Type 1 Diabetes - Treatment Overview
Treatment for type 1 diabetes is a lifelong commitment of monitoring blood sugar, taking insulin, maintaining a healthy weight, eating healthy foods and exercising regularly. The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. In fact, tight control of blood sugar levels can reduce the risk of diabetes-related heart attacks and strokes by more than 50 percent.
If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.
Blood sugar monitoring
Depending on what type of insulin therapy you select or require — single dose injections, multiple dose injections or insulin pump — you may need to check and record your blood sugar level up to four or more times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
Even if you take insulin and eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.
Blood sugar monitoring
Depending on what type of insulin therapy you select or require — single dose injections, multiple dose injections or insulin pump — you may need to check and record your blood sugar level up to four or more times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
Even if you take insulin and eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
Food.
What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
Physical activity.
Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level. To compensate, you might need to lower your insulin dose before unusual physical activity.
Medication.
You need insulin to lower your blood sugar level. But any other medications you take may affect your blood sugar level as well, sometimes requiring changes in your diabetes treatment plan.
Illness.
During a cold or other illness, your body will produce hormones that raise your blood sugar level. This might require changes in your diabetes treatment plan.
Alcohol.
Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time.
Stress.
The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
For women, fluctuations in hormone levels.
As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.
In addition to daily blood sugar monitoring, your doctor may recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan.
Insulin and other medications
Anyone who has type 1 diabetes needs insulin therapy to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.
An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Examples include regular insulin (Humulin R, Novolin R, others), insulin isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog) and insulin glargine (Lantus). Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
Sometimes other medications are prescribed as well. For example, an injection of pramlintide (Symlin) before you eat can slow the movement of food through your stomach to curb the sharp increase in blood sugar that occurs after meals. Your doctor might prescribe low-dose aspirin therapy to help prevent heart and blood vessel disease.
In October 2007, the manufacturer of inhaled insulin (Exubera) announced a decision to stop selling the drug because too few people are using it. If you use inhaled insulin, work with your doctor to adjust your diabetes treatment plan as soon as possible. In the meantime, it's safe to continue using inhaled insulin as directed.
Healthy eating
Contrary to popular perception, there's no diabetes diet. You won't be restricted to a lifetime of boring, bland foods. Instead, you'll need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your meal plan.
Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
Physical activity
Everyone needs regular aerobic exercise, and people who have type 1 diabetes are no exception. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.
Remember that physical activity lowers blood sugar. If you begin a new activity, check your blood sugar level more often than usual for a few weeks. You might need to adjust your meal plan or insulin doses to compensate for the increased activity.
Transplantation
The only potential cure for type 1 diabetes is a pancreas transplant. Other types of transplants are being studied as well.
Pancreas transplant.
With a successful pancreas transplant, you would no longer need insulin therapy. But pancreas transplants aren't always successful — and the procedure poses serious risks. You'd need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury. Because the side effects can be more dangerous than the diabetes, pancreas transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.
Islet cell transplant.
The islet cells are special cells in the pancreas that make insulin. Researchers are experimenting with islet cell transplants, which provide new insulin-producing cells from a donor pancreas. Although this experimental procedure has met with problems in the past, new techniques and better drugs to prevent islet cell rejection may hold promise for the future.
Stem cell transplant.
In a 2007 Brazilian study, a small number of people newly diagnosed with type 1 diabetes were able to stop using insulin after being treated with stem cells made from their own blood. Although stem cell transplants — which involve shutting down the immune system and then building it up again — can be risky, the technique may one day provide an additional treatment option for type 1 diabetes.
What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
Physical activity.
Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level. To compensate, you might need to lower your insulin dose before unusual physical activity.
Medication.
You need insulin to lower your blood sugar level. But any other medications you take may affect your blood sugar level as well, sometimes requiring changes in your diabetes treatment plan.
Illness.
During a cold or other illness, your body will produce hormones that raise your blood sugar level. This might require changes in your diabetes treatment plan.
Alcohol.
Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time.
Stress.
The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
For women, fluctuations in hormone levels.
As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.
In addition to daily blood sugar monitoring, your doctor may recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan.
Insulin and other medications
Anyone who has type 1 diabetes needs insulin therapy to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.
An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Examples include regular insulin (Humulin R, Novolin R, others), insulin isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog) and insulin glargine (Lantus). Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
Sometimes other medications are prescribed as well. For example, an injection of pramlintide (Symlin) before you eat can slow the movement of food through your stomach to curb the sharp increase in blood sugar that occurs after meals. Your doctor might prescribe low-dose aspirin therapy to help prevent heart and blood vessel disease.
In October 2007, the manufacturer of inhaled insulin (Exubera) announced a decision to stop selling the drug because too few people are using it. If you use inhaled insulin, work with your doctor to adjust your diabetes treatment plan as soon as possible. In the meantime, it's safe to continue using inhaled insulin as directed.
Healthy eating
Contrary to popular perception, there's no diabetes diet. You won't be restricted to a lifetime of boring, bland foods. Instead, you'll need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your meal plan.
Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
Physical activity
Everyone needs regular aerobic exercise, and people who have type 1 diabetes are no exception. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.
Remember that physical activity lowers blood sugar. If you begin a new activity, check your blood sugar level more often than usual for a few weeks. You might need to adjust your meal plan or insulin doses to compensate for the increased activity.
Transplantation
The only potential cure for type 1 diabetes is a pancreas transplant. Other types of transplants are being studied as well.
Pancreas transplant.
With a successful pancreas transplant, you would no longer need insulin therapy. But pancreas transplants aren't always successful — and the procedure poses serious risks. You'd need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury. Because the side effects can be more dangerous than the diabetes, pancreas transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.
Islet cell transplant.
The islet cells are special cells in the pancreas that make insulin. Researchers are experimenting with islet cell transplants, which provide new insulin-producing cells from a donor pancreas. Although this experimental procedure has met with problems in the past, new techniques and better drugs to prevent islet cell rejection may hold promise for the future.
Stem cell transplant.
In a 2007 Brazilian study, a small number of people newly diagnosed with type 1 diabetes were able to stop using insulin after being treated with stem cells made from their own blood. Although stem cell transplants — which involve shutting down the immune system and then building it up again — can be risky, the technique may one day provide an additional treatment option for type 1 diabetes.
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