusual for oral hypoglycaemic medicines to control type 2 diabetes for a long period of time and then not work as effectively. Insulin treatment may then be required, as in one-third of people living with type 2 diabetes after 10–15 years of successful management using oral hypoglycaemic agents.

However, insulin is still not a substitute for following a healthy eating plan, having a regular activity program, weight management and taking any other medications as directed by your doctor.

People living with type 2 diabetes who require insulin can often manage their blood glucose levels with a single daily dose injected through the skin into the fatty tissue.

There are several types of insulin, usually classified according to the length of their action in the body. You may need varying amounts of short-, intermediate- and longer-acting insulin. There are pre-mixed preparations with fixed proportions of short- and intermediate-acting insulin. Everyone is different and will respond differently to the amount and type of insulin they take.

While using insulin may seem difficult and frightening at first, your healthcare professionals such as a diabetes educator, GP/diabetes specialist and pharmacist can help you adjust to the new routine. Even with their help, it often takes a while to find the right routine to control your blood glucose levels and suit your lifestyle. If you have any concerns about any of your medications, such as what they are for and how and when to use each one, talk to your pharmacist or GP.

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PREVENTING AND MANAGING COMPLICATIONS OF TYPE 2 DIABETESDiabetes is a risk factor for a range of health conditions that can become major causes of illness and even death. This includes heart disease, stroke, kidney damage, mental health issues, eye diseases and feet problems.

Look after your heart and blood vessel healthPeople living with diabetes have a higher risk of cardiovascular disease — heart attack and stroke — compared to those without the condition. In fact, cardiovascular disease accounts for the majority of deaths in people with diabetes.

That’s why it’s so important to not only manage your blood glucose levels, but also other factors that affect your heart and blood vessel health, such as smoking, alcohol intake, weight, blood pressure and cholesterol levels.

Australian guidelines recommend six important targets for optimal heart health:

° HbA1c level of ≤ 53 mmol/mol

° Not smoking

° Blood pressure under 130/80

° BMI < 25

° No more than two standard drinks a day

° Blood lipid (fat) levels according to recommended targets:Total cholesterol < 4.0 mmol/L HDL-cholesterol > 1.0 mmol/L LDL-cholesterol < 2.0 mmol/L Triglycerides < 2.0 mmol/L

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Check your kidneys Good control of blood glucose levels and blood pressure reduces your risk of blood vessel and nerve damage in the kidneys that leads to kidney disease. Protein in the urine (proteinuria) is an early warning sign of kidney damage, and the presence of a particular component of protein (microalbuminuria) is a sign of high cardiovascular disease risk. So it’s important for people living with diabetes to have their urine albumin creatinine ratio (ACR) and their kidney function checked every year.

Put your best foot forwardCommon causes of hospitalisation for people living with diabetes are foot problems. This often happens because blood vessel and nerve damage in the foot leads to a lack of circulation in the area and loss of feeling, so when a foot injury happens it may go unnoticed. The untreated injury can then become infected and if it’s severe enough it may require hospital treatment and even surgery.

You can prevent this by controlling your blood glucose levels and checking the condition of your feet regularly — perhaps every second or third day. Check the tops and bottoms of your feet and in between the toes for any redness, swelling, cuts or pus. If you can’t reach or see your feet, use a hand mirror or ask someone else to help. Always report any problems (such as foot ulcers, reduced circulation or sensation or abnormal foot structure) to your GP immediately.

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If you don’t currently have any foot problems, it’s recommended you have your risk of developing foot complications classified by your GP or podiatrist to determine how often you need your foot health checked. It’s recommended you have your feet checked by your GP or podiatrist every three to six months if you’re at intermediate-to-high risk, and every 12 months if you’re at low risk.

It’s also a good idea to pay attention to foot hygiene and footwear. It’s suggested you purchase shoes in the late afternoon or evening, when feet are usually most swollen, to avoid shoes that are too tight. Your podiatrist can also help you assess if your shoes are suitable for you and teach you how to look after your feet to reduce the risk of damage.

Watch out for eye damagePeople living with diabetes are more likely to develop eye complications and often earlier, including cataracts, retinopathy (damage to the blood vessels of the retina), and the most common cause of vision loss in people with diabetes, maculopathy (damage to the macula).

When you are diagnosed with type 2 diabetes, have an initial eye check with an optometrist or ophthalmologist (eye specialist). Then have your eyes checked at least every two years or more frequently if eye problems exist.

Care for your mental healthDepression is reported to be 24 percent more likely in people with diabetes than in those without. However, the good news is that it’s treatable. If you’re worried you might be depressed, talk to your doctor about how you might be able to address your symptoms and start to feel better again. You may need therapies such as counselling and/or medical treatment with antidepressants. Talking to a qualified medical professional is often the first step to getting the help you need to care for your mental health and wellbeing.

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OTHER CONSIDERATIONS WHEN MANAGING TYPE 2 DIABETESSick daysBeing ill can interfere with your ability to manage your blood glucose, and can often lead to increased blood glucose levels. It’s important to develop a sick day management plan with your GP, diabetes specialist or diabetes educator.

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This plan usually includes:

° How often you need to measure your blood glucose levels

° What medicines to take and any dose changes required

° Any changes you may need to make to your eating habits

° When to call your GP or get additional help and support.

DrivingPeople living with type 2 diabetes may have problems with safe driving. This can be due to having unexpected ‘hypos’ when taking glucose-lowering medications or from complications such as reduced sensation in the feet and vision loss. You will need to satisfy certain medical standards to determine that you’re fit to drive. It’s also a good idea to keep quick-acting carbohydrate foods on hand (either in your bag or in the car) in case you experience signs of hypoglycaemia while driving.

Family historyResearch has shown that diabetes often has a hereditary component. Those with several close family members with diabetes may develop the condition at an earlier age. If there’s a history of type 2 diabetes in your family, maintaining healthy lifestyle habits can be your best defence to prevent or delay the onset of diabetes. Research suggests obesity and physical inactivity are key risk factors, so address these as a priority.

Early detection is also important because diabetes can remain silent for many years and complications may set in well before the diagnosis is made, especially in the case of type -2 diabetes. Talk to your doctor about whether you and family members need to have regular checks for your risk of developing type 2 diabetes.

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The TYPe 2 DIABeTeS AcTIon PlAn

Name Date

/ /

Take this Action Plan and Health Medication Record with you when you visit your doctor.

checkS or revIewS BY DocTor or heAlTh ProfeSSIonAl

recommenDeD frequencY

DATeS Due (DocTor To fIll In)

DATeS Due (DocTor To fIll In)

DATeS Due (DocTor To fIll In)

Review medications Every routine visit as required

Review exercise program:

° mobility exercises

° strengthening exercises

° cardiovascular exercises

Every 3 months or as required

Review weight Every routine visit

Review diet and alcohol intake Every 6 months or as required

Review glucose monitoring Every 6 months

Blood test for HbA1c Every 3 months

Blood pressure Every routine visit

Smoking status As required

Blood test for lipid profile Every 12 months or as directed by doctor

Kidney check Every 12 months

Eye check by eye specialist Every 12–24 months

Feet check by podiatrist Every 3–12 months depending on risk

Review general and mental health Every 6 months or as required

Review information needs Every 6 months or as required

For a medical or psychiatric emergency, call 000 or go to the nearest hospital. If you aren’t sure, call your doctor or local hospital.

Your doctor can fill in the due dates or actions required. Use this plan to remind you when to go for your check-ups.

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meDIcATIon DoSAge how ofTen /when

InSTrucTIonS eg Before eATIng

commenTS

The TYPe 2 DIABeTeS heAlTh meDIcATIon recorD

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References

Alberti KG Zimmet P Shaw J. International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med. 2007; 24(5):451-63.

Australian Diabetes Educators Association. Guidelines for sick day management for people with diabetes. [Online] 2006 [Accessed May 2014] Available from: www.adea.com.au

Chadban S Howell M Twigg S et al. National evidence-based guideline for diagnosis, prevention and management of chronic kidney disease in type 2 diabetes. Canberra: Diabetes Australia and the NHMRC. [Online] 2009 [Accessed Jun 2014] Available from: diabetesaustralia.com.au

Craig M Twigg S Donoaghue K et al. National evidence-based clinical care guidelines for type 1 diabetes in children, adolecents and adults. [Online] 2011 [Accessed May 2012]. Available from: www.apeg.org.au

Diabetes Australia. Diabetes information sheet. [Online] [Accessed Jun 2014]. Available from: www.diabetesaustralia.com.au

Diabetes Australia. Diabetes management in general practice: guidelines for type 2 diabetes. [Online]. 2012 [Accessed May 2014]. Available from: www.diabetesaustralia.com.au

Diabetes Australia — Vic. Talking Diabetes: Blood glucose monitoring. [Online] 2010 [Accessed Jun 2014]; 4. Available from: www.diabetesvic.org.au

Das SK Elbein SC. The Genetic Basis of Type 2 Diabetes. Cell Science. 2006; 2(4):100-31.

Dietitians’ Association of Australia (DAA). [online] Available from: daa.asn.au

Endocrinology Expert Group. Therapeutic Guidelines: endocrinology. Version 5. Melbourne:Therapeutic Guidelines Limited; 2012.

Jones GR Barker G Goodall I et al. Change of HbA1c reporting to the new SI units. Med J Aust. 2011; 195(1):45-46.

Kidney Health Australia. Chronic kidney disease (CKD) management in general practice (2nd edition). [Online] 2012 [Accessed May 2014] Available from: www.kidney.org.au

National Diabetes Information Clearinghouse, National Institiute of Diabetes nad Digestive and Kidney Disease (NIDDK). Causes of diabetes. [Online] 2011 [Accessed Jul 2012]. Available from: diabetes.niddk.nih.gov

National Health and Medical Research Council (NHMRC). Guidelines to reduce health risks from drinking alcohol. [Online] 2009 [Accessed May 2014] Available from: www.nhmrc.gov.au

NHMRC. National evidence-based guideline on prevention, identification and management of foot complications in diabetes (part of the Guidelines on Management of Type 2 Diabetes). [Online] 2011 [Accessed Jun 2014] Available from: www.nhmrc.gov.au

Nouwen A Winkley K Twisk J et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010; 53(12):2480-2486.

Robertson C. The role of the nurse practitioner in the diagnosis and early management of type 2 diabetes. J Am Acad Nurse Pract. 2012; 24 Suppl 1:225-33.

Rossi S (ed). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. 2013.

Shaw J Tanamas S. Diabetes: the silent pandemic and its impact on Australia. [Online]. 2012 [Accessed Jul 2012] Available from: www.diabetesaustralia.com.au

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The information in this brochure has been developed and reviewed for Bupa Australia Pty Ltd and its related entities (‘Bupa’) by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It is intended to be a guide only and should not be relied upon as a substitute for professional medical advice. The mention of specific products, services, tests, doctors, specialists or other health care professionals, procedures or opinions does not constitute or imply a recommendation or endorsement by Bupa, unless specifically stated as such. Bupa makes no warranties or representations regarding the completeness or accuracy of the information and is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health or wish to discuss your individual symptoms or circumstances.

The information in this brochure does not represent which products and services may or may not be covered under your level of cover.

FURTHER INFORMATIONFor more information and support, contact:

° Your GP, diabetes specialist or diabetes educator

° Diabetes Australia on 1300 136 588 (local call cost) or at www.diabetesaustralia.com.au

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Bupa Australia Pty Ltd ABN 81 000 057 590

Effective June 2014 09617-07-14S

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