Diabetes
Pathway

You are newly diagnosed with diabetes, or you have pre-existing diabetes but are looking for further diabetes education or information.

You will be referred, or you can self-refer to the Diabetes Education Center (DEC).

You do not require a family physician to access DEC services.

We are team of diabetes educators, made up of Registered Dietitians and Registered Nurses. We do not have a physician or nurse practitioner in our clinic.

You will be contacted by a diabetes administrator to book an appointment with a diabetes educator.

You also have the option of participating in a nutrition group.

Diabetes educators will provide education, address questions, and support you in managing your diabetes.

For those with a primary care provider, we may be able to order select blood work, adjust insulin, and provide samples of some injectable medications, if applicable and available.

Most often, people are followed by our team every 3 months, but this is individualized based on need.

Your diabetes educators will communicate with your family doctor/nurse practitioner and/or diabetes specialist.

What is Type 2 diabetes?

Let’s set the record straight – you did not “give yourself” Type 2 diabetes.

Diabetes is not caused by eating too much sugar and unfortunately, society often depicts diabetes in a harmful light. There are many reasons why someone might develop diabetes; it depends on the type of diabetes, your family history, genes, as well as your ethnic background and overall health.

Type 2 diabetes is a disease in which your pancreas does not produce enough insulin, and/or your body does not effectively use the insulin it makes due to being resistant to insulin (insulin resistance).

Insulin is a hormone that helps to move the sugar from your bloodstream into your cells where it can be used for fuel/energy. If you do not make enough insulin, or have insulin resistance, sugar (glucose) builds up in your blood and leads to high blood sugars (hyperglycemia).

Click here for more information about type 2 diabetes.

Click here for a short video about diabetes.

How do I know if I have diabetes?

Common symptoms of high blood sugars are:

  • being tired
  • feeling thirsty and struggling to quench thirst
  • urinating frequently

Having one or more of these symptoms can be a clue that your blood sugars are high, and you should talk to your healthcare provider, BUT you may not have ANY signs of having diabetes.

Your doctor can use a few different tests to diagnose you with diabetes, but the most common one is called HbA1c, often just called “A1c”. Diabetes is diagnosed if your A1c is above or equal to 6.5%.
People over 40 should be screened for diabetes every 3 years, and more frequently, and/or earlier if they are at higher risk.

Click here for a short video about the A1c test.

Why do my blood sugars matter?

Keeping your blood sugars in good control can help to prevent complications of diabetes.

These include:

  • eye disease
  • nerve damage and foot problems
  • kidney disease
  • heart disease
  • erectile dysfunction
How do food and exercise help my blood sugar?

What, when and how much we eat can affect blood sugar.

Carbohydrates raise blood sugar the most – starch, fruit, milk and yogurt, and sweets and sugar sweetened drinks are all carbohydrate foods. These foods fuel your brain and body.

Common examples of starches are bread, potatoes (as well as potato chips and French fries), pasta, rice, corn, crackers, and cereal.

Fat, protein, and fiber do not raise blood sugar much and can help to keep blood sugars more stable when eaten with carbohydrates.

Common foods high in protein are meat, fish, nuts and nut butters, eggs, cheese, tofu, beans, and lentils.
Fats include oil, butter, margarine, and avocados. Try to include plant-based fats more often than animal fats.

Fiber is found in vegetables, fruit, and whole grains.

It is important to choose foods from each category to get the nutrients your body needs. Everyone needs different amounts of food, but a helpful guide is the Plate Method (see picture below).

 Image from Canada’s Food Guide.



Tips for Healthy Eating with Diabetes include:

  • Eat at least 3 regular meals throughout the day.
  • If meals are more than 4-6 hours apart, or if you prefer smaller meals, include snacks in between.
  • Limit high sugar foods, such as sweets, pop, juice, jam and honey
  • Eat more high fiber foods, such as whole grains (brown rice, whole grain bread, barley, oats), beans and lentils, and fruit and vegetables.
  • Choose water as your main drink. Plain tea, coffee and sugar free drinks also do not raise your blood sugar.
  • Limit alcohol consumption.
  • Limit fried foods.

Healthy Snack Ideas:
A great snack combination is a healthy carbohydrate source and a protein source. Examples are: a piece of fruit and nuts, Greek yogurt with berries, whole grain toast with nut butter, whole grain crackers with cheese, or whole wheat pita with cottage cheese or hummus.

Click here for a short video about diabetes and nutrition.

Click on the links below for in depth nutrition videos from one of our Registered Dietitians:

https://youtu.be/BUfcSXKuBqw
https://youtu.be/5_sRFmr9Hig

Click on the links below for additional nutrition resources:

Diabetes Canada – Glycemic Index Food Guide
Canada’s Food Guide
Unlockfood.ca – Diabetes


Physical activity is one of the BEST ways to help manage your diabetes and improve your health, but it isn’t always easy to get started or to keep up.
Activity helps your body control blood sugar better, even up to 1-2 days AFTER the activity.

Aim for at least 150 minutes of physical activity per week (or 30 minutes, 5 days per week) for the most benefit. You can start with 5-10 minutes per day and increase the amount gradually.

Include aerobic activities such as walking, running, cycling, playing sports, taking the stairs, playing with your kids, or mowing the lawn.

It is also important to include resistance exercises, such as lifting weights or using resistance bands, 2-3 times per week.

How do I know what my blood sugars are?

You may not need to test your blood sugar at home. This depends on how well controlled your blood sugars are, what medications you are taking, and what type of diabetes you have. Check with your healthcare team to see if blood sugar testing is recommended for you.

Even if you do not test your blood sugar at home, it is important to do regular blood work, including an A1c test. For most people A1c should be tested in the lab every 3-6 months.

Click here for a short video about the A1c test.


 

Blood sugar is the amount of sugar (glucose) in your blood at that specific moment in time. Testing your blood sugar can aid in diabetes management by helping you to:

  • determine if your blood sugar is too low, too high, or in target
  • see how your lifestyle efforts (nutrition, activity, etc.) affect your blood sugar levels
  • see how your diabetes medications affect your blood sugar levels
  • make informed decisions about lifestyle and medication management, together with your healthcare team

There are two main types of devices for checking your blood sugars at home: glucometers and flash glucose monitors/continuous glucose monitors. You can get one of these devices with a prescription, or it may be provided by your physician or diabetes educator.


Glucometers measure blood sugars using a small drop of blood placed on a disposable test strip.

Before using your glucometer to measure your blood sugar, ask your healthcare team the following:

  • How do I use my specific meter?
  • Where should I prick myself to get a blood sample? How much blood do I need for a sample?
  • Where do I dispose of lancets? (the small needle that punctures your skin)
  • How should I keep track of my blood sugar?
  • When and how often you should I test my blood sugar?
  • What should my blood sugar be?

Flash glucose monitors (FGMs) and Continuous glucose monitors (CGMs) are newer devices to measure blood sugar without pricking your finger.

These newer devices use a sensor that is inserted just beneath the skin. It can be scanned by a meter or via Bluetooth with most smart phones. In most cases these monitors allow the user to be alerted if their blood glucose is too high or too low.


 

Examples of these in Canada are Dexcom and Freestyle Libre monitoring systems.

Cost:

Glucometers and test strips are covered for people with diabetes under the following programs:

  • Private drug plans
  • ODB (65 years and over)
  • OHIP+ (24 years and under)
  • ODSP
  • OW
  • Trillium
  • NIHB

See links below to find out how many tests strips are covered annually by government programs:

ODB (includes OHIP+, ODSP, OW, Trillium) Get coverage for prescription drugs | ontario.ca
NIHB https://www.sac-isc.gc.ca/eng/1572896520426/1572896565524

Depending on your coverage and the type of medication you take, a flash glucose monitor/continuous glucose monitor may be covered.


See links below for use of many common glucometers/flash glucose or continuous glucose monitoring systems:

AccuChek Guide meter: https://www.youtube.com/watch?v=9F1vIO10cfI

Contour Next meter:
https://www.youtube.com/watch?v=7s8W4dnsFQQ&t=52s

OneTouch Verio Flex meter:
https://www.youtube.com/watch?v=WFLqUrubid0

OneTouch Verio Reflect meter:
https://www.youtube.com/watch?v=ycu00ef1zcA

Libre 2 meter:
https://www.youtube.com/watch?v=AY7RFB7OzAM

Dexcom G6 CGM meter:

https://www.youtube.com/watch?v=1MRU6_GTEtg
https://www.youtube.com/watch?v=MDPrpSRJI7c

Dexcom G7 CGM meter:

https://www.youtube.com/watch?v=G-ys4476MtE
https://www.youtube.com/watch?v=KLbBidcY4lA

Important note: If you are sick or starting to feel sick, it is even more important that you are paying close attention to your blood sugar. See the “I’m feeling under the weather, what should I do?” section for more information

What is a “good” blood sugar?
For most people with diabetes:

  • A1c (see above) should be 7% or less
  • Fasting blood sugar (in the morning, before eating or drinking) should be 4-7mmol/L
  • Blood sugar should be between 5-10mmol/L 2 hours after meals

Click here for a short video about the A1c test.

BUT your targets are specific to you, so talk to your healthcare provider for your specific targets.

See links under “How do I know what my blood sugars are?” to learn how to use your meter your FGM/CGM.

Oh no, my blood sugar is low! What should I do?
Hypoglycemia (low blood sugar) occurs when your blood sugar drops below 4mmol/L.

Symptoms may include:

  • Shakiness
  • Sweating
  • Light-headedness
  • Nausea
  • Nervousness, irritability, anxiety
  • Hunger
  • An irregular or fast heartbeat
  • Confusion or difficulty concentrating
  • Headache
  • Weakness or drowsiness
  • Looking pale
  • Tingling or numbness of the lips, tongue, or cheek


Severe hypoglycemia
is a blood sugar below 2.8 mmol/L and can cause confusion/disorientation, seizure, or loss of consciousness.


Common causes of a low blood sugar are:

  • Eating less than usual, or not on time
  • More activity than usual
  • Taking too much medication
  • Drinking alcohol

Treatment:
If you’re experiencing low blood sugar symptoms, check your blood sugar immediately. It is important to treat it right away. You may need help from another person if your blood sugar is extremely low.

If you don’t have your meter with you, treat the symptoms anyway. It’s better to be safe!

First, eat or drink a fast-acting carbohydrate (15 grams).

Good options include:

  • 15 grams of glucose in the form of glucose tablets
  • 15 mL (one tablespoon) or three packets of sugar dissolved in water
  • 150 mL (⅔ cup) of juice or regular soft drink
  • Six LifeSavers® (one = 2.5 grams of carbohydrate)
  • 15 mL (one tablespoon) of honey (do not use for children less than one year old)

Next, wait 15 minutes & re-check your blood sugar

If your blood sugar is still low, repeat these steps until your blood sugar is above 4 mmol/L.

If your blood sugar is above 4 mmol/L and your next meal is within an hour, no further action is needed.

If blood sugar is above 4 mmol/L and your next meal is over one hour away—or you will be physically active—eat a snack, such as half of a sandwich or some cheese and crackers (something with 15 grams of carbohydrate and a protein source).

If your blood sugar remains below 4mmol/L despite treatment at home, please seek medical attention.

Click here for more information about treating a low blood sugar.

Click here for a short video demonstrating how to treat a low blood sugar.


Driving Guidelines:
If you take insulin and/or an insulin secretagogue (such as gliclazide MR) and intend to drive:

  • Consider testing your blood sugar before driving.
  • Always keep an emergency supply of fast-acting carbohydrate (such as dextrose tablets/juice boxes) in your car, within easy reach.
  • Keep your blood sugar testing supplies with you while driving.
  • Do not start driving if your blood sugar is less than 4mmol/L. If you do have a blood sugar below 4mmol/L before driving, treat with 15g of carbohydrate and test again 15 minutes later. Do not start driving until your blood sugar is above 5mmol/L.
  • If hypoglycemia occurs while driving, stop the vehicle in a safe location, remove the keys from the ignition, and treat the low blood sugar.
  • Consider waiting 40 minutes after recovering from a low blood sugar before driving.

Click here for more information about driving safety drive safe with diabetes.

My blood sugar is too high, what should I do?

Hyperglycemia (high blood sugar) affects people with diabetes. Several factors can play a role in hyperglycemia in people with diabetes. They include food and physical activity, illness, and some medications. Skipping or not taking enough insulin or other diabetes medications can also cause hyperglycemia.

Symptoms of hyperglycemia can develop slowly over several days or weeks. The longer blood sugars are high, the more serious symptoms may become. People who have had type 2 diabetes for a long time may not have hyperglycemia symptoms.


Early symptoms of hyperglycemia include:

  • Increased thirst and/or hunger
  • Frequent urination (peeing)
  • Headache
  • Blurred vision


Effects of long-term hyperglycemia include:

  • Fatigue
  • Weight loss
  • Genital yeast infections
  • Skin infections
  • Slow-healing cuts and sores

Talk to your healthcare provider about how to manage short or long-term high blood sugars. Make sure to drink extra water or sugar free fluids to help replace fluid losses through urine.

Important: If you are drowsy or disoriented or if blood sugars continue to rise with no known cause, seek medical attention.

How can medication help my blood sugar?
There are many medications that are used to help control your blood sugar. Many are pills, taken once or multiple times a day, and some are injections. Diabetes medications work in different ways in your body, and it is common to be on more than one.

It is important to remember that taking diabetes medications is not a failure on your part, but that your body may need extra help controlling blood sugars.



Metformin
helps slow sugar release from your liver and helps your body use insulin. It does not cause low blood sugar or weight gain and is taken 1-3 times daily with meals. It is often the first medication prescribed for people with type 2 diabetes.

Click here for more information about this drug class:
Medication_List_EN.indd (diabetes.ca)



Diamicron MR and Glyburide
“squeeze” the pancreas to put out more insulin. They are pills that are taken in the morning (Diamicron MR) or twice daily (Glyburide) and work all day long. Risks include low blood sugar and weight gain with these medications.

Click here for more information about this drug class:
Medication_List_EN.indd (diabetes.ca)



Januvia, Trajenta and Onglyza
are pills that help the incretin hormones last longer in the body. Incretin hormones help the body produce insulin, only if needed, and reduce sugar being released from your liver. They do not cause low blood sugar or weight gain and they are taken once daily.

Click here for more information about this drug class:
Medication_List_EN.indd (diabetes.ca)



Jardiance, Forxiga and Invokana
are pills that help lower your blood sugar by causing you to pee out the extra sugar. They only work if your blood sugar is above a certain level, so they do not cause low blood sugar. They do not cause weight gain and may result in some weight loss. They also provide kidney & heart protection.

Click here for more information about this drug class:
Medication_List_SGLT2_EN.indd (diabetes.ca)



Ozempic, Mounjaro, Trulicity and Victoza
are medications that are taken by injection. Victoza is taken daily, and the others are once weekly. They increase the amount of incretin hormones in your body. This helps the body produce insulin, only if needed, and reduces sugar being released from your liver. They do not cause low blood sugar. They can cause weight loss by slowing down digestion and keeping you feeling fuller, longer often resulting in smaller food portions. Ozempic and Trulicity also provide cardiovascular protection. Rybelsus is a pill form of Ozempic that is taken daily.

Click here for more information about this drug class:
Medication_List_EN.indd (diabetes.ca)



Insulin
is taken by injection and can be once daily or multiple times a day. It helps to increase the amount of insulin in your body for a specific time. It can cause low blood sugar and weight gain.

It is important to know that you may need to stop taking some medications for a short time if you become ill or are having a medical procedure. Below is a guideline for illness and you can speak with your health care provider about any medication concerns for planned medical procedures.

Stay safe when you have diabetes and are sick or at risk of dehydration.

I am starting insulin, what does that mean?
Type 2 diabetes can often be managed with lifestyle changes and non-insulin medications. It is a progressive disease, however, and over time many people with type 2 diabetes eventually need insulin to manage their blood sugars.

Injected insulin is designed to replace the insulin your body normally makes.

Some people feel nervous or guilty about starting insulin – that’s ok! It is important to remember that using insulin can help improve your blood sugars and help prevent complications of diabetes.

Your healthcare provider can help you feel more comfortable about taking injections by providing education before starting and support you once you start using it.

Depending on your needs, you might start on one or more injections per day. Your healthcare provider will work with you to find the treatment that works best for your lifestyle and to manage your blood sugars. They will help you decide how much to take, and when.


Types of insulin:
There are different types of insulin – the 2 main types used in Type 2 diabetes today are:

  • Basal insulin (aka long-acting insulin) – usually taken once per day and works in your body all day and night to keep your blood sugars stable.
  • Bolus insulin (aka short-acting insulin) – taken with one or more meals, helps your body absorb the sugar from the food you eat.

How to take insulin:
There are different methods of injecting insulin, but it is most often taken with “insulin pens”.

Click here for a video demonstrating how to inject insulin:
How to inject with your injection pen?


 

Usually, people are advised to take a specific amount of insulin to start. Insulin is measured in “units.” For example, you may be told to take 10 units (or 10u) of basal insulin once per day at bedtime OR 4 units (or 4u) of bolus insulin 10 minutes before each meal.

Because everyone needs different amounts of insulin, your healthcare provider will teach you how to change your dose as needed to get your blood sugars in target range.

If you take bolus insulin, you may be taught how to adjust your dose depending on what your blood sugar is, and/or what you are eating.

The main side effect of insulin is hypoglycemia (low blood sugar), so it is especially important when you start insulin, to understand what a low blood sugar is, how to prevent it, and how to treat it.

See the “Oh no, my blood sugar is low! What should I do” section for more information.


See additional video links below for information about storage, injection site rotation, and travelling with insulin.

Storage: How to store your injection pen?
Site Rotation: How and when to rotate injection sites?
Travel: How to travel with your injection pen?

I am feeling under the weather, what should I do?
When you are not feeling well it is important to continue to take your medications and insulin. If you are unable to eat and drink as normal and/or have vomiting or diarrhea, there may be some medications you need to temporarily stop. This linked handout below will show you which medications to temporarily stop. Do not stop taking insulin during illness unless your blood sugar is too low. In fact, you may require more insulin during illness.

Diabetes Canadastay safe when you have diabetes and are sick or at risk of dehydration

If you are unwell, you may need to test your blood sugar more often. Your blood sugar can help you decide what type of fluids you should be drinking. Some people have high blood sugars when ill, even if they are not eating. This is because when your body releases hormones to fight the illness, and those hormones can raise your blood sugar levels. In this case you would want to consume carbohydrate-free liquids like broth, water, or diet drinks. If blood sugars are normal or low, drink carbohydrate-containing fluids such as juice, sports drinks, and popsicles.

Skip to content