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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 Diabetes Resources in Calgary.PDF- click here.Diabetes Resources for Patients (diabetes phone-lines, classes, urgent help, routine 1:1 help). Diabetes Resources in Calgary.PDF- click here.Diabetes Resources for Patients (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.  See the heading COMPUTER below if your patient needs help accessing the internet, has no internet or no computer. 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

See the Diabetes Canada Quick Reference Guide for a short summary of screening, targets, glycemic therapies, cardiovascular protection, preventing hypoglycemia and goal seting. See this resource for Time Management guidelines.

Biosimilars

A biosimilar insulin is highly similar to another insulin (with an expired patent). No differences in clinical performance are expected from the biosimilar in comparison to the original medication. Government drug plans, such as those in Alberta, often promote the use of biosimilars as they are frequently lower in cost. For use of biosimilar insulins in insulin pump brands, see here.  

 

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 Basics 
  • 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 and pricing. The product manufacturer or label is always the best resource for processed foods. 


Classes for Diabetes (for patients)

Client Centered Counseling (Motivational Interviewing)

Complications

 

Computer and Internet Access for Patients

Some patients do not have access to a computer and/or internet or do not have adequate skills to help them navigate online. Unfortunately, they cannot benefit from servers that upload glucose or other data into reports or even from haing an email account. Please note the possible resources to help these patients. 

  • All Calgary Public Library (CPL) locations (except for Rocky Ridge) have computers with internet access and printers available for members to use.
    • These computers don’t need to be booked. People need either a Calgary Public Library card (free if live in the city; can sign up by calling 403-260-2600 or in-person) or to connect with a staff member to get a guest internet-only card.
    • CPL regularly has introductory technology programs. These can be booked online or by calling the library. Details are here. Usually these sessions are in person with safety measures per local COVID protocols.
    • CPL has a volunteer-led program called Tech Mentors which assists members one-on-one with specific inquiries (e.g. setting up a gmail account) or assists members who need more individual help. This help is available either online or in person (but not at all sites, so members need to call to ask.)
  • The Alex may have computer access, although it may be discontinued during COVID. Patients can call to ask 403-520-2260. 

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. If there is nothing specific listed further down, patients could also consider approaching alternate groups such as:

  • Lions/Lioness Clubs
  • Royal Purple organization
  • Legions
  • Larger companies/business as sometime either the business or employees may have funds they collect for community types of goodwill funding
  • Churches

See the Psychosocial page for financial resources available in Alberta 


Diabetes Canada Resources

Diabetes in Pregnancy

Calgary DIP Clinics, referral and fax numbers see here, and scroll down to Diabetes in Pregnancy.

COVID-19 and Pregnancy

General Pregnancy Resources: 

 Gestational Diabetes (GDM) Resources:

Diabetes in Pregnancy: Other Resources

Diabetes Prevention

Diabetes Services (AHS) & Referrals - Calgary Zone

Diabetes -Type 1 

Diabetes-Type 2

Diabetes Updates 

Donating Supplies

  • General Diabetes Supplies
    • There's a team at U Calgary that can redistribute unexpired supplies to those in need. Contact Tucker Reed (), who works with Dr D Campbell, and he can direct people to a venue that serves people in need.
  • Pumps & Pump Supplies:
  • 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.
  • Insulin for LIfe no longer has their donation service. 
  • CUPS primary care clinic will accept diabetes supplies and unused insulin that has not expired. Supplies can be brought to the CUPS clinic. Please call first (403-221-8780 dial 1 to talk with primary care clinic) and they will instruct re: drop off.

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 

  • If you suspect your patient may have gastroparesis, you can advise they discuss with their endocrinologist or primary care physician. 
  • A patient handout is available on the AHS Nutrition Education handouts page here. Use the search box to search "gastroparesis". Refer to a dietitian.
  • 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)

 

Indigenous Health Services

  • Indigenous Support Line: 1-844-944-4744:  Support for issues related to referrals, culture, primary care, addictions mental health, and other general concerns. Poster is available here.
  • NIHB (Non-Insured Health Benefits Program): Libre and Dexcom sensors are covered under NIHB. Patients to connect with their pharmacists once they have a prescription.

 

Inpatient & Outpatient Diabetes Resources & Supporting Documents (Alberta Health Services)

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

INSULIN PUMP BRAND INFORMATION SESSIONS & OTHER

 

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 (in the fridge, no freezing) and expiry of insulin (see Complete Medication Table for duration at room temperature)
  • 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

Ketone Testing Supplies

Patients testing ketones have access in Alberta to:

  • Urine ketone test strips
  • Abbott Blood ketone test strips used in the appropriate device e.g. Libre 1 or Libre 2 hand held reader. Although these readers are intended to "scan" Libre glucose sensors, they can also be used to manually measure blood ketones and blood glucose, when using the appropriate Abbott blood test strips for each. Unfortunately, the product boxes do not indicate that these handheld readers can also be used for blood ketone measurement and blood glucose measurement.  

Knowledge Resource Services (KRS - AHS "Library")

  • Knowledge Resource Services provides AHS employees access to journals, Lexicomp and other resources. 
  • KRS Learning How to Use Resources (sign up for live session or click associated link for video e.g. Finding Full Text Articles)

 Marijuana (Cannabis) and Diabetes 

  • Impact of Marijuana use on Diabetes Management:
    • Review Diabetes Canada Position Statement on Recreational Cannabis Use in Adults and Adolescents With Type 1 and Type 2 Diabetes (2019)
    • Marijuana may also indirectly impact diabetes management through its negative effects on self-care practices, decision making, appetite, judgement, memory or other effects.
  • Health Effects of Marijuana: The two main cannabinoids in marijuana are THC and CBD. Health effects of cannabis apart from recreational use for the THC (“high” or relaxed) or medicinal use of TCH and/or CBD (reduced nausea, vomiting, pain, spasticity, seizures) can include the following:
    • Decreased: Memory, concentration, reaction time, coordination, decision-making abilities, ability to judge distances
    • Increased: Heart rate, sleepiness, anxiety, fear, panic, paranoia, delusions, hallucinations, mood disturbances, psychotic symptoms and appetite
    • ( Health Effects of Cannabis Factsheet Canada.ca; and Nat. Inst. of Drug Abuse U.S,  )
  • Duration of Cannabis Impairment and Side Effects:
    • “Cannabis Impairment: There is no standard waiting time to drive after using cannabis. If you are using cannabis, do not drive. Find an alternative.” (Cannabis Impairment- Canada)
    • The effects of smoked cannabis may last 6 hours or longer, ingested cannabis 12 hours or longer (Health Effects of Cannabis Factsheet, Canada) and medicinal cannabis up to 48-72 hours (e.g. nabilone for treatment of nausea in chemotherapy. (product monograph)
  • For more information visit: 
    • Cannabis in Canada: Get the Facts (Government of Canada) 
    • www.drugcocktails.ca  (enter a prescription medication ie. Insulin, search and it will list interactions with alcohol, illicit drugs, tobacco or marijuana.) 
    • Alberta Health Services's
      • Cannabis Information 
      • Drug Safe site for younger adults for practical advice

 

 Medical Identification (Medic Alert I.D.)

  • Medic Alert offers a subscription service with their medical alert bracelets. The bracelets are engraved with key health concerns and a phone number. This allows first responders to call a centralized Medic Alert phone number 24/7 to receive health and family contact information about the person wearing the I.D. 
  • Various jewellers may offer medical identification bracelets with custom engraving. There is no service fee attached if not associated with Medic Alert.  

 

 Medical Procedures

Generalized Summary: (scroll a few inches for more options for pump)

  • 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:
    • Consider holding SGLT-2 two days before colonoscopy prep to reduce the risk of DKA.
    • The morning of the GI procedure, hold other diabetes meds until the patient is eating after the procedure. 
    • GLP-1 & Dual GLP-1/GIP Receptor Agonists: No change in dosing is required for GI tests including colonoscopy. Advise the patient to discuss potential extended preparation with their GI team. For procedures requiring general anesthesia, advise the patient to discuss GLP-1 & Dual GLP-1/GIP Receptor Agonists dosing with their surgical team. 
  • 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):

  • Adjusting Your Diabetes Medicine & Diet for Fasting Blood Tests 
  • Adjusting Your Diabetes Medicine & Diet for a Hydrogen Breath Test (HBT) for Lactose intolerance 
  • Adjusting Your Diabetes Medicine & Diet for a Hydrogen Breath Test (HBT) for Small Bowel Overgrowth 
  • Adjusting Your Diabetes Medicine & Diet for a Gastroscopy or EGD  
  • Adjusting Your Diabetes Medicine & Diet for a Barium Enema or Colonoscopy 

Algorithm for the Safe Use of Insulin Pump during Procedures and Surgery

There are resources for the safe use of insulin pump therapy in hospital. Some of these guidelines may also apply to outpatient procedures requiring local anesthesia or conscious sedation, in particular this resource: Algorithm for the Safe Use of Insulin Pump during Procedures and Surgery. Alternately, click the image below to enlarge. 

For patients that come off pump for procedures and have insulin replaced by IV or manual BBIT, please instruct on how to safely resume basal insulin in pump and automated delivery of correction or basal insulin if being used (AutoMode, Control IQ, Loop, APS etc). This will vary depending on how insulin was replaced when the pump was removed, how much of that replacement will still be active and for how long. 

 

 

 Medication Resources

  • AHS Medication Policies. Use a keyword  to search policies by clicking here. 
  • Adjustment Guidelines
    • Diabetes Medication Adjustment Protocol for Adults - AHS 
    • Insulin Adjustment Guidelines (DCC webpage)
    • Basal Bolus Insulin Therapy (BBIT) - AHS
  • Cost Coverage information: See heading Cost Coverage heading above

  • Detailed diabetes medication information:
    • Medication Intro page
    • Complete Medication Table.  
    •  Choosing Next Line Agents: Diabetes Canada Interactive Tools.
    • NOTE 2020 Diabetes Canada Updates Type 2 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update PDF (or via DOI  or webpage)  as well as The User Guide FAQ. 
    • Choosing Next Line Agents: Summary Table for Medication Class Benefits (CKD, HF, CVD, Weight)
    • Therapeutic Considerations for Renal Impairment (click for heading below)
    • Indications: Health Canada Drug Product Database for product monographs
    • AHS Lexicomp... Insite>Teams>Pharmacy>Drug information (on left)>Popular Drug Info (on right, scroll down). 
  • Inpatient Providers: See Inpatient Diabetes Resources heading above

  •  Patient Medication Handouts:
    • Also visit AHS Lexicomp... Insite>Teams>Pharmacy>Drug information (on left)>Popular Drug Info (on right, scroll down). Search the drug name, Then scroll for patient education handouts. Ctrl +P (choose Microsoft Print to PDF and save).
    • The following are from Diabetes Canada. To verify the most recent versions, please visit this Diabetes Canada page (click here). 
    • Alpha-glucosidase inhibitor  
    • Biguanide (metformin)
    • DPP-4 inhibitor
    • GLP-1 Receptor Agonist & Dual GIP/GLP-1 Receptor Agonist
    • Sulfonylurea insulin secretagogue 
    • Non-sulfonylurea insulin secretagogue 
    • SGLT-2 inhibitor  
    • SGLT-2 STOP DKA in Type 1
  • Safety
    • See Hypoglycemia Heading above
    • SADMANS Sick Day Medication List (Diabetes Canada)
    • Medication & Herbal Advice Line 24 hrs/day (AHS) 1-888-944-1012
    • For SGLT see Hyperglycemia (DKA, HHNS) in Safety Checklist  and SADMANS in bullet above and "SGLT-2 STOP DKA in Type 1" under patient medication handouts (here).
    • www.drugcocktails.ca - Enter a prescription medication (ie. Insulin) and search and it will list any interactions with alcohol, illicit drugs, tobacco or marijuana.  (It also gives the street names of the substances listed.)
    • Related heading Marijuana and Diabetes

  Nutrition Resources

  • Alberta Health Services Nutrition and Food Services (AHS NFS). 
    • Nutrition guidelines for all clinicians are available at AHS Nutrition Guidelines for Healthcare Providers .
    • More detailed guidelines are available to RDs within AHS on the NFS shared drive. Dietitians who work in PCNs have access via Nutrition Services Sharepoint. Other dietitians might be able to get access, but this is controlled by Nutrition and Food Services - please email us at for details.
    • Publicly Available AHS Nutrition Education Materials (Click on Diabetes). 
  • Calgary: Access to Food Resources
  • Canada's Food Guide (Health Canada)
    • Canada's Food Guide 2019
    • Health Professionals' document for Canada's Dietary Guidelines
    • Snapshot of Canada's Food Guide in 28 languages
  • Diabetes Canada Nutrition Handouts - click "management". For HCP professional guidelines, see Diabetes Canada Guidelines Chapter 11 - Nutrition Therapy. Click here to order the poster "Beyond the Basics". They also have a separate Position Statement on Low Carbohydrate Diets for Adults wtih Diabetes (2020). (The statement does not look at diabetes in pregnancy. For all others consider: addressing an agreement to treat hypoglycemia appropriately and discussing differences between DKA and dietary ketosis.)
  • Natural Medicines Comprehensive Database
  • PEN: Practice Based Evidence in Nutrition for healthcare professionals.(This link is for access from AHS server computers only). Or visit PEN's home site for subscription information.

 Nutrition - Low Carbohydrate Diets

  • Diabetes Canada Position Statement on Low Carbohydrate Diets for Adults wtih Diabetes (2020) The statement does not look at diabetes in pregnancy. For all others consider: addressing an agreement to treat hypoglycemia appropriately and discussing differences between DKA and dietary ketosis.
  • For a short summary of considerations for people asking about ketogenic diets, please see this page.
  • Diabetes Canada more detail: Diabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review
     

 Obesity Resources

  •  Obesity Canada
  • Dr. Sharma's Obesity Notes 
  • Calgary Adult Bariatric Speciality Clinic
  • Alberta Obesity Centre

Pharmacy

  • For quick access to Calgary area pharmacy phone and fax numbers, click on this link from the Calgary Region Pharmacists webpage.
  • Patient's pharmacy and pharmacy phone number are usually available on Netcare when viewing medications. 

 Physical Activity (Exercise)

  • Alberta Healthy Living Program's supervised exercise classes (AHS) Calgary Zone 403-9-Health (403-943-2584)
  • Prescription to Get Active (no cost or low cost access to physical activity programs in the community)
  • Patient handout: Physical Activity and Type 1 Diabetes 
  • Diabetes Canada Exercise Resources for Patients
  • PCNs 
    • Mosaic PCN Active Adult Program (Calgary Zone)
    • Check with other Calgary Zone PCNs

 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 

 Key Mental Health Resources

  • Call 1-833-456-4566 for Canada's Suicide Crisis Hotline
  • MENTAL HEALTH HOTLINE 1-877-303-2642. Translation services available.
  • Calgary Distress Line: 403-266-4357 (403-266-HELP) Delivers 24-hour support, free crisis counseling and resource referral services to Calgary and the surrounding area.​
  • Mobile Response Team Call the Calgary Distress Line at 403-266-4357, and ask for Mental Health Crisis Triage. They offer urgent mental health support, assessments and referrals (mobile if necessary).
  • Guidelines on how to respond to disclosed Domestic Violence, Abuse or Neglect

   

For a comprehensive list of counselling resources, see this handount.

 

See the Psychosocial page for more resources and information

 

Stress and Your Health, click to visit "Stress" heading below

 

 Ramadan

  • 2025 Ramadan starts Feb 28 and goes to to Mar 29
    • Diabetes Canada: Ramadan Guidelines
    • The International Diabetes Federation (IDF):  'Diabetes and Ramadan Practical Guidelines 2021Diabetes and Ramadan Practical Guidelines 2021Diabetes and Ramadan Practical Guidelines 2021'
    • Slides from the 2024 presentation to DCC with practical and informative advice, by Dr. Hanan Bassyouni. 

    Research

    • See the University of Calgary's Diabetes Clinical Trials Unit
    • PREDISPOSE Study - Aims to Assess if CGM use immediately after delivery in people with Gestational Diabetes can predict the future development of Type 2 Diabetes.

     Renal Disease (Chronic Kidney Disease - CKD)

    • Diabetes Canada Renal Dosing Chart  (click the chart to enlarge)
    • Product monographs may be more up to date for eGFR levels and SGLT-2i as research advances. See Canada's Drug Product Database. Remember that SGLT-2’s may not be as effective for glucose lowering with lower GFR’s but may be initiated for cardiac/renal protective effects.
    • Alberta Chronic Kidney Disease Clinical Pathway
    • Alberta Kidney Care Programs (previously SARP) and the AKC-S Renal Diabetes Nurse 
    • Jump to
      •  Nephropathy (Chronic Renal Disease) 
      • Stage 5 CKD - Management of Diabetes for Individuals on Renal Replacement Therapies
    • Diabetes Considerations in Stages 4-5 Renal Disease (DCC older and shorter summary document).
    • For Diabetes Centre Calgary staff (interim process):
      • Stage 4 (GFR 15 - 30): Check if the nephrologist or endocrinologist is adjusting insulin doses. If not, use the guidelines for Stages 4-5 directly above. 
      • Stage 5 (GFR <15): If patient is on hemodialysis or peritoneal dialysis, insulin adjustment is the responsibility of the nephrologist or the endocrinologist. Defer to them. For patients on conservative management (no dialysis) insulin adjustment may be done by the nephrologist/endocrinologist, or the educator if that is the preference of the specialist physicians. Use the guidelines above.

     Retinopathy

    • See our Retinopathy page for information and resources.
    • Canadian National Institute for the Blind (CNIB)

    Safety Checklist 

    • See our Diabetes Safety Checklist webpage

     Sick Days (Illness)

    • Staying Safe with Diabetes When Sick or Dehyrated  (Diabetes Canada)
    • See heading Diabetes - Type 1 for How to Manage Illness in Type 1 Diabetes and Prevent DKA
    • SADMANS Sick Day Medication List (Diabetes Canada)

    Skin Care 

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

     Smoking Cessation

    • Becoming Tabacoo Free - AHS list of resources
    • AHS list of resources (provider and patient) for tobacco intervention
    • Alberta Quits - patient resources
    • Consider directing clients to their family doctor, PCN  and pharmacist to ask if they have in-house classes or programs for quitting smoking.

     Steroids & Glucorticosteroids (GC)

    • See page 29, section 13b. Suggestions for Patients Receiving Corticosteroid Therapy under BBIT.CA > Education & Resources > How to BBIT for Prescribers. 
    • General guidelines:
      • As the dose of the glucocorticoid is being modified, the dose of
        antihyperglycemic needs to be modified
      • Insulin dose can be adjusted by half the percentage of the GC dose change. For example, when GCs are increased or reduced by 50%, insulin dose is suggested to be increased or reduced by 25%, respectively. 
    • Prednisone impact on glycemia
      • Given in morning, hyperglycemia occurs in afternoon and evening (duration 16-18 hours)
      • Peak about 4-8 hours after administration
      • Hyperglycemic effect diminishes by morning
      • If administered in multiple doses, hyperglycemia may be present throughout the day (mostly post prandial)
    • IV hydrocortisone (multiple doses) and Dexamethasone impact on glycemia
      • Levels expected to peak about 5 hours after IV administration
      • May cause increased glycemic effect through 24 hour period
      • May have slight decline in overnight fast
    • If patients have blood glucoses equal or greater than 10.0 mmol/L,
      • blood glucose lowering therapy should be started.
      • Suggested blood glucose lowering therapies: see page 29 of section 13b. Suggestions for Patients Receiving Corticosteroid Therapy under BBIT.CA > Education & Resources > How to BBIT for Prescribers. 
    • Reduction or Cessation of Steroid
      • Reduce insulin or sulfonylurea dose with reduction of steroid dose
      • Significant risk of hypoglycemia if insulin dose or sulfonylurea not reduced in line with blood glucose monitoring and anticipated dose tapering
      • With once daily steroid especially, there is a high risk of hypoglycemia in the evening,as steroid effect tends to wear off overnight

     Stress

    • See our Psychosocial page for additional information.
    • The Diabetes Distress Scale] -Diabetes Canada (and Using the Diabetes Distress Scale)
    • Steps to Stress Management Diabetes Canada
    • "ABATE" the Stress: Understanding the Stress Response - Diabetes Canada
    • Stress and Your Health - video, AHS

     Support Groups & Services

    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
      • Patient Information Sheet
      • Patient Information Trifold
    • Calgary Insulin Pumpers
    • Diabetes Canada Calgary 403-266-0620 ask about events, groups (all types of diabetes)
    • No longer available: 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 
    • I Challenge Diabetes
    • Roche offers Accu-chek Engage - an online behavioral change support program, for patients who are using the Accu-chek meter. Sign up information is here. Note that patients can register without linking their account to a clinic.
    • Canada Virtual: Support Group for 14-24 year olds with type 1 diabetes 

     Translated Diabetes Materials (Language, Ethnic/Cultural Resources) 

    • Search notes:
      • Use all of these with caution. They have not been reviewed by Health Canada and do not direct patients to local Canadian resources. 
      • The best way to search for resources is to use"ctrl"+F (pc) or command+F (mac) and type in the language (e.g Punjabi), then hit enter to take you to each listing on this page with that language in its name
      • You can also browse the items below 
      • You may also find possible translated materials under topic headings above e.g. Starting Insulin, Hypoglycemia
    • French:
      • Diabetes Canada's Ressources Françaises webpage. 
      • Diabetes Canada's Chinese Handouts and Resources
      • Quebec Diabetes Association , specifically the page on Living with Diabetes, The 4 Pillars of Balance . Suggestion: Once on website, click English in the top right of desktop brower. Find the page/handout you want. Then check French for the corresponiding French versions. E.g. consider this English Hypoglycemia page and the pdfs on right of it; then click French in top right of webpage (NOT google services) and you should be viewing their corresponding French version of hypo page with all the French PDFs. 
      • Diabetes Toolbox (French site)- an online diabetes resource for health care professionals: www.schalifouxdiabete.com 
      • Canada's Food Guide (French and 19 other languages)
    • Tagalog (Filipino):
      The Mosaic Primary Care Network and the Filipino Healthcare Providers Group of Calgary provided these handouts. The English resource documents from which these were adapted are in brackets.  
      • Just the Basics - Mahalagang Pamumuhay Para sa Diabetes Tagalog/Filipino  (English resource doc is here) 
      • What is Diabetes - Ano ang Dyabetes Tagalog (English resource doc is here) 
      • Carbohydrate in Foods Tagalog (no portions included; the English resource doc is here)
      • Managing Your Diabetes Tagalog - Paano Manatiling Malusog Kahit may Diabetes (English resource doc is here)
      • Driving and Hypoglycemia Tagalog
      • Driving Guidelines and Diabetes Tagalog
      • Hypoglycemia Tagalog
      • Sadmans Tagalog 
      • Filipino Plate
    • Ukrainian translations:
      • General diabetes information
      • High Blood Sugar
      • Diabetes in Pregnancy
    • AHS staff visit Lexicomp (insite>pharmacy services>Lexicomp (right hand side) --Type in medication or disease condition, scroll to click patient education, English shows as default choose "select language" in upper right.
    • www.ethnomed.org: Diabetes information with pictures in a variety of languages (Amharic, Somali, Vietnamese, Khmer, Oromo, Tigrinya, etc.)
    • BC Fraser Health Region: South Asian Nutrition Resources (Punjabi)
    • Canada's Food Guide is available in over 20 languages
    • Dietitians of Canada: Picture list of common South Asian snacks, carbohydrates, proteins, side dishes, desserts and beverages
    • Diabetes Canada: Just the Basics South Asian (in English)
    • Carbohydrate counts of common ethnic foods: Asian, Chinese, Japanese, Indian, Korean, Filipino 
    • Carbohydrate guide for common Somali foods 
    • Carb counting- Adapted for African and Caribbean communities (PEN)
    • Enhancing Cultural Competency - A Resource Kit for Health Care Professionals (Note that this resource is from 2009 and may contain outdated material. Educators are encouraged to view pages 108 and 109 for the ETHNIC and LEARN models of asking culturally sensitive questions). 
    • National Diabetes Service Scheme - Australian Government Initiative: (if using any patient handouts please inform patients not to call the contact #'s listed) Many language handouts and videos including resources for Diabetes in Pregnancy. Languages include: Arabic, Bengali, Chinese (simplified and traditional), Dari, Farsi, Greek, Hindi, Italian, Karen, Khmer, Korean, Macadonian, Nepali, Punjabi, Samoan, Sinhalese, Somali, Spanish, Tagalog, Tamil, Thai, Tongan, Turkish, Urdu and Vietnamese. 
    • Other Punjabi resources (also search Punjabi on this Topics Catalogue): National Diabetes Services Australia; How To Use Insulin Injection (Punjabi)  Dr. Nikhil Gupta M ;  MyWayDiabetes; Fraser Health - On the Road to Diabetes Health (Type 1 or Type 2) booklet; 
    • One Touch Reveal App is available in the following languages: Czech, French, German, Italian, Japanese, Polish, Portuguese, Slovenian, Spanish, Vietnamese. In order for the user to benefit from these languages, they would need to surf into the phone settings menu, then select the app (OneTouch) then they will find a section (Language) from there they can change to any language they want.

     Travel

    • See our Travel page for advice regarding preparation, medication adjustments, and links to patient handouts
    • Frio Insulin Cooling Cases may be ordered through their Canadian website. Please see the brochure for 10% discount code. Rep:  

     Vascular Risk

    • See Diabetes Canada Interactive Tools for Vascular Risk Assessment Tool
    • AHS list of cardiovascular resources for healthcare providers
      • Masimo Root User Guide
      • Masimo Root Quick Reference Guide
    • Canadian Cardiovascular Society Resources (apps, pocket guides, guidelines etc)
    • Heart and Stroke Foundation of Canada
    • Patient handout: Understanding and Managing Your Blood Pressure - Hypertension Canada
    • Patient handout: Healthy Eating for Healthy Blood Pressure - Hypertension Canada
    • Hypertension Canada home site Canada home site
      • Hypertension Canada patient resources (how to measure blood pressure at home) 
    • See Nutrition Resources above

     Websites and Directories

    • Canadian Diabetes Educator Certification Board (CDECB) and the Essentials Diabetes study guides (you can purchase monthly access and discontinue when not needed) https://essentialsdiabetes.com/pricing/ 
    • Diabetes Canada 
    • Diabetes Toolbox (online Diabetes resource for health care professionals sponsored by Diabetes Quebec, AstraZeneca and Roche).
    • Find a family doctor - Calgary Zone
    • Health Link call 811
    • International Diabetes Federation
    • Inform Alberta
    • MyHealth.Alberta.ca
    • National Aboriginal Diabetes Association (NADA)

     

    Handout Key:

    AHS: Alberta Health Services

    DCC: Diabetes Centre Calgary, AHS

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

     

     

     

     

     

     

     

     

     

     

     

      Basic Workshop Certificate Oct 2024