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Copyright © 2025 The Children and Young People’s Wales Diabetes Network (CYPWDN), Cardiff and Vale University Health Board

In Type 2 diabetes the body is still able to make insulin, but it isn’t able to use it as well. This is known as insulin resistance.

This means the pancreas needs to keep making more insulin in order to control blood glucose levels. Eventually, the cells in the pancreas can become worn out and can stop making insulin. Type 2 diabetes can often be managed with lifestyle changes and medication but, as the condition progresses, many people will end up needing to inject insulin as well.

Claire Baker
Dietetic lead and programme lead for SEREN
Yvonne Davies
Nursing lead for SEREN
Dr Nirupa D'Souza
Medical co-lead for SEREN
Dr Rebekah Pryce
Medical co-lead for SEREN

Checking your blood glucose levels frequently is also beneficial in the longer term as it helps you and your diabetes team to change your insulin doses and ratios.

 Blood glucose levels are measured in millimoles per litre, which is written as mmol/l. Your diabetes team will help you learn how to measure your blood and ketone levels.
If you break down the word (Hyperglycaemia), you can see what it means:

Hyper = “high”       Glyc = “glucose”       Aemia = “blood”

So rearranging these words gives “high blood glucose”

 At the end of this section you will:

    • Understand the principles of healthy eating for people with Type 1 diabetes
    • Consider the different aspects of their own family’s mealtimes
    • Recognise the benefits of mindful eating
    • Recognise the three main nutrients: protein, fat, and carbohydrate and why they are important
    • Have an awareness of the different sources of carbohydrates in their diet

 

SEREN-hypo-treatment-sheet-pens

    Foods containing carbohydrate

    Foods containing carbohydrate

    Starting-blood-glucose-level-mmoll-42-x-70-cm-1

    Annual assessment clinic

    Your team wants to give you the best standard of care, for you to look after your diabetes, and keep you healthy and well. They will carry out checks every year which will help to spot any changes early and treat them before they become a problem.

    These are set by an organisation called NICE and are known as the 7 care processes.

     

     At the end of this section you will:
    • Recognise which foods and drinks contain carbohydrate
    • Understand the benefits of carbohydrate counting
    • Understand the principles of insulin dose adjustment
    • Use a range of information to calculate the carbohydrate value of food and drinks

    Some meals contain small amounts of carbohydrate and require less insulin, whilst other meals contain larger amounts of carbohydrate and therefore require more insulin.
    Remember you take 2 types of insulin:
    • The long acting insulin, which you take once or twice a day, works for up to 24 hours and is called the basal insulin (also known as your background insulin).
    • The fast acting insulin, which you take with food, is called the bolus insulin. This is the insulin that you adjust to correct your blood glucose level and match the amount of carbohydrate in your food and drink.
    • SEREN ACTIVE Information for coaches and teachers
    • Sport Wales (www.sports.wales)
    • Adult members of the family can refer to National Exercise on Referral Programme
    • Local sport clubs
    At the end of this section you will:
    • Understand what Type 1 diabetes is
    • Understand what happens in a person who does not have Type 1 diabetes
    • Understand how insulin works
    • Recognise the signs and symptoms of Type 1 diabetes
    • Understand the checks carried out at diagnosis
    At the end of this section you will:
    • Understand what Type 1 diabetes is
    • Understand what happens in a person who does not have Type 1 diabetes
    • Understand how insulin works
    • Recognise the signs and symptoms of Type 1 diabetes
    • Understand the checks carried out at diagnosis
    How we can continue to support you?
    • Keep in touch with us and help us understand how to help you and your family
    • Help us to get to know you and what is important to you in your life now and in the future
    • Share your diabetes data with us if you feel happy to – by uploading your devices at home
    • Let us know if things are tricky so we can help, or find others to support you
    • Come to all of your appointments where possible and let us know if you aren’t able to come so that we can rearrange them
    • Let us know if we’re not quite getting it right, for example, if you need more help with diabetes management

    Hypoglycaemia


    Hypo
     = “low” Glyc = “glucose” Aemia = “blood”
    So rearranging these words gives “low blood glucose”

     

    There are three different types of hypos. 

    Mild: This is when the blood glucose falls below 4mmol/l and is easily corrected. It is important not to ignore mild hypo symptoms and to take action straight away.

    Moderate: This is when the blood glucose falls below 3mmol/l. You may require help from someone else as your brain will struggle to make the right choices when your blood glucose level is very low.

    Severe: If you have a severe hypo you will not be aware of it and you will require help from your family. Severe hypos are extremely rare and your family will be taught how to manage them.

     

     At the end of this section you will:
    • Understand what to expect from the diabetes team
    • Understand your role in looking after your diabetes
    • Be aware of how clinic is set up
    • Understand the different care processes and why they are carried out
    • Know that there are a range of SEREN education modules

    If you have a severe hypo you will not be aware of it and you will require help from your family. Severe hypos are extremely rare and your family will be taught how to manage them.

     

      This is when the blood glucose falls below 3mmol/l. You may require help from someone else as your brain will struggle to make the right choices when your blood glucose level is very low.

       

        This is when the blood glucose falls below 4mmol/l and is easily corrected. It is important not to ignore mild hypo symptoms and to take action straight away.

         

          Hypoglycaemia

          If you break down the word hypoglycaemia, you can see what it means:
          Hypo = “low” Glyc = “glucose” Aemia = “blood”

          So rearranging these words gives “low blood glucose”

           

          • Builds confidence and social skills
          • Develops co-ordination
          • Helps to maintain a healthy weight
          • Strengthens bones and muscles
          • Improves sleep
          • Improves concentration and learning
          • Improves health and fitness
          • Makes you feel good
          • Helps the body use insulin more efficiently

          (reference UK Chief Medical Officer’s Physical Activity Guidance)

          https://serendiabetes.com/wp-content/uploads/2021/12/hba1c-end-cardmov-2_ui46ANt0.mp4

          Fear of needles

          You may now have realised that injecting insulin will be a routine part of your life. Living with a fear of needles can make living with diabetes really tricky.

          If you find giving your insulin injection a struggle your team can help and may offer suggestions or injection aids.

          They can give you a self-help book written by a clinical psychologist called ‘Talking Type 1…Not OK with needles?’.

          Timing of fast-acting insulin dose

          This image has an empty alt attribute; its file name is new-graph-2.png

           

          Traditionally it was recommended to give fast acting insulin 15 to 20 minutes before food. However, the newer ultra fast acting insulins can be given just before food.
          • Fast acting (bolus) insulin (e.g. Novorapid/ Humalog) should be taken 15-20 minutes before food
          • Newer ultra fast insulin (e.g. Fiasp) can be taken just before food
          • Delaying your bolus insulin can result in a glucose spike (see graph above)
          Bolus Insulin

          The fast acting insulin, which you take with food, is called the bolus insulin

          Basal Insulin

          The long acting insulin, which you take once or twice a day, works for up to 24 hours and is called the basal insulin (also known as your background insulin)

           At the end of this section you will:
            • Further understand the link between carbohydrate intake and insulin dose
            • Recap on basal and bolus insulin doses
            • Understand what an insulin to carbohydrate ratio (ICR) is
            • Learn how to calculate insulin doses using ICR
            • Understand what a correction ratio, or insulin sensitivity factor (ISF), is
          At the end of this section you will:
          • Understand how to carry out a blood glucose check and why it is important
          • Recognise the different times when it can be useful to check blood glucose
          • Be aware of the different blood glucose targets for different times of the day
          • Understand how to perform a blood ketone check
          • Understand what the ‘honeymoon period’ is
          • Recognise that there are alternative ways of measuring glucose
          • Understand what HbA1c is and the target value
           At the end of this section you will:
                • Understand what wellbeing is and why it is important
                • Understand that all emotions are normal
                • Recognise the different ways to support wellbeing
                • Develop a coping plan
           At the end of this section you will:
              • Understand how illness affects blood glucose levels and can lead to the production of ketones
              • Recognise the symptoms of Diabetic Ketoacidosis (DKA)
              • Understand the importance of following sick day rules if unwell
              • Recognise how to respond to blood glucose and ketone levels
              • Understand how to manage low blood glucose during illness
           At the end of this section you will:
              • Recognise the importance of physical activity
              • Understand the possible effects of exercise on blood glucose
              • Understand that you will need to make a plan for managing blood glucose during exercise
           At the end of this section you will:
            • Understand what hypoglycaemia (hypo) means
            • Recognise the possible causes of hypoglycaemia
            • Recognise the signs and symptoms of hypoglycaemia
            • Understand that glucose is required to treat a hypo and that the recommended amount varies according to body weight
          At the end of this section you will:
          • Understand the types of insulin: basal and bolus
          • Understand how to calculate starting insulin dose
          • Understand how to correct a high blood glucose
          • Understand how to give an insulin injection
          • Understand where insulin can be injected
          • Understand why it is important to rotate injection sites
           At the end of this section you will:
          • Understand that there are a range of emotions that can be felt following a diagnosis of diabetes
          • Understand that there are different diabetes team members and roles
          • Share information about themselves
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