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Diabetes Topics Catalogue

To search this Diabetes Topics Catalogue, hold "Ctrl" + "f" (PC) or "Cmd" + "f" (Mac) and type in your search word. If problem opening PDFs, right click on the document, "save as" and save to desktop. 

Consider giving all your patients the short list of Diabetes Resources for Patients.PDF  (diabetes phone-lines, classes, urgent help, routine 1:1 help).

AHS - Misc Documents & Sites

Apps (diabetes related), Reports, Passwords

Numerous apps are available to assist those with diabetes. These include apps from companies for specific glucose meters, sensors, insulin pumps as well as third party apps. Most allow patients to view data and/or send reports from the app or from an online cloud service directly to their clinicians. It's important for eduators to direct patients to send reports, since not all health authorities have the approval to use "Clinic" clouds (e.g. an online server for the clinician/program that stores the glucose data of just their patients.) 

Forgotten App Passwords for Glucose Data:

  1. If on iPhone under phone settings > passwords > search the app name, tap to review the username & password. (There is no one location in Android phones to access all passwords.)
  2. Or open the specific app, then settings > user account, to learn the email account used to set it up. Use this email address to log into the corresponding cloud service ( Carelink, Clarity, Libreview, OneTouchReveal etc). Click "forgot password" to reset it if can't recall. The email used to set up the app must be used to sign into the online cloud service. Connect with the company IT or rep for help if needed. 
  3. Additionally, although not ideal for the depth of data, a screenshot can be taken and emailed to a clinician. 

Apps for "Bolus Calculators" or "Insulin on Board". We cannot endorse the accuracy of these apps. 

  1. Ypsomed App: This app is intended to pair with the Ypsomed pump, but the option exists to choose MDI and see Insulin on Board.
  2. Lifescan Insulin Mentor has a bolus calculator that can be used independently from their meters, if desired. See the meters page and use <Ctrl + f> to search for ‘Mentor’.

 See Carbohydrate Counting Heading below for related apps. 


Assessment Tools and Safety

Blood Glucose Logs & Records - click to redirect

 

Carbohydrate Counting

The following are some of the many tools available for determining the carbohydrate content of foods. Not all sources of carbohyrate content may be acccurate (particularly for apps). For suggested nutrient intakes in diabetes, see Diabetes Canada Guidelines Chapter 11 - Nutrition Therapy. Also see section under Nutrition heading below for Low Carbohyrate Diets

Carb Counting Handouts

Other Carb Info and Resources

  • Labels: Subtract grams of fibre from the grams of carbohydrate for the portion on the label.
  • Restaurant websites: Many fast food and other restaurants have nutrient analysis posted online for their products.
  • Diabetes Canada Educator Resource: Helpful hints for educators using Beyond the Basic
  • Ordering Beyond the Basics
  • Nutrient Analysis Apps: Through smart phones' app stores or AppCrawlr .
  • General carbohydrate estimates. One carbohydrate choice contains 15 grams of carbohydrate (after the fibre is subtracted).A general guideline for the number of carbohydrate choices to eat per meal is 2-4 for most women and 4-6 for most men. For snacks: 0-1 for women and 0-2 carb choices for men.
    ​One Carb Choice (15g) equals:
    • 1 slice of bread
    • 1/2 cup (125 mL) cooked pasta/potato/other starch
    • 1 medium piece of fruit
    • 1 cup (250 mL) of milk
    • 1 tbsp (15 mL) of sugar, jam or honey.

Nutrient Analysis Websites or Apps

We cannot verify accuracy of data. Some apps or websites have customers input data. Please advise patients to carefully consider options. Some may require subscriptions. The product manufacturer or label is always the best resource for processed foods. 


Classes for Diabetes (for patients)

Client Centered Counseling (Motivational Interviewing)

Complications

Continuous Glucose Monitors (CGM)

Cost Coverage Information (Alberta)

Patients are encouraged to meet with  psychosocial services in their PCN or diabetes centre to review potential additional options available to help assist with the costs of managing diabetes. Below are some resources for the cost of strips and medications in Alberta. 
  • Alberta 211 patients can call or visit https://www.ab.211.ca/  to find community resources and financial supports for other concerns including tax preparation services
  • Alberta Blue Cross Private – Patients are encouraged to ask their pharmacist if their private coverage allows for glucose test strips and/or sensors. Sensors may be included under different headings e.g. blood glucose meter or medical device.
  • Alberta Blue Cross Formulary of Covered Medications: Interactive Drug Benefit List .     The form for Special Authorization of GLP-1, DPP-4 or SGLT is here. All other SA forms: Blue Cross Forms page.
  • Alberta Insulin Pump Therapy Program (IPTP): Those in the IPTP can receive up to 700 strips per 100 days, plus infusion sets or pods.
  • Alberta Adult Health Benefit
  • Alberta Works: Emergency support to help purchase medications is available to those who qualify. Patients can call Alberta Works Income Support 1-866-644-5135 (press 0).
  • Dispensing Fees: Patients may investigate switching to pharmacies with loser dispensing fees e.g. Walmart and Costco
  • Glucose Monitoring Supplies 
  • Sanofi Products:
    • Sanoficares.ca Medication Certificates: Patients visit, Sanoficares.ca , click "Download a certificate" (no personal information is required). They show the certificate via phone (or can print it) to the pharmacist to receive a free box, repeatedly and indefinitely, so we are told (1 box= 5 disposable pens of Apridra, Lantus, Toujeo, Soliqua or 3 disposable pens of Toujeo Doublestar). The patient must have a prescription.  When the patient needs more of the medication, they download another new certificate. Works best on mobile, and we've also used easily and quickly on MS Edge desktop browser. 
    • Prescribers may also request 6 month supply through a new online program (paper compassionate request forms no longer accepted). Program can be accessed through the website:www.innomarstart.com/sanofi (Access Code : SANOFI)
  • Novo Nordisk Insulins NovoRapid, Tresiba:
    • Clients without insurance can see if they are eligible for NovoRapid and/or Tresiba through the Novo Nordisk Diabetes Care Program online at https://nncare.ca/ or over the phone 1-833-595-1899. 
    • There are some eligibility questions (household income, number of dependents, province, and patient must have no insurance).
    • To apply, the client must have a NovoNordisk Client ID number as listed on a NovoNordisk Diabetes Care Program card. These cards are either physical (DCC supply room) or virtual as provided bycontacting Amy at This email address is being protected from spambots. You need JavaScript enabled to view it.. To repeat, clinicians are to obtain a card (client ID) for their patient first (no patient information is required) before having the patient apply.
    • Contact This email address is being protected from spambots. You need JavaScript enabled to view it. if you need to need information on how the patient can arrange for a translator when applying. 
  • Physical medication Cards offered by NovoNordisk for: Fiasp, Tresiba (Tresiba expiry dates are extended to Dec 2021); and by Lily for Trulicity.
  • Compassionate Glucagon is via the distributer. Click here to visit the NovoNordisk glucagon section of the Complete Medications Table
  • Government of Canada Disability Tax Credit – some people with type 1 diabetes may apply and be successful in receiving this tax benefit, which could assist with funds for glucose monitoring supplies.
  • Health Benefits Card Coverage, for those who qualify for Alberta Income Support. 
  • Innovicares Card
  • Seniors Health Benefits may provide some funds for glucose strips if the patient is on insulin. 
  • Psychosocial Resources - You may wish to visit the heading below
  • Consider reviewing the costs (before addition of dispensing fees) for similar medications on the Complete Medication Table
 

Diabetes Canada Resources


Diabetes in Pregnancy

COVID-19 and Pregnancy

General Pregnancy Resources: 

 Gestational Diabetes (GDM) Resources:

Diabetes in Pregnancy Resources: 

Diabetes Prevention

Diabetes Services (AHS) - Calgary Zone

  • See Diabetes Services Calgary page for referral documents as well as links to rural and indigenous (Siksika, Morley) diabetes services and endocinrologist consults. 

Diabetes -Type 1 

Diabetes-Type 2

Diabetes Updates 

  Donating Supplies

  • Insulin for Life Canada
  • Pumps & Pump Supplies: It's possible JDRF (1.877.287.3533, This email address is being protected from spambots. You need JavaScript enabled to view it.) or Diabetes Canada (1-800-226-8464, This email address is being protected from spambots. You need JavaScript enabled to view it.) may know where to donate pumps and supplies. Please consider contacting them to ask. Also, the Calgary Insulin Pumpers group (contact page is here) may accept them as their members may not all have insurance or Alberta Insulin Pump Therapy Program coverage.
  • Medtronic pumps: Medtronic may help someone donate a Medtronic pump to someone they specifically know. It's possible the person receiving the pump pays $500 to have the warranty transferred. Medtronic takes the pump back and provides a new one. If this is someone in Alberta, it is preferred for them to go through the Alberta Insulin Pump Therapy Program (IPTP) for funding of supplies and pump.

Driving

Emergency Wait Room Times

Endocrinology & Metabolism Patient Services 

Exercise

  • See heading for Physical Activity 

Foot Care

Health Care Provider Foot Care Assessments and Resources

Footcare Handouts and Patient Resources

Calgary Foot Care Services: Low - Moderate Risk 

Calgary Foot Care Services: High Risk 

 If patient has a wound refer to the Sheldon Chumir wound clinic.  

Fructosamine

Gastroparesis 

  • Refer your patient to a dietitain. The patient handout is only available through AHS Nutrition and Food Services private shared drive for dietitians. Dietitians in PCNs have access via Nutrition Services Sharepoint
  • If you suspect your patient may have gastroparesis, you can advise they discuss with their endocrinologist or primary care physician. 
  • Physicians can consult Specialist Link with patient related gastroenterology questions.  

 

Glucagon

Glucose Management Indicator (GMI) for CGM

  • Simply put, GMI replaces the terms "Estimated A1c"and 'eA1c' that were used in glucose sensor reports. Eventually eA1c will be removed from most sensor reports. GMI estimates the A1c using average sensor glucose data of ideally  ≥ 14 days. GMI may be reported in % or mmol/mol (as is A1c). 
  • GMI and A1c are not the same and may differ for various reasons including individual’s biology or a short-term fluctuation in glucose control. 
  • Convert GMI mmol/mol to GMI% (A1c conversion chart)
  • Convert average sensor glucose to GMI% (Calculator)
  • For GMI use in Medtronic reports, see here

 

Glucose Meters


HbA1c - Hemoglobin A1c

Healthcare Provider Education

Homecare

  • Calgary area clients and staff may call 403-943-1920 to inquire about eligibility for homecare services.
  • Homecare staff are not permitted to take insuiln orders or adjustments from educators. DCC educators please refer to their Medication Adjustment Policy for options (e.g. if familiy is adjusting instead, a certain consent is required). 

Hypoglycemia (Low Blood Sugar)

Inpatient Diabetes Resources (Alberta Hospitals)

Insulin Adjustment

Insulin Allergy 

Insulin allergies were more common with bovine and porcine insulins. As technology has improved with recombinant and analogue insulins, the reported prevalence of insulin allergy is 0.1-0.3%.
If your patient lets you know about a reaction to their insulin, it is important to gather appropriate history and inform the patient’s family physician or diabetes specialist. Assessment considerations: 

  • Type of reaction? *A diffuse, systemic response requires prompt assessment and treatment*
    -local (immediately around injection site) or diffuse (covering large area of body)?
    -skin only, or systemic (airway/breathing)?
    -Does it resolve, or worsen over time?
  • Relationship to insulin administration? 
    -immediately -1 hour after injection
    -delayed- 2-24 hours after injection
  • Type of insulin?
  • Changes or interruptions to insulin?
  • History of other allergies? (many needles use silicon or lubricants)
  • Any other triggers such as change to medications, diet, cosmetics, detergents or other autoimmune diseases?

Treatment considerations to be discussed with physician or diabetes specialist, depending on severity of reaction:

  • Observe and optimize patient’s injection technique to avoid any possible site irritations (i.e. proper site rotation, not injecting where clothes/belts rub, not massaging after injection, not using alcohol wipes)
  • Cool site before and after injection
  • Possible use of insulin port devices if allergy to pen needles
  • Avoid insulin if possible
  • Switch to a different type or brand of insulin
  • Use of anti-histamines for symptom relief
  • Rapid desensitization protocol – complex protocol that involves starting insulin at very low doses in an intensive care setting

Insulin Pump

  • Roche Accu-Chek Combo or Spirit (No longer for sale in Canada)
    • IMPORTANT NOTICE Roche insulin pumps are no longer sold in Canada: For support of existing Roche pumps call 1-800-688-4578 or email This email address is being protected from spambots. You need JavaScript enabled to view it.
    • User Guide for Spirit pump. 
  • Tandem t:slim X2
  • YpsoPump by YpsoMed Canada 
  • Support Group: Calgary Insulin Pumpers

Insulin Review

Periodically, consider reviewing the following with those using insulin. In practice, glucose levels are frequently impacted by one or more of the following. Perhaps consider an annual "Insulin Review" with patients to touch base on:

  • role of insulin
  • type and action(s) of insulin(s) prescribed and carbohydrate requirements
  • use of insulin delivery device and accessories
  • time that insulin is administered (e.g. before or after meals etc)
  • storage and expiry of insulin
  • injection sites and rotation
  • pen needle length (e.g. not 12 mm, to avoid intramuscular injections)
  • barriers to giving all injections, if any
  • impact of missed or late injections
  • driving
  • travel (e.g. 2x supply in carry-on)
  • basics of how and when to self-adjust bolus and basal insulin if appropriate (use of ICR and ISF; targets used with ISF)
  • when and how to seek help (Consider giving the handout: Diabetes Resources for Patients. It contains a list of urgent concerns.)
    • hypoglycemia (prevention, symptoms, treatment)
    • hyperglycemia/DKA (prevention - ketone testing, symptoms, treatment)

 Insulin Safety - AHS Provincial

Insulin Senstivity Factor (ISF)

Insulin Starts and Injectables

  • Useful Healthcare Provider Actions
    • Explaining insulin benefits
    • Demonstrating the injection process
    • Collaborating (collaborative style)
    • The LEAST useful was an authorative style

A study identified the healthcare provider actions (above) that helped patients who didn't want to start insulin change their mind and start insulin. Reference: William H. Polonsky et. al. Identifying solutions to psychological insulin resistance: An international study. Journal of Diabetes and its Complications. Available online 17 January 2019. https://doi.org/10.1016/j.jdiacomp.2019.01.001

Marijuana (Cannabis) and Diabetes 


Medical Procedures

Generalized Summary:

  • Basal Insulin:
    20% reduction in basal insulin the night before and morning of a procedure. Tresiba (degludec) may need to be reduced 2-3 days prior. (No reduction is suggested for fasting labwork unless individually required for safety.)
  • Bolus Insulin:
    The day(s) of clear fluid preparation, consider reducing meal bolus by 20%. 
    The morning of the procedure, hold bolus insulin until eating after the procedure. 
    For hydrogen breath test for small intestine bacterial overgrowth, consider reducing the bolus by 20% for the75g glucose required for the test.
  • Meds other than insulin:
    The morning of the procedure, hold other diabetes meds until eating after the procedure. Consider holding SGLT-2 two days before colonoscopy prep to reduce the risk of DKA. 
  • Individualization and more:
    These suggestions need to be individualized according to the patient's current glucose values, risk for hypoglycemia and other factors. See handouts below for additional instructions for specific tests. 

Patient Education for Medical Procedures (AHS myHealthAB):

Medication Resources

Nutrition Resources

Nutrition - Low Carbohydrate Diets

Obesity Resources

Pharmacy

Physical Activity (Exercise)

Primary Care Networks (PCNs)

  • Calgary Family Medicine Physician Directory identifies the PCN a family doctor is attached to. If not in the directory, the GP is likely not part of a PCN. 
  • MyPCN.ca shows Calgary PCN coverage maps and websites
  • https://albertafindadoctor.ca/ to find a family doctor.
  • CFPCN 
    • Patients from any PCN can refer themselves for (or units can call to arrange) an individual appointment for diabetes with a CFPCN RD, RN, pharmacist, SW or Behavioral Health Consultant. They can visit https://cfpcn.ca/ , click Services, choose the health professional and follow the instructions on that page (soon, those instructions will include online booking!)
  • Mosaic PCN
    • Patients from Mosaic PCN can refer themselves for an individual diabetes appointment with a Mosaic RD, RN, pharmacist, SW or Behavioral Health Consultant. They can visit http://mosaicpcn.ca/, click Programs & Services, choose either Primary Health Care Team or other service (Social work, mental health etc) and follow the instructions on that page.

Psychosocial Resources 

 

Ramadan

Research

Renal Disease (Chronic Kidney Disease - CKD)

Retinopathy

Safety Checklist 

Sick Days (Illness)

Skin Care 

  • See the Skin Care page for products for CGM, insulin pumps and infusion sets.

Smoking Cessation

Stress

Support Groups

Please note that most of these supportive groups or organizations are not managed, reviewed or endorsed by Alberta Health Services (AHS).

  • Alberta Healthy Living Program (AHS) “Better Choices, Better Health may also involve groups with type 2 diabetes. 403-943-2584
  • Calgary Neuropathy Association
  • Calgary Insulin Pumpers
  • Diabetes Canada Calgary 403-266-0620 ask about events, groups (all types of diabetes)
  • Transitioning Youth with Diabetes in Calgary (AHS) Twitter: @TYDcalgary; Facebook:TYP Calgary 
  • Connected in Motion (type 1 diabetes)
  • JDRF Southern Alberta - type 1 diabetes. Contact Chelsie 403.255.7100 This email address is being protected from spambots. You need JavaScript enabled to view it.
  • I Challenge Diabetes

Translated Diabetes Materials (Language, Ethnic/Cultural Resources) 

Travel

  • Patient handout: Travel and Diabetes (AHS)
  • Medication Adjustment Flowchart (AHS) with Timeline worksheet
  • Fillable Timeline Worksheet for Travel (downloads as .doc; doesn't open in browser)
  • Frio Insulin Cooling Cases may be ordered through their Canadian website. Please see the brochure for 10% discount code. Rep: This email address is being protected from spambots. You need JavaScript enabled to view it. 

Vascular Risk

Websites and Directories

 

Handout Key:

AHS: Alberta Health Services

DCC: Diabetes Centre Calgary, AHS

DC: Diabetes Canada (previously Canadian Diabetes Association - CDA)

 

 Advanced April 28