How To: Give Your Feet a Pedicure

This section is for all of you. If you want to treat your ten little tootsies this is how.

Its lovely to have nice looking, comfortable, happy feet.  After you’ve been doing all that exercising your feet could do with a little pampering.  The more you can make this part of your daily routine the happier your feet will be. You may soak your feet for up to five minutes if you intend to cut your nails.

Fill a basin or bath with some warm water.
Test it with your hand to see its not too hot.
Add a good sprinkle of salt.
Add some bath gel, liquid soap or use a bar of soap.
Add a favourite aromatherapy oil – just a few drops – if you like.
Put your feet in and give them a gentle wash.
You may leave them to soak for up to five minutes.

Take your feet out and put them on a towel.
Give them a thorough dry particularly between the toes.
Place your feet where you can see them and if you are not flexible enough to see the sole of your foot use a mirror.

Are there any rough areas, unusually reddened areas?
Any sores? Any cuts? Any blisters?
How are your nails?
Any breaks in the skin between your toes?

If any problems are apparent you may need to deal with them yourself, see your podiatrist within the week or even see a doctor as an emergency if you suspect you have an infection.

Do your nails need cut?
To cut them use nail clippers or scissors. Be sure to look exactly where you are going with the scissors. Cut the big nail straight across so the nail edge does not cut into your skin.

Now for a massage.
Bring out your container of vegetable or animal oil. Pour some into your palms and then stroke it all over your feet.
Rub it into the nails, between the toes, and on the sole of your foot.
Give the ball of your foot which takes a lot of pressure a good massage.

You can extend the massage up your leg to your knee. Sweep your hand upwards towards the heart. The shin area and round the ankle area can be affected by poor circulation in later years so keeping the skin supple here is helpful.

To finish off gently use the towel to absorb any excess oil on your legs or feet.
Put on a fresh pair of socks for a while. This will keep your carpets, bedcovers and shoes from becoming oily.

Make a date with your feet to have the same loving experience very soon.

Quick Quiz:
There is no quiz in this section. The only thing you need to ask your tootsies is what soaps and oils they like best.

Reference Info:
Acknowlegements to my ten little friends and to my podiatrist Simon Littlejohn.

Where to Next?
Did you enjoy that? I hope you did. Your happy feet can now toddle along to the next section How To: Know What Things Beyond Food Can Affect My Blood Sugar.

How To: Eat from a Hospital Menu

This section is for everyone. It could happen to you!

Ironically one of the most risky places for a diabetic to eat is as an inpatient in a hospital.

Because you are a diabetic you will be told by nursing and dietetic staff that you must choose from the “Healthy Eating” section of the menu. This “Healthy Eating” section is specifically designed to be high in carbs, lowish in protein and very low in fat. I’m not at all sure what kind of metabolism is suitable for this sort of diet but it it’s certainly not a good idea if you have the sort of metabolism that cannot handle sugar and starch.  This is the situation for all those people with glucose intolerance or diabetes. Yes. You!

It is necessary for you and your relatives to be very firm at the outset that you must be able to choose from the whole menu, be able to choose large or small portions as you desire and to bring in supplementary food items if necessary.  This could include olive oil and vinegar to dress your salads, fresh temperate grown fruits, cheese, cooked meats, oatcakes and diet drinks.

For breakfast ignore the toast and cereals and porridge and go for the cooked breakfast and eggs in a large portion. Supplement this with a small portion of fresh fruit. Grapefruit and mandarin orange segments are often offered on hospital menus but they are usually tinned and sweetened with sugar so are best avoided.

Instead of digestive biscuits as a midmorning and midafternoon snack try some cheese and oatcake with butter.  Many hospitals routinely offer diabetics snacks as this used to be necessary with twice daily insulin regimes. You may not really need  a snack however. If you are hungry at a snack time you may not have eaten as much protein and fat as you really needed to at the previous meal. If you are insulin dependent you will need to have lucozade or gatorade or snacks available for low blood sugar treatment. A longer acting carb and some protein can work well provided you are not too low.

For lunch and dinner pick large portions of meat, fish, poultry, cheese and egg dishes with vegetables or salad. Ignore any potatoes, chips, rice, pasta or bread items. Avoid deep fried battered food if possible due to the high hydrogenated fat content and carb content of the batter.

Before bedtime toast and biscuits are about the only thing that is offered in hospital. These are likely to be too high glycaemic for you and cheese and cold meat or cheese and oatcakes usually work better to prevent a blood sugar spike or nightime lows.

Despite the difficulties in getting fed properly in hospital it is well worth the effort  to keep your sugars normal. Your infection rate is decreased and your recovery will be faster.


Quick Quiz:
1. Maintaining normal blood sugars by following a low carb diet in hospital results in three of these. What won’t happen?
a Less post operative infection.
b More chance of surviving a life threatening illness.
c Faster discharge from hospital.
d Getting on the dietetic staff’s Christmas card list.


2. In hospital suitable breakfasts for a diabetic are…
a Whatever the nurse thinks looks good from the healty eating section of the menu.
b Porridge, skimmed milk, fresh orange juice with cholesterol lowering margarine.
c Toast, butter, boiled eggs, tinned grapefruit and mandarin oranges.
d Bacon, scrambled eggs, tomato, half a grapefruit.

3. The most risky eating situation for a diabetic is…
a As an inpatient in hospital.
b As a passenger in an aeroplane.
c From a roadside snack shack.
d As a guest at a dinner party that includes Miss Marple, Hercule Poirot, Ellery Queen, Lord Peter Whimsey and Detective Columbo.

Have you got it?
1. ABC have been proven to result from good glycaemic control in hospital. Sadly D is something that is not as likely from low carbing in hospital. Well there is a first time for everything and sooner or later dieticians will come on board. If you are the first patient to get a card in these circumstances we MUST hear about it!

2. D is correct. The others are too high in sugar and starch. At least with option C you could eat the boiled eggs. Unfortunately the “Healthy Eating Menu in hospitals usually entails LOW FAT. The sugar content is usually high and the protein content is usually low. Most hospital dieticians and nurses will automatically dragoon you into choosing from this menu unless you make it very clear that you object.

3. These are all very risky eating situations. How do you choose between them? In hospitals and aeroplanes you have a very restricted choice of meal. Snack shacks may not be as hygeinic as you would wish. And someone always get poisoned when these super sleuths are near. The only way to deal with these risky situations is to plan ahead and that often means bringing your own meal.

Reference Info:
Acknowlegements for this section to John Gibson the first of my patients who stood up up to the dietetic staff in the hospital I work in. I am also grateful to hospital administrative staff who did their absolute best to bully me into backing down. I would never have believed what was necessary to secure a guarantee of freedom from the “Healthy Eating Plan.” To cut to the chase YOU MUST THREATEN TO SUE THEM. If they don’t back down. It’s okay. Call your lawyer and sue the pants off them.

Where to Next?
All of you need to know about the next topic. March this way to the How To: Take Care of Your Feet section.

How To: Cook and Bake the Low Carb Way

This section is for everyone.


Looking at Ingredients: Carbohydrate

Foods to Eat Regularly

Eat in Moderation

Eat Sparingly 

What Fats Should I Use?

What Protein Should I Use? 

How do I successfully substitute ingredients?

Sugar Conversions

Recipe Books

Internet Sites


There are two ways of cooking and baking the low carb way.

By far the easiest way is simply to use ingredients that are naturally low in total carbohydrate and in glycaemic index and cook the way you usually do. For example many meat, fish, poultry and egg dishes can be made just the same as usual and served with plenty of low starch vegetables and butter or olive oil instead of rice, pastry, pasta, bread or potatoes.

The more tricky way is to substitute lower carb ingredients for the higher glycaemic, high carb items such as sugar, flour, potatoes, rice and bread. This tends to be a lot more expensive and there is often some compromise regarding the texture and flavour of these dishes.

Learning how to cook and bake low carb well is a pleasure not only for the cook but for those who get to eat the end result. You need not give up old favourites entirely. You simply enjoy them in a different way.

Before my son was diagnosed with type one diabetes I often bought entire meals from the cook chill cabinets at the supermarket. My son loves  cakes and desserts and to maintain excellence in blood sugar control without an apparent restriction in these food items I now make time to have  a regular cooking and baking slot about twice a week.


What carbs raise your blood sugar very little and what ones raise it rapidly and a lot?

I have listed some of the commoner ingredients which Dr Atkins has listed according to how generous or restricted you should be with them.


Asparagus, green beans, bok choy, broccoli, brussels sprouts, butter beans, cabbage, cauliflower, celery, chard, collards, cucumber, aubergine, fennel, lettuce, mushrooms, okra, onion, mangetout, snow peas, peppers, radishes, rutabaga, saukerkraut, spinach, sprouts, courgettes, tomato, water chestnuts.

Cottage cheese,ricotta.

Almonds, brazil nuts, coconut, hazelnuts, macadamias, pecans, pine nuts, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, walnuts.

Chickpeas, hummus, kidney beans, lentils, lentil soup, minestrone soup, peas dried or split, soybeans, unsweetened soy milk, tofu.

Apple, blackberries, blueberries, cherries, cranberries, grapefruit, unsweetened grapefruit juice, oranges, peach, pear, plum, raspberries, strawberries, tangerine.

All bran, cooked barley, low carb bread and muffins, low carb pasta, old fashioned oatmeal, wheat bran.

EAT IN MODERATION (ie infrequently or in small portions)

Carrots, green peas, mashed pumpkin, buttenut squash, tomato juice, tomato soup.

Whole milk, unsweetened yoghurt.

Cashew nuts, peanuts.

Black eyed beans.

Apricots, grapes, kiwifruit, mango, melon, papaya, pineapple.

Bran flakes, 100% wholegrain bread, pumpernickel bread, rye bread, sourdough, buckwheat, bulgur, whole wheat couscous, egg fettucine, melba toast, no sugar added muesli, pasta, popcorn, raisin bran, brown rice, taco shell.

EAT VERY SPARINGLY (these are the “bad guys”)

Sweet corn, parsnips, pea soup, potato

Full fat ice cream with sugar

Baked beans

Apple juice, bananas, cranberry juice, tinned fruit cocktail, grape juice, orange juice, prunes, raisins.

White bread, wholewheat supermarket brand breads, cornflakes, couscous, semolina, crackers, croissants, pita bread, pizza, pretzels, most breakfast cereals, all white rice, shredded wheat.


Use lard, butter and macadamia nut oil in  preference to refined vegetable cooking oil  and margarine for frying and in baked goods.

Use extra virgin olive oil, unrefined flax oil, hazelnut oil, walnut oil and macadamia nut oil for dressing salads.

Use grapeseed oil and canola oil for cooking at higher temperatures but stir fry instead when you can.


Free range meat, poultry, fish and eggs are best as they usually contain healthier fats and have less hormones and antibiotics added.

Cold and cured meats may contain added sugar and preservatives that are not beneficial.

Lightly grill meats and fish and avoid getting them black.

Partly cook your barbeque meats in the oven to minimise the black on the outside and raw on the inside health risks.

Use marinades to tenderise meat. Marinades with reduced levels of oil can reduce flaming that burns the meat. Trimming fatty meat can reduce this too.

If you eat about the palm of your hand size minus the fingers of lean protein three times a day your are having about the right amount for you.


Some things lend themselves to substitution better than others.

Grate cauliflower and then gently fry it to simulate fried rice or steam it briefly to simulate boiled rice.

Mashed potatoes
Steam or boil the cauliflower cauliflower for at least 7 minutes till it is tender and then mash with butter and cream. You can add grated cheese or fried shallots or finely cut onions to taste. This can also be used to top cottage pie and moussaka.

Low carb pasta can be purchased in certain specialist stores. It usually has  a high gluten content.  It seems to become high glycaemic again when it is overcooked or reheated so just cook lightly and once.

Spaghetti squash can be baked and then used in pasta dishes to mimic spaghetti.

Instead of using flour to thicken sauces use cream instead of milk for white sauces.  Very small quantities of xanthan powder can also be used to thicken sauces.

For a traditional loaf which is low in carbs you could make Graeme’s version which is in the downloads section of this site. He even includes a photograph.

For a microwave bread which is faster to prepare see the recipe section at our sister site Mandy, a fellow “Bernie” has spent a lot of time perfecting this recipe (requires login) and has some variants you may wish to try.

Instead of using flour use ground almonds and instead of sugar use a substitute.

Instead of flour use such items as flaxseed meal, whey protein powder, soya flour, ground almonds.

These are very easy to low carb because the texture depends on the fat rather than the sugar.  They can have no base or a low carb pastry base can be made.

Dark chocolate is a very versatile and healthy ingredient when a high cocoa content, 70% or above , version is used.

Cakes and Shortcrust Pastry
Such items as  courgettes, almonds, ground hazelnuts,  soya flour and  whey protein powder are used in various combinations as flour substitutes.

Because of oxidative damage caused by an excess of omega six vegetable oils and margarines it is better to use unsalted butter, lard and macadamia nut oil for many baked goods. Hydrogenated fats have the advantage of being cheaper and they produce lighter textured baked goods with a longer shelf life. On the long run though we are aiming at not only improving your blood sugars but also your general health. As hydrogenated vegetable fat consumption is related to higher obesity, diabetes, heart disease and cancer risks it is better to avoid them. As my friend Rosie puts it, “If bacteria are smart enough to know not to eat hydrogenated fats I’m certainly not going to either.”  Baked goods may be heavier than you would like as a result. Beating egg whites separately till they peak and then adding them in ito the cake mix is a technique that can help.

If you have a favourite family recipe that you can’t de carb successfully it is  often possible to compromise and use half the high glycaemic flour or sugar and substitute the rest.  It is the texture that is more commonly affected than the taste by going full low carb.

All of the sugar substitutes are more expensive than sugar. There is not the same caramelisation and texture benefits or the range of sugar substitute types.  To mimic brown sugar you can add a small quantity eg a teaspoon of black treacle or black strap mollasses to eg a carrot, passion cake or gingerbread recipe along with the sugar substitute.

To mimic white granulated sugar I have found the best one to be Steviva Blend.

To mimic icing sugar I have found Splenda to be the best. This is also more available and cheaper than Steviva Blend.  I find this sweeter than sugar and would recommend you use about half a cup or half the weight of the amount of granulated sugar you would normally use in a recipe.


I packet of sucralose (eg Splenda) = 2 teaspoons sugar in  bulk but = 4 teaspoons in sugar of sweetness.

24 packets of sucralose (eg Splenda) = one cup splenda = 2 cups in sweetness

Use half the usual bulk of sugar that you would normally use when using Splenda for your first go. You can increase or decrease the amount according to taste at your next baking session.

Two tablespoons of Stevia Plus  = one cup sugar

One cup of Steviva Blend = one cup sugar

One and a half tablespoons of Sweet and Slender = one cup of sugar

*any other sugar substitute conversions would be very welcome here*


These are my personal selection of books that I cook from regularly.

344 Pages of Low Carb Recipes

500 Low-Carb Recipes  Dana Carpender

500 More Low-Carb Recipes  Dana Carpender

The Low-Carb Gourmet Karen Barnaby

Low Carb Italian Cooking Francis Anthony

Low-carb Vegetarian Celia Brooks Brown

The Illustrated Atkins New Diet Cookbook  Robert Atkins

Extreme Lo-Carb Meals On The Go  Sharron Long

Low Carb Sinfully Delicious Desserts  Victor Kline

George Stella’s Livin’ Low Carb George Stella

Eating Stella Style George Stella


I have listed some helpful sites for you in the metabolic section. My favourite is:

The Bernies have been experimenting for years and have a very varied selection of recipies for you.

Bernie Forum Recipes (requires registration)

Quick Quiz:
There is no quiz for this section. I hope you now know that almost anything can be lower carbed with a bit of effort. As Dr Atkin’s was fond of saying. “This is not deprivation diet.”

Reference Info:
Much of this section is from Atkins for Life.

Where to Next?
“From the sublime to the ridiculous” is another saying. No matter how healthy you think you are, you never know when. In the next section we all need to get to grips with that most chilling of subjects,  How To: Eat from a Hospital Menu.




How To: Monitor My Blood Sugar Appropriately

This section is for everyone.  It is somewhat more applicable to type one diabetics but type twos need to know some of this too.

Normal blood sugars for fit young non diabetics are 4.7 on waking and prior to meals and bedtime provided no snacks have been eaten.  Two hours after a meal such a persons blood sugar will be down to five or six. Blood sugars should not normally go below 4.0 even if a person has not eaten or has been exercising. A healthy young person can expect to have a hbaic of less than 5.0 although the range given in laboratories takes the not so fit into consideration and often gives an upper limit of normal as 6.0.

What we are trying to achieve with type one and type two diabetes is a replication of normal blood sugar patterns as much of the time as is achievable for you.

In the non diabetic person the pancreas secretes a small amount of insulin all the time. This small amount stops the liver from converting body proteins such as the muscles and vital organs such as the heart into sugar. This is called basal insulin. About the only time this is switched off completely is during very vigorous exercise.

When a meal is eaten an immediate surge of stored insulin enters the blood stream and tells the cells to grab hold of any glucose molecules that are circulating. This is called a first phase insulin response.

As eating continues the pancreas makes as much insulin as it needs to keep the blood sugar normal and it makes this insulin to order as it goes along. This is called the phase two insulin response.

There have been some advances recently in drugs and transplants that will help diabetics of both types one and two get better control or even cure the disease. Meanwhile, unless you are a mouse with a very good health insurance policy, you are best to  take charge of your diet and glucose monitoring. Lower carbohydrate diets particularly can help you keep damage from high or swinging bood sugars minimal.

What you want to get from a tight food plan and monitoring schedule

  • Normal blood sugar levels – or as near as you can get.
  • Improvements in hbaic, lipids and kidney tests.
  • Achieve a suitable weight for you.
  • Reverse at least some diabetic complications
  • Reduce the frequency and severity of low blood sugars.
  • Relief from mild neurological problems associated with high blood sugars such as chronic fatigue and short term memory impairment.
  • Blood pressure reduction.
  • Reduced demand on pancreatic beta cells – this is important for type 2s and type ones in honeymoon or earlier in the disease process.
  • Increased strength, stamina and sense of well being.
  • Sleep better.
  • Have fewer infections.
  • Have healthier skin.


When do I test my blood sugars?

In order to find out how well your body is dealing with your diet and any medication you are taking blood sugars need to be taken:

  • On waking
  • Immediately before breakfast
  • Before each meal
  • Two hours after each meal
  • At bedtime

When you are testing out new foods to see how they affect you testing every half hour or alternately at one hour after eating, two hours after eating and three hours after eating.  This gives you a good idea of what types and dosages of insulin may be needed to cover that food successfully. See the “Eat to Meter” section in the type two diabetes section of this course for more information on this.

You also need to check blood sugars before, during and after exercising till you know how that particular sport, duration and intensity of exercise affects you.

Shopping and running errands can drop your blood sugar so have your meter and glucose handy.

It is extremely important to check your sugars before you drive and after every hour of driving.

Intense brain work such as sitting an exam can use up glucose but adrenaline can also raise it.  Better check before the exam when you can correct a little or eat something.

Whenever you are hungry or suspect your blood sugars are running higher or lower than expected you should check.

It is useful to teach a toddler a nursery rhyme or song and get them to repeat it often.  If you suspect a low blood sugar get them to repeat the song. If they get muddled up they may well have a low blood sugar. Test to check this system works for you a few times and if it is reliable for you you may omit the fingerstick.

If your vision for small print starts to go this can be a sign of low blood sugars so check.

For new college students or those in new or different jobs from usual increased walking to different places and different work schedules can put your sugars way out.  You need to check your blood sugars more frequently than usual if your work pattern changes.

Shift work is a whole big problem area for diabetics. Your patterns will change with each type of shift and the transition periods will be particularly difficult as lack of sleep can seriously affect blood sugars too.

Women’s blood sugar patterns shift a lot in relation to their menstrual cycle, some hormonal methods of contraception and of course in pregnancy. You will need to check more frequently during these periods.

If you drink alcohol always eat along with it and be moderate. Alcohol can cause low blood sugars but sugary mixes can raise your blood sugar.  You must again test more frequently and  of course before you go to sleep no matter how late or early you get in.

Tell people you see regularly that you can get quite crabbit with high and low blood sugars and ask them not to take it personally. Make a deal to check your blood sugar if they ask you to.

Finger prick testing is more accurate than arms pricks if your blood sugar is falling rapidly or if you are very low. If you think you are low test the finger tips or base of the thumb. If you think you are high test wherever you fancy.


How to I monitor my blood sugars in hospital?

Apart from times that your are under an anaesthetic or extremely unwell the person who should take responsibility for your blood sugar monitoring in hospital is YOU.

You must bring in all your kit and continue to look after yourself as if you were at home.

You must have your kit by your bedside or with you if you go off on a hospital trolley for any tests and do not allow it to be disposed of or hidden by the nursing staff.

To reduce the number of finger pricks you need get the nurses to check your figures against theirs. As long as the first few are reasonably similar they should give their agreement to accept your figures.

It is NOT SAFE to assume that the medical or nursing staff know more about your diabetes than you. Given the wide range of medications, insulins and delivery devices it is indeed unfair to expect them to know better than you do.

For insulin dependants it is very important indeed that you administer your own insulin if you are at all able to do this. There have been deaths from staff making mistakes with this.

For people on insulin that should be administered prior to food it may be best to wait till the trolley arrives on the ward or at your bedside before you inject. You may not get it delivered at the time you are expecting and you may also have to count the carbs and estimate the protein before injecting. You may need the food to be kept warm for you to get the optimal time for eating or for allowing a high blood sugar to drop if you need to.

What laboratory test may I need to have regularly?

Thyroid function tests
Type one diabetics are prone to the development of other autoimmune diseases so this test should be done every so often and particularly if you begin to feel particularly cold, tired, you gain weight unexpectedly, you have more hypos than usual or your cholesterol suddenly rockets.

Lipids and Liver Tests
All diabetics in the UK over the age of 40 are routinely put on drugs called statins whether they have a raised lipid level or not. Recent guidance is that this should be extended to all type ones over 18 who have one or more complications from their diabetes.

Statins work because they reduce inflammation in the lining of blood vessels and reduce atheroma and clot formation which damage blood vessels and blood supply.  Statins can upset liver function and creatine kinase so these are tested routinely.

It is accepted by most doctors that there is a benefit in taking statins for people with diabetes and those with ischaemic heart disease. The problem is that a group benefit may not transfer into a personal benefit for YOU. One in 20 people get liver enzyme rises, muscle pain or general malaise and need to stop statins. They are dangerous to take if a woman is pregnant or at risk of becoming pregnant so women in their childbearing years need to think very carefully about them.

Kidney Tests

The albumin-creatinine ratio is as test that can detect early signs of kidney damage. If this or microalbumen tests in the urine are positive you may be asked for 24 hour samples and blood tests to clarify the extent of any problem.

The estimated glomerular filtration rate or eGFR is a new blood test done at the same time as the Urea and Electrolyte test. It gives an idea of what stage of kidney impairment may be going on.

ACE inhibitors or ARBs are new drugs that can reduce the rate of kidney deterioration. They  end in “pril” or “sartan” respectively.  They are also effective in reducing high blood pressure. If you start them for the first time you need a blood test after two weeks to see that they are not worsening kidney function. This can happen in some people who have a condition called renal artery stenosis which is hard to detect otherwise.

Coeliac Disease Tests
Coeliac disease is an autoimmune disease of gluten sensitivity. It can occur at any age.  The symptoms can be very vague and it can take a very long time to develop the raised enzyme tests of endomysial antibody and tissue transglutamase and obvious anaemia.  Tiredness and abdominal pains are probably the main symptoms. An easy and less expensive test to do is the ferritin level in the blood. This is the amount of stored iron and low levels occur frequently in coeliac disease.

The C reactive protein test is a non specific tests that indicates inflammation.  It is often raised in metabolic syndrome and type 2 diabetes.

In the absence of any inflammatory condition or infection you could have high levels of this if you are a type one who is getting quite tubby round the middle and you seem to need a lot of insulin to get your sugars down.  In other words it is a marker that you are getting both kinds of diabetes at once. A good exercise regime and lower carb diet is what you need to deal with this problem.  High insulin levels cause damage to blood vessels too. Getting insulin and blood sugar levels reduces cardiovascular deterioration.

The hbaic must be the diabetologists favourite blood test. It is also known as the haemoglobin AIC or the glycosylated haemoglobin. It is a test of your average blood sugar over the last 3 months. A truly normal level is less than 5.0 and more accurately 4.2-4.8%.

The average UK figures for 10-18 year old diabetics is a whopping 9.5%

The American Association of Endocrinologists have set a target of 6.5 % or less for diabetics and the UK National Institute for Clinical Excellence are going to recommend that level quite soon. Diabetes UK have set the level at 7.4% or less for children and teenagers but less than one in 7 meet this target at present.

Control of 8.0 or over is considered to be poor and can be an indication that insulin is necessary in type 2s who are struggling on maximal oral therapy.

Diabetic complications can come on in people who have never been diagnosed with diabetes but who have had hbaics of 5.5 or more for many years.  Type 2 diabetics are often discovered to have complications at the time of their diabetes diagnosis because of the slow and stealthy development of problems.  Visual troubles, breathlessness on exertion and subtle coordination problems are often seen as something to do with middle age or complications can entirely asymptomatic as in kidney disease.

The American Diabetes Association have decided that from next year they will provide patients with a measure of their average blood sugar to help them understand more about what the hbaic test really means.

Here is a chart to help you:

hbaic   =   average blood glucose value UK / US

5 = 5 / 90

6 = 6.6 / 119

7 = 8.3 / 149

8 = 10 / 180

9 = 11.6 / 209

10 = 13.3 /239

11 = 15 / 270

12 = 16.6 / 299

13 = 18.3 / 329

14 = 20 / 360

It is in your best interest to keep as low as you can towards normal without risking severe hypoglycaemia. Fortunately this is achievable with a low carbohydrate diet.

Why not find out what tests you have been getting done by your doctor ?
If you keep a record of them you will be in a much better position to understand more about how the diabetes has been affecting you. This can help if you need to see a different doctor from usual or you take ill on holiday.


Quick Quiz:
There is no quiz for this section. Type ones however will be getting questions on it later!

Reference Info:

Where to Next?
Please move on to the How To: Know How Proteins, Fats, and Carbs Affect My Blood Sugar section next.

How To: Safely Dispose of Needles and Other Sharps

This section is for everyone.

Sharps are a problem because they can stick into other people legitimately handling your waste or animals who are raiding your garbage.

The worry that someone will get AIDs from being pricked by a used sharp is greatly in excess of the likelihood of this happening. But you never can tell. Hep C and B can also be transmitted from sharps and hepatitis C is the most transferable of these.

To treat a contaminated sharp injury in time a person has to get appropriate antiviral drugs within an hour. These are highly toxic and need to be taken for a month.

Please take the safest measures you can to dispose of your sharps. Here are the best ways:

Use a specially designed container. This is usually hard plastic with a lid that cannot be opened once it is locked.  They can often be obtained from pharmacies or your diabetic clinic.

Some pharmacies and hospitals provide a sharp box swap system. You may have to pay towards this service.

You can clip off the needle or lancet tip with a needle clipping device that stores the needles inside. This can then be thrown away when full. If you do this dispose of your syringes appropriately too.

A “cin bin” or sharps box is easiest to use because the whole syringe and needle can be disposed of at once. They can be bulky so having a needle clipper for use outside the house can be a great help.

If you have to dispose of sharps in your garbage as a last resort you can use a heavy opaque plastic bottle  eg a bleach bottle. When it is 3/4 full screw the lid back on and securely tape it down.

Keep your sharps and disposal box away from younger children or pets.

Reference Info:
Thanks to the BC (British Columbia) Children’s Hospital . They have a great selection of leaflets particularly aimed at younger type ones.

Where to Next?
Please all proceed to the  How To: Monitor My Blood Sugar Appropriately section.

How To: Match Insulin Reduction to Carb Reduction and Get The Best out of the Insulin Calculator

This section is for everyone.  For the purposes of this module I am going to assume that you are currently on a high carb/ low fat diet, that you are on a basal bolus regime with a long acting insulin and a rapid acting insulin analogue. This could be in vial and syringe or pen form.

The total time that you can expect to take from going from where you are to normal blood sugars is about 3 months if you follow this programme. This can be considerably shortened if you already have a high degree of background knowledge and do not encounter any particular problems with your carb reduction and insulin adjustments.




This step can be expected to take 4 weeks if you allow 30 – 60 minutes a day.

Before you are ready to reduce your carbohydrate and therefore insulin it is best to do the modules appropriate for you and have a buddy to help you. Help from your diabetes team is most helpful but they may not have the time to help you or may not be happy with carbohydrate reduction. If you haven’t already joined an internet support group this could be the time to do it.

You should already have:

  • Read and understood all the course modules that have been selected for insulin users.

Reviewed thoroughly the modules:

You now know a great deal about your diabetes: the sort of insulin regime you are on, basal insulins, meal insulins, correction doses, carb sensitivity at different times of the day, how much insulin you need for most commonly eaten meals, and how much carbohydrate you are consuming for meals and snacks and the effect that exercise has on your blood sugars. You also will have an idea of what you are aiming to eat in the future compared to what you are doing now.

You may need to obtain extra testing stix, glucograph sheets, regular insulin and syringes/needles or pens. If you are already using a pen a half unit one is best. You will need one for each type of insulin you are on. Unfortunately the Autopen Classic which is used with Hypurin Pork (regular) insulin only comes in one unit pens.





This step can be expected to take about a week. If you don’t have any hypos you won’t need to do this but you are likely to need to know about it once your insulin regime gets better control of your blood sugars.

Are you having regular hypos?  If so what time of day or night?

You need to cut back gradually on your insulin that governs that time of day.

Night hypos – reduce basal.

Morning hypos – reduce breakfast insulin

Afternoon hypos – reduce lunch insulin

Evening hypos – reduce lunch insulin



In order to get the best match between insulin and food the insulin needs to be delivered in a predictable way. The key to this is the 7 units per shot rule.


Write down how much basal you take in 24 hours.

If you are only on one injection of basal a day you can improve 24 hour coverage by changing to an injection on rising and an injection before bed. The gap between the night insulin is best to be 9 hours or less but up to a 12 hour gap may be fine if you don’t have a pronounced dawn phenomenon. The aim is to stop over dosage of basal which at some points during the day may make you need to eat to stop from going low. We also need to keep the basal high enough at other times of the day so you are not overdoing meal insulin to cover gaps that can arise in the evening if you are only on a single night dose of eg Lantus or  Detemir.

How much insulin will you need at each injection when you go to twice daily basal injections?

If this is over 7 units per shot you may need to reduce your basal slightly. You will be checking your 3 am blood sugar in this phase to check how accurate your basals are.  If your basal insulin is currently over a 24 hour total of 14 units you need to reduce the total insulin injected by 15%.

Example:  Mary is on Detemir 34 units once before bed.

This is going to need a reduction of 15% to start with. This leaves 29 units over 24 hours.

Divide this by two to find out the amount this will be when split into two injections:

14.5 units each.

The total number of injections to cover basal will therefore be expected to be 7u x 2 separate injections both night and morning. This does leave a deficit of 0.5 units but  as this is quite a small amount it would be okay to see how this regime goes. If this regime is tried for three nights and the 2-4 am blood sugar is 4.4-5.6 this would be satisfactory. If the readings were higher the additional half units or progressively more insulin could slowly be added. It is best not to change basals more than every 3 days as it takes a while for insulin levels to balance out. If hypos occur through the night and you are certain it is not the effect of two much meal insulin beforehand you would need to reduce the amount of insulin given at your basal injections eg to 6 units x 2 morning and night and gradually adjust upwards for fine control.

Within one to two weeks I would expect your basals to be much more stable. You are now ready to proceed to sorting out your meal insulins.


The first step to sorting your meal insulins is to know what effect the insulin you gave yourself for the last meal actually had. You have little chance of getting this right till you stop snacking.

If you have a hypo and usually snack you need to change what you do when you have a hypo. The best thing is to have a small quantity of pure glucose in liquid or gel form and be careful not to overtreat.  Over correction of hypos is hard to prevent if less than very rapidly acting carb is taken as it acts too slowly to get you feeling better fast enough.

If you have a hypo due to exercise and this is a regular thing the best way of dealing with it is to have the snack – which could in this instance be a food item – before or during the particular exercise.  Getting this right can take some practice.  This is fine for regular activities eg twice weekly supermarket shop, a weekly game of tennis.  If the exercise is not a regular thing can you put it off till you have finished this run in phase? It will only take a few weeks.

Hunger and a need for snacks can also be due to basal insulin being too high. Is this well under control now?

You now have got the hang of the 7 shot rule, no snacking and have sorted out your basals and hypos.





Breakfast is usually eaten at home. It is beneficial to eat a high protein meal to reduce the tendency to snack from hunger late on.  The lower amounts of carb usually eaten at this meal to help deal with the dawn phenomenon.  For the purposes of all your meal experiments in this second month  however we are going to aim for the following plan meanwhile.

Plan out the minimum amount of protein you need for the day.  This is your ideal body weight in kilograms divided by six.  Eat no less than one third of this in ounces of lean protein for breakfast.  Do the same for  lunch and dinner.

Lets assume you are a bit overweight but ideally are 60kg. You would be looking at 10oz of protein a day and would want to eat at least 4oz of protein at breakfast.

E.g. three egg omelette with some ham chopped into it.

It is amazing how filling this sort of breakfast is compared to a high carb one.

For carbohydrates you will already know the approximate carb count for what you eat.

Banana  30g

Glass of milk 15g

2 slices of toast 40g

Marmalade 5g

Breakfast cereal 40g

Coffee 0g

The total is 130g.

To start with reduce your carbohydrate by half of what you are on or to 30g whatever is the highest.

What of these foods could you do without?

Work it out.

Say you go for 65 g and go for the breakfast cereal, milk and a half slice of toast with butter instead of marmalade.

Give yourself the insulin you would normally give in proportion to the carb you intend to eat.

Eg  If you normally give 13 units for the 130g breakfast give yourself 6.5 units for the 65 g breakfast.

If the insulin injection is more than 7 units then you need to split the insulin into more than one shot.


You may need to have obtained regular insulin in syringe and vial or pen form. In the UK pen regular insulin is only available in pork or beef versions from Wokhardt Pharmaceuticals. This is able to be imported to other countries however.

Use 2 units of regular insulin for each 3oz portion of lean protein you are eating. This is a starting dose to use till you start to profile your meals and fine tune them with different proportions of different insulins. Ideally inject this 15 minutes before eating. Alternatively you can use a small amount eg 1- 1.5 units of rapid acting insulin to cover protein but inject this 1.5 – 2  hours after eating.


The next step is to cut back your breakfast carbs to 30g or less. Again adjust your insulin accordingly. At this stage you are aiming to have your blood sugar before your next meal within your target range. It is unlikely that you won’t spike at one or two hours on this amount of carb without running low before your next meal. The goal however at this stage is simply to work your way down gradually and particularly to avoid hypos.




Follow the same steps for your breakfast.

Your insulin sensitivity is likely to be best at this time of day.  You may well be able to cut insulin doses somewhat.


Follow the same steps as your previous meals. Your insulin sensitivity will be a bit lower than at lunch but usually not quite as high as at breakfast.



Follow the same steps as your previous meals. If you don’t usually have a bedtime snack you don’t need to have one just for the sake of it.

Your final level for this phase is a bedtime snack of 15g or less.

You should now be on three meals a day of 30g carb and an optional bedtime snack of 15g maximum of carb.  You may also be having some extra carb to cover planned daily exercise.   Your insulin doses should be much less than usual and your predictability should be much improved. You may have had hypos in this reduction phase and you should have been adjusting your insulin doses downwards to sort this out. The main blood sugars that are of most concern right now are the fasting, pre-meal and 3am blood sugars that you can expect to be around target by now.




How low in total carbs would you be happy to go for each meal?

Can you reduce higher glycaemic carbs that you may have been eating?

Can you substitute lower glycaemic  options eg avocados at breakfast instead of bananas?

The optimal is 6g for breakfast  and 12g of carb for each other meal. This is based on Dr Bernsteins work which aims to give no blood sugar spikes at all and highly consistent blood sugars 24 hours a day.

It is perfectly acceptable to have higher amounts than this. The important thing is that you reckon you can be consistent about what you are going to do.


You know how much protein is considered a minimum for you and you’ve been eating this for a few weeks. Is this completely satisfying for you?

If you are hungry before your next meal is due perhaps you could do with more? Some of us need a lot more!

Alternatively you may have delayed stomach emptying and need to reduce your dinner portion of protein?

You will now have good experience of varying your regular insulin to your protein at various times of day and you can adapt what you have found out to sorting out the right dose for the protein you prefer to consume.


The good news for variations in your fat intake is that you don’t need insulin to cover fat.

How is your weight doing?

Have you lost weight on this regime? Have you gained?

You need to adjust your fat intake to reflect the calorie balance you want to have. This is easier than previous adjustments. Eat enough fat to make your meals enjoyable as a reasonable minimum and up the fat as needed to keep your weight at a level that is ideal for you.



Now you are eating your ideal or near ideal diet regarding carb/ protein and fat proportions it is time to again fine tune your insulin.

For each actual meal that you are going to profile you need to:

Eat the same  food in the same proportions each time at around the same temperature and the same time of day.  Eat it at around the same speed.

Weigh or measure your portions. You may as well have the portion size you really want to eat.

You need to have a blood sugar in your target range, you need to avoid unusual exercise and you need to be well ie not coming down with a cold or have a gum infection for instance.

Take the insulin you think you should take at the time you should take it and then eat the meal when you plan to.  Check the bs every half hour – one hour after finishing the meal until the next meal is due.

You can see several patterns.

No hypos till next meal. Well done. You have not overdone the insulin.

Hypo in the first two hours after eating.  You need to reduce the rapid acting insulin for that meal.

Hypo in the 2.5- 5 hour mark after the meal. You need to reduced the regular acting insulin for that meal.

Spikes in the first 2 hours after the meal.  You need to increase the time interval between giving the rapid acting insulin and eating OR you need to up the dose.

Spikes in the 2.5 – 5 hours after the meal.  You need to increase the regular insulin for the protein or carbohydrate component of the meal.

Hypos in the early post meal period and spikes in the later post meal period may indicate that the meal is best covered by a higher proportion of regular insulin than rapid acting insulin. This is common for high fat meals as carbohydrate absorption is delayed. This phenomenon is called the “Pizza Effect”. It is discussed more in the insulin calculator section which follows.

Once you have hit the right dose for that meal put a note of it in your favourites list. You can add this to your insulin calculator should you choose to use this.



You are now almost at the end of the course. The next three sections are all about making life a bit easier for you.

What do you really miss, or know that you would like to eat sometimes?

Have a good look at the carb cooking and baking modules again. This is the time for you to experiment with something you haven’t tried so far. If you can find a good substitute and you won’t miss that item eg cauliflower mash instead of mashed potatoes or low carb muffins/ cheesecake you simply have to organise yourself to have a regular cooking/ baking day and prepare packed lunches for when you need them.


If there is an item that you think you must have eg pizza, a burger bun or so forth you need to review the carb weighting technique section again. To do your experiments on this it is best to do these at lunch time and when you have company to help if you over do the insulin and have a hypo.



There are two versions of the insulin calculator available. One is for downloading onto your pc and the other is a more sophisticated programme for a palm top which has the advantage of greater portability.

The insulin calculators have background tables that you programme yourself. What you are doing is putting in your particular information into several of these background tables. When you are using the calculator you will usually be putting in the carb values of the food you intend to eat, the particular meal involved and your current blood sugar.  The machine calculates the amount of insulin you need to take. As there are differences between the calculators I will explain them separately. For using either of them is essential that you have done all your experiments to find out the correction factors, carb sensitivities and weightings that work for YOU. It also helps to understand more about the “Pizza Effect” so that you can adjust the proportion of rapid acting and regular insulin for the type of meal you are having.

The Pizza Effect is the pattern of blood sugars you get when you use the correct carb sensitivity for the total carb content of the food but don’t take into consideration the effects of delayed glucose absorption when high amounts of fat or protein are also in the meal. It isn’t just pizza that can do this !

If you use a single injection of rapid acting insulin to cover these types of  meal you will end up with low blood sugars soon after eating the meal and a delayed rise in blood sugars after the meal. To counteract this you need to be prepared to allocate some of your total insulin dose to regular insulin taken at the same time as your pre-meal insulin or another separate injection of rapid acting insulin some time after eating the meal.  A pragmatic way of doing this is to allocate 50% of the carb allowance to rapid acting insulin and 50% to regular insulin. You then can see what results you get and vary the doses for that meal in the future accordingly. Some meals eg toast and jam are likely to need all rapid insulin. Others eg thin crust pepperoni pizza or a meaty lasagne are likely to need all regular insulin. Mixed meals like fish and chips could well be a 50: 50 split between the types.

There are a few things to remember:

  1. Rapid acting insulin has x 1.5 the potency of Regular insulin.

Say your carb content of the meal is 30g and you wish to give half of this to rapid insulin and half to regular insulin. Your sensitivity happens to be one unit of rapid for each 15g of carb. You would therefore need to give one unit of rapid acting insulin and 1.5 units of regular insulin.

  1. Correction doses are always rapid acting insulin.
  2. Protein cover is always regular acting insulin.
Personal Computer Insulin Calculator Version

This is the basic programme.  The background tables are needed for your:

Correction doses.

Insulin sensitivity for breakfast, lunch, dinner and bedtime snack.

Carb weighting values.

When you use the programme you will enter:

Current blood sugar.

Breakfast, lunch, dinner or bedtime snack.

Total carb count of the meal.

You will receive an insulin dose based on any correction dose needed, carb sensitivity you have registered for that particular meal and any additional carb needed for carb weighting factors. This will be the total  rapid acting insulin dose equivalent.

You then need to:

Consider how much of the total dose may need to be split between rapid and regular insulin if this applies to the type of meal you are having.

Calculate the conversion factor ( 1.5 ) to change rapid to regular insulin.

Visually estimate your protein amount in the meal and add this to the amount of regular you are going to inject. The sum is approximately 2 units of regular for each 3oz size of lean protein. This is the size of a pack of cards.

You should then have the total amounts of rapid and regular insulin you are likely to need. You need to profile each meal. Are you happy with the results? Feel free to adjust your insulin for that meal. From time to time you may also need to adjust the background tables. Remember the maximum your are going to inject is 7 units per shot.

Portable Palm Insulin Calculator Version

This programme has some extra features that are not available on the pc version.

The same background tables are filled in for correction doses, insulin sensitivities for different meals and carb weighting values.

When you use the programme you enter the same data regarding blood sugar, time of meal and total carb count of the meal.

These features are all exactly the same as the pc version.

The difference with this calculator is that additionally you have another programme in which you can:

  1. Add your estimate the amount of protein for your meals. The insulin needed to cover this is automatically added to the amount of regular insulin total.
  2. Decide how much of a percentage of the carb count should be allocated between rapid acting and regular insulin.
  3. Put your profiled meals on a favourites list. When you are going to eat any of these meals the calculator will adjust the doses according to the time of day you intend to eat it.

Things to be aware of:

  1. You do need to calculate any pre-meal correction doses separately when you use the protein calculator. A pop up box reminds you of this when this applies.
  2. When putting in the protein value from nutritional information on a meal packet you multiply the protein amount in grams for the portion you are eating by 4.6 and put this total in the protein box.
  3. When putting in the protein value from a visual estimate or measured amount of lean protein that does not have nutritional information you need to estimate the amount in ounces, multiply by 30 and put this total in the protein box.

The palm version offers the advantage of portability, a favourites list and calculates the protein insulin for you.  It is a bit more complex to use and programming the protein is not quite as straightforward as programming the carbs. It can be helpful to use to get specific meals sorted out. I would recommend that for most meals you start with a 50:50 rapid: regular split to avoid the worst of the  “Pizza Effect” and adjust according to your results from there.

Neither insulin calculator is a necessary feature of good meal profiling and manual collection of information is just as good. What they do is make the sums that you would be doing as a matter of course for new meals easier. This particularly applies to larger meals and processed ready meals that contain nutritional information.

Reference Info:

Where to Next:

We have now completed one of the toughest parts of this course. Well done. Congratulations to our helpers too.

To complete our journey I would like to read you a little story. There is no quiz in the next section.

Please all continue to the Endings and New Beginnings page.

How To: Keep Healthy with Type 1 Diabetes

This section is for everyone – who is still here!


For most children or young people they will find out very quickly after diagnosis that they will need to be on injected insulin for life. Perhaps they will have had symptoms of weight loss, drinking a lot and passing urine a lot.  Others will have become very ill with diabetic ketoacidosis and will have been hospitalised.

More and more often younger people are being diagnosed with metabolic syndrome and type 2 diabetes. This is usually related to being overweight, sedentary and genetic influences.  Women with type 2, gestational or type one diabetes may find themselves being intensively treated with insulin during the planning or carriage of a pregnancy. Outwith pregnancy most people with type 2 diabetes will remain on diet and oral medications to control their diabetes. After about six years around half  of type 2 diabetics will have needed to add insulin to their medication regimes to maintain good control. Diabetics who use certain drugs to stimulate the pancreas to produce more endogenous insulin from their own pancreatic beta cells are more at risk of beta cell failure.

Type one diabetes results when the pancreas can no longer make enough insulin to prevent high blood sugars.  For early onset patients it is an autoimmune disease that used to be a death sentence.  Now that insulin is widely available for most people it is rarely as rapidly fatal. But until a real cure can be found and made available it can still feel like a life sentence.

Insulin is a drug that needs to be used very carefully.  It can rapidly lower blood sugars and cause hypoglycaemia which can cause death if it is very severe and is untreated. Lower levels of hypoglycaemia may not be obvious to drivers or their passengers and yet can cause impaired reaction times and judgement which can lead to accidents.  High blood sugars are less of a worry on the short term but on the long term damage accumulates that can severely affect the nerves, eyes, kidneys and heart.

Pancreatic beta cells start to die in tissue culture at sugar levels of 6.1 or higher. This is not a threshold effect and if blood sugar levels are brought below this level soon enough the cells can start to recover.

At the time of diagnosis and for up to decades afterwards type one diabetics still produce a small amount of insulin. The remaining beta cells are still subject to attack by autoimmune antibodies but can be nursed along for many years if high blood sugars can be avoided.

The more of your own pancreatic beta cells that are still active the easier it is to control your diabetes as the pancreas can still fine control sugar levels in a way that injections cannot. This is a major reason for all new diabetics to strive for normal blood sugars so they can prolong the “honeymoon” phase of diabetes.

Even the most rapidly effective injected insulins eg novorapid and humalog cannot replicate the immediately effective blood sugar lowering effect of the stored insulin from a normal pancreas beta cells. This means that blood sugars will be inappropriately high for at least some time after even small amounts of very fast releasing carbohydrates are eaten in eg bread or fruit. Over the long term these sugar spikes can add up to a lot of damage to body tissues.

We have already discussed what level of control you already have and what level of control may be optimal for certain groups of people in the Type Two Section. Please take a moment or two to review this.

This Type One section aims to give you more specific information on the use of insulin and other information to help you achieve the best health you can.

The insulin users section tends to lean heavily towards younger type ones. I will give some guidance about when older type twos can skip.

Quick Quiz:
1. For insulin users it is safe to go straight onto a low carb diet as long as you have…
a Thrown out all your crisps, breakfast cereals and biscuits.
b Bought a good low carb book to help you.
c Bought in plenty of meat, vegetables and olive oil.
d Planned out a gradual reduction of carbohydrates and appropriate reduction in your insulin.

2. Type One diabetics…
a Make plenty of their own insulin from beta cells in the pancreas.
b Can be sure there will be a cure within the next five years.
c Rely on carefully measured and timed amounts of injected insulin to keep well.
d Can eat whatever they like, when they like.

3. You are an insulin user going into hospital for a planned operation. You need to do three of these….
a Speak to an anaesthetist well before your operation to let them know how you manage your blood sugars.
b Speak to the dietician about your meal choices from the Healthy Diabetic section of the menu.
c Bring in your insulins, testing kit and any special foods or drinks you may need.
d Arrange for a friend to provide, transport, supplies and to liase with clinical staff.

4.Type ones can do three of these things…
a Get other autoimmune diseases.
b On first diagnosis go through a honeymoon period when pancreatic function improves for a period of time.
c Use inhaled insulin to control blood sugars.
d Die rapidly from severe hypoglycaemia.

5. Tests type ones should be having regularly include three of these…
a Amylase which is raised in pancreatitis.
b Thyroid function tests.
c Tissue transglutamase for coeliac disease.
d Albumin creatinine ratio which is a kidney test.

Have you got it?

1. D is correct. You MUST plan and change your diet and insulin doses GRADUALLY. This means more freqent blood sugar testing till you are stable on your new regime.

2. C is correct. If only we could be certain of a widely available and affordable cure within the next five years then we possibly could eat what we want, when we want without paying too much for the consequences. Unfortunately for the forseeable future most certainly DO have to live with the consequences so the tighter the control the better for most diabetics.

3. You need to do ACD. You don’t need to speak to the dietician. You decide yourself from the entire menu.

4. ABD are correct. Inhaled insulin is available now. It comes in 3 unit increments though and this is likely to make it less precise than is required for really tight blood sugar control for type ones. It may have a place for type twos who are still producing some of their own insulin.

5. Tests type ones should be having regularly include three of these…

Thyroid tests, coeliac tests, and kidney tests are all needed. Blood pressure, eye examination or retinal photography and foot examinations are other necessary tests.

Reference Info:

Where to Next?
Please proceed to the section How To: Deal with the Stress of a Newly Diagnosed Child section.

Study Finds Intensive Glucose Control Halves Complications of Longstanding Type 1 Diabetes — Improved Long-Term Outlook

  Near-normal control of glucose beginning as soon as possible after diagnosis would greatly improve the long-term prognosis of Type 1 diabetes, concludes

Source: Study Finds Intensive Glucose Control Halves Complications of Longstanding Type 1 Diabetes — Improved Long-Term Outlook