Diabetes (Type 1)

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is Type 1 diabetes?

A healthy pancreas contains cells that produce insulin, a hormonethat transports a form of sugar called glucose from the bloodstreaminto all your cells. It’s an important job: Sugar is the body’s fuel.When you develop Type 1 diabetes, however, your immune system getsconfused and destroys the insulin-producing cells in the pancreas.Because the insulin supply then dwindles, your cells are deprived ofglucose, which builds up in your bloodstream. Your body then tries toget rid of this excess glucose through your kidneys, its normalfiltration system. That can make you feel weak and hungry, need tourinate frequently, and be intensely thirsty. If you don’t drink a lotof water, you may even get dehydrated.

Such high blood glucose isknown as hyperglycemia. It can cause serious health problems. Bloodvessels and nerves can become damaged, leading to kidney failure,blindness, heart disease, and other complications.

Who is at risk for Type 1 diabetes?

Of the three variations of diabetes, Type 1 was once known as “juvenile” diabetes and usually appears before age 30.

Treatment for Type 1 diabetes

To deal with this chronic, potentially damaging disease, you’ll needlong-term specialized medical care. Your caregivers will help you learnhow to keep your blood sugar levels in normal ranges, and how to giveyourself daily insulin injections. To determine how much insulin youneed, you’ll have to test your blood sugar levels several times a day.If they’re too high, you inject insulin. If they’re too low (acondition called hypoglycemia), you eat a sugar-containing food such asorange juice or candy. In the long run, a balanced diet and regularexercise will go a long way toward regulating your blood sugar levels.

There’s no cure for diabetes, but by monitoring your blood sugar levelsand maintaining meticulous control, you can dramatically reduce yourrisk for damage to your eyes, nerves, kidneys, and blood vessels, aswell as other complications. The good news is that once you starttreating diabetes, you’ll rapidly feel better, and you’ll find there’spractically no limit to your daily activities.

Medications for Type 1 diabetes

To keep your blood sugar levels within normal limits, you’ll need insulin therapy,in amounts determined by your weight, diet, activity level, overallhealth, and other factors. Insulin is destroyed by digestive juices, soyou can’t take it by mouth. It must be injected through the skin.

Variousforms of insulin are used for different situations. Fast-acting insulin(Humalog, Novolog) enters the blood in 15 minutes. It can be valuablebefore eating and for tight glucose control. Intermediate- andlonger-acting insulins are active for more than 24 hours. Therelatively new Glargine (rDNA origin) is particularly valuablebecause insulin levels remain nearly constant throughout the period.Your doctor will help design a program using one or more types ofinsulin to optimize your blood sugar control. A common regimen includesa short-acting insulin before you eat, and a longer-acting one forcoverage between meals or at night.

Most people admit thatinsulin injection is far simpler than they thought it would be. After acouple of meetings with an instructor (often a nurse), you’ll feelcomfortable drawing insulin into a syringe, cleaning your skin withalcohol, and administering a virtually pain-free shot. Prefilledinsulin “pens” are convenient. Jet injectors use a high-pressure streamof air to send a fine flow of insulin through the skin. They’re bulky,expensive, and not pain-free, but they’re a good choice if you’reafraid of needles. Battery-operated insulin pumps can achieve tighterglucose control.

Lifestyle Changes

Stick to a strict timetable for injections, glucose testing, meals, and exercise. A chart or a portable journal can be very helpful. Wise diet choices will make a huge difference in how you feel. Some people with Type 1 diabetes gain weight when they start insulin because their cells have been “starved” for sugar, but, unlike with Type 2 diabetes, obesity is rare.

The best way to control your weight is through exercise, which can even lessen your insulin needs. When your body is active, its demand for glucose increases—and the glucose in your bloodstream is used up first. Time your injections to avoid working out when insulin is peaking. (If you don’t, you risk a dangerous drop in blood sugar.) A few other tips: Avoid exercise if your glucose is above 300 mg/dl or under 100 mg/dl. Inject in sites far from the muscles you exercise most intensely. Eat a snack (bread, pasta, or potato) 30 minutes before you work out.

Related Procedures for Type 1 Diabetes

The goal of successful diabetes management is to get just enough insulin to keep glucose levels neither too high nor too low. This can be a delicate balance to maintain: You’ll need to do regular glucose testing, from one to four times a day. Aim for pre-meal levels of 90 to 130 milligrams per deciliter (mg/dL), and bedtime levels of 100 to 140 mg/dL.

To test glucose levels, most people use a device that makes a tiny jab in their fingertip. Then they place a drop of blood on a specially treated test strip, and insert the strip into a glucose meter for a reading. Microneedle devices are so tiny you can barely feel the pinprick. Ask your doctor about the possibility of using an insulin pump. Worn on your body, this amazing device is programmed to silently inject insulin all the time.

Rarely, for people with very severe diabetes, a transplant of the pancreas or a double pancreas/kidney transplant may be needed.

Questions for Your Doctor

• Would any of the new insulin forms be good for me?
• Given my medical history, are there steps I need to take to avoid diabetic complications?
• What kind of exercise is best?
• Should I try an insulin pump?

Living with Type 1 Diabetes

If you have Type 1 Diabetes, here are a few helpful hints to help you take control of it:

• Wear medical identification (a bracelet or medallion) saying you have diabetes. If you’re unconscious in an emergency, a medical team will need this information.
• Get a good health-care team. Count on seeing your doctors, nurses, and dietitians every one to three months.
• Make a smart plan. Educate yourself about diabetes—and let others help you devise a strategy for dealing with glucose testing, insulin shots, exercise, and diet.
• Overwhelmed? Start by visiting an outpatient diabetes clinic every day until you and your family feel confident and comfortable. What now seems so new (and maybe frightening) will soon become second nature and little more than a minor inconvenience.
• Improve the accuracy of your home glucose monitor by taking these simple measures. Keep the monitor clean. Test it once a month. Recalibrate it whenever starting a new packet of strips. Use fresh strips. Periodically, compare your results with those from a laboratory.
• Take care if you get sick. You’re especially susceptible to diabetic ketoacidosis if you develop the flu or a urinary tract infection. Never stop your insulin during an illness. Check your urine for ketones every six hours. If your condition is worsening, let your doctor know right away.