เบาหวาน พบได้ประมาณ 3.5
มากกว่า 40 ปีขึ้นไป
ชนิดใหญ่ ๆ ที่มีอาการ สาเหตุ
(Insulin-dependent diabetes mellitus/ IDDM)
ภูมิแพ้ต่อตัวเอง" หรือ "ออโตอิมมูน (autoimmune)"
จนทำให้ผ่ายผอมอย่างรวดเร็ว และถ้าเป็นรุนแรง จะมีการคั่งของสาร
คีโตน (ketones) ซึ่งเป็น
คีโตน หรือ คีโตซิส (Ketosis)"
2. เบาหวานชนิดไม่พึ่งอินซูลิน(Non-insulin-dependent diabetes mellitus
แรงน้อยมักพบในคนอายุมากกว่า 40 ปี
Causes and Prevention of Diabetic Neuropathy
High blood sugar in diabetes patients can lead to diabetic neuropathy. Learn more about how diabetic neuropathy can cause damage to the nervous system, and how a healthy lifestyle can prevent diabetic neuropathy in diabetes
Diabetic Nephropathy Causes and Prevention
Often, high blood pressure from diabetes can cause diabetic nephropathy, and this can lead to kidney failure. A healthy lifestyle will help to prevent kidney damage and diabetic nephropathy.
your blood sugar on the level
When insulin was first discovered and
made available for people with diabetes, there was only one kind of short-acting
insulin. This required several injections a day. As time went on, new insulins
were developed that lasted longer, requiring fewer injections, but requiring
strict attention to timing of meals. Now, there are different types of insulin
available, made from different sources. This gives more flexibility in the
number and timing of injections, making it easier to maintain target blood
glucose levels, based on your lifestyle. One to four injections a day may be
suggested to you for optimal control of your blood glucose. Ask your health care
team about the best insulin plan to meet your needs.
Insulin works differently in different
people depending on factors such as: injection site, amount of insulin, etc. The
following are general guidelines only.
Type of Insulins
||STARTS TO WORK IN
||5 - 15 minutes
||½ - 1 ½ hours
||3 ½ - 4 ½
||Regular (R), or Toronto
||30 - 40 minutes
||2 - 4 hours
||6 - 8 hours
||NPH (N), Lente (L)
||1 - 3 hours
||2 - 12 hours
||18 - 24 hours
||4 - 6 hours
||12 - 18 hours
||24 - 28 hours
|Premixed insulin (%R %N)
||10/90, 20/80, 30/70,
|½ - 1 hours
||2 -12 hours
||18 - 24 hours
|Premixed insulin analog
||5 - 15 minutes
||½ - 12 hours
||18 - 24 hours
What do I need to know about
blood glucose levels?
The Canadian Diabetes Association's Clinical
Practice Guidelines for the Management of Diabetes in Canada provide people
with diabetes with definite goals for levels of glucose control. They are as
of glucose control for people with diabetes
(adults and adolescents)
(target goal but may be hard to achieve for some people)
(action may be required - not low enough to prevent complications)
(action required - at increased risk for long-term complications)
(ask your doctor)
|Glucose before meals
||4 - 7 mmol/L
||7.1 - 10 mmol/L
||Over 10 mmol/L
|Glucose 1 - 2 hrs after
||5.0 - 11 mmol/L
||11.1 - 14mmol/L
||Over 14 mmol/L
|HbA1c (depending on lab)
||Less than 0.07%
||0.07 - 0.084%
The above information
serves only as a guide.
You need to know what your own blood glucose target ranges are, so be certain to
discuss this with your doctor.
How to test your blood glucose level
You can purchase a meter from your local pharmacy. Checking blood glucose
requires obtaining a small drop of blood to place on a blood glucose strip. Talk
to your diabetes educator or pharmacist about the various methods, and which one
is right for you. When you decide, make sure you receive the proper training.
- The size of the drop of blood and the
type of blood glucose strips to use
- How to clean you meter
- How to check if your meter is accurate
- How to code your meter
Your province or territory may subsidise
the cost of injection and monitoring supplies. Contact your local Canadian
Diabetes Association office to find out if this applies to you.
Why you should test your blood glucose
What causes a low blood glucose level or
- Blood testing is a quick measurement of
your blood glucose level at any point in time.
- Blood checking shows how your blood
glucose levels are affected by your food intake, insulin, stress levels, illness
and physical activity.
- Blood checking is a quick method to
identify high and low blood glucose levels.
- Blood checking will help you, your
doctor and diabetes health care team, to make the necessary changes in insulin,
meal planning or exercise to achieve good blood glucose control.
A low blood glucose level can occur when your blood glucose drops below a
certain level (usually less than 4 mmol/L).
This is caused by:
- Not eating enough food
- Missing or delaying a meal
- Exercising without taking the necessary
- Taking too much insulin
- Drinking alcohol.
Low blood glucose can happen quickly, so
it is important to take care of it right away.
The warning signs of a low blood
Note the symptoms you are feeling, and this will help you to identify low blood
glucose in the future.
You may feel:
- Shaky or light-headed
- Nervous or irritable
- Your heart beats at a faster rate
- A numbness or tingling in your tongue or
Other signs of low blood glucose
You may also:
- Have a headache
- Be unusually sleepy
- Experience mood changes
Remember: Some people do not have
early warning signs of hypoglycemia. These individuals must check their
blood glucose levels more often to avoid this condition. It is especially
important for all people with diabetes to check before driving a car.
How to treat low blood glucose
- Check your blood glucose. If you do not
have your meter with you treat the symptoms anyway. It is better to be safe.
- Eat or drink a form of sugar such as:
- 3 B-D Glucose Tablets™ or 5
- 6 Life Savers TM
- 3/4 cup (175mL) of juice or regular pop
- 1 tablespoon (15mL) of honey.
- Wait 10 to 15 minutes, then test your
blood glucose again.
If it is still low:
- Treat again.
- If your next meal is more than one hour
away, or you are going to be active, eat a snack, such as half a sandwich or
cheese and crackers (something with starch and protein).
Severe Low Blood Glucose:
If your blood glucose drops very low you may:
- Become confused and disoriented
- Lose consciousness
- Have a seizure
You will need assistance from another
person. Make sure you always wear MedicAlert® identification. Talk to your
doctor or diabetes educator about prevention and emergency treatment for severe
low blood glucose.
What causes high blood glucose?
High blood glucose can result when food, activity and insulin are not balanced.
High blood glucose may happen when you are sick, pregnant or under stress.
The signs of high blood glucose
You may be:
If you think your blood glucose is high,
check your blood glucose levels
- Urinating more often
If you have type 2 diabetes, call or see your doctor. If you have type 1
diabetes, test your urine for ketones. Seek medical advice immediately if
ketones are present.
VDO : Types of Insulin Delivery
Many people who suffer from diabetes take insulin to stabilize their blood sugar levels. Learn more about the different types of insulin delivery.
Insulin is a hormone made by a gland
called the pancreas. Insulin helps the sugars obtained from the foods we eat get
into the cells of the body to provide energy.
People develop diabetes when the body no
longer makes any insulin; enough insulin; or is unable to utilize properly the
insulin it makes.
do we need injected insulin?
For persons who do not have diabetes, the
production of insulin by the pancreas varies according to the level of sugar in
the blood. Each time we eat, our blood glucose, or sugar rises, an appropriate
amount of insulin is produced and the blood sugar returns to normal within a
couple of hours. For the person with diabetes whose body is not making any
insulin or not enough insulin, insulin injections are necessary to maintain this
proper balance of sugar in the blood and in the cells.
Insulin cannot yet be given by mouth
because the acids in the stomach destroy it before it can begin to do its work.
Insulin must be given by injection.
and amounts of insulin
Each person with diabetes is unique - an
individual. The development of an insulin therapy schedule is thus dependent
upon how much insulin each person's pancreas is still making; how sensitive they
are to the insulin; their lifestyle; their activity level; and their eating
pattern. Capillary blood sugar monitoring, through a finger prick, provides the
person and his or her management team with very concrete information to assist
in determining the type, amount, and timing of insulin injections.
The various insulin programs can range
from one or two injections of insulin per day up to three or four injections.
The main goal of insulin therapy is to
keep the blood sugar levels as close to the target range as possible (4 to 6
mmol/L before a meal, 10 or less two hours after a meal).
The Diabetes Control and Complications
Trial (1993) reinforces the importance and the benefits of good blood sugar
control in preventing or reducing the progression of long term complications of
There are three distinct characteristics:
Onset: the time it takes the
injected insulin to reach the blood stream and begin to work.
Peak: the time period in which the
insulin is working its hardest to lower the blood sugar.
Duration: the length of time the
insulin will be working in the bloodstream.
It is important that each person have a
clear understanding of the characteristics of each type of insulin that he/she
is taking. When blood sugar levels are not well controlled at certain times
during the day, or if reactions are occurring, the knowledge of the action and
characteristics of each insulin being taken will help to determine where changes
need to be made.
Insulin absorption can be affected by the
injection site, exercise, the accuracy of the dosage measurement, the depth of
injection and by environmental temperatures.
To obtain consistency in daily insulin
absorption and action, you should vary injection sites within the same
The abdomen provides an excellent area
for consistent absorption of insulin, whereas the leg and arm areas are often
affected more by exercise.
Repeated injection in the same area may
cause a delay in absorption whereas massaging the site of injection may lead to
an increased rate of absorption.
Insulin should be injected at a 90-degree
angle using an insulin syringe (25 unit, 30 unit, 50 unit, or 100 unit size) or
with an insulin pen. If redness, pain, or lumps are noted at the injection site,
this area should be avoided until the problem goes away. Notify your doctor if
a syringe with two types of insulin
If you are preparing an injection drawing
up two different types of insulin it is extremely important to measure dosages
accurately and not to accidentally inject insulin from one bottle into the
second bottle that holds a different type of insulin. You would not want to get
intermediate-acting insulin into your bottle of short-acting insulin, thus
altering the characteristics of the short-acting insulin.
Most people today are taught to draw up
the short-acting insulin first then the longer-acting type. Air bubbles that
occupy space in the syringe where there should be insulin must be cleared before
the longer-acting insulin is drawn up. These air bubbles will not harm you
directly but will result in an inaccurate dosage of insulin.
Premixed insulin are a combination of
specific proportions of short-acting (R) and intermediate acting (N) insulin in
one bottle or an insulin pen cartridge.
The premixed combinations include 10/90,
20/80, 30/70, 40/60, and 50/50. These different combinations, for example 30/70,
mean that 30 percent of the insulin is short acting (R) and 70 percent is
These premixed insulins work well for
individuals whose insulin requirements are quite set and who may be having
difficulty with measurement of their dosages.
Premixed insulins do not, however, allow
flexibility in dosage adjustment. You are not able to give yourself more N
without also getting more R.
The increased number of premixed insulin
on the market over the last three years makes the possibility of finding the
appropriate ratio of R and N insulin in the one bottle or cartridge much more
The pen is the newest way of giving your
insulin. It is convenient, quite portable, accurate, easy to use, and great for
taking to work or when travelling.
Delivery: Audible and
tactile unit "clicks"
Display: Large, easy to read display
315 units (3.15 ml)
range: 1-80 units, one unit increments
Standard luer needle 27 or 30 gauge
Accepts plastic or glass
cartridges that fit your H-TRONplus or Dahedi pumps
All insulin types with the exception of L
(Lente) and U (Ultralente) are available in cartridges. The various premixed
insulins are also available for use with the pen. If your insulin treatment plan
requires taking N and R insulin and the amounts do not fall into the proportions
of one of the premixed insulins, then you would be required to take two
If you are interested in learning more
about the pen, speak to your doctor or diabetes educator for more information.
The insulin vial you are using each day
is quite stable at room temperature (25 C/77 F) for one month. Cartridges are
stable for 21 days. Extra insulin stored in the refrigerator is good until the
expiry date. Never store extra insulin in the freezer. Freezing can damage
insulin and the insulin should not be used if this has occurred. Keep insulin
away from heat and strong light. Never store your insulin in the trunk or in the
glove compartment of your car.
Always check your insulin solution to
ensure that the appearance is normal.
All cloudy insulin should appear
uniformly cloudy when mixed by rolling between your hands. If particles are
floating in the insulin solution or adhering to the bottom or sides of the
bottle, do not use this insulin. If the short-acting insulin solution is no
longer clear and colorless, discard the bottle.
In order to establish an insulin
treatment plan that will be effective, it is essential that the blood sugar
levels be checked at various times during the day to determine how each
component of the treatment plan is working. The blood sugar results help you
identify the need for adjustments to the timing or amount of insulin, food, or
exercise in order that better control will be achieved.
Discuss the times and the frequency of
testing with your doctor or diabetes educator.
It is beneficial to test your blood sugar
several times during the day (ideally before each meal and at bedtime) so that a
pattern of your blood sugar control for the day can be determined. These
patterns of blood sugar levels help you and your management team identify
problem areas and make the necessary corrections to promote good blood sugar
If you have more questions or you are
interested in learning more about insulin adjustment based on your blood sugar
monitoring results, contact your doctor or diabetes educator. Your management
team is there to work with you, to help you live a full healthy life with the
best possible control of your blood sugar levels and thus your diabetes.
with this new knowledge, your next step is to visit your Doctor and/or Diabetes
Educator and discuss switching your therapy program to an insulin pump. Since
using an insulin pump does require more effort on your part, some Doctors and
Diabetes Educators will want to test your resolve to determine if you are ready.
you and your medical advisor have agreed that an insulin pump is right for you,
you will begin learning the basics of using a pump. This includes learning to
count carbohydrates, monitor your blood glucose levels, adjusting insulin doses
and understanding the different bolusing options.
begin to better understand the basics of pump therapy, you can investigate which
pump is right for you. Your Doctor or Diabetes Educator may only recommend a
single brand or model of pump, but take the time to explore all of your choices.
The pump that is best for you may not be the pump your medical advisors
recommend, so take chargeyou'll be the one using it everyday.
you've selected a pump, your Pump Trainer will meet with you to explain how the
pump works. That person will take you through every function and scenario to
make sure you understand exactly how to operate your pump safely and
efficiently. Most pumps, such as the D-TRON™, come with free training
materials (like an interactive CD-ROM) to assist you. Your Pump Trainer may ask
that you begin using a pump containing a non-active, NaCl (saline) or salt water
solution to monitor your progress, before switching you to pump delivered
insulin (you must continue your current insulin therapy while using the NaCl
entire process of switching from your current therapy to pump therapy can take
as little as a month, depending on your involvement. Once the change is made,
the benefits will be immediatemore control, greater flexibility and more
personalized insulin matching.
course, this is only a general outline of what's involved in switching to an
insulin pump. Your situation may differ, but will include all of these steps in
combination with others, as determined by your Doctor and Diabetes Educator.
to beginning pump therapy, you will have to become competent in the use of
injection therapy for controlling your diabetes. This assumes that you
understand the basics of insulin treatment, before moving on to more advanced
Pump Therapy FAQs
you use insulin pump therapy to manage your diabetes or are considering
it, rest assured that it's normal to have questions. To help you, we have
compiled a list of some of the most common questions people ask.
have insulin pumps been available?
pumps have been available in the U.S. since the late 1970s. Today's
insulin pumps, however, are much more advanced than early models. Modern
pumps use the latest microchip technology to regulate insulin delivery and
provide safety checks.
are insulin pumps?
Insulin pumps are proven to be safe. They have been used by thousands of
people around the world for years with few complications. And today's
technology makes them even better. The computer systems on today's pumps
perform continuous safety checks.
the advantages of an insulin pump?
The biggest advantage of an insulin pump is that it can help you better
manage your blood glucose level. In addition, it can provide you with
lifestyle flexibility-you can travel, exercise, work or eat without
worrying about injections and when the insulin will take affect. Health
advantages may include lower HbA1c, fewer low blood glucose (hypoglycemic)
reactions, the reduced likelihood of diabetes-related complications (heart
and kidney disease, vision loss and nerve damage), and improved physical
and psychological well-being.
are the disadvantages of an insulin pump?
Some people say a disadvantage of an insulin pump is that you are attached
to the device 24 hours a day. Others say that pump therapy can be
demanding because you have to change insulin cartridges and infusion sets.
Another disadvantage for some people is that insulin pump therapy requires
blood glucose testing at least four times every day.
is it like wearing a pump 24 hours a day?
Because today's pumps are about the size of a personal pager and weigh
only a few ounces, many pump users forget they're wearing an insulin pump.
During the day, you can clip it to your pant or skirt waistband or put it
in a pocket. Some women even wear the pump in their bra. You have choices
at night, too. Some people clip the pump to their pajamas, while others
put it in a pocket or under their pillow. Many people simply lay the pump
next to them.
type of insulin is used with a pump?
Your health care professional will prescribe the insulin that is
appropriate for you. Some important points to remember about insulin pumps
and insulin include:
pumps use only short-acting insulin.
using long-acting insulin will no longer will need it after they begin
using an insulin pump.
insulin pump delivers a continuous supply of fast-acting insulin.
insulin has more predictable absorption than intermediate or short-acting
insulin, so your blood glucose levels are better controlled.
I use an insulin pump will I automatically have good control of my blood
Good control (or "tight" control, as you'll hear many people
say) requires a balanced approach. An insulin pump certainly will help you
control your blood glucose level, but eating properly, monitoring your
blood glucose and exercising regularly are equally important. The pump
doesn't take care of your diabetes, you do.
a pump and insulin, what other supplies does pump therapy require?
You'll need infusion sets, cartridges for the insulin, batteries, skin
cleansers, and blood glucose monitoring supplies.
much do supplies cost?
If you have traditional insurance, which typically pays 80 percent of
expenses (i.e., an 80/20 plan), you'll pay approximately $30 every month
for supplies (the insulin itself is extra).