Treatment for diabetes, type 1
Treatment complications
Too much insulin can make the blood glucose level go too low (hypoglycaemia, sometimes called a 'hypo'). This can cause you to feel sweaty, confused, and unwell, and you may lapse into a coma. Emergency treatment of hypoglycaemia is with sugar, sweet drinks, or a glucagon injection (a hormone which has the opposite effect to insulin). Then eat a starchy snack such as a sandwich.
What are the aims of treatment?
Symptoms will ease, and you will feel well again, if a high blood glucose level is reduced below a certain level with some insulin. However, you still have some risk of developing complications in the long-term if your blood glucose level remains mildly high.
Therefore, the main long-term aims of treatment are:
- To keep your blood glucose level as near normal as possible.
- To reduce any other 'risk factors' which may increase your risk of developing complications. In particular, to reduce your blood pressure if it is high, and to lead a healthy lifestyle.
- To detect any complications as early as possible. Treatment can prevent or delay some complications from getting worse.
Treatment aim 1 - keeping your blood glucose level near normal
Insulin To stay alive and healthy you will need insulin injections for the rest of your life. Insulin is not absorbed in the gut so it needs to be injected rather than taken as tablets. Most people take 2-4 injections of insulin each day. Your doctor or diabetes nurse will give a lot of advice and instruction on how and when to take the insulin. There are various types of insulin and the type advised will be tailored to your needs.
Healthy diet
The healthy diet is the same that is recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Like everyone else, you should aim to eat eat a low fat, high fibre diet with plenty of starchy foods, fruit and vegetables. However, you will need to know how to balance the right amount of insulin for the amount of food that you eat. Therefore, you will normally be referred to a dietician for detailed advice.
Balancing insulin and diet, and monitoring blood glucose levels
Many people with Type 1 diabetes are shown how to do blood tests at home to monitor the blood glucose level. This helps you to adjust the amount of insulin and food according to the blood glucose level and your daily routine.
What is the level of blood glucose to aim for?
If you check you blood glucose level, ideally you should aim to keep the level between 4 and 7 mmol/l before meals, and less than 10 mmol/l two hours after meals.
Another blood test is called HBA1c. This test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your blood glucose control over the last 2-3 months. This test may be done once or twice a year by your doctor or nurse. A level of HBA1c of 7% or less is usually the target to aim for.
Treatment aim 2 - to reduce other risk factors
You are less likely to develop complications of diabetes if you reduce any other 'risk factors'. These are briefly mentioned below, but are discussed more fully in another leaflet called Preventing Cardiovascular Disease. Everyone should aim to cut out preventable risk factors, but people with diabetes have even more of a reason to do so.
Keep your blood pressure down
Have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor. Even mildly raised blood pressure should be treated if you have diabetes. Medication may be needed to keep your blood pressure down. See separate leaflet called 'Diabetes and High Blood Pressure'.
You should not smoke
Smoking is a high risk factor. See a practice nurse if you smoke and have difficulty stopping. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.
Do some physical activity regularly
Regular physical activity also reduces the risk of some complications such as heart and blood vessel disease. If you are able, a minimum of 30 minutes brisk walking at least five times a week is advised. Anything more vigorous is even better. For example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day. (For example, two fifteen minute spells per day of brisk walking, cycling, dancing, etc.)
Other medication
Depending on your age and how long you have had diabetes, you may be advised to take a drug to lower your cholesterol level, and to take a daily aspirin. These help to lower the risk of developing some complications such as heart disease and stroke.
Try to lose weight if you are overweight or obese
Excess weight is also a risk factor for heart and blood vessel disease. Getting to a 'perfect weight' for many people is unrealistic. However, if you are overweight, losing some weight will help.
Some of these lifestyle issues may not seem to be relevant at first to young children who are diagnosed as having diabetes. However, as children grow, a healthy lifestyle should be greatly encouraged for the long-term benefits.
Treatment aim 3 - to detect and treat any complications
Most GP's surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, chiropodists, optometrists, and other health care workers all play a role in giving advice and checking on progress. Activities in diabetes clinics include:
- Checking levels of blood glucose, HbA1c, cholesterol, and blood pressure.
- Ongoing advice on diet and lifestyle.
- Checking for early signs of complications. For example:
eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse. Glaucoma is also more common in people with diabetes, and can usually be treated.
urine tests - these include testing for protein in the urine which may indicate early kidney problems.
foot checks - to help to prevent foot ulcers.
blood tests - these include checks on kidney function and other general tests. They also include checks for some auto-immune diseases which are more common in people with diabetes. For example, coeliac disease and thyroid disorders are more common than average in people with Type 1 diabetes.
Some complications can be treated much easier if they are detected early. So, regular checks are important.
Immunisation
You should be immunised against 'flu (each autumn) and against the pneumococcus bacteria (just given once). These infections can be particularly unpleasant if you have diabetes.
Diabetes UK
This leaflet gives only a brief account of diabetes. For further information on diabetes, contact Diabetes UK (formerly the British Diabetic Association). There are numerous branches throughout the country. They produce information leaflets on various topics related to diabetes and their careline answers enquiries on all aspects of diabetes.
Diabetes UK 10 Parkway, London, NW1 7AA Tel (careline): 0845 120 2960 (lo-call rate) Tel (office): 020 7424 1000 Web: www.diabetes.org.uk
© EMIS and PIP 2006 Updated: September 2006 PRODIGY Validated
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