TYPE 1 DIABETES

Management of Type 1 Diabetes

The management of Type 1 Diabetes involves a combination of

• Insulin by multiple daily injections or insulin pump

• Exercise

• Healthy diet

• Regular blood sugar measurements.

People living with Type 1 Diabetes need regular specialist care as their medical needs change and to screen for potential diabetes related complications. Activities and illness also affect their management.

Insulin Treatment in Type 1 Diabetes:

Insulin is essential for people with type 1 diabetes as the body produces little or no insulin.  Without insulin, people with type 1 diabetes cannot survive. Whether you have an insulin pump or give multiple daily insulin injections, it is recommended that you:

• Monitor your blood glucose levels regularly

• Bolus for insulin if your blood glucose level is high

• Bolus for insulin if you are eating carbohydrate containing foods

• Learn to carbohydrate count so you can match the amount of insulin given with the amount of carbohydrate in the food

• Adjust your insulin doses depending on activities such as exercise or work and illness

• See your GP and endocrinologist routinely

• Have routine screening for diabetes complications

Success requires work and effort. If you are willing to work at it, you will see the rewards!

What are the types of insulin used in type 1 diabetes?

There are two main types of insulin.

1. Basal insulin

Basal insulin is also known as background insulin. This mimics the body’s natural steady release of insulin.  When basal insulin is given it is absorbed slowly and gives the body a steady, low level of insulin to manage blood glucose.

Examples of basal insulin include Lantus (insulin glargine) and Levemir (insulin detemir).  Alternatively, giving small continuous amounts of quick acting insulin via an insulin pump acts as basal insulin.

2. Quick acting insulin

A bolus of quick acting insulin is taken to cover the rise in blood sugar with food and/or if blood sugar levels are high.  This mimics the body’s large peaks in insulin that are normally released in response to food or a high blood glucose level

Quick acting insulins can be given via:

• Pens

• Needle and syringe

• As a bolus via a insulin pump

Examples of quick acting insulin include Humalog (Lispro), Novorapid (Aspart) or Apidra (Glulisine).

Quick acting insulin is usually best taken 10-15 minutes before a meal.  This is so that the insulin is “kicking in” and reaching its peak effect as you are about to digest the meal.

How long does insulin last?

Depending on which type of insulin and how much insulin you take will determine how long an insulin will last.

Common insulin profiles include:

Knowing how long your insulin lasts is important.  You should avoid taking repeated doses of quick acting insulin before they have had time to “kick in” or you can cause “stacking” of insulin.  Hypoglycemia or a lower blood glucose level can occur if you “stack” multiple doses of insulin. Instead you should allow 2 or 3 hours for your quick acting insulin to reach its peak before giving a second dose of quick acting insulin.  

How often should I check my blood glucose level if I have type 1 diabetes mellitus?

Knowing your blood glucose level can help you decide how much insulin to take. It is recommended to check your blood glucose level:

• Before driving

• Before eating or giving insulin

• Before exercising

• Before going to bed

• If you think you are having a “hypo” (low blood glucose)

What do I do if I have diabetes and I have a low blood sugar level?

A low BGL or hypoglycemia is a blood sugar less than 4 mmol

Some people may or may not have symptoms if they are having a hypo.  If you think you are having a hypo or have a low blood sugar level check your blood glucose level. (If you can’t check your BGL, treat it as a hypo, just in case.)

After you have recovered from your hypoglycemic event try and think what things may have caused your low blood sugar so that you can try and avoid it in the future.  Hypoglycaemia can be caused by one or a number of events, such as:

• Too much insulin

• Too much of glucose lowering diabetes tablets

• Delaying or missing a meal

• Not eating enough carbohydrate

• Unplanned physical activity

• More strenuous exercise than usual

• Drinking alcohol

It is an emergency if the person is hypoglycaemic and is unconscious, drowsy or unable to swallow.  Do not give them any food or drink by mouth. Treat as follows:

1.    Place them on their side making sure their airway is clear

2.    Give an injection of Glucagon if available and you are trained to give it

3.    Phone for an ambulance (Dial 000)

4.    Wait with them until the ambulance arrives

What are the top tips for exercising with type 1 diabetes?

• Have more carbohydrate before the exercise

• Have less insulin before and/or after exercising

• Change the type of activity or take the type of activity you are doing into account when you are planning on the types of food you will eat and how much insulin you will give

• Check your blood glucose level more often

What routine screening is recommended for people living with Type 1 diabetes?

By having regular screening tests, you can reduce your risk of long term diabetes related complications.

Your diabetes care plan or annual cycle of care should include regular tests such as:

• Eye check with your optometrist or ophthalmologist

• Checking your feet with GP or podiatrist

• Blood pressure monitoring

• Kidney checks with blood and urine tests

What do I do if I have type 1 diabetes and become sick or unwell?

Everyone with type 1 diabetes mellitus should have a sick day plan so that you can avoid developing life threatening diabetic ketoacidosis (DKA).  When you are unwell it is important to:

• Monitoring your blood sugar more frequently

• Check your blood or urine ketones

• Take extra insulin corrections if your blood sugar is high

• Drinking lots of water if possible

• Never stop taking your background or basal insulin

You need to go to hospital if you:

• Have blood or urine ketones that are not lowering despite insulin

• Have persistent vomiting

• Have persistent hypoglycaemia

• Become drowsy or confused

• Develop fast or unusual breathing

• Develop abdominal pain

• Are unsure what is wrong

• The people who are caring for you are not sure what to do or are exhausted

What do I do if I have type 1 diabetes and want to travel?

• Get travel insurance prior to booking your holiday– Some companies have HbA1c requirements

• If you are an Australian citizen consider travelling to countries with reciprocal health agreement such as New Zealand, United Kingdom, Republic of Ireland, Sweden, Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway

• Think about which country you are travelling to. What access to health care you may require?

• Think about who you are travelling with.  Do they have the information and skills to help you if required or do they need further education?

• Think about what you will do with time zone changes – remember you always need to have insulin on board to avoid becoming unwell with DKA

• Calculate what insulin you need and take 20% more as spare

• Take a spare glucose meter- One that uses the same strips

• See you doctor before in case you need other medications:

  • What if you get “Bali belly” or gastro?

  • Do you have medications to take if you are vomiting?

  • Do you need travel immunisations?

• Make sure you pack everything you need

  • Travel letter (+PDF digital copy)

  • Take a list of medications (+PDF digital copy)

  • Sick day plan (+PDF digital copy)

  • Food & hypo treatment

  • Insulin pump failure action plan and spare insulin needles/pens

  • Pack your insulin in your hand luggage. Don’t pack insulin in stowed luggage as it will freeze in the hull of the plane