Type 1 diabetes

Because type 1 diabetes can start quickly and the symptoms can be severe, people who have just been diagnosed may need to stay in the hospital.

If you have just been diagnosed with type 1 diabetes, you may need to have a checkup each week until you have good control over your blood sugar. Your provider will review the results of your home blood sugar monitoring and urine testing. Your provider will also look at your diary of meals, snacks, and insulin injections. It may take a few weeks to match the insulin doses to your meal and activity schedules.

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As your diabetes becomes more stable, you will have fewer follow-up visits. Visiting your provider is very important so you can monitor any long-term problems from diabetes.

Your provider will likely ask you to meet with a dietitian, clinical pharmacist, and certified diabetes care and education specialist (CDCES). These providers will also help you manage your diabetes.

But, you are the most important person in managing your diabetes. You should know the basic steps of diabetes management, including:

• How to recognize and treat low blood sugar (hypoglycemia)
• How to recognize and treat high blood sugar (hyperglycemia)
• How to plan meals, including carbohydrate (carb) counting
• How to give insulin
• How to check blood glucose and urine ketones
• How to adjust insulin and food when you exercise
• How to handle sick days
• Where to buy diabetes supplies and how to store them

INSULIN

Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone with type 1 diabetes must take insulin every day.

Most commonly, insulin is injected under the skin using a syringe, insulin pen, or insulin pump. Another form of insulin is the inhaled type. Insulin cannot be taken by mouth because the acid in the stomach destroys insulin.

Insulin types differ in how fast they start to work and how long they last. Your provider will choose the best type of insulin for you and will tell you at what time of day to use it. Some types of insulin may be mixed together in an injection to get the best blood glucose control. Other types of insulin should never be mixed.

Most people with type 1 diabetes need to take two kinds of insulin. Basal insulin is long-lasting and controls how much sugar your own body makes when you are not eating. Meal-time (bolus or prandial) insulin is rapid acting and is taken with every meal, usually a few minutes before you start eating. It lasts only long enough to help move the sugar absorbed from a meal into muscle and fat cells for storage.

Your provider or diabetes educator will teach you how to give insulin injections. At first, a child’s injections may be given by a parent or another adult. By age 14, most children can give themselves their own injections.

Inhaled insulin comes as a powder that is breathed in (inhaled). It is rapid acting and used just before each meal. Your provider can tell you if this type of insulin is right for you.

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People with diabetes need to know how to adjust the amount of insulin they are taking:

• When they exercise
• When they are sick
• When they will be eating more or less food and calories
• When they are traveling

HEALTHY EATING AND EXERCISE

By testing your blood sugar level, you can learn which foods and activities raise or lower your blood sugar level the most. This helps you adjust your insulin doses to specific meals or activities to prevent blood sugar from becoming too high or too low.

The American Diabetes Association and the Academy of Nutrition and Dietetics have information for planning healthy, balanced meals. It also helps to talk to a registered dietitian or nutrition counselor.

Regular exercise helps control the amount of sugar in the blood. It also helps burn extra calories and fat to reach and maintain a healthy weight.

Talk to your provider before starting any exercise program. People with type 1 diabetes must take special steps before, during, and after physical activity or exercise.

MANAGING YOUR BLOOD SUGAR

Checking your blood sugar level yourself and writing down the results tells you how well you are managing your diabetes. Talk to your provider and diabetes educator about how often to check.

To check your blood sugar level, you may use a device called a glucose meter. Usually, you prick your finger with a small needle, called a lancet, to get a tiny drop of blood. You place the blood on a test strip and put the strip into the meter. The meter gives you a reading that tells you the level of your blood sugar.

A continuous glucose monitor (CGM) measures your blood sugar level from fluid under your skin. These monitors are used mostly by people who also use insulin pumps to control their diabetes but they are often helpful for people not using an insulin pump. Most monitors do not require a finger prick.

Keep a record of your blood sugar for yourself and your health care team. This can often be done most easily using a website designed for this purpose. These numbers will help if you have problems managing your diabetes. You and your provider should set a target goal for your blood sugar level at different times during the day. You should also plan what to do when your blood sugar is too low or high.

Talk to your provider about your target for the A1C test. This lab test shows your average blood sugar level over the past 3 months. It shows how well you are controlling your diabetes. For most people with type 1 diabetes, the A1C target should be 7% or lower.

Low blood sugar is called hypoglycemia. A blood sugar level below 70 mg/dL (3.9 mmol/L) is too low and can harm you. A blood sugar level below 54 mg/dL (3.0 mmol/L) is cause for immediate action. Keeping good control of your blood sugar can help prevent low blood sugar. Talk to your provider if you’re not sure about the causes and symptoms of low blood sugar.

FOOT CARE

People with diabetes are more likely than those without diabetes to have foot problems. Diabetes damages the nerves. This can make your feet less able to feel pressure, pain, heat, or cold. You may not notice a foot injury until you have severe damage to the skin and tissue below, or you get a severe infection.

Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal, or become larger, deeper, or infected.

To prevent problems with your feet:

• Stop using tobacco, if you use it.
• Improve control of your blood sugar.
• Get a foot exam at least once a year from your provider, and learn whether you have nerve damage.
• Ask your provider to check your feet for problems such as calluses, a bunion or hammertoe. These need to be treated to prevent skin breakdown and ulcers.
• Check and care for your feet every day. This is very important when you already have nerve or blood vessel damage or foot problems.
• Treat minor infections, such as athlete’s foot, right away.
• Good nail care is important. If your nails are very thick and hard, you should have your nails trimmed by a podiatrist or other provider who knows you have diabetes.
• Use moisturizing lotion on dry skin.
• Make sure you wear the right kind of shoes. Ask your provider what kind is right for you.

PREVENTING COMPLICATIONS

Your provider may prescribe medicines or other treatments to reduce your chances of developing common complications of diabetes, including:

• Eye disease
• Kidney disease
• Peripheral nerve damage
• Heart disease and stroke

With type 1 diabetes, you are also at risk of developing conditions such as hearing loss, gum disease, bone disease, or yeast infections (in women). Keeping your blood sugar under good control can help prevent these conditions.

Talk with your health care team about other things you can do to lower your chances of developing diabetes complications.

People with diabetes should make sure to keep up on their vaccination schedule.

EMOTIONAL HEALTH

Living with diabetes can be stressful. You may feel overwhelmed by everything you need to do to manage your diabetes. But taking care of your emotional health is just as important as your physical health.

Ways to relieve stress include:

• Listening to relaxing music
• Meditating to take your mind off your worries
• Deep breathing to help relieve physical tension
• Doing yoga, tai chi, or progressive relaxation

Feeling sad or down (depressed) or anxious sometimes is normal. But if you have these feelings often and they’re getting in the way of managing your diabetes, talk with your health care team. They can find ways to help you feel better.

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