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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 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.

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

  • 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")

Marijuana (Cannabis) and Diabetes 

 

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):

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

 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 

 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

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

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,
  • 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

Support Groups & Services

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

Translated Diabetes Materials (Language, Ethnic/Cultural Resources) 

Travel

Vascular Risk

Websites and Directories

 

Handout Key:

AHS: Alberta Health Services

DCC: Diabetes Centre Calgary, AHS

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

 

 

 

 

 

 

 

 

 

 

 

 Basic Workshop Certificate Oct 2024

   Intermediate Workshop Certificate Oct 2024

   Advanced Workshop Certificate Nov 2024