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How To Manage Type 1 Diabetes




Learn About The Different Types Of Insulin For Type 1 Diabetes And Newer Therapies To Help You Better Manage Your Glucose Better

Amy Hess-Fischl MS, RD, LDN, BC-ADM, CDEDaphne E. Smith-Marsh PharmD, CDEW. Patrick Zeller MD

Type 1 diabetes is an autoimmune condition in which the pancreas can no longer produce insulin to control your blood sugar naturally. So you need to take insulin in order to manage your blood sugar to remain healthy and avoid serious complications. 

Since type 1 diabetes arises in response to the complete inability of the pancreas to produce this essential hormone, you need to provide your body with supplemental insulin. Having enough insulin is critical because this hormone is responsible for helping to regulate your blood sugar and keep it in a healthy range—not too high and not too low .


Principle Low Carbohydrate Foods Make It Easier To Achieve Normal Glucose Levels

The aim of treatment is to keep glucose levels as normal as possible. As almost every meal will lead to an increase in glucose levels, then it makes sense to try and make life a bit easier for you by avoiding consuming large quantities of carbohydrates – the vast majority of which are turned into glucose by the body’s digestive system. Although modern insulins are very good, even “rapid-acting” insulins do not work as quickly or as effectively as naturally-produced insulin. There was a vogue about fifteen years ago, to think that a person with type 1 diabetes could eat anything they wanted, as long as they took the correct insulin dose. The years of experience since then have convinced me that this is just not true. I therefore recommend that you recognise the limitations of injected insulin: even a large dose simply cannot keep up with very large amounts of carbohydrate. It also risks bringing the glucose level too low and causing hypoglycaemia.

Managing Type 1 Diabetes Takes Constant Work And Planning I Never Get A Break

“Type 1 diabetes is very unique,” says Ramage. “If I’ve been diagnosed with type 1, I’ve had one of my organs fail. And the pancreas is a vital organ, not like an appendix. It’s key for glucose metabolism, which we need to live. Imagine if my heart stopped beating properly and that every 10 beats I was the one responsible for making sure … it’s of that gravity,” she says.


“Diabetes never takes a break. I check my blood sugar around six times a day, and probably in the middle of the night at least three nights a week,” says McKean. “I also give insulin when I first wake up, and then anytime I eat or my blood sugar goes high during the day.”

Even more taxing can be the mental energy required to manage type 1 diabetes. “There’s constant thinking that goes into diabetes — calculating how many carbs you’re eating, if it’s worth eating them, wondering if you’re a bit tired because your blood sugar is high or if you just didn’t sleep well, not to mention playing detective if your blood sugar is not what you expected,” McKean says.

People with type 1 diabetes are just like the rest of us; sometimes they wish they could just relax. “My endocrinologist noted that my blood sugar levels are consistently in a good range during the week, but not so much on Saturday and Sunday,” says Grady Cecile, 45, a senior services worker in North Carolina. “I jokingly told him, ‘That’s because I don’t have diabetes on the weekend!’” In reality, having type 1 means being “on” every day of the week.

Understanding The Drug Process So You Can Take Control Of Your Diabetes Care


It is always good to have a conversation with your healthcare professional about the benefits of using any and all new medications and don’t be shy about asking about what the cost will be if you agree to try a recommended medication.  

When the FDA approves new medications, this government regulatory agency stipulates who can receive the drug and for what conditions based on data presented usually by a pharmacuetical company who developed the drug. 

This information is based on results of clinical trials that were conducted to see how well people respond to the medication when compared to no treatment or to another effective medication. Given the individual nature of people’s response to medications and the wide variety of complications you may face, doctors rely more often on the use of drugs for reasons beyond its initially approved purpose.

It is becoming increasingly more common for drugs to be prescribed for reasons that may be suitable to a patient’s needs that fall outside its original approval—a practice called “off-label” use. What this means is that when there are no  enough studies to demonstrate its use for a particular condition but your doctor recognizes that the way it works is likely to beneficial for you, it is worth trying it. 


Principle Education Is Essential For Good Management Of Type 1 Diabetes

St John Victoria Blog

As a person with type 1 diabetes, you have to live with the condition for 8,760 hours every year . You will probably spend less than two hours a year with a health professional to discuss diabetes. That leaves 8,758 hours when you have to manage the diabetes yourself. And as I have illustrated, unlike other hormone problems, it is not just a question of taking a tablet or an injection every day, it requires a more detailed level of understanding of the principles of diabetes management than most doctors and nurses have. It also requires the ability to solve problems independently, as for most of the time, you will know far more about your diabetes than anyone else you are in contact with.

This sixth principle builds upon the other five and emphasises the primary importance of self-management education to everyone with type 1 diabetes. And it is never too late to learn. I can think of many, many people who lived with type 1 diabetes for several years, experiencing debilitating problems with their glucose control, who benefitted enormously in later life from attending a course where they learnt some basic principles on how to match their insulin to their food intake and their activity levels.

Take Control of Type 1 Diabetes has been written to help everyone with type 1 diabetes embrace these principles so that they can truly take control of their condition. You can order a copy at or the Diabetes.co.uk shop.


Understand The Types Of Insulin Available To Be In Good Glucose Control

All types of insulin have the same effect in helping control your blood sugar, and the original forms of insulin required delivery by in needle into a blood vessel so the body can absorb it or inhaled into the lungs so your body can make use of it. Until recently, if insulin were swallowed, as in a pill form, your stomach acids would break it down so it wouldn’t be available to do the job of controlling blood sugar levels; now, with new technology, an oral form is becoming more widely available.

There are many types and brands of insulin available for use today and the brand you use is dependent upon your insurance coverage, your lifestyle, and your overall needs. 

However, types of insulin do differ in how quickly and how long they will last. See Table 1 for a comprehensive list of the types of insulin, their delivery method, how quickly they act, and how long they last.


First, there are four basic categories of insulin:

The goal of taking insulin is to keep your blood sugar in a healthy range; this is considered well controlled. You will check your blood sugar and consider the number of carbs in your next meal or snack in order to determine the amount of insulin you will need.

In addition to daily blood glucose checks, your doctor will calculate your hemoglobin A1c, which is a blood measure that provides a guide to your estimated blood glucose levels over three months. Generally speaking, the average serum hemoglobin A1c decrease using insulin is between 1-2.5%. 

Try To Stick To Your Meal Plan Or Get Some Solid Foods Into Your System


If you are on a specific meal plan, try to stick to you if you can.  If you are having trouble eating, try bland foods like unsweetened apple sauce, regular gelatin, toast, or crackers.  Should you be unable to stomach bland foods, try clear soup or bouillon that contain salt.

Should vomiting continue for any amount of time, contact your doctor to see if he/she would advise the use of products such as Gravol or Zolfran. They may be able to reduce nausea.

Principle Just About Everything You Do Affects Blood Glucose Levels

I have heard it said so often that a person with type 1 diabetes can do anything, it just requires a bit of adjustment. While the first part is undoubtedly true, the second is in my opinion a massive understatement. The reason is that, if you have type 1 diabetes, just about everything you do affects your blood glucose level. There are the obvious things like eating – most foods will have some effect on increasing blood glucose levels; alcohol – which can decrease or increase glucose levels depending on the relative content of alcohol and carbohydrate; and exercise – which will often reduce, but can also increase the blood glucose level. Then there are the less obvious, like routine physical activity, such as housework, shopping, walking the dog or sexual intercourse, all of which can cause the blood glucose level to drop, sometimes quite sharply. Or stress, which often causes an increase in the glucose level, but sometimes can cause a decrease. Illness can cause quite a significant increase in glucose levels, even with a minor illness such as a cold. And if that isn’t enough, women have the added issue of the menstrual cycle, which in some people can be associated with very troublesome fluctuations in glucose level, as a result of the impact of changing hormone levels. And there are probably many more that I am not even aware of.


How To Manage The Stress Of Your Childs Type 1 Diabetes Diagnosis

Getting a Type 1 diabetes diagnosis can be incredibly hard on both the child and their family. Here’s how to manage the stress and keep your mental health on track.

Ylva Van BuurenJune 24, 2021


Melissa Zimmermann will never forget the day her 15-month-old son, Carter, was air-lifted by ambulance—unresponsive and not breathing well—from a regional hospital in Red Deer to Alberta Children’s Hospital. In the intensive care unit, surrounded by multiple IV lines and monitors, “the doctor told us it was type 1 diabetes, and from that moment our lives changed completely.”

According to the Canadian Pediatric Society, 33,000 Canadian children ages 5 to 18 have type 1 diabetes1—and a diagnosis like that can be incredibly stressful, not only for the child who is diagnosed, but for everyone in the family. In a 2020 global study conducted by Abbott, the makers of the FreeStyle Libre 2 flash glucose monitoring system, 93 percent of parents said they were distressed by the diagnosis while almost half of the children in the study said they perceive their illness as being a burden on their family2. Experts say that a child’s anxiety about the condition often increases in school and public places.

So how do you manage the stress of a diabetes diagnosis? Here are five ways to bring some peace of mind.

Be Open To Additional Therapies To Improve Your Glucose Control


Therefore, it is always good to have a conversation with your healthcare professional about the benefits of using such medications and also inquiring about what the cost of taking a recommended medication may mean to you. 

Your healthcare provider will choose the insulin will depend upon many things including the expiration date for insulin once the vial or pen is used for the first time as well as their onset , the peak and duration .

Of course, your level of physical activity level, the presence of a fever, and stress level as well as your usual meals and snacks , will also be considered when planning for your insulin needs.

 


Type 1 Diabetes And Hyperglycemia: Handling High Blood Sugar

One of the hallmarks of type 1 diabetes is hyperglycemia, or high blood glucose . There’s a very good reason that glucose levels climb high in type 1 diabetes, and that’s a lack of insulin. When the pancreas shuts down insulin production, blood glucose levels start to climb. If there is sufficient insulin in the bloodstream, say, from an insulin injection or insulin infusion from a pump, glucose levels return to a safe level. If there is little or no insulin available, the situation becomes serious, both in the short term and the long term.

To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, !

How To Handle Low Blood Glucose Levels When You Are Nauseous


Rescue doses of glucagon can be used to help bring back up blood glucose levels when a person with diabetes is unable to consume or absorb carbohydrate because of nausea, vomiting or diarrhea and blood glucose below 4 mmol/L or 72mgdL. 

Contact your doctor or diabetes team to see if they recommend the use of rescue glucagon when ill.

How To Engage Young Adults With Type 1 Diabetes: A New Study

diabetes management tips for parents with diabetic children

Type 1 diabetes affects the mental wellbeing of everyone living with it, and this can be particularly challenging for young people who are also learning the essential lessons of self-care for adulthood. A recent study by the National University of Ireland , Galway, indicated that there is “a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.” This study, called D1 now, is significant because, according to the researchers, it’s one of the first to examine “interventions,” or solutions, and the role they play in ensuring that young adults have the best possible outcomes in their independent diabetes management.

The Galway-based team, with a network of stakeholders across Ireland, the UK and beyond, found in the D1 now study that young adults are the driving force behind change in diabetes care and that healthcare providers need to change the way they work with young adults.

Since 2014, the D1 now researchers have worked with Galway University Hospitals to examine how young adults interact with their diabetes teams and how consistently they attend appointments to figure out ways to improve the diabetes management and overall health of these patients. Along the way, D1 now has also come up with new ways to engage with the Type 1 community.

Keep up with the D1Now project on Facebook and Twitter.

REFERENCES

Glycemic Control During Serious Medical Illness And Surgery

Serious medical illness and surgery produce a state of increased insulin resistance and relative insulin deficiency. Hyperglycemia can occur even in patients without diabetes as a consequence of stress-induced insulin resistance coupled with the use of dextrose-containing IV fluids. Increases in glucagon, catecholamines, cortisol, and growth hormone levels antagonize the effects of insulin, and the alpha-adrenergic effect of increased catecholamine levels inhibits insulin secretion. Counterregulatory hormones also directly increase hepatic gluconeogenesis.

Much less is known about optimal blood glucose levels in hospitalized patients with preexisting diabetes whose hyperglycemia reflects both their diabetes and a stress response to illness. Nonetheless, it is clear that management of hospitalized patients with preexisting diabetes requires modification of treatment regimens to compensate for both the decreased caloric intake and the increased physiologic stress. Near-normal blood glucose levels should be maintained in medical and surgical patients with diabetes, for the following reasons:

  • To prevent the development of ketosis

  • To prevent electrolyte abnormalities and volume depletion secondary to osmotic diuresis

  • To prevent the impairment of leukocyte function that occurs when blood glucose levels are elevated

  • To prevent the impairment of wound healing that occurs when glucose levels are elevated

Advances In Diabetes Management: Introducing New Therapies

There has been concerted effort to develop new treatments either to enhance the function of insulin or improve glucose management.  This push has occurred perhaps because more people have type 1 diabetes and are not achieving the target hemoglobin A1c level of below 7% or 6.5%.

While it is common to believe that people with type 1 diabetes are at a healthy weight or even underweight, this is no longer true. In fact, more than two in three individuals with type 1 diabetes patients are facing overweight or obesity, further complicating their health status.1

So it is understandable that the research is continuing with the goal of findings add-on drugs or adjunctive medications that will complement the effects of the insulin and help you achieve a stable blood glucose level with more time-in-range. To date, many of these new treatments have been tested in individuals with type 2 diabetes.Yet, there is good reason to believe that these same medications may be helpful to many with type 1 diabetes as well.

There are a few medications that are typically used to help manage type 2 diabetes  that have been making their ways into the type 1 diabetes world, specifically, metformin; however, it has not been approved by the FDA for use specifically in people with type 1 diabetes but is becoming a common consideration, particularly in anyone who is struggling to keep blood sugar in control and facing weight gain.

Why Carbohydrates Matter Meal Planning And Carb Counting

Carbohydrates have a larger impact on blood glucose compared to other food groups such as proteins and fats.

What is carb counting?  This is a meal planning technique where your dose of insulin is chosen based on the amount of carbs in a meal.  The balance between the carbs you eat and the insulin in your body affects how much your blood sugars rise after a meal.  Counting carbs can help you decide how much insulin to take.

Managing Glucose In T1d Once Had But One Treatmentinsulin

The first and primary medication given to someone with type 1 diabetes is insulin. This has been our standard approach to treatment since the discovery and development of exogenous or sythetically produced insulin in humans for more than a century. The two insulin options originally approved by the Food and Drug Administration to manage blood sugars in people with type 1 diabetes are—insulin and Symlin.

Insulin is the essential treatment to manage blood sugar in people with type 1 diabetes. There are many devices available to help you take insulin.

Treating T1D is all about the amount and timing of insulin, as well as the best way for you to get the right dose of this essential hormone to assure that the glucose circulating in your bloodis able to be properly absorbed by your body. Glucose is the main source of energy that your body uses to keep all key functions running properly.The trick is that in order for your body to properly take in and use blood glucose properly, insulin is required to make this reaction work.

Insulin was first successfully used in humans in 1922. Originally, it was made by extracting it from the pancreas of animals: dogs, cows, and pigs, specifically. But by 1978, insulin was created synthetically, or exogenously, meaning it is now made in the lab.  You can read more about insulin.

Blood Pressure Drugs Cholesterol Medications And Aspirin

Medications for high blood pressure and high cholesterol as well as aspirin can be prescribed with insulin to help the overall health and treatment of diabetes. Since people with diabetes have an increased chance of cardiovascular disease, these drugs are used in combination with other diabetes medications.

Our Diabetes Care: Experience The Blessing Difference

With our top-notch self-management program, we make it easy for newly diagnosed patients to control their blood sugar effectively. After they are diagnosed, people come to us to master all the details involved in living well with diabetes.

Patients choose the Blessing Diabetes Center because of our:

  • Convenience: Our Diabetes Center staff includes a range of specialists all in one place, from diabetes educators and nurses to podiatrists and pharmacists. You spend less time and energy on travel so you can focus more on your health. Learn more about our team.

  • Accredited education program: Our 7-week self-management program is accredited by the American Diabetes Association, which means it meets stringent guidelines that reflect the latest research. This accreditation translates into a high quality of care and the most effective recommendations for patients.

  • Care that focuses on you:Our care starts with an in-depth one-on-one analysis with our nurse that assesses your strengths and challenges. From there, we come up with solutions that fit your unique lifestyle, then help you follow the plan.

  • Family focus: Support is a critical part of diabetes management. By encouraging family participation in our education program, we help everyone get on board with practical cooking tips and lifestyle recommendations that benefit the entire family unit.

Principle The Aim Of Treatments Is To Maintain Near

Insulin does many useful things in the body but as far as type 1 diabetes is concerned, the most important is to keep the level of blood glucose as near-normal as possible. That will ensure that you avoid glucose levels that are dangerously low or high, which can cause immediate and unpleasant symptoms and potentially lead to a medical emergency. It will also ensure than in the longer term, your diabetes does not cause harm your health as a result of high glucose levels. Achieving near-normal blood glucose levels means aiming to keep your glucose between 4 and 7 mmol/l before meals and no higher than 9 mmol/l two hours after meals.

Maintaining this level of glucose control is not easy and requires regular measurement of glucose levels, using a meter and test strips. As a minimum, it is recommended that the glucose level is checked before each meal and before bedtime and also if feeling unwell; before, during and after exercise; and before driving – this may require up to 10 tests a day.

Type 1 And Type 2 Diabetes Are Distinct Conditions

Diabetes Management

Diabetes is a disorder in which the body has trouble regulating blood glucose, or blood sugar, levels. The two main types of diabetes are type 1 and type 2.

Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the cells in the pancreas that make insulin. Insulin is a hormone that enables sugar to enter the bloodstream to be used by cells for energy or stored for later use. Without it, a person with type 1 diabetes can’t process glucose and their blood sugar levels can get dangerously high.

Type 2 diabetes is a metabolic disorder; the pancreas still produces insulin but is unable to use it effectively or the body has developed a resistance to it.

“In general, there’s not a lot of awareness about type 1 diabetes,” says Melinda Ramage, FNP-BC, a certified diabetes educator practicing in Asheville, North Carolina. “When you say diabetes, type 2 is what most people think of — that’s what the majority of the awareness campaigns have focused on. Many people falsely assume that all diabetes is the same.”

Please Dont Tell Me What I Should And Shouldnt Eat

People try to tell me all the time what I can and can’t eat,” says Cecile. “I’ll be out or at work and someone will say, ‘You can’t eat that cupcake.’ They wouldn’t dream of saying that to someone else, but because of my diabetes, they think they should tell me what to eat.”

Ramage agrees: People often intervene on what would otherwise be “a stranger’s decision-making,” she says. “It goes back to that stigma. People think you’ve made poor choices that have led to your condition, therefore, they should share what they know to help you make better choices.”

Living With Type 1 Diabetes Helped Shape Who I Am

Even though most people with type 1 diabetes wouldn’t chose to have the disease, managing it may lead to insights and a heightened awareness of the struggles everyone faces.

“Diabetes has brought a lot of wonderful things into my life,” says McKean. “I am more empathetic toward anyone with a chronic condition, and I try hard to remember that you don’t usually know all that’s going on in a person’s mind, so be kind to them.”

Support and relationships can grow out of a type 1 diagnosis as well. “As a kid, I attended the Florida Camp for Children and Youth with Diabetes and I went back as a counselor and volunteer for six years. I met some incredible people there and really relished the chance to be surrounded by people ‘like me’, says McKean. “And as an adult I interned at a diabetes charity in the UK and met my husband there. So, I certainly can’t be too hard on the disease!”


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