How to Manage Type 1 Diabetes

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parts

1Starting Insulin Therapy

2Making Lifestyle Modifications

3Educating Yourself

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Tips and Warnings

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Article Summary

Juvenile diabetes, now known as Type 1 diabetes or insulin dependent diabetes mellitus (IDDM), is a disease in which the pancreas, which normally produces insulin, stops producing insulin. Insulin is important because it's a hormone that regulates the amount of glucose (sugar) in the blood and helps to transfer the glucose to your cells for energy. If your body isn't producing insulin, this means that the glucose stays in your blood and your blood sugar level can become too high, making you sick. Though there is no cure for Type 1 diabetes, you can learn to effectively manage your diabetes through a combination of insulin therapy, lifestyle changes, and education about diabetes.

Steps

Part 1

Part 1 of 3:

Starting Insulin Therapy

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   Learn the basics of insulin therapy. For most diabetics, physicians recommend insulin combinations containing types of insulin with different durations of action. In practice, this usually means that a combination of long-acting and rapid-acting insulin is considered safe and most appropriate. Rapid-acting insulin is given before meals to counter the rise of blood glucose after eating and longer-acting insulin is given later on to maintain normal glucose levels and prevent hyperglycemia.

   • There are four classifications of insulin, all depending on the duration of action: rapid, short, intermediate and long-acting. Glulisine, lispro, and aspart insulin are rapid-acting, regular insulin; a preparation of zinc solution is short-acting; neutral protamine Hagedorn (NPH) is intermediate-acting; glargine and detemir are long-acting insulins.
   • Insulin is available in various combinations and dosages commercially. Your doctor will prescribe the right insulin therapy based on your particular condition.
   • There are several different brands for each type of insulin, such as Humalog, Humulin N, Novolin, Levemir, and Lantus.
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   Consider the different possible insulin therapy regimens. Currently, there are four options:

   • Split or twice-daily regimen: This includes 2/3 of daily your insulin requirement administered before breakfast and 1/3 before supper. NPH with rapid or short-acting insulin is generally used according to individualized dose calculations.
   • Split or mixed variant: This involves NPH and rapid or short-acting insulin before breakfast, followed by rapid or short-acting insulin before supper, and plain NPH before bedtime. This regimen prevents early morning and nighttime hypoglycemic episodes.
   • Multiple daily injections or (MDI): This includes one or two daily doses of long-acting insulin such as detemir or glargine in addition to rapid-acting insulin before meals, adjusted according to the carbohydrate intake during every meal and then blood glucose levels after eating.
   • Continuous subcutaneous insulin infusion (CSII): This involves a continuous infusion of rapid-acting insulin through a battery-operated insulin pump over 24 hours at varied rates and insulin boluses before each meal. Additional doses may be required if blood glucose levels are higher than desired. These pumps are very convenient; they can be paused up to an hour or re-programmed as required. Patients themselves can easily adjust the insulin dose according to the carbohydrate content of the meal and their caloric intake.
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   Be aware of the complications of insulin therapy. While taking insulin you are always at risk of developing the following complications:

   • Hypoglycemia - Trouble starts when the blood glucose falls below 54mg/dl. At this level, you may feel palpitations, an increase in heart rate, nausea, vomiting, excessive sweating and trembling. If these symptoms are ignored and blood glucose falls below 50mg/dl, you'll likely experience excessive tiredness, headache, difficulty in speech, irritability, and confusion. Further decline can lead to unconsciousness and seizures. Insulin-dependent individuals should carry some glucose or juice with them since even 15 gm of glucose can neutralize the hypoglycemia and make you feel better.
   • Insulin allergy - This may range from pale red rash at the injection site to a hypersensitive life-threatening reaction called anaphylaxis (though this is quite rare). Allergic reactions are more common with human insulin, the name given to the synthetic insulin grown in a laboratory to mimic the insulin in humans; usually these reactions can be easily managed with antihistaminic drugs or corticosteroids.
   • Insulin resistance - Since the advent of highly purified varieties of insulin, this condition is rare. In the past, antibodies could form against the insulin, making it resistant and, as a result, heavier doses in higher increments were required.
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   Take regular doses of insulin. Juvenile diabetics need insulin injections or can take insulin via a pump; oral medicines are not an option. Self-monitoring of blood glucose levels along with multiple injections of insulin (to balance hyperglycemia) is mandatory for the effective day-to-day management of diabetes.

   • For the injections, you'll use a fine needle and syringe or, alternatively, an insulin pen to inject the drug beneath the skin. Needles come in a variety of sizes so you can choose what size is most suitable and comfortable for you.
   • For an insulin pump, you wear a device about the size of a cellphone on the outside of your body. A tube connects the insulin to a catheter inserted beneath the skin of your stomach. The pumps are programmed to dispense the appropriate dosage of insulin. You can also get wireless pumps.
   • Your insulin requirement is calculated based on individual criteria such as weight, age, carbohydrate count during each meal, exercise, and hypoglycemic attacks due to low sugar levels.
   • Your total daily dose of insulin may vary from 0.5 to 1 unit/kg/day, depending on your particular age, gender, body mass index and mode of therapy (intermittent or continuous). Each case should be individualized. Consult your doctor and/or a diabetes specialist to determine the appropriate dose and mode of administration for you.
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   Know how and when to monitor your blood glucose levels. Optimal diabetic control requires frequent self-monitoring. All patients with Type 1 diabetes should learn how to self-monitor and record their blood glucose levels at home with glucose monitors, so that they can adjust their insulin doses accordingly. This is a regimen that needs to be discussed with your doctor.

   • You should check and record your blood glucose level at least four times daily or more; the American Diabetes Association recommends testing it before eating, sleeping, exercising, and driving.
   • To test your glucose levels, you can use a continuous glucose monitor (CGM), which attach to the body and use a fine needle under the skin to assess your blood glucose level every couple of minutes. This is one of the newest advances in blood glucose monitoring. Examples include the FreeStyle Libre, a flash glucose monitoring system, and Dexcom.
   • You can, however, also use a more traditional blood glucose meter, in which you insert a test strip into a small device. You then prick a clean fingertip with a special needle so that you get a small drop of blood. Press the test strip against the blood and wait for the blood glucose reading to appear on the screen.
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   Know what appropriate blood sugar levels are. With Type 1 diabetes, you'll be constantly monitoring your blood glucose levels, making sure your body is operating properly. To do this properly, you'll need to be able to identify appropriate from excessive or low blood sugar levels. Here's what you need to know:

   • In your day-to-day life and monitoring, the goal is to keep blood sugar levels before eating in the range of 70-130 mg/dl. After eating, you want to see blood sugar levels should below 180mg/dl.
   • In the HbA1c test, your blood levels of glycosylated hemoglobin should be less than 7%.
   • However, it's important to note that the guidelines of the American Association of Clinical Endocrinologists (AACE) suggest that the blood sugar level targets should be individualized according to the patient’s specific circumstances (age, occupation, medical conditions, family support, etc.). For instance, if the patient has associated heart disease, repeated episodes of hypoglycemia, some mental illness or a substance abuse problem, he can be given higher targets, such as a glycosylated hemoglobin level up to 8% and pre-meal glucose levels of 100-150 mg/dl.
   • Tight control—keeping your blood glucose levels as close to that of a non-diabetic—is highly effective in preventing complications.
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Part 2

Part 2 of 3:

Making Lifestyle Modifications

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   Understand the importance of prevention. Getting diagnosed with Type 1 diabetes is going to seem unfair. But if you place high value on prevention — even after diagnosis — you can navigate your life with diabetes relatively easily. Regular care and treatment of the condition can prevent the development of complications and can reduce its progression.

   • As the old saying goes, "An ounce of prevention is worth a pound of cure." With insulin therapy, a monitored diet, and the right lifestyle habits, you can learn to live with your diabetes and prevent the development of major complications, such as heart and blood vessel disease, nerve damage, kidney damage, and eye damage (including blindness).
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   Plan and schedule your meals. For better control of sugar levels, the amount and frequency of each meal should be constant and it should be in balance with your insulin doses. What you eat and when you eat play a vital role in avoiding increased blood sugars as well as hypoglycemia, which is caused by a deficiency of glucose in the bloodstream.

   • Always have small meals at intervals of two to three hours to avoid hypoglycemia. Distribute your daily calorie requirement, such that you consume 20% of it for breakfast, 35% for lunch, 15% at tea-time (late afternoon), and 30% for dinner.
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   Eat a healthy diet. An ideal diabetic diet is low in calories, sugars, cholesterol, and carbohydrates. Here are some important tips:

   • Have six to eight ounces of protein daily. A three-ounce serving is about the size of a deck of cards, so try to have two of these or thereabouts in your diet each day. Eggs, lean meat, skinless chicken, fish, soya beans, tofu, seeds, legumes, milk and milk products are some recommended protein-rich food items.
   • Have more of fiber-rich foods, such as whole oats, prunes, green leafy vegetables, spinach, watercress, celery, kidney beans and berries.
   • Avoid processed foods with added sugars and preservatives like jams, syrups, ice cream, cookies, pastries, bread, etc.
   • Replace refined carbohydrates, such as processed flour, white bread, and polished rice, with healthy complex carbohydrates like whole wheat breads, whole grains and brown rice. You can have fruits such as papayas, apples, bananas, and pears.
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   Take high-quality nutritional supplements. Due to soil depletion, plants contain less nutrients than they used to. Even if soil was not depleted of nutrients, it can be difficult to reach therapeutic doses of vitamins and minerals.

   • Many type 1 diabetics are deficient in vitamin D3. Whether or not you are deficient, you should regularly take a few thousand IU of vitamin D3 daily regardless of age. This is a safe therapeutic dose and is more effective than current RDAs. The pancreas has vitamin D3 receptors and the vitamin can even protect and repair beta cells. As well, vitamin D might even prevent type 1 diabetes.
   • The antioxidant vitamin C can help protect against diabetes complications and improve wound healing, which are just a few of its benefits. You cannot poison yourself with vitamin C, but doses over 2,000 milligrams can result in side effects, such as diarrhea. Consider doses of at least 1,000 milligrams.
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   Exercise. Exercise in moderation is good for improving insulin effectiveness, since it helps your body's metabolism and utilization of fats and carbohydrates. Try walking for half an hour in the morning and evening and seeking out active leisurely activities, like dancing, yoga, swimming, or hiking. You should strive to get 150 minutes of moderate aerobic exercise as well as engage in resistance exercise (like weight training) three times a week.

   • However, it's important to avoid strenuous exercises. Overexertion can precipitate hypoglycemia and be very dangerous. Be sure to only increase your exercise routines gradually to monitor what your body can handle. You should also consult your primary care physician before beginning any exercise regimen.
   • Drink lots of fluids to keep yourself well hydrated, and monitor pre-workout and post-workout sugars. Since exercise reduces blood glucose levels, you may have to reduce your pre-workout insulin by 20-30%. Insulin is more readily mobilized from a site of injection compared to normal insulin production from the organs, so it's doubly important to keep an eye on it. Again, it's best to ask your doctor for tips on how to manage your blood glucose levels while working out and sweating.
   • Insulin-dependent patients who need to do some strenuous activity should take insulin injection at a site away from the muscle involved in the activity.
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   Make hygiene a priority. Personal hygiene is very important in those with Type 1 diabetes, especially the hygiene related to the skin, teeth, and feet. Infections in these areas can lead to an increase in insulin requirement, so your dose may need to be adjusted. But as long as you stay hygienic and maintain general good health, infections should be kept at bay.

   • Have a bath or shower after any activity that makes you sweat. Make efforts to keep your armpits, back, genital area and feet clean and dry.
   • Inspect your feet regularly and treat any cuts and blisters immediately. Make sure your feet are receiving adequate blood flow and give them a regular massage.
   • Apply moisturizers in cases of dry skin and itching to avoid skin infections due to scratching.
   • Attend to any boils, acne or skin infections promptly. You can clean cuts and wounds with disinfectants and oxum solution at home, but in the case of swelling, pus or fever, visit your doctor for evaluation and possible treatment.
   • Type 1 diabetes normally results in repeated vaginal yeast infections in girls and general skin infections. Avoid vaginal infections by wearing clean, cotton underwear and keeping the vaginal area clean and dry. Change out of sweaty clothes and bathing suits immediately to avoid bacteria growth in the vaginal area.
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   Quit unhealthy and addictive habits. Quit smoking, alcohol, tobacco chewing, substance abuse and any other type of addiction. Any consumption, inhalation or exposure to these things can cause unpredictable changes in blood glucose levels. It's best not to risk it.

   • Further, alcohol, smoking, and other drugs can have adverse effects on your physical and mental health beyond aggravating your diabetes. Consider quitting these drugs and substances as beneficial for your overall health and well-being.
   • You don't need to quit alcohol, so to speak, but you should cut back as it can cause either high or low blood sugar, depending on how much you have consumed and what you have eaten. If you drink, only do so in moderation (one to two drinks per day) and alongside a meal.
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   Reduce stress. Managing your stress effectively is key to coping with diabetes in a healthy manner. This is because the hormones your body releases in response to stress can prevent the effective functioning of the insulin you are taken. This often creates a cycle of frustration and stress that can have serious repercussions for your diabetes.

   • Schedule in some downtime in your life, where you can do something you enjoy, whether that be reading, spending time with family, or gardening.
   • Try relaxation techniques, including breathing exercises, yoga, meditation and progressive relaxation therapy. A good breathing exercise to try involves sitting or lying down with all of your limbs uncrossed. Take in a deep breath and then push out as much air as you can until you are completely empty. Breathe in and out again and deliberately relax your muscles while exhaling. Do this for at least 10 minutes once a day.
   • Another way to relax involves moving your body. You can loosen yourself up mentally through physical movements such as circling, stretching, and shaking.
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   Get regular medical checkups. Diabetes is a disease that can lead to other debilitating conditions if not properly monitored and treated. In addition to your healthy lifestyle, stay up to date in scheduling and attending medical appointments that assess how your body is coping with diabetes and act as necessary precautions against the development of complications.

   • Apart from your daily blood sugar tests, you will require HbA1c testing two to four times annually to check for diabetic control. The HbA1c, or glycated hemoglobin, test provides information about your blood sugar levels over the past two to three months by measuring the percentage of blood sugar attached to the hemoglobin in the blood. Hemoglobin is a protein that carries oxygen in the red blood cells. The higher your blood sugar levels, the more sugar will be attached to the hemoglobin. This test is the standard test for diabetes assessment, management, and research.
   • Annual eye examinations and monitoring of your serum creatinine (a chemical waste product produced by your muscle metabolism) levels are needed to screen for diabetic retinopathy, a disease of the retina that can result in impairment or loss of vision, and nephropathy, also known as kidney disease.
   • Annual lipid profiles and blood pressure checks will be necessary four times a year to check for heart diseases.
   • Tetanus vaccines are also recommended due to the increased risk of infections with daily insulin shots and impaired wound healing ability.
   • Keep your immunizations up to date. Get the flu shot every year and potentially also the pneumonia vaccine. The Centers for Disease Control and Prevention also recommends hepatitis B vaccination if you haven't been previously vaccinated and have Type 1 or Type 2 diabetes. It's important to be vaccinated because high blood sugar can cause your immune system to be weaker.
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    Be prepared. Know how to handle hypoglycemia if it strikes, particularly if you are out and about. It's important to realize that hypoglycemia can be life-threatening and that you take steps to prepare yourself in the event that a blood sugar spike occurs.

    • Carry some sugar cubes, candy or juices in your briefcase, backpack or purse, and take them on slightest hint of impending hypoglycemia.
    • Carry a card in your purse or pocket that explains hypoglycemia and its treatment. Be sure to include the phone numbers of your treating physician and family members. If you are confused and dizzy, this helps someone else understand what to do and who to inform.
    • You can also wear a tag or bracelet that identifies you as a diabetic. This can help others identify and help you if needed.
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Part 3

Part 3 of 3:

Educating Yourself

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   Know what Type 1 diabetes really is. In the body of someone with Type 1, the β (Beta) cells of the pancreas cannot synthesize the insulin sufficiently, and Type 1 diabetes is the result.The body produces auto-antibodies, which destroy the insulin-producing Beta cells and sometimes also the Islets of Langerhans, the regions of the pancreas that contain its endocrine cells. If your body isn't producing insulin, this means that the glucose stays in your blood and your blood sugar level can become too high.

   • Type 1 diabetes can technically develop at any age but typically occurs in people under 30 years old and is the most common type of childhood diabetes. Type 1 diabetics requires life-long insulin therapy for survival. Currently, there is no other alternative. However, there is much ongoing research for long-term treatments or even cures, such as an artificial pancreas, and pancreas or islet cell transplants.
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   Recognize the signs and symptoms of Type 1 diabetes. Initially, juvenile diabetes causes such minor complaints that they may be credited to other things. However, the symptoms are typically rapid in onset and should be diagnosed and treated immediately because Type 1 worsens as time goes on and can result in serious health problems, such as renal failure, coma and even death. Visit your doctor if you notice the following symptoms:

   • Increase thirst and frequent urination especially at night
   • Generalized weakness without any reason
   • Weight loss
   • Changes in eyesight
   • Recurrent fungal infections
   • Increased hunger
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   Understand that diabetes is a serious medical condition. Doctors always emphasize the necessity of maintaining tight glycemic control, and that's for good reason. Even a slight spike in blood glucose levels can trigger the button of a good lecture from your physician. This is because the damage can go unnoticed until it is fairly advanced. Because of this, tight glycemic control is mandatory.

   • You may find yourself thinking, “If I am feeling well and my sugar levels are just a bit above normal, then so what?" These are the normal feelings of a diabetic, but they need to be adjusted. Diabetes is a silent killer; high blood glucose levels can harm the blood vessels from inside leading to damage to various organs, primarily the retinas (retinopathy), kidneys (nephropathy) and heart muscles (cardiomyopathy).
   • Give yourself your best chance at a healthy and happy life by acknowledging your illness as a serious medical condition, but one that can be managed with effective medical treatment and lifestyle modifications.
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   Learn to recognize the symptoms of diabetic ketoacidosis. Diabetic ketoacidosis is a very serious complication of diabetes caused when your body produces increased levels of blood acids called ketones as it breaks down fat to use as fuel since there is insufficient insulin production. All patients with Type 1 diabetics should learn the method of testing for urine ketones (high acid levels, not solids) at home with commercially available reagent strips. These strips are the most direct method of testing for the condition since they will tell you if you there are high ketone levels in your urine. However, you can also look for other symptoms of diabetic ketoacidosis, such as:

   • Hyperglycemia, or high blood sugar
   • Excessive thirst
   • Frequent urination
   • Nausea and vomiting
   • Abdominal pain
   • Weakness, tiredness, or vomiting
   • Shortness of breath
   • Blurred vision
   • Difficulty concentrating
     • If you experience any of the above, you should call emergency services so that you can be admitted to hospital and receive treatment. You will need to begin correction doses of insulin while waiting for help.
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   Know the symptoms of hypoglycemia. When on insulin therapy, hypoglycemia can readily develop whenever there is less food intake, vomiting, a missed meal, strenuous exercise, or when the insulin dose is increased. If not treated on time, the individual with hypoglycemia may become unconscious, so it's important to know the signs, which include:

   • Light-headedness
   • Shakiness
   • Dizziness
   • Confusion
   • Sweating
   • Severe headache
   • Blurred vision
   • Fast or irregular heartbeat
   • Note that B-blocker drugs used in some heart disorders like angina pectoris can mask all other symptoms of hypoglycemia, except sweating.
     • If you experience any of the above, eat or drink something with sugar in, such as fruit juice or a sugar cube. Even 15-20 grams of something with sugar can help. Test your blood sugar 15 minutes later and if it's still low, try another 15-20 grams and call emergency services.
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Tips

• Keep your hopes up for a cure—research to find a cure for Type 1 diabetes is ongoing. The cure may be discovered any minute.

  • One specific and promising example is Dr. Denise Faustman who is using the BCG (Bacillus Calmette–Guérin) vaccine—a tuberculosis vaccine—to reverse type 1 diabetes by modulating he immune system.
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• Though there is no cure for diabetes, technology and treatment have developed to such an extent that most individuals with Type 1 diabetes live happy and healthy lives once they know how to manage their diabetes.
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• Consider joining a support group for people who have Type 1 diabetes. These are available both online and in-person. If you’re feeling alone, try reaching out to a diabetic camp, other diabetics in your community or going online. Remember, you’re not alone.
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Warnings

• Always consult your doctor on how you can best manage your Type 1 diabetes. Your doctor can work with you to develop a treatment plan that connects your body, medication, lifestyle changes (e.g. diet), day-to-day schedule, and technologies (e.g. insulin pumps).
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