By Amy Campbell, MS, RD, LDN, CDE
Whether you or a loved one has been recently diagnosed with type 1 diabetes or you’re a seasoned veteran of managing the condition, you’re likely to have questions about the best approach to management. Get top type 1 diabetes questions and answers here.
Type 1 diabetes occurs when the body’s immune system attacks and destroys the cells in the pancreas that make insulin. When this happens, the pancreas can no longer make insulin, a hormone that helps move glucose, or sugar, from the blood into cells to be used for energy. As a result, glucose levels in the blood rise above normal. High blood glucose levels can cause damage to the body, both in the short term and the long term, and left untreated, can lead to coma and even death. People who have type 1 diabetes must take insulin in order to survive.
Researchers don’t know the exact cause of type 1 diabetes, but they believe that genes play a role (in other words, type 1 diabetes can run in the family). Also, environmental factors, such as viruses, may trigger the onset of type 1; in particular, the B4 strain of the coxsackie B virus, German measles, mumps and rotavirus are more likely than other viruses to lead to type 1 diabetes.
Both type 1 and type 2 diabetes are chronic conditions in which the body can’t properly store and use glucose for energy. Glucose levels can build up in the blood — rather than entering cells to be used for fuel — and can lead to serious complications. But this is where type 1 and type 2 diabetes part ways. In type 1 diabetes, the immune system attacks the beta cells (the cells that produce insulin) in the pancreas. This means that a person with type 1 must take insulin in order to survive. In type 2 diabetes, the pancreas makes insulin but the body has a hard time using it properly. This is called insulin resistance. Lifestyle changes, such as weight loss, a healthy eating plan, and regular physical activity can help manage type 2 diabetes, although most people with this condition also need medication, including insulin, to help keep blood glucose levels within a safe range.
It’s a fairly common misconception that type 2 diabetes can eventually turn into type 1 diabetes. However, type 2 diabetes is a very different condition than type 1 diabetes. Yes, both “types” of diabetes cause high blood glucose, but the causes of each type are unrelated. Type 1 diabetes is an autoimmune disease, which means that the body’s immune system “attacks” the cells in the pancreas that make insulin. Because these cells can no longer make insulin, a person with type 1 must take insulin to survive. On the other hand, type 2 diabetes is a condition of insulin resistance — the body makes enough insulin but the cells can’t use it properly. Healthy food choices, regular physical activity, weight loss and medication are ways to manage type 2.
The only way for type 2 diabetes to become type 1 diabetes is if the type of diabetes is misdiagnosed. And the reality is that some people are told they have type 2 diabetes when they actually have type 1 diabetes, especially if they are adults who are overweight. In addition, there is yet another type of diabetes called latent autoimmune diabetes in adults (LADA) that shares characteristics of both type 1 and type 2 diabetes. LADA, which tends to appear in adults over the age of 30, is actually a slow but progressive form of autoimmune diabetes that eventually requires insulin injections.
Unlike type 2 diabetes, type 1 diabetes symptoms generally appear fairly quickly (e.g., weeks or months) and are severe. Typical signs and symptoms of type 1 diabetes include:
• Constant thirst
• Frequent urination
• Increased hunger
• Blurry vision
• Unexplained weight loss
• Fatigue and weakness
• Cuts or sores that are slow to heal
• More infections than usual
Other symptoms can include nausea, vomiting, stomach pain and trouble breathing.
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Type 1 diabetes used to be called juvenile diabetes because it was thought that only children and adolescents got this condition. This condition is typically diagnosed in people before the age of 40, but some people are diagnosed at an older age. To muddy the waters even further, there is yet another type of diabetes called latent autoimmune diabetes in adults (LADA), which is a slow but progressive form of diabetes that is diagnosed during adulthood. Initially, LADA appears as type 2 diabetes. However, like type 1 diabetes, LADA is an autoimmune condition. This means that, eventually, the beta cells will stop producing insulin and insulin injections are necessary.
There’s no cure — yet — for type 1 diabetes, but it’s treatable with insulin. In type 1 diabetes, the pancreas no longer makes insulin. This means that a person with type 1 must replace the insulin that the body no longer produces. Insulin can be taken in several ways: by injection (using a pen or a syringe), by an inhaler or by using an insulin pump, which is an electronic device that administers insulin. There are many different types of insulin available: rapid-, short-, intermediate- and long-acting insulin, which act in a way that more closely resembles how the body’s own insulin would act. If you are injecting insulin with a syringe or a pen, you will likely need to take both a short- and a long-acting insulin. If you use an insulin pump, you only use a short-acting insulin. Your doctor or diabetes educator will help you determine the best way to give yourself insulin, as well as the best types of insulin to use.
In addition to insulin, an individualized eating plan and activity plan play an important role in helping you to manage your blood glucose levels. Checking your blood glucose with a meter or using a continuous glucose monitor are crucial for you and your health-care team to know how your diabetes treatment plan is working and if any changes are needed.
Finding out that you have type 1 diabetes can be scary and overwhelming. Learning how to manage it can be challenging and, at times, even frustrating. The good news is that managing diabetes is definitely doable! There are millions of people who have type 1 diabetes and are doing great. However, there are some steps you need to take to figure out the best way to manage your diabetes. The first step? Learn about your diabetes. You can’t manage something if you don’t know what’s happening. Ask your doctor for a referral to a diabetes educator or look into diabetes programs at your local hospital or health center.
You’ll need to take insulin, and your doctor may refer you to an endocrinologist, which is a doctor who specializes in diabetes to prescribe an insulin regimen that works best for you. Ideally, the endocrinologist will have a diabetes educator in the office who will show you the ropes on how to inject your insulin, how it works, when to take it and what to do if your blood sugar drops too low or goes too high. You should also meet with a dietitian or attend some nutrition classes to learn about how food affects your blood glucose and how to balance your carbohydrate intake to keep your blood glucose within your target range. Checking your blood sugar with a meter is vital for you to know if your blood glucose is at a safe level — many people with type 1 diabetes check before and after meals, and before going to bed, as well as before and after exercising. It may seem like a lot of finger-sticks — but it’s great information for you and your health-care team to understand if your insulin is working for you. You might eventually look into using an insulin pump to deliver insulin (no more injections) and/or a continuous glucose monitor (no more finger-sticks). Find out about the different tests and exams that you’ll need, as well, such as an A1C test and an annual dilated eye exam, for example. Keep all of your doctor appointments and go to your appointments prepared with questions. Finally, realize that diabetes education is a lifelong process. There is always something new to learn, so seek out classes, websites, support groups and diabetes publications so that you can stay on top of new treatments and research.
Type 1 diabetes can lead to high blood glucose, or hyperglycemia. While it’s not possible — or even necessary — to have perfectly controlled blood sugars when you have diabetes, blood sugars that are consistently high (meaning, above your target range) can lead to long-term complications. The longer you live with diabetes and the less controlled your blood sugars are, the higher your risk of complications. These complications, if left untreated, can be serious and even life-threatening. The most common complications of type 1 diabetes are as follows:
This includes heart attack, stroke, chest pain and narrowing of the arteries.
Also called nephropathy, the filtering system of the kidneys can be damaged by high blood glucose, leading to kidney failure or end-stage kidney disease, requiring dialysis or a kidney transplant.
Also called neuropathy, nerve damage occurs because high blood glucose levels affect the arteries that keep your nerves healthy. Peripheral neuropathy is nerve damage that occurs outside of the brain and spinal cord, primarily affecting the nerves in your hands and feet. Numbness, tingling, pain and loss of sensation are symptoms of neuropathy. But all of the nerves in the body can be affected by diabetes, including nerves in your digestive tract, your reproductive organs, and your heart.
High blood glucose levels can damage the blood vessels of the retina, causing diabetic retinopathy. Left untreated, it can lead to blindness. Other eye problems are more likely to occur due to diabetes, as well, such as glaucoma, cataracts and macular edema.
High blood glucose levels can cause damage to both the arteries and nerves in the feet, putting your feet at risk for infection and possible amputation if left untreated.
Other complications include certain skin conditions, gum disease and dental problems, hearing loss, and bone and joint disorders. Try not to get disheartened, though. Complications can be prevented with good self-management and medical care, and today, there are better, more effective treatments to slow their progression.
Currently, there is no cure for type 1 diabetes. Interestingly, in some people who are newly diagnosed with this condition, it seems like their diabetes has gone away! This happens because the pancreas may still be making enough insulin to keep blood glucose levels in a safe range. Called the “honeymoon period” (because it doesn’t last forever), you may find that you don’t have to take any insulin for a few weeks or even months. After a while, though, the pancreas peters out and you’ll need to start taking insulin again. So, despite the respite from the honeymoon period, type 1 diabetes doesn’t go away. But researchers are working to find a cure, including ways to turn immature cells into beta cells that make insulin, for example, along with immunotherapy that would kill the immune cells that attack the pancreas in the first place.
An eating plan (sometimes called a meal plan) can help you manage your diabetes, along with taking insulin, fitting in physical activity, and checking your blood glucose. Many people find that trying to figure out what, when and how much to eat is the hardest part of managing diabetes, however. There is no one “diet” for people who have type 1 diabetes. Instead, your eating plan should be based on a number of factors, including your age, gender, level of physical activity, lifestyle, cultural preferences and other conditions that you may have, such as high blood pressure. In addition, the American Diabetes Association recognizes that many different types of eating patterns can work well for people with diabetes, including a vegetarian plan, a Mediterranean-style plan, and even a low-carbohydrate eating plan.
When you’re first diagnosed with diabetes, it’s helpful to meet with a dietitian who has experience with diabetes. He or she can tailor an eating plan that works for you, but that also takes into consideration the type of insulin you take as well as when you take it. Very likely, the emphasis will be on controlling the amount of carbohydrate foods you eat, such as bread, pasta, rice, fruit and milk, since carbohydrate is the nutrient that has the most effect on your blood glucose. Carbohydrate counting is an easy way to plan out meals and include variety in your food choices. Your eating plan should provide a balance of foods, including vegetables, fruit, whole grains and starches, healthy protein foods and healthy fats, not just for blood glucose management, but also to make sure you are getting the nutrients you need for overall health. Your eating plan may include snacks, although with the many newer forms of insulin available, snacks are often not necessary. And if you choose, you can even fit sweets into your eating plan. A dietitian can also help you fit in favorite foods, plan for holidays and navigate eating out at restaurants. In general, what you eat is what your spouse or family can eat, too, so there is generally no need to prepare separate meals for yourself.
Insulin is a hormone that is made in the pancreas. Specifically, there are special cells in the pancreas, called beta cells, that produce insulin. There are also alpha cells in the pancreas that make glucagon, another hormone. But back to insulin: when insulin is made in the beta cells, it initially is in the form of “proinsulin,” which then splits into C-peptide and insulin. C-peptide plays a key role in the diagnosis of type 1 diabetes, as well as diabetes treatment, because it indicates how much insulin the pancreas is making.
Insulin helps the body use glucose from the carbohydrate in food for energy, and prevents glucose levels in the blood from rising too high. Insulin attaches to cells to absorb glucose from the bloodstream, much like a key that opens a lock. Once inside the cells, glucose is then used for energy. What happens if you have more glucose in your blood than the cells need? Insulin will funnel that extra glucose in your liver where it’s stored. If your blood glucose drops too low or if you need more fuel for, say, exercise, glucagon signals the liver to release that stored glucose.
If you have type 1 diabetes, you need to replace the insulin that your body no longer makes. Insulin can be injected, using a syringe or an insulin pen; it can also be infused by using an insulin pump. There is no insulin “pill” at this time. There are different types of insulin that mimic how insulin works in the body; for example, rapid-acting insulin starts to work in 5–15 minutes and is typically taken before you eat a meal. Intermediate and long-acting insulins start to work more slowly, and are used to help keep blood glucose levels steady between meals and overnight while you’re sleeping. You will likely need to use two different types of insulin to help you manage your blood glucose. Your doctor and diabetes educator should work with you to decide the best type and amount of insulin to take, and give you guidance on how to adjust your insulin for changes in food and physical activity, and for times when you need more insulin, such as when you are sick or under stress.
You don’t have to go it alone when you have diabetes. In fact, the more support that you get from your health-care team, family and friends, the easier it will be to successfully manage your diabetes. But who should be on your health-care team? For starters, your primary-care provider — a physician, physician’s assistant or nurse practitioner, for example — is the gatekeeper and can help coordinate your care. Ideally, you should have an endocrinologist, which is a doctor who specializes in the treatment of diabetes. A certified diabetes care and education specialist (formerly known as a certified diabetes educator) can teach you how to inject insulin or use an insulin pump, check your blood glucose, and make sense of your blood glucose readings. A dietitian can help you develop an eating plan that works with your lifestyle and helps to keep your blood glucose levels within your target range. An ophthalmologist can provide you with annual dilated eye exams to detect (and treat, if necessary) eye problems, such as diabetic retinopathy. If you have complications, you may need to see a cardiologist (heart specialist), a nephrologist (kidney specialist), neurologist (nerve specialist) or a podiatrist (foot care specialist). Your pharmacist can help you learn more about the medications that you may need to take. Finally, because you may feel overwhelmed, discouraged or even depressed about having diabetes, a mental health provider can be an invaluable member of your team to provide you with support. You might be more comfortable finding support from other people who live with type 1 diabetes, whether that’s from a support group or an online community.
If you aren’t sure how to put together your own team, talk with your primary-care provider. Also, look for resources in your community — for example, your local hospital may have a diabetes program. You can also call your local office of the American Diabetes Association. They can point you to programs and specialists in your community, as well. Finally, remember that you are the center of your health-care team. Don’t be afraid to ask questions and speak up if something isn’t working for you. Your team is there to work together to support you.
Diabetes self-management involves taking your insulin and other medications, eating healthfully, staying active and, of course, checking your blood sugar. But how do you know if everything you’re doing is working for you? And how can you minimize your risk of complications? There are certain tests and exams that you’ll need to help you and your health-care team know how you’re doing. These include:
This is a number that measures your average blood glucose over the past 2–3 months. For most people with diabetes, the A1C goal is less than 7%. Get your A1C checked two to four times a year.
To help lower your risk of heart disease, stroke and kidney problems, it’s important to keep your blood pressure in a safe range, typically less than 140/90.
High cholesterol and triglycerides (blood fats) raise your risk of heart disease. Your lipids include total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides. In general, total cholesterol should be under 200; LDL less than 100; HDL greater than 40 for men and greater than 50 for women; and triglycerides less than 150.
A microalbumin test checks your urine for protein; if your microalbumin is above 30, it may be an early sign of kidney damage.
A dilated eye exam can detect early signs of diabetic retinopathy, as well as other eye problems related to diabetes. Make sure you have a dilated eye exam at least once a year or as ordered by your eye care specialist.
Checking your feet daily is important to detect cuts, sores, redness or swelling. But your doctor should check your feet at least once a year during a regular office visit to check for problems with circulation, sensation, foot structure and infection. Remove your shoes and socks at each visit to remind your doctor to check your feet.
Diabetes can affect the health of your gums and teeth, and gum disease is more common in people with diabetes. Have regular dental exams and teeth cleanings at least twice a year to detect and treat gum disease and other oral health issues.
While not actual “tests,” it’s important to make sure you receive certain vaccinations if you have type 1 diabetes. These include a yearly influenza vaccine, a pneumonia vaccine, a hepatitis vaccine, and a shingles vaccine. Other vaccines may be recommended for you, as well.
Make sure you talk with your doctor or endocrinologists about the tests and exams that you need. Ask about your results and be sure you that you know what your goals are, as well.
Want to learn more about type 1 diabetes? Read “The Type 1 Diabetes Diagnosis,” “Top 10 Tips for Better Blood Glucose Control” and “Be Aware of Hypoglycemia Unawareness.”
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