Managing type 2 diabetes during COVID-19: a guide for primary care providersTo search this Diabetes Topics Catalogue, hold "Ctrl" + "f" (PC) or "Cmd" + "f" (Mac) and type in your search word.
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
- Consent to Disclose Form
- MyHealth Records Portal for patients to review lab results and other information
- Patient and Caregiver Journal can be found on this AHS page. (Includes checklists of questions for patients to ask when referred to specialists).
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:
- 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.)
- 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.
- Additionally, although not ideal for the depth of data, a screenshot can be taken and emailed to a clinician.
- Assess Diabetes Risk/Screening:
- Assess Agenda:
- Assess Safety:
- Assess Targets and Complications:
- See our Diabetes Targets and Priorities page
- Assess if vascular protection medication required- See Diabetes Canada Interactive Tools
- Diabetes care flow sheet and targets (Diabetes Canada)
- Assess Patient Knowledge:
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
- Healthy Meal Planning for Diabetes (lists 15g carb choices). See the NFS Online Database in Nutrition Resources below. (AHS)
- Matching Insulin to Carbohydrates Handout under Diabetes -Type 1 heading below. (AHS-DCC)
- Basic Carbohydrate Counting (Diabetes Canada)
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.
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.
- Canadian Nutrient File
- MyFitnessPal Recipe Calculator
- Self Nutrition Data
- Calorie King
- Sushi nutrient analysis
- Canadian Nutrient File (downloadable file)
- USDA Nutrient Database (online use)
- Alberta Healthy Living Program
Patients may self-register for Calgary AHLP Classes Online. If difficulties, call Calgary Zone 403-9-Health (403-943-2584) or visit their website
- Diabetes Canada Virtual Classes
Diabetes Canada Virtual Classes as well as their toll-free phone & email support.
- Primary Care Networks (PCNs)
Encourage patients to contact their Primary Care Network (PCN) regarding classes. PCN information can be accessed through mypcn.ca
- Also see Diabetes Prevention
- Diabetes Canada
- Our resources:
- Interview Overview (agenda setting + conviction/confidence + goal setting) - PDF(DCC-AHS)
- Agenda Setting -webpage
- Conviction and Confidence: Assessing and Building - webpage
- Conviction & Confidence 1 page Summary: An easier way to promote change - PDF (DCC-AHS)
- Read: Tips for Instructing Groups
- Read: 3 Minute Empowerment - Dr. Jacques Bedard
- Read: Motivational Interviewing in the Prevention and Management of Chronic Disease: Improving Physical Activity and Exercise in Line with Choice Theory.International Journal of Reality Therapy, 2008: 27(2):26-29.
- Read: Welch G, Rose G, Ernst D. Motivational Interviewing and Diabetes: What Is It, How Is It Used, and Does It Work? Diabetes Spectrum January 2006 Vol 19 (1): 5-11
- Visit and browse your PCN Learning Resources (ABSORB) for courses
- Visit and browse My Learning Link for AHS staff for courses
- See heading for Assessment Tools and Safety above
- Staying Healthy with Diabetes - Diabetes Canada handout
- See our Complicatons page
- Continuous Glucose Monitoring (CGM): The Basics (AHS)
- Glucose Sensors: Suggested Practices
- Dexcom Trend Arrows: Preventing High & Low Readings by Adjusting
- Libre Arrows: Scanning Frequency & Adjusting Insulin Using Trend Arrows
- Related pages:
- 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 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
- Abbott (Libre sensors): Have the prescriber and patient fill in the Libre Compassionate Supplies Request. It must be filled in by a physician and involves verification of income. Short term, consider "Libre: Getting Started" program if available as provides one free sensor. See CGM Brand Information, Libre, Website/Company.
- Ascensia (Contour Meters) Compassionate Program: Have patients call 1-800-268-7200 for a maximum of 50 strips one time only and if requested, a meter and limited lancets. English and French customer service available.
- Brands with less expensive strips: Have patients investigate brands with less costly strips at their pharmacy, including GE200 meter which also has reductions though Innovicares Card.
- Roche: Main Roche Webpage has link to obtain free meter with 10 strips. Also check clinic supply rooms for coupons to mail patients for 100 free lancets. These are redeemed online by patient and lancets are mailed.
- Alberta Works Income Support at 1-866-644-5135. They may be able provide emergency support for test strips to those who qualify.
- 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)
- Physical medication Cards offered by NovoNordisk for: Fiasp, Tresiba; by Lily forTrulicity.
- 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 Interactive Tools
- Clinical Practice Guidelines
- PDF Clinical Practice Guidelines 2018 - Diabetes Canada
- PDF Quick Reference Guide 2018 CPGs - Diabetes Canada
- PDF Diabetes Patient Care Flowsheet - Diabetes Canada
- Managing type 2 diabetes during COVID-19: a guide for primary care providers
- COVID-19 and Diabetes
- Diabetes Education Line or 1-800-BANTING where a volunteer certified diabetes educator provides individualized answers and support.
- Webinars for those with diabetes
- Virtual diabetes education classes for those with type 2 diabetes.
COVID-19 and Pregnancy
- COVID-19: Pregnancy, Birth, Postpartum, Breastfeeding - Information for Expectant and New Parents (handout)
General Pregnancy Resources:
- Antenatal resources for healthcare providers (updated July 2019): Alberta Antenatal Pathway
- Resource provided to patients by their primary care team when pregnant or planning pregnancy: Healthy Parents, Healthy Children (healthy weight gain, exercise, etc.)
- Best Beginnings Program: Best Beginnings Referral Form
- Nutrition Guidelines for Pregnancy (Nutrition Services) - (see diabetes specific guidelines below)
Gestational Diabetes (GDM) Resources:
- Patient Video: Gestational Diabetes - How to manage with healthy eating and activity(DCC)
- Patient Video: Starting Insulin in Diabetes in Pregnancy (DCC)
- Patient Handout: Gestational Diabetes (Diabetes Canada)
- Patient Handout: After Gestational Diabetes (Diabetes Canada)
- Patient Handout: Metformin Use in GDM
- Fillable Food Record
- Fillable Blood Sugar Log with comments
- Fillable Blood Sugar Log with medications
Diabetes in Pregnancy Resources:
- Website resource for patients with GDM, type 1 or type 2 diabetes in pregnancy: diabetes-pregnancy.ca
- Nutrition Guidelines for Diabetes in Pregnancy (Nutrition Services- updated 2018)
- Forum for Injection Technique (FIT): Guidelines for insulin injection in pregnancy.
- Patient Handout:Pregnancy and Type 1 or Type 2 Diabetes
- Patient Handout:Type 1 and type 2 diabetes After Pregnancy
- Nutrition handouts for diabetes in pregnancy see Nutrition Resources below.
- Canadian Diabetes Prevention Program Online. Patients may self-register.
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.
- Education: Type 1 diabetes: the basics (Diabetes Canada) AND Type 1 Diabetes Education Review (Diabetes Canada and AHS documents in one PDF download)
- Basic nutrition guidelines for type 1 diabetes (AHS)
- Activity and type 1 diabetes (AHS)
- How to Manage Illness in Type 1 Diabetes and Prevent DKA (sick days) (AHS)
- Glucagon and diabetes handout (AHS). See the Complete Medications Table for glucagon information (including Baqsimi).
- Matching carbohydrate to insulin
- Low blood sugar: go to heading Hypoglycemia
- Diabetes and Driving (AHS)
- To search AHS Nutrition Database for handouts, see Nutrition Resources below.
- See Glucose Meters heading for logbooks and blank record books.
- See Lipohypertrophy webpage
- Type 2 Diabetes - The Basics (Diabetes Canada Handout)
- Search this page or Diabetes Canada's patient resources for more handouts
- Sign up for periodic emails reivewing new meds, gadgets, etc in diabetes (for heathcare providers)
- View archives
- Patient Handout: Diabetes and Driving (AHS)
- Patient Handout: Drive Safe with Diabetes (Diabetes Canada)
- Diabetes Canada Guidelines Chapter on Driving
- Note that Physicians adhere to the CCMTA Drivers Medical Standards [Canadian Council of Motor Transport Administrators]. Any questions about interpretation should be directed to the CCMTA and the Alberta Ministry of Transportation. People using insulin will be required to submit a Medical Examination for Motor Vehicle Operators.
- Visit our Ucalgary Patient Website at www.endometab.ca for all Endocrinology & Metabolism Program, Calgary services as well as patient resources
- Or view just our diabetes services
- See heading for Physical Activity
Health Care Provider Foot Care Assessments and Resources
- See our Foot Care webpage
- Why a Proper Foot Assessment is Important- DON SCN Video
- Foot Care Pathway: Alberta Diabetes Foot Care Clinical Pathway (DON SCN) Assessment Tools and Resources
- Additional reading: The American Podiatric Association's Guidelines
- Monofilaments - Reusable (with cleaning, appropriate for use on multiple patients):
- Monofilaments - Disposable (not for use on more than one patient):
- AutoControl Canada (search: filament)
- PediCare Professional Foot Care Instruments (search: filament)
- Wounds Canada eBoutique (Don’t use search. See Healthcare Professionals > Resources > eBoutique)
- Note, some clinics give a disposable monofilament to the patient directing him/her to bring it back to appointments for reuse at future foot checks.
Footcare Handouts and Patient Resources
- myHealth.Alberta (DON SCN patient education)
- Encourage patients to ask their PCN about services. e.g. Mosaic PCN offers those living in their catchment area classes and individual appointments for foot care.
- Alberta Aids to Daily Living may provide therapeutic footwear or orthotics for those who qualify and who are prescribed this by a physician in one of Alberta's High Risk Foot Teams. In Calgary the clinic that can prescribe is the Zivot Limb Preservation Centre at PLC.
- DON SCN Alberta Foot Care Patient Handouts
- Diabetes Canada Patient Handouts:
- Alberta Foot Care (previously Victoria Order of Nurses)
- College of Podiatric Physicians of Alberta website to find a current list of podiatrists and clinics in Calgary.
- Kerby Centre for Seniors Foot Clinics
- If finances are a concern, suggest patients call local podiatry services and ask what is charged for initial assessement and ongoing footcare appointments.
If patient has a wound refer to the Sheldon Chumir wound clinic.
- The Sheldon Chumir Wound Clinic information.
Fax Referrals to Community Care Access 403-943-1602
Fax both the Foot Risk Assessment Form together with the Wound Clinic referral form.
- Peter Lougheed Centre: Zivot Limb Preservation Centre information.
- Fax number: 403-943-6423.
- Fax both the Foot Risk Assessment Form together with the PLC referral form.
- IMPORTANT: Educators MUST include the name and info of the MD who referred to DCC (GP or Endo). Zivot will send the report back to that physician. You can include your name in the signature as an educator from Diabetes Centre Calgary and add "for Dr. ...(referring doctor)." As per usual charting standards, please inform the referring physician of the action you've taken.
- Serum fructosamine may be used as an alternative to Hemoglobin A1c. It indicates average glucose level over the previous 2-3 weeks.
- According to Medscape (https://emedicine.medscape.com/article/2089070-overview#showall) updated October 2019, the formula for comparing HbA1c to fructosamine is:
- HbA1c = 0.017 X fructosamine level (µmol/L) + 1.61
- Detailed infomation on serum fructosamine available in this review by Dr. Ghaznavi and Dr. McKeen.
- 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.
- 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.
- Accuracy of blood glucose meters
- Blood Glucose Meter Summary Sheet for Health Educators 2020 (Includes steps to manually access results etc)
- CGM- See CGM Heading for continuous glucose monitoring
- Cloud accounts and clinic upload boxes
- Diasend portal . The Diasend Professional Clinic box will upload Libre handheld scanners, glucose meters, most CGM cloud server data, most insulin pumps (Omnipod, Tandem, Ypsomed) and merge glucose and pump data. See the Diasend document: Interpretting Charts and Graphs.
- Glooko portal to access professional & personal accounts. (The clinic Glooko box currently doesn't upload Libre - Oct 2019.)
- In many cases, patient data is accessible via company specific cloud services or apps. See specific meter brand websites listed on Glucose Meters page or CGM Brands page. e.g Libre phone app users can view their data by signing into their cloud account on Libreview, Dexcom on Clarity.
- Diabetes Canada Interactive Tools for glucose monitoring frequency
- Glucose Meters page. Also includes link to the Genteel lancing device.
- Health Canada: Approved medical devices.
- Patient Handout: Managing your blood glucose (testing blood sugar, sick days (Diabetes Canada)
- DOWNLOADABLE LOGBOOKS / RECORD SHEETS
- 4 Day Food, Insulin and Blood Sugar Worksheet (AHS)
- Fillable food and glucose record sheet
- Your Blood Sugar Log Fillable PDF Versions:
- English: Your blood sugar log-Fillable PDF (AHS)
- French: Your blood sugar log-Fillable PDF (AHS)
- Spanish: Your blood sugar log-Fillable PDF (AHS)
- Arabic: Your blood sugar log-Fillable PDF (AHS)
- Urdu: Your blood sugar log-Fillable PDF (AHS)
- Traditional Chinese: Your blood sugar log - Fillable PDF (AHS)
- Vietnamese: Your blood sugar log-Fillable PDF (AHS
- Blank glucose record book (AHS)
- Glucose Log Book (Diabetes Canada)
- Pump records: 5 days: Glucose & insulin records for pump and 3 days: Blood glucose and insulin record for pump therapy
- Patient handout: A1c Testing for Adults - handout (AHS)
- Visit our A1c page for why A1c matters (research summaries) and what A1c is
- Diabetes Canada Interactive Tool - Individualizing A1c
- Video: Diabetes Canada's What, When, Why? Understanding A1c
- Glucose Wands (Canadian Orders, see page 72) or (U.S. orders).
Healthcare Provider Education
- 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).
- Patient PICTORIAL handouts:
- Patient handout: Hypoglycemia unawareness: When you don't feel your low blood sugar (AHS)
- Patient handout: Glucagon and diabetes (AHS)
- Educator reference: Troubleshooting Hypoglycemia (with and without insulin pump therapy)
- Provincial Inpatient AHS Glycemic Policy: Glycemic Management Policy Suite (includes inpatient Hypoglycemia and Hyperglycemia Policies)
- Provincial Clinical Knowledge Topic: Perioperative Management of Patients with Diabetes Mellitus, Adult – Inpatient
- Provincial AHS Insulin Safety & Diabetes Management for Health Care Professionals includes:
- General Diabetes Information
- Nutrition Information for Patients with Diabetes
- Basal Bolus Insulin Therapy (BBIT)
- Insulin Pump Therapy (IPT) – Safe Management in Acute Care
- Provincial Glycemic Management Policy Suite
- General Information on Insulin Safety
- Insulin Pen Information
- AHS Insulin Formulary Information
- Provincial: myLearningLink > Courses and Registration>Basic Diabetes Education - this is designed for inpatient staff.
- Provincial BBIT
- Basal Bolus Insulin Therapy (BBIT) in Hospital Self Study Guide (AHS - Provincial)
- Basal Bolus Insulin Therapy (BBIT): AHS educational materials for professionals
- Insulin Pump Therapy In Hospital: AHS processes and documents
- BD AutoShield Duo Safety Pen Needle Video
- Calgary zone: Inpatient Diabetes Educator Triage: Inpatient Diabetes Educator Triage and Referral Guidelines; Updated February 2019
- Calgary zone patient Handout: Visit the top of this page for the handout Diabetes Resources for Patients (AHS) Diabetes Resources for Patients (AHS)
- Please see related headings on this page:
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
- Alberta Health Services Pump Resources
- Alberta Health: Alberta Insulin PumpTherapy (IPT) Program Site
- Approved specialist physicians for Alberta IPT program
- Insulin Pump Therapy Patient Learning Module for Patients (online) and accompanying questionnaire.
- Guidelines for safe management of insulin pump therapy in hospital (AHS)
- Troubleshooting Hypo and Hyperglycemia in insulin pump therapy
- Skin care products for infusion site management
- Patient Handouts & Forms:
- Diabetes Centre Calgary Pump Program: Insulin Pump Therapy Preparation & Expectations
- Prevention of Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy (AHS)
- Coming off the pump (AHS)
- DKA prevention in insulin pump: Practice Cases #1 (pdf)
- Basal testing worksheet- Checking and adjusting basal rates in insulin pump therapy (AHS)
- Emergency / Urgent Care Insulin Pump Document
- Blank pump glucose/insulin records
- IPTP Patient Responsibility Agreement
- Medtronic Virtual Intro Sessions
- Omnipod Virtual Intro Sessions
December 2, 2020 6:00pm-7:00pm MST (handout)
- Tandem Virtual Info Sessions
Every Tuesday 5-6 PM MST (handout)
- Insulet Corporation - Omnipod
- Medtronic - 670G, 630G
- Roche Accu-Chek Combo or Spirit (No longer for sale in Canada)
- User Guide for Spirit pump.
- Tandem t:slim X2
- YpsoPump by YpsoMed Canada
- Support Group: Calgary Insulin Pumpers
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
- 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
- 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
- Diabetes Canada Resources
- Getting started with insulin handout; DCC staff also to print Medication Supply Checklist to provide patient.
- Insulin Pen Start Checklist for Healthcare Professionals
- Traditional Chinese: Getting started with insulin (handout)
- Video: How to Inject Insulin Step by Step Guide length 7m:39s
- Video: Insulin Pen, What You Need to Know length 2m:22s
- Video: Introduction to Insulin length 2m:45s
- Alberta Health Services (AHS) Resources
- Insulin start formulas
- Low Blood Sugar (handouts - link to heading)
- Diabetes and Driving (handout)
- Average Insulin Action Time (handout)
- Inpatient hospital staff resources (AHS login is required): Insulin Safety & Diabetes Management Toolkit for Health Care Professionals
- Patient Video: Starting Insulin in Diabetes in Pregnancy (DCC)
- Forum for Injection Technique (FIT)
- FIT teaching handouts
- Needle Length Summary FIT 2017
- 4, 5 and 6-mm needles are suitable regardless of BMI
- 8 mm may be preferred by some
- 12 mm or more are not recommended
- Skin Lifts (pinch) Summary FIT 2017
- may prevent intramuscular injections, even with a shorter needle
- 4 mm: skin lift may not be required
- 8 mm: skin lift advised
- Angle of Injection Summary FIT 2017
- 4,5,6 mm: 90 degrees
- 6 mm: 45 degrees may be needed in lean adults, if no skin lift is used
- 8 mm: 90 degrees or 45 degrees for lean individual BOTH with a skin lift
- Additional Insights (not FIT)
Estimated intramuscular injection risk by injection site (1376 subjects) can be higher than expected in sites other than abdomen, even with short needles. Although the above was a Turkish study, this can still impact Canadians. According to the Worldwide Injection Technique Questionnaire Study (13289 subjects), the Canadian subjects (376, data accessed here) used these injection sites:
- FIT teaching handouts
- List of usermanuals for injection devices (pens) and injection aids
- For more detailed information on insulin visit the Complete Medication Table.
- Also see Inpatient Diabetes Resources
- 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.
- Review Diabetes Canada Position Statement on Recreational Cannabis Use in Adults and Adolescents With Type 1 and Type 2 Diabetes (2019)
- 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
- Please note, these suggestions were changed in Oct 2020. Previously reductions were 25%. If you have an older version of a D2L diabetes exam open, the answer is 25%. Newer versions of the exam reflect the correct answer as a 20% reduction per suggestions below.
- 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 morning of the procedure, hold bolus insulin until eating after the procedure.
The day(s) of clear fluid preparation, consider reducing meal bolus by 20%.
- Meds other than insulin:
The morning of the procedure, hold other diabetes meds until eating after the procedure. Consider holding SGLT-2 a few 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.
Handouts for Medical Procedures:
- Adjusting Your Diabetes Medicine & Diet for Fasting Blood Tests (AHS-myHealthAlberta)
- Adjusting Your Diabetes Medicine & Diet for a Hydrogen Breath Test (HBT) for Lactose intolerance (AHS-myHealthAlberta)
- Adjusting Your Diabetes Medicine & Diet for a Hydrogen Breath Test (HBT) for Small Bowel Overgrowth (AHS-myHealthAlberta)
- Adjusting Your Diabetes Medicine & Diet for a Gastroscopy or EGD (AHS-myHealthAlberta)
- Adjusting Your Diabetes Medicine & Diet for a Barium Enema or Colonoscopy (AHS-myHealthAlberta)
- Adjustment Guidelines
- 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
- Inpatient Providers: See Inpatient Diabetes Resources heading above
- Patient Medication Handouts:
- 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
- Alberta Health Services Nutrition and Food Services (AHS NFS).
- Nutrition guidelines for all clinicians are available at AHS Nutrition Guidelines for Healthcare Providers .
- Publicly Available AHS Nutrition Handouts: Healthy Eating Starts Here (Click on Diabetes)
- AHS Nutrition Resources Online (Database to order or download additional NFS handouts). Username: NFSpublic Password: 2014nfs03. Search the catalog for handouts on topics. In most cases the pdf handouts are downloadable. Click on the picture of the handout you want, then click the printer icon or the save icon. Some handouts are indicated for RD use only and need to be ordered through Nutrition and Food Services.
- Grocery Resources COVID - Food Bank, 211 and grocery delivery services in Calgary
- Canada's Food Guide (Health Canada)
- 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.
- 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.
- Diabetes Canada more detail: Diabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review
- 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.
- 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
- 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.
- 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.
- COVID-19 Mental Health Resources
- MENTAL HEALTH HOTLINE 1-877-303-2642. Translation services available.
- AHS: Help in Tough Times
- AHS: COVID-19 and Your Mental Health
- AHS: Coping & Connection for Children & Families during COVID-19
- Canadian Psychological Association: Managing COVID-19 Anxiety Resources
- The Wellness Society: Coronavirus Anxiety Workbook
- AHS Staff: Wellness And Mental Health Guide
- AHS - CAMHC COVID-19 Toolkit
- AHS Self-Care Tip Sheets: COVID-19 worker supports
- Supporting Your Mental Health: COVID-19 worker supports
- Wellness Check-in Overview during COVID-19- Employee Family Assistance Program
- Canada Together Wellness Portal: The federal government provides Canadians access to free supports and counselling for mental health and substance use. This includes counselling via phone, videoconference and text. They offer access to immediate crisis support via text for adults and a separate number for front-line workers. A counselling session can be accessed immediately via 1-866-585-0445.
- Also see Community Connect YYC below under General Social Services.
- Mental Health
- 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.
- Access Mental Health: 403-943-1500 helps direct people to the most appropriate mental health services in the Calgary zone.
- Diabetes Canada Handouts: Diabetes and Mental Health; Steps to Stress Management; Understanding the Stress Response
- Educator Tool: Diabetes Distress Scale
- See Stress topics below
- General Social Services
- Community Connect YYC connects Calgary communities with affordable and barrier free access to phone or video counselling services.This initiative is supported by the City of Calgary, and seeks to create a “one-stop shop” for community members who are in need of affordable counselling supports, or other social service including basic needs help.
- Grocery Resources - See Nutrition Heading above
- Social worker services are available for clients of the Diabetes Centre Calgary. They may also be available for clients of Calgary Area Primary Care Networks (PCNs).
- Visit or Call 211: Free, confidential, multilingual, 24 hour information on government and community based health and social services, including tax preparation services!
- Supports and Services for People with Diabetes - Diabetes Canada list
- Diabetes Supplies
- Also see the heading above for Cost Coverage
- Compassionate diabetes supplies: Family doctors can call the 1-800 number of insulin or medication companies to discuss and request forms for compassionate care supplies. Many companies offer this, but not all.
- 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).
- The Government of Canada offers a Disability Tax Credit for those who qualify. This requires physician help in completing forms. Income taxes must be completed prior to sending into the federal government.
- Also view the section on Alberta resources in the Diabetes Canada's PDF called Diabetes Resource Manual (or view other province's resources).
- Stress and Your Health, click to visit "Stress" heading above
- In 2020, Ramadan starts at sunset on April 23rd and ends at sundown on May 23rd.
- Diabetes Canada: Ramadan Guidelines
- The International Diabetes Federation (IDF): 'Diabetes and Ramadan Practical Guidelines'
- Notes from the 2014 educator rounds session on Ramadan. Presenters were Dr. Hanan Bassyouni, Ali Chatour, Raman Virk, Satvir Malhi and Ruchi Chopra.
- Diabetes Canada: 2018 Therapeutic Considerations for Renal Impairment edited with product monoraph updates 2019-11-15. Product monographs for some SGLT-2 meds may have changed; they may list lower GFR levels under indications. Please check Canada's Drug Product Database for the specific SGLT-2. 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)
- Diabetes Considerations in Stages 4-5 Renal Disease (DCC 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.
- See our Retinopathy page for information and resources.
- Canadian National Institute for the Blind (CNIB)
- 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)
- See the Skin Care page for products for CGM, insulin pumps and infusion sets.
- AHS list of resources (provider and patient) for tobacco intervention
- Alberta Quits - patient resources
- Consider directing clients to their PCN to ask if they have in-house classes or programs for quitting smoking.
- Also click to view COVID specific resources above, under Psychosocial Resources
- 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
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 groups for 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)
- I Challenge Diabetes
- Find possible translated materials inside topic headings above e.g. Starting Insulin, Hypoglycemia
- Search this page: use "ctrl"+F (pc) or command+F (mac) and type in the language
- 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 is available in over 20 languages
- 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)
- 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
- 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).
- 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)
- See Diabetes Canada Interactive Tools for Vascular Risk Assessment Tool
- AHS list of cardiovascular resources for healthcare providers
- 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
- Canadian Diabetes Educator Certification Board (CDECB)
- 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
- National Aboriginal Diabetes Association (NADA)
AHS: Alberta Health Services
DCC: Diabetes Centre Calgary, AHS
DC: Diabetes Canada (previously Canadian Diabetes Association - CDA)