A type 1 diabetes diagnosis means lifelong treatment with insulin. Here’s what else you need to know to stay healthy.
“When I diagnose type 1 diabetes, I talk to patients about the fact that they don’t make insulin, and that their elevated blood sugars are not their fault,” says Minisha Sood, MD, an endocrinologist in New York City.
Type 1 diabetes means your pancreas is not producing insulin, which the body needs to convert glucose from your diet into energy for your daily life. Type 1 diabetes must be treated with insulin therapy, and people with type 1 diabetes need to be on insulin lifelong.
Types of Insulin Therapy
Insulin therapy refers to introducing insulin into the body to keep blood sugar levels in a healthy range. Patients can do this in a few different ways.
Insulin injections. Delivering insulin via a disposable syringe is the most common method. The injection goes just under the skin and delivers up to 100 units of insulin. (Learn about insulin injection sites here.)
Insulin pumps. Also called continuous subcutaneous insulin infusion devices, these pumps are durable, small, and computerized to deliver continuous insulin into the skin through a strong adhesive.
Inhaled insulin. In addition to either injection or infusion, patients can also inhale insulin at the beginning of a meal to control blood sugars at mealtime.
Besides choosing the insulin delivery method, patients with type 1 diabetes also need to know about the various types of insulin. Insulins differ based on their absorption speed, how quickly they take effect, and how long they act. Two main types of insulin all patients with type 1 diabetes will need are basal and bolus insulin.
Basal insulin is a longer-acting insulin that steadies blood sugar overnight and between meals, when they are mostly likely to dip.
Bolus insulin is a rapid-acting insulin to manage blood sugar during meals, when they are most likely to spike.
Find more about the different types of insulin here.
Monitoring Blood Glucose
An important component of insulin therapy is keeping track of blood glucose levels and making sure they are in the target range. (Too much insulin can make blood sugar drop too low, and too little insulin can cause blood sugar to be higher than is healthy, so monitoring blood sugar closely with type 1 diabetes is key.)
Using a device called a glucometer, type 1 diabetes patients test the amount of blood glucose present in the blood several times a day. At a minimum, they should check blood sugar before each meal and before bedtime. Ideally, fasting blood sugar should be under 100-130 mg/dL, and post-meal blood sugar shouldn’t exceed 180 mg/dL.
“Someone with well-managed type 1 doesn’t have a lot of blood sugar variability throughout the day,” says Dr. Sood. This means blood sugar won’t jump from, say, 40 to 400 in a short amount of time. Successful treatment of type 1 diabetes also means reaching healthy levels of A1C, blood pressure, and cholesterol.
Future Type 1 Diabetes Treatment
While insulin therapy provides effective treatment, researchers are searching for alternative forms of treatment. These possible future treatments include:
Islet cell transplant
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When I diagnose type 1 diabetes I talk to
patients about the fact that they don't
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make insulin and that their elevated
blood sugars are not their fault.
00:00:10,498 --> 00:00:14,016
00:00:14,016 --> 00:00:17,524
When I talk about treatment, I have to
point out to them that it has to be
00:00:17,524 --> 00:00:20,330
because their body does not make it.
00:00:20,330 --> 00:00:23,980
There's no other thing that I can give
them to encourage their body to make
00:00:23,980 --> 00:00:24,780
00:00:24,780 --> 00:00:27,438
Typically patients with type
1 diabetes will administer
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insulin injections to themselves.
00:00:29,126 --> 00:00:31,114
They can also use an insulin pump,
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which is an insulin delivery system
that delivers continuous insulin.
00:00:35,720 --> 00:00:39,890
And in some cases, for meal time insulin
they can also use inhaled insulin.
00:00:39,890 --> 00:00:42,415
There are many insulins available for
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They're primarily characterized
by how quickly they're absorbed,
00:00:46,150 --> 00:00:50,068
how quickly they take their peak effect,
and how long they act.
00:00:50,068 --> 00:00:53,486
A type 1 diabetic needs to use at
least two different types of insulin.
00:00:53,486 --> 00:00:57,860
They need to use a basal insulin,
which is a longer-acting insulin.
00:00:57,860 --> 00:01:01,730
And that's used to control their
blood sugar overnight, fasting, and
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in between meals.
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They'll also need to use a more
rapid-acting insulin that can cover their
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blood sugar spikes when they eat meals or
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If I take a long-acting and
short-acting insulin throughout the day.
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I ultimately found the right levels and
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type of insulins that work for me, and I
am very happy with how it's transitioned.
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Blood sugar monitoring is
important in type 1 diabetes,
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as in any type of diabetes, but
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especially type 1 because these are
patients that are dependent on insulin.
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And because insulin lowers blood glucose,
which is why we use it,
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sometimes it can lower
blood glucose too low.
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So making sure the blood glucose levels
are in the target range is really
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important to success.
00:01:44,410 --> 00:01:47,730
Blood glucose is measured
through a blood sugar meter,
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which is called the glucometer,
and will display a reading and
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will tell a patient what their blood
sugar is in that moment in time.
00:01:53,940 --> 00:01:57,760
I use a continuous glucose monitor,
which has been a lifesaver for me.
00:01:57,760 --> 00:02:01,230
It provides me with information every
five minutes in terms of where my blood
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sugars are at.
00:02:02,370 --> 00:02:05,060
Patients with type 1 diabetes
should be checking their
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blood sugar several times a day.
00:02:06,970 --> 00:02:10,140
Minimally before each meal and
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Fasting blood sugar should be less
than 100-130, and after meals
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blood sugar shouldn't exceed 180 in order
to maintain a reasonable level of control.
00:02:20,940 --> 00:02:23,895
Someone with well managed type 1
doesn't have a lot of blood sugar
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variability throughout the day.
00:02:25,438 --> 00:02:29,458
So they're not 40 one minute,
in terms of blood glucose level, and
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400 the next minute.
00:02:31,180 --> 00:02:35,750
Their A1C levels are on target, they
have normal blood pressures, they have
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normal cholesterol levels, and they feel
comfortable managing their diabetes.
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Where are we going in terms of
treatment with type 1 diabetes?
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Well, there's the artificial pancreas,
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which is the holy grail of
type 1 diabetes treatment.
00:02:48,550 --> 00:02:52,670
Other things to think about are pancreatic
transplant and islet cell transplant.
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Another hot topic in type 1 diabetes is
the development of a vaccine that maybe
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could prevent type 1 diabetes
from forming in children.
00:02:59,940 --> 00:03:03,398
We'll certainly have better ways of
dealing with the insulin need, but
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to eliminate the need all
together is a pretty far reach.
00:03:06,128 --> 00:03:09,387
Artificial pancreas. New York, NY: JDRF. (Accessed on December 4, 2017 at http://www.jdrf.org/research/artificial-pancreas/.)
Beta cell replacement. New York, NY: JDRF. (Accessed on December 4, 2017 at http://www.jdrf.org/research/beta-cell-replacement/.)
Glucose control. New York, NY: JDRF. (Accessed on December 4, 2017 at http://www.jdrf.org/research/glucosecontrol/.)
Goals of treatment. San Francisco, CA: Diabetes Teaching Center at the University of California, (Accessed on December 4, 2017 at https://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/monitoring-diabetes/goals-of-treatment/.)
Insulin basics. San Francisco, CA: Diabetes Teaching Center at the University of California, (Accessed on December 4, 2017 at https://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/insulin-basics/.)
Patient education: Diabetes mellitus type 1: insulin treatment (beyond the basics). Waltham, MA: UpToDate, 2017. (Accessed on December 4, 2017 at https://www.uptodate.com/contents/diabetes-mellitus-type-1-insulin-treatment-beyond-the-basics.)
Prevention. New York, NY: JDRF. (Accessed on December 4, 2017 at http://www.jdrf.org/research/prevention/.)
Restoration. New York, NY: JDRF. (Accessed on December 4, 2017 at http://www.jdrf.org/research/restoration/.)
Treatment of type 1 diabetes. San Francisco, CA: Diabetes Teaching Center at the University of California, (Accessed on December 4, 2017 at https://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/.)