“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