Ethiopian Diabetes Association Diabetes Education Program for People with Diabetes

1. Ethiopian Diabetes Association Diabetes Education Program for People with Diabetes Authors and contributors: Prof. Jemal Abdulkadir, Health First Higher Clinic Dr. Ahmed Reja, Ethiopian Diabetes Association Jutta Schroth, Roche Diagnostics GmbH, Germany Roland Schindler, Roche Diagnostics GmbH, Germany Misrak Tarekegn, Ethiopian Diabetes Association Sr. Felege Berhane, Health First Higher Clinic Ethiopian Diabetes Association Patient Education Program

2. Diabetes Mellitus • Diabetes mellitus is aworldwide chronic disease. • The cost of diabetes therapy is very high for patients and their families as well as for the national economies. • One way to lower costs is to educate persons with diabetes and their families. This will help them to learn to take better care of their diabetes and live a normal and productive life. • This program helps to achieve this. Ethiopian Diabetes Association Patient Education Program

3. What is Diabetes? • Diabetes mellitus is a lifelong disease caused by too much sugar in your blood. • This happens because your body produces little or no insulin or the insulin produced is no longer working. • Insulin is a hormone that is produced in the pancreas. • Insulin is necessary to bring sugar from the blood to the different parts of your body, where it is needed to produce energy. • Blood sugar comes mainly from the food we eat. • You can learn to manage your diabetes and live a normal and productive life. Ethiopian Diabetes Association Patient Education Program

4. Why does the body need insulin? Our body burns sugar to make energy! Insulin Sugar House = Bodycell Pancreas Blood Intestine Ethiopian Diabetes Association Patient Education Program

5. Type 1 Diabetes All keys need to come from the outside= Insulin must be injected Insulin Sugar House = Bodycelll Pancreas Blood Intestine Ethiopian Diabetes Association Patient Education Program

6. Type 2 Diabetes Some insulin keys are not working= the pancreas has to work very hard Insulin Sugar House = Bodycell Pancreas Blood Intestine Ethiopian Diabetes Association Patient Education Program

7. With these symptoms you are at risk of having diabetes • Frequent urinating (especially at night) • Constantly feeling thirsty • Sleepy or no energy • Losing weight inspite of being hungry all the time • Symptoms which are often not noticed: • Wounds are not healing • Problems with seeing • Many infections • Itchy skin • Tingling sensations or no feeling in hands or feet • A woman gave birth to a very large baby Ethiopian Diabetes Association Patient Education Program

8. High blood sugar causes no pain, but damages the body over time brain eyes heart kidneys feet Ethiopian Diabetes Association Patient Education Program

9. What should a person with diabetes do? Eat healthy • Eat small meals at regular times • Include one starchy food with each meal • Have more vegetables and some fruit • Eat less fatty, sugary and salty foods Be active • Do a 30 minute walk every day Take good care of your feet • Check every day for injuries, if possible with a mirror • Do not walk without shoes • Dry your feet after washingand use cream or lotion Ethiopian Diabetes Association Patient Education Program

10. What should a person with diabetes do? Check your weight • Keep a record of your body weight. If you constantly loose weight see your doctor. Keep your teeth and mouth healthy • Rinse your mouth after meals and clean your teeth 2 times a day. For bleeding gums or other non-healing wounds in mouth see your doctor. Know your blood sugar • Check your blood sugar regularly,or have it checked at a lab.Have a lab check also HbA1c. Take your medication or insulin as explained by your nurse See your doctor or nurse regularily • Keep contact with your doctor at least 2 times a year Ethiopian Diabetes Association Patient Education Program

11. Taking your diabetes medication Why diabetes medication? • If you have type 2 diabetes, you can lower your blood sugar with diabetes medication. • If you forget to take your medication, your blood sugar level will rise and you risk diabetes complications like eye damage and foot ulcers. Diabetes medication will not help people with type 1 diabetes! They must be treated with insulin! Ethiopian Diabetes Association Patient Education Program

12. Why you need to take good care of your feet People with diabetes very often develop foot problems.This can result in amputation! Do you know somebody who lost his legs due to diabetes? This happens because of • Nerve damage – you do no longer feel pain or heat in your feet • Foot deformities – you do not feel that your shoes are too tight or hurt you • Poor circulation in the legs and feet – this gets worse if you smoke • Infection in badly healing wounds Ethiopian Diabetes Association Patient Education Program

13. How to take good care of your feet (1) Pay attention to the warning symptoms! • Redness or swelling of the foot or ankle • The foot gets bigger or smaller • Very cold feet or legs • Pain in the legs at rest or while walking • Open sores • Non-healing wounds • Ingrown toenails Do not self-treat small even small wounds. See you doctor or nurse! Ethiopian Diabetes Association Patient Education Program

14. How to take good care of your feet Wear good shoes! Ethiopian Diabetes Association Patient Education Program

15. Things you need to know before Insulin therapy • Know how to store your insulin • Know about the technique of insulin injection • Know about the effect of insulin • Know about the effect of food upon the blood sugar • Know about the effect of exercise upon the blood sugar • If possible: self-control of glucose in blood and/or urine Ethiopian Diabetes Association Patient Education Program

16. What you need to know about handling Insulin • If possible, store your supply of insulin in a fridge (2–8 degrees celsius), but never freeze the insulin! • Other ways to keep insulin cool are • Store the insulin in a waterproof container (like a plastic bag) and put it into a clay pot filled halfway with water. • Dig a hole into the sand in your house and put the insulin container into it. Keep the sand moist. • Store the insulin in a container wrapped with rope and keep the rope moist. • Make sure children in your household cannot get to your insulin. • Always keep needle and syringe in a very clean place like a small box. Store the syringe with the caps on both ends. • When you use the syringe, keep the caps in your clean box • Never share syringes or needles with another person. Risk of infection! Ethiopian Diabetes Association Patient Education Program

17. fastereffect slowereffect Injecting Insulin Control your syringe and the needle. Never share syringe or needle with another person! Danger of infections! Mix (or roll) the insulin inside the ampoule slowly, about 20 times for about 2 minutes. Don‘t shake it! Clean the place of injection with some alcohol. Let it dry before you inject. Never wipe the needle with alcohol! Make a skinfold, hold it while you inject the insulin and then let it go. Count to 10, before you remove the needle. More body fat: inject at 90° angle. Less body fat: inject at 45° angle. Important to know: change the place of injection each time. Stay away from the area around the belly button (2 fingers wide) Ethiopian Diabetes Association Patient Education Program

18. Handling your Insulin syringe • Mix your insulinhow you have learnt it 2. Draw up the same quantity of air in the syringe you need in insulin 3. Push the air whichis inside the syringe inthe bottle with insulin 4. Draw upthe insulin 5. Check theinsulin-dose 6. Injectthe insulin Ethiopian Diabetes Association Patient Education Program

19. 7 12 19 24 7 7 12 19 24 7 Effect of eating and exercise on Insulin levels Release of insulin if you do NOT have diabetes sugar insulin Your body automatically regulates the amount of insulin according to the sugar in the blood (from the food) Ethiopian Diabetes Association Patient Education Program

20. 6 am 6 am 9 12 3 6 pm 9 12 3 Using an Intermediate Acting Insulin breakfast bed time snack lunch dinner • Inject it regularly and always at the same time of the day. • Inject it two times a day (morning time, evening time). One injection is effective for about 12 hours. • Have regular meals (look at the arrows!). • Have a small meal (e.g. a banana) between breakfast and lunch and between lunch and dinner. • Do not wait too long (no longer than 30-45 minutes) with the next meal after injecting insulin • Save a little food from dinner and eat before you go to bed. • If you exercise more than usual, reduce thequantity of the next dose you inject. Ethiopian Diabetes Association Patient Education Program

21. Is your blood sugar too high? Blood sugar (normal – high) Insulin and time Some common causes of high blood sugar: • Eating too much food • Injected too little insulin or injecting insulin incorrectly • Excitement/anxiety • Not taking your medication • Illness See poster 9 for symptoms of high blood sugar Ethiopian Diabetes Association Patient Education Program

22. What to do? Warning signs and treatment of low blood sugar • Early symptoms: • Hunger • Irritability • Tiredness and poor concentration mild Eat a starchy food and some fruit • Later symptoms: • Sweating • Shaking • Rapid heartbeat • Nausia, headache • Confusion, difficulties to speak Immediately eat or drink sugar based foods • Some candies • One glass of fruit juice ot cola (not sugar free!) • Tea with 4 teaspoons of sugar • A tablespoon of honey or heavy syrup severe • Severe symptoms: • COMA You need to be treated in the hospital Ethiopian Diabetes Association Patient Education Program

23. Causes of low blood sugar We speak of low blood sugar (Hypoglycaemia) when the value is lower than 60 mg/dl. Causes of low blood sugar are • Skipping or delaying a meal • Eating too little (especially a meal low in carbohydrates) • Alcohol intake (especially without eating) • Excessive exercise • Medication (too much insulin or diabetes pills) • To prevent low blood sugar especially during the night, keep to an evening ritual • Wash and carefully dry your feet • Check your feet with a mirror for injuries • Tab your whole body with your hands to detect feelings of numbness • Pay attention to your tongue and mouth Ethiopian Diabetes Association Patient Education Program

24. Diabetes and food If you have diabetes, you do not have to keep a „diet“ or eat different food than the rest of your family. It is important to keep to a healthy eating plan. This will also be good for the health of your family. To eat healthy meals • Do not eat more food than your body needs (if you keep gaining weight you are probably eating too much) • Eat one starchy food with each meal. Try to eat starchy foods which raise your blood sugar slowly, like injera, potatoes, pasta, darker breads, rice and high fibre unsweetened cerials • Know the amount of starchy food you eat with each meal, like 2 pieces of injera, or 3 potatoes. You can do this best, if you use your own plate during family meals • Eat more vegetables. Vegetables and fruit are protecting your body. Try to eat 2 times more vegetables than starchy foods and meat. • Reduce the amount of fat you eat. Use more unsaturated fats, like sunflower and olive oils and avoid saturated fat like butter and cream • Reduce sugary foods like candy, cookies, sweetened ready made cerials, pastries and all kinds of softdrinks (Cola, Fanta, etc.) • Drink very little alcohol (less than 1 drink per day) Ethiopian Diabetes Association Patient Education Program

25. The plate method is a way to eat healthier meals without measuring. You fill your plate (20 centimeters in diameter) to match the amount of vegetables, starches and meat and then add a piece of fruit and/or a glass of low fat milk Breakfast low-fat milk Protein/meatoptional starch vegetable Lunch/dinner fruit Protein/meat vegetable starch Ethiopian Diabetes Association Patient Education Program

26. Starchy and energy giving foods injera corn potatoes bread pasta Ethiopian Diabetes Association Patient Education Program

27. Starchy foods raising blood sugar very quickly Eat those only in small amounts. crackers sugar cookies Fruit juicemix juice with water cake Ethiopian Diabetes Association Patient Education Program

28. Vegetables protect your health Ethiopian Diabetes Association Patient Education Program

29. Fruits protect your health Ethiopian Diabetes Association Patient Education Program

30. Meat, fish and other protein foods ¼ of your meal should be protein Ethiopian Diabetes Association Patient Education Program

31. Reduce oily and fatty foods, but some fats are better than others Good fats from vegetables and fish Bad fats from meat and industrially baked products Ethiopian Diabetes Association Patient Education Program

32. Foods to avoid are softdrinks, candy and saturated fats like margarine, butter and very fatty meat like Kitfo Ethiopian Diabetes Association Patient Education Program