• Onset refers to when the insulin starts to work.
• Peak refers to when the insulin is working its hardest.
• Duration refers to how long the insulin works.

The chart below describes the insulin action of the types of insulin most commonly used in treating diabetes.

All insulin's can be delivered with a special insulin syringes with different needle sizes or through flexpens, optipens, disposable and non-disposable ones.

Insulin pump therapy helps to improve your blood sugar levels and maintain A1c targets, reduce the risks of long-term complications. It also helps to make adjustments at any time to keep your blood glucose levels in control.

It's a small, handheld device about the size of small cell phone; it's not implanted and therefore does not require surgery.

It will deliver insulin through plastic tube thinner than spaghetti, and at the end of the tubing there will be a soft plastic cannula which will be placed under the skin.

With an insulin pump, you can adjust the volume of insulin anytime, based on your own body's needs by simply pressing a few buttons.

The system needs to be changed every 3 days for protection of the skin and prevention from infection.

Continuous glucose monitoring technology adds a new, supplementary dimension to selfmonitoring, as it provides patients with real-time as well as trend information about glucose levels. The sensor is a small device that you insert in the tissue beneath your skin. It measures the glucose level of the tissue beneath your skin while the blood glucose meter measures the glucose in your blood. The sensor values give you an idea of what your glucose level is without doing a finger stick blood glucose check.

Because your blood glucose meter and the sensor will measure the glucose in different body fluids, these values may differ. Most of the time, you will find that the sensor readings are within 20% of your meter readings. When your glucose level is rapidly changing, there may be differences of more than 20%.

Calibration is very important for best system performance. Suggested times for calibration:

• 4 times a day, best times are before meals and at bedtime
• minimum is twice/day, every 12 hours
• when your blood sugar is stable

The sensor system will give you high and low alarms.

High alarm will go off if your sensor glucose reads at or above the high value you have set.

Low alarm will go off if your sensor glucose reads at or below the low value you have set.

Training sessions for sensor management including managing alarms, insertion techniques all are available in our center by certified team.

Home blood glucose monitoring empowers people with diabetes to understand and manage their own glycemic control which is essential in lowering HbA1c levels. Self blood glucose monitoring devices are easy and harmless. Our team will advise and teach you the methods, techniques and frequency of measurement.

By monitoring your blood glucose levels, you will take an active part in managing your diabetes and your healthcare professional can adjust your treatment better according to your glucose levels (recommending changes in diet, exercise and medications)

Measuring glucose level using blood is more accurate than urine testing, it's easy and harmless, and your healthcare professional will advise you about the best method of measuring your glucose levels based on your needs.

Not everyone with diabetes needs to carry out the same number of glucose tests. This depends on your type of diabetes, your treatment and your level of physical activity. For people treated with insulin, frequent glucose monitoring is important.

Don't forget to record the results in your logbook. Always bring the book when visiting your healthcare professional, and ask to talk through your recent results.

If any result is high or low, try to write down at the time why you think it happened. Did you eat more or less? Did you do more exercise? Were you ill? Was there any thing else that could have affected the result?

The above recommended blood sugar levels are according to the American Hospital Dubai, Diabetes Center of Excellence.

Once a year, ask your healthcare professional to check your glucose meter to make sure its working properly.

Continuous glucose monitoring system provides continuous awareness of your current glucose level 24 hours a day, preventing lows and highs. It will allow you to clearly identify personal patterns and take actions to treat your highs and lows.

• Before and after exercise
• If you suspect your blood sugar level may be low
• If you have fever
• If you are ill or thrown up
• If you have diarrhea

Diabetes nurse educators provide excellent patient care, perform health and learning assessments, develop and update your individualized self-management education plan.

They will teach you about Diabetes and management skills, including:

• What is Diabetes and its types
• Blood Glucose Monitoring
• Sick Day Management
• Signs and symptoms of Hypoglycemia and its prevention
• Signs and symptoms of Hyperglycemia and its prevention
• How to treat your diabetes when traveling across time zones
• How to treat Hypo and Hyperglycemia
• Urine testing for Ketones
• Foot care
• How to begin an intensive diabetes program or use an insulin pump, sensors and other new technologies
• Reducing risks for complications
• Living healthy with diabetes
• Self management
• Personalized approach

The team of Diabetes Center of Excellence organizes 3 or 4 support group meetings yearly to different age groups. These meetings can be indoor (hospital) or outdoor activities.

The purpose of these meetings is to help patients and families to deal with this chronic condition, to meet others, express their fears and concerns. We believe this kind of help can be value for them and their children, as well as for the whole family.

The center has two qualified dietitians that can translate scientific information about nutrition and diabetes into understandable and practical dietary advice. An adult needs to consult a dietitian to help him adjust his normal eating habit and lifestyle with his diabetes management plan and goals. A child needs to see a dietitian periodically to ensure that his nutritional intake is meeting his growth needs and diabetes goals.

The other form of diabetes that affects women is gestational diabetes, which develops during pregnancy. Mirroring the epidemic of type 2 diabetes, rates of gestational diabetes are also on the rise in the United States, particularly in the African American, Hispanic, American Indian and Alaskan native communities.

Gestational diabetes usually develops between the 24th to 28th weeks of pregnancy and affects about four percent of all pregnancies. This condition typically ends after birth; however, these women have a 50 percent risk of developing type 2 diabetes over the next 10 to 20 years.

Factors that increase a woman's risk of developing gestational diabetes:

• Obesity
• Previous history of gestational diabetes
• Sugar in the urine
• A parent or sibling with diabetes
• Polycystic ovary syndrome or other glucose metabolism problem
• Previous pregnancy in which the baby weighed more than nine pounds at birth

If you fall into any of these categories, you should be screened early, within the first trimester, for gestational diabetes. Women who find out that they have gestational diabetes should see a nutritionist and diabetes nurse educator, as diet is the first line therapy.

With careful diabetes management, women can and do have successful pregnancies and healthy babies.

Through the centre you can access care for endocrine and other diseases as well such as:

• Thyroid diseases
• Pituitary gland
• Adrenal gland
• Endocrine hypertension
• Endocrine tumors
• Male and female infertility
• Hirsutism
• Hormone disorders
• Sexual dysfunctions
• Polycystic ovaries
• Lipid disorders
• Calcium and mineral disorders
• Metabolic bone diseases
• Osteoporosis