Type 1 Diabetes: Living With the Disease

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

Is this topic for you?

This topic provides information for teens and their parents and for adults who have had diabetes for more than a few months. Before reading this topic, you may want to read Type 1 Diabetes: Recently Diagnosed.

If this topic does not answer your questions, see:

• Type 1 Diabetes, if you want to learn about type 1 diabetes but do not have the disease.
• Type 1 Diabetes: Recently Diagnosed, if you have been told recently that you or your child has type 1 diabetes.
• Type 1 Diabetes: Children Living With the Disease, if your child age 11 or younger has type 1 diabetes. Before reading this topic, you may want to read Type 1 Diabetes: Recently Diagnosed.
• Type 1 Diabetes: Living With Complications, if you have complications such as eye, kidney, heart, nerve, or blood vessel disease caused by diabetes.

What is type 1 diabetes, and what is it like to live with the disease?

Type 1 diabetes is a lifelong disease that develops when the pancreas stops making insulin. Your body needs insulin to let sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.

Everyone experiences type 1 diabetes differently. But the treatment is the same. You need to take insulin, eat a balanced diet that spreads carbohydrate throughout the day, and exercise. Part of your daily routine also includes checking your blood sugar levels regularly, as advised by your doctor.

The goal is to keep your blood sugar in a target range. You and your doctor may decide to keep your blood sugar at a normal or near-normal level. This is called tight control. It is the best way to reduce your chance of having more problems from diabetes. These are called complications.

Taking care of your diabetes takes time and energy every day. It is a big part of your life. But it will help you feel better and may prevent, or at least delay, complications. If your teen has diabetes, tight control of blood sugar levels may help prevent complications from developing in early adulthood.

What symptoms do you need to watch for?

It’s important to watch for signs of low and high blood sugar:

• Early symptoms of low blood sugar are sweating, weakness, shakiness, and hunger. But your symptoms may vary. After you have had diabetes for a long time, you may not notice these symptoms anymore. Low blood sugar happens quickly. You can get low blood sugar within 10 to 15 minutes after you exercise or take insulin without eating enough.
• Early symptoms of high blood sugar are increased thirst, increased urination, increased hunger, and blurred vision. High blood sugar usually develops slowly over a few days or weeks.

Both low and high blood sugar can cause problems and need to be treated. Check your blood sugar often during the day.

What are the complications of diabetes and their symptoms?

Over time, high blood sugar can damage blood vessels and nerves throughout your body. This can cause problems with your eyes, heart, blood vessels, nerves, and kidneys. Complications can lead to blindness, kidney failure, amputation, and death. High blood sugar also makes you more likely to get serious illnesses or infection. It's hard to know if you will have complications. Some people are more likely to have problems than others. The longer you have diabetes, the greater your risk of complications. You are not likely to have signs of complications until you have had diabetes for about 5 years.

Watch for early symptoms of problems. Tingling and numbness in your feet may be a sign of early nerve damage. Seeing flashes of light may be a symptom of early eye damage. Eye and kidney problems often develop at the same time. Kidney damage does not have early symptoms, so make sure you have regular screening tests for protein in your urine.

Is it possible to prevent complications?

You may be able to prevent, or at least delay, problems from diabetes by keeping your blood sugar level as close to normal as you can. Treatment of high blood pressure and high cholesterol can also help.

See your doctor every 3 to 4 months. During these visits, your doctor will review your treatment and do tests and exams to see if your blood sugar is staying within your target range and if you have developed any complications.

Some exams and tests need to be done at every visit; others are done once a year, such as eye exams and tests for protein in your urine. Other tests may be done only if there is a problem.

How will your treatment change over time?

Your insulin dose, possibly the types of insulin, and the way you give it (by shots or insulin pump) may change over time to fit your changing needs. This is especially true for teens, because they are still growing.

The goal of treatment is to always keep your blood sugar level as close to your target range as you can. To meet this goal, take care of yourself, get regular checkups, and keep learning about how to care for yourself.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Carbohydrate counting for people who use insulin
	Dealing with low blood sugar from insulin for diabetes
	Dealing with your feelings about the diet for diabetes
	Foot care for people with diabetes
	Giving an insulin injection to an adult with diabetes
	Home blood sugar monitoring
	Preventing high blood sugar emergencies from diabetes
	Using a food guide for people with diabetes

You have type 1 diabetes because your pancreas can no longer produce insulin. When your pancreas was working, it adjusted the amount of insulin it made based on your changing blood sugar. However, insulin injections cannot control your blood sugar moment to moment, as your pancreas would. As a result, you will have high and low blood sugar levels from time to time.

Causes of high blood sugar

• Skipping a dose of insulin or eating more food than usual
• Stress and being ill (such as with severe flu) or having an infection, especially if you are not eating or drinking enough
• Taking medications that can raise blood sugar levels, such as those for sleep, some decongestants, and corticosteroids (such as prednisone)
• The dawn phenomenon or the Somogyi effect, which can cause early-morning high blood sugar
• Adolescence, because of hormone changes and rapid growth

Causes of low blood sugar

• Taking too much insulin
• Skipping or delaying a meal or snack
• Exercising more than usual without eating enough food
• Drinking too much alcohol, especially on an empty stomach
• Taking medications that can lower blood sugar, such as aspirin and medications for mental disorders
• Starting your menstrual period, because hormonal changes may affect how well insulin works

Treating type 1 diabetes with insulin injections means you may have high and low blood sugar from time to time.

• Symptoms of high blood sugar include increased thirst, increased urination, and blurred vision.
• Symptoms of low blood sugar include sweating, weakness, and hunger. Severe low blood sugar may cause loss of consciousness and seizures.

High blood sugar usually develops slowly over hours or days, so you can take steps to correct it before your symptoms become severe and require medical attention. On the other hand, your blood sugar level can drop to dangerously low levels within 10 to 15 minutes of exercising or taking insulin without eating enough. You also can get low blood sugar if you have previously taken intermediate- or long-lasting insulin and skip a meal.

Signs of complications

The longer you have diabetes, the more likely you are to develop complications. You are not likely to develop signs of complications from diabetes until you have had the disease for about 5 years. Still, you should watch for complications. Signs may include:

• Burning pain, numbness, or swelling in your feet or hands. These symptoms may signal damage to the nerves that affect sensation and touch. This complication is called peripheral neuropathy. If one nerve is affected (focal neuropathy), you may have symptoms in one area of your body, such as carpal tunnel syndrome.
• Blurred or distorted vision; seeing floaters, flashes of light, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in your eyes. These symptoms may indicate diabetic retinopathy. You are also at risk for other eye diseases, such as glaucoma and cataracts.
• A wound that won't heal or that looks infected. This may mean you have damage to the blood vessels that supply that area. It also can happen because your body's white blood cells do not fight infection well when blood sugar is high.
• Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These are signs of gastroparesis, or slow emptying of the stomach. It happens when the nerves that control your internal organs and systems are damaged (autonomic neuropathy).
• A lot of sweating (especially after meals) or reduced sweating; feeling dizzy or weak when you sit or stand up suddenly; not being able to tell when your bladder is full or to empty your bladder completely; erection problems or vaginal dryness; or difficulty knowing when your blood sugar is low (hypoglycemia unawareness). These also may indicate autonomic neuropathy.

You will not have symptoms of kidney problems (diabetic nephropathy) until severe damage has developed. Then you may notice swelling in your feet, legs, and throughout your body. Having regular tests for protein in your urine is the only way to detect kidney damage before symptoms develop.

Your experience with type 1 diabetes will be different from that of other people. But your treatment will be the same: taking insulin, eating a balanced diet that spreads carbohydrate throughout the day, getting regular exercise, and checking your blood sugar levels.

If you work closely with your health professional and follow your treatment, you will feel better and more in control of your life. You also may prevent or delay complications.

Not everyone with diabetes develops complications from the disease. Keeping blood sugar levels within a normal or near-normal range may prevent or delay complications. If your adolescent with diabetes tightly controls his or her blood sugar, he or she can avoid developing complications in young adulthood.

Injected insulin cannot perfectly match the action of a working pancreas, so you will have high and low blood sugar levels from time to time. If your blood sugar stays above your target range for a long time, your blood vessels and nerves may be damaged. This damage can lead to:

• Microvascular disease, which affects your eyes or kidneys. Diabetic retinopathy and diabetic nephropathy develop without early signs. For more information, see the topics Diabetic Retinopathy and Diabetic Nephropathy. You are also at risk for other eye diseases, such as cataracts and glaucoma.
• Macrovascular disease, which affects your heart and your body's large blood vessels. Diabetes damages the lining of large blood vessels. They become clogged with hard, fatty deposits called plaques. This process, called atherosclerosis, narrows the vessels. Blood supply drops to the affected area. A heart attack or stroke may occur when the blood vessels that supply your heart and brain are affected. Peripheral arterial disease develops when the large vessels in your legs are affected. This leads to problems with blood circulation in your legs and feet and causes changes in the skin color, decreased sensation, and leg cramps. For more information, see the topics Heart Attack and Unstable Angina and Peripheral Arterial Disease of the Legs.
• Diabetic neuropathy, which affects the nerves in your body. Diabetic neuropathy can decrease or block the movement of nerve signals through your organs, legs, arms, and other parts of your body. Nerve damage can affect functioning of internal organs, such as the stomach (gastroparesis), and your ability to feel pain when injured. When blood vessels and nerves are affected, bone and joint deformities can develop, especially in your feet (Charcot foot). For more information, see the topic Diabetic Neuropathy.

People with diabetes often already have other health problems. These may include high blood pressure and high cholesterol. Or, they may develop them as diabetes progresses. These conditions, along with smoking, can cause diabetes complications or can make existing ones worse. Not smoking and controlling your blood pressure and cholesterol level can help prevent or help slow complications.

Other health problems in adolescents

Studies have found that adolescent girls are at higher risk than other people for diabetic ketoacidosis; they may skip insulin doses to lose weight.¹

Eating disorders are also common among adolescents and young adults with diabetes. Eating disorders and the tendency to skip insulin injections can cause swings in blood sugar levels outside the target range. Eating disorders need to be diagnosed and treated as quickly as possible to prevent serious health problems.

Type 1 diabetes puts you at risk for high and low blood sugar and complications.

Risk factors for high and low blood sugar

• Age. Adolescent girls are at great risk for high blood sugar, which can lead to diabetic ketoacidosis. Girls are often concerned about their weight and body image and they may skip insulin injections to lose weight.¹
• Tight blood sugar control. Tight control of blood sugar helps prevent complications, such as eye, kidney, heart, blood vessel, and nerve disease. But it does put you at risk for frequent low blood sugar levels. Tight control means keeping your blood sugar at a normal or near-normal level.
• Adolescence. The rapid growth spurts and changing hormone levels of adolescence can make it difficult to keep blood sugar levels within your target range. This is the blood sugar goal you set with your health professional.
• Psychiatric conditions. Eating disorders, depression, anxiety disorder, panic disorder, and addiction to alcohol or drugs increase the risk of frequent high and low blood sugar levels.¹

Risk factors for complications

It is hard to know why some people develop complications and others do not. Factors that contribute to the risk of complications include:

• High blood sugar over time. The higher your blood sugar level is and the longer it remains too high, the greater your risk for complications.
• Length of time you have the disease. The longer you have diabetes, the more likely you are to develop complications, even if you control your blood sugar levels.
  • About 60% of people with type 1 diabetes develop diabetic retinopathy after 10 years, and almost all have it to some degree after 20 years. About 25% develop the advanced stage, proliferative retinopathy, after 15 years.²
  • Diabetic nephropathy eventually occurs in 20% to 30% of all people with diabetes. Without treatment to slow kidney disease, most people with type 1 diabetes will move from the early form to the advanced stage of nephropathy in 10 to 15 years.³ Children who develop nephropathy usually show the first signs of the condition after puberty.
  • Most people with diabetes develop some diabetic neuropathy over the years, but only about 13% to 15% have noticeable symptoms.⁴
• Having one complication. Once you have a complication, you are at risk for others.
• Other risk factors. Smoking, psychiatric disorders (such as depression), high blood pressure, high cholesterol, and a family history of diabetic complications may increase your risk for developing a complication. Encourage teens not to smoke. Smoking increases their risk for developing complications in early adulthood. Not having health insurance coverage for supplies and other medical expenses related to diabetes care can contribute to poor control of the disease. Eventually, this leads to developing complications.

Call 911 or other emergency services immediately if you or your adolescent has trouble staying awake and has a blood sugar level of less than 60 milligrams per deciliter (mg/dL).

• Follow the steps for emergency care for low blood sugar.

Call a health professional if:

• Your or your adolescent's blood sugar level is above the normal range after you follow the steps for high blood sugar.
• Your or your adolescent's blood sugar level is below the normal range after eating some quick-sugar food.
• Your or your adolescent's blood sugar level stays high after taking a missed dose of insulin or taking an extra dose of insulin (if prescribed by your doctor).
• You or your adolescent has frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
• You or your adolescent is having problems following the meal plan or getting physical activity, and you want help.
• You or your adolescent is sick for more than 2 days (unless it is a mild illness, such as a cold), and you:
  • Have been vomiting or had diarrhea for more than 6 hours.
  • Have followed your doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
  • Have blood sugar levels that are often above 300 mg/dL and your urine tests for ketones show you have more than 2+ or moderate or higher ketones.
• You begin to notice symptoms of diabetes complications, such as:
  • Burning pain, numbness, or swelling in your feet or hands.
  • Blurred or distorted vision; seeing floaters or flashes of light, large red or black spots that float, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in your eyes.
  • A wound that won't heal or that looks infected.
  • Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain.
  • A lot of sweating or reduced sweating; feeling dizzy or weak when you sit or stand up suddenly; trouble sensing when your bladder is full or difficulty emptying your bladder completely; erection problems or vaginal dryness; or difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

Watchful Waiting

Watchful waiting (or surveillance) is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. It is not appropriate if you have frequent high or low blood sugar levels. See your health professional. Your treatment may need to be changed.

Also see your health professional if you begin to notice symptoms of complications. Early treatment can prevent complications or keep them from getting worse.

Who To See

Health professionals involved in your treatment may include:

• An endocrinologist.
• A family medicine physician.
• A general practitioner.
• An internist.
• An adolescent medicine specialist.
• A pediatrician.
• A nurse practitioner.
• A physician assistant.
• A certified diabetes educator (CDE).
• A registered dietitian.

Who to see for complications

If you begin to have symptoms of complications from diabetes, you may be referred to:

• A cardiologist or vascular specialist, for treatment of heart and circulation problems.
• A nephrologist, for treatment of kidney disease.
• An ophthalmologist or optometrist, for diagnosis and treatment of eye disease; ophthalmologists treat retinal complications from diabetes.
• A neurologist, for treatment of nerve damage.
• A gastroenterologist, for treatment of problems in the stomach and intestines.
• A urologist, for treatment of problems with sexual function or the urinary tract.
• A podiatrist, pedorthist (a certified technician who can make special shoes or shoe inserts), or orthopedic surgeon, for foot and ankle problems.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You need to see your health professional about every 3 to 4 months throughout your life for tests and exams to see how you are doing and to adjust your treatment.

After you have had diabetes for 3 to 5 years, you will need annual tests to look for signs of eye damage (diabetic retinopathy), kidney damage (diabetic nephropathy), and less feeling in your feet (diabetic neuropathy).

Other possible tests

You may also need:

• Continuous glucose monitoring, if your doctor recommends it. This is a new test; you wear a monitor that checks your blood sugar level continuously for 24 to 72 hours. The results are stored in the monitor and can show your blood sugar level pattern. The monitor also can be used to spot low or high blood sugar levels. In the future, these devices may use an alarm to warn you of low or falling blood sugar. Also, someday they may be used with insulin pumps to automatically change your insulin dose as needed.
• An electrocardiogram (ECG or EKG) if you have had a heart attack or have heart disease.
• An exercise electrocardiogram (treadmill EKG test) before you begin a vigorous exercise program. Your doctor may want you to have this test to see whether you have signs of heart disease. Your doctor may use an EKG along with a test called a nuclear scan to measure the blood flow in your heart. These tests together may be especially useful for finding heart problems in people with diabetes.
• An examination by a cardiologist, if you develop heart problems related to diabetes.
• A thyroid-stimulating hormone (TSH) test to check for thyroid problems, which are common in people with diabetes.

The goal of treatment for type 1 diabetes is to keep your blood sugar levels within a normal or near-normal range and to reduce the risk for complications. Daily diabetes care and regular medical checkups will help you stay healthy.

Keeping your blood sugar at a normal or near-normal level—which is called tight control—is the best way to reduce your chance of diabetes complications.

A normal to near-normal blood sugar level is 90 mg/dL to 130 mg/dL before eating or less than 180 mg/dL 1 to 2 hours after eating. It also may be measured as a hemoglobin A_1c of 6% or less (normal) to 7% (near normal). This is a test of your blood sugar control for the past 2 to 3 months. If you do not have problems with low blood sugar, you may be able to tightly control your blood sugar to an A_1c of 6% or less. If you often have severe low blood sugar, the target range you set with your health professional may have to be higher than 6%.

Daily care

Your daily care includes:

• Preparing and giving insulin injections or using an insulin pump.
• Home blood sugar monitoring.
• Dealing with low blood sugar levels.
• Preventing high blood sugar levels.
• Counting carbohydrate grams or using the food guide for diabetes.
• Caring for your feet.
• Dealing with your feelings about your diet.

You will also need to:

• Get 30 minutes of active physical exercise on most days. Take steps to exercise safely.
• Take an aspirin daily. If you are age 30 or older, talk to your health professional about taking a low-dose, or baby, aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.⁵
• Control your blood pressure. Blood pressure should be less than 130/80 millimeters of mercury (mm Hg) in people with diabetes. Moderate exercise, such as 30 minutes of brisk walking most days of the week, can help lower blood pressure. But you may need to take one or more medications—such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)—to achieve your goal.⁶
• Control your cholesterol. A low-fat diet, exercise, and weight loss can lower your cholesterol. Your body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (especially triglycerides) can rise a lot. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) for low-density lipoprotein (LDL), or "bad," cholesterol. HDL should be more than 40 mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less than 150 mg/dL. You may need to take lipid-lowering medications, such as statins, to reach your goals.⁷
• Not smoke. Or, if you have a teen with diabetes, encourage him or her to not smoke.
• Take precautions when you are driving and not drive if your blood sugar is below 65 milligrams per deciliter (mg/dL).
• Take care of your skin and your teeth and gums.
• Know what to do when you are sick.
• Learn how to prevent problems while traveling.
• Grieve the things you feel that you have lost because you have diabetes.

You may also want to know:

• What needs to be done if you want to become pregnant, such as changing your treatment or getting additional screening tests.
• Where to find a support group or camp for people with diabetes.
• How to limit your alcohol intake to no more than one drink a day for women (none, if you are pregnant) and two drinks a day for men.
• What immunizations you need. For more information, see the topic Immunizations.
• How to deal with a rebellious adolescent who has diabetes.

How often should I see my doctor?

See your doctor about every 3 to 4 months for the rest of your life. During these checkups, your doctor will look at your treatment and adjust it, if needed. Other exams and tests will be done according to a recommended schedule. After you have had diabetes for 3 to 5 years, you will start having annual exams and tests to monitor for eye and kidney damage.

What if my blood sugar level is very high?

If you do not take enough insulin, have a severe infection or other illness, or become severely dehydrated, your blood sugar level may rise very high. This can cause diabetic ketoacidosis, which is usually treated in a hospital and often in the intensive care unit (ICU). There you are watched closely and get frequent blood tests for glucose and electrolytes. You will get insulin through a vein (intravenous, or IV) to bring your blood sugar levels down.

You also will get fluids through the IV to correct the electrolyte problem in your body. You may have to stay in the hospital for a few days to get your blood sugar level back into your target range.⁸

What To Think About

The 10-year Diabetes Control and Complications Trial (DCCT) and follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study showed that keeping blood sugar levels within a near-normal range helps decrease your chances of developing complications from diabetes, such as eye, kidney, heart, blood vessel, and nerve damage. As a result of this study, experts recommend that you carefully control your blood sugar. This is often referred to as strict or tight blood sugar control.

If you tightly control your blood sugar levels, you reduce your risk for long-term complications. However, you are also 3 times more likely to have episodes of very low blood sugar. These episodes can be dangerous unless you treat them early.

Studies are ongoing to find painless ways for people with diabetes to test their blood sugar and give themselves insulin, such as through insulin pumps and improved needles. Ways to prevent or decrease complications from diabetes also are being studied. Talk to your health professional if you would like to participate in these diabetes studies.

Preventing high and low blood sugar

Taking insulin for type 1 diabetes helps keep your blood sugar at normal levels. But insulin by injection cannot exactly match the minute-by-minute adjustments your pancreas would make on its own. So, you will have low and high blood sugar from time to time.

You can prevent many of these episodes by:

• Taking your insulin as prescribed.
• Eating meals according to your meal plan.
• Exercising about the same amount and at about the same time each day.
• Checking your blood sugar level several times a day and whenever you think it may be high or low.
• Recognizing and treating high or low blood sugar quickly.

For more information, see:

Dealing with low blood sugar (hypoglycemia) emergencies

Preventing high blood sugar (hyperglycemia) emergencies

Preventing complications

Keeping your blood sugar levels carefully within a normal or near-normal range is the most effective way to prevent complications. The higher your blood sugar level, the greater your risk for developing complications. An adolescent who keeps his or her blood sugar levels tightly within a target range can prevent complications from developing in early adulthood.⁹

You can also help prevent these complications by:

• Having yearly screening for protein in your urine after you have had diabetes for 5 years. This is the only way to detect early kidney damage (diabetic nephropathy). If kidney damage is found, medication can help slow, or possibly reverse, the damage.
• Having yearly exams by an ophthalmologist or optometrist after you have had diabetes for 3 to 5 years. This is the only way to check your eyes for signs of damage (diabetic retinopathy), glaucoma, and cataracts.
• Treating high blood pressure and high cholesterol. These conditions increase your risk for developing diabetic complications, especially heart and blood vessel diseases.¹⁰
• Taking aspirin. If you are age 30 or older, talk with your doctor about whether you should take a low-dose, or baby, aspirin to help prevent complications.⁵ People with diabetes are 2 to 4 times more likely than people who don't have diabetes to develop fatal heart and blood vessel diseases. If you have had a heart attack, stroke, or other large blood vessel disease, you may need to take aspirin, unless there are other health reasons why you cannot take it. Do not give aspirin to your adolescent with diabetes. It has been linked with Reye's syndrome.
• Not smoking. Smoking increases your risk for diabetes-caused damage to the blood vessels.¹¹ Smoking could increase your adolescent's risk for developing complications in early adulthood.
• Keeping your immunizations up to date. Diabetes affects your immune system, increasing your risk for developing a severe illness, such as influenza or pneumonia. See the topic Immunizations for the recommended immunization schedule.
• Caring for your feet. Wearing padded, absorbent socks and cushioned shoes can reduce injury to your feet. You also should check your feet every day for sores, hot spots, and cuts.
• Wearing medical identification to let medical personnel know that you have diabetes. You can buy medical identification bracelets, necklaces, or other forms of jewelry at your local pharmacy.

Type 1 diabetes requires daily attention to diet, exercise, and insulin. You may have times when this job feels overwhelming, but taking good care of yourself will help you will feel better, have a better quality of life, and prevent or delay complications from diabetes.

Eat well and count carbohydrate grams

Follow one of these meal-planning methods to help you eat a healthful diet and spread carbohydrate through the day. This will help prevent high blood sugar levels after meals. For more information, see:

Food guide for diabetes

Carbohydrate counting

Focusing on the type of carbohydrate as well as the amount might help you maintain your target blood sugar level. Foods with a low glycemic index (GI) may have a small but helpful role in preventing spikes in blood sugar; it is not yet known if they have a role in preventing complications.¹² Low glycemic foods do not raise blood sugar as quickly as high glycemic foods. Foods with a low GI include high-fiber whole grains, lentils, and beans. High GI foods include potatoes and white bread.

Using fat replacers—nonfat substances that act like fat in a food—may seem like a good idea, but talk with a registered dietitian before you do. Some people may eat more food, and therefore more calories, if they know a food contains a fat replacer.

Take insulin

Make sure you know how to give yourself insulin.

Preparing and giving an insulin injection

If you are using an insulin pump, make sure you know how to use it properly.

Get physical exercise

Try to get 30 minutes of exercise a day on most days of the week. However, exercise safely.

Monitor your blood sugar

Checking your blood sugar level is a major part of controlling your blood sugar level and keeping it in a target range you set with your health professional. For more information, see:

Home blood sugar monitoring

Handle high and low blood sugar levels

Be sure you:

• Recognize and treat high and low blood sugar levels. For more information, see:

  Dealing with low blood sugar (hypoglycemia) emergencies

  Preventing high blood sugar (hyperglycemia) emergencies

• Always wear medical identification to let medical personnel know that you have diabetes.
• Take precautions when you are driving and do not drive if your blood sugar is below 65 milligrams per deciliter (mg/dL).

Control your blood pressure and cholesterol

• Blood pressure in people who have diabetes should be less than 130/80 millimeters of mercury (mm Hg). Moderate exercise, such as 30 minutes of brisk walking most days of the week, can help lower blood pressure. But you may need to take one or more medications, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to achieve your goal.⁶
• A low-fat diet, exercise, and weight loss can lower your cholesterol. Your body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (especially triglycerides) can rise a lot. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) for low-density lipoprotein (LDL), or "bad," cholesterol. HDL, or "good," cholesterol should be more than 40 mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less than 150 mg/dL. You may need to take lipid-lowering medications, such as statins, to reach your goals.⁷

Take an aspirin every day

If you are age 30 or older, talk to your health professional about taking a low-dose, or baby, aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.⁵

Deal with your feelings

A chronic illness creates major change in your life. You may need to grieve the loss of your old life from time to time. In addition, you may feel resentful, deprived, or angry about having to pay attention to what and how much you eat. For more information, see:

Dealing with your feelings about the diet for diabetes

Protect your feet

Daily foot care can prevent serious problems. Foot problems caused by diabetes are the most common cause of amputations. For more information, see:

Foot care for people with diabetes

Learn more about diabetes

Diabetes is a complex disease and there is a lot to learn, such as:

• How to better care for your skin and your teeth and gums. For example, using a humidifier in your house or wearing gloves when gardening can keep your skin from becoming dry and cracking. Daily flossing and brushing can reduce the risk of gum disease.
• Precautions to take when you are sick. You need to drink more fluids than usual to prevent dehydration and test your urine for ketones when you are sick.
• How to prevent problems while traveling. You may want to take extra insulin with you and have plenty of snacks on hand in case you are in an area where you cannot get food.
• Where to find a support group for people with diabetes. Camps are also available for adolescents who have diabetes.
• How to stop smoking, or how to prevent your adolescent with diabetes from starting.
• How to limit your alcohol intake to no more than one drink a day for women (none, if you are pregnant) and two drinks a day for men.
• What immunizations you need. For more information, see the topic Immunizations.
• How to deal with a rebellious adolescent with diabetes. Ideas for helping your teen include letting him or her use an insulin pen or pump and letting your teen meet alone with his or her diabetes educator. This may help your teen feel more in control of his or her diabetes care.

Insulin is the only medication that can treat type 1 diabetes. You are probably taking more than one type of insulin, either as an injection or using an insulin pump.

The amount and type of insulin you take will likely change over time, depending on changes that occur with normal aging, changes in your exercise routine, and hormonal changes (such as during rapid growth of adolescence or pregnancy). You may need higher doses of insulin when you are ill or experiencing emotional stress. A woman needs much more insulin than usual during the last part of pregnancy.

You should:

• Know the dose of each type of insulin you take, when you take the doses, how long it takes for each type of insulin to start working (onset), when it will have its greatest effect (peak), and how long it will work (duration).
• Never skip a dose of insulin without the advice of your doctor.

Medication Choices

Insulin

What To Think About

You may need other medications at some point in your life.

• If small amounts of protein are found when your urine is tested (microalbuminuria), you are in the early stage of diabetic nephropathy. You may be given an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB). An ACE inhibitor may reverse early kidney damage.¹³
• If you have had a heart attack, stroke, or other large blood vessel disease, you need to take aspirin, unless there are health reasons why you cannot. If you are age 30 or older and are at risk for heart and blood vessel disease, you also may want to take aspirin to help prevent these complications.⁵ Do not give aspirin to your adolescent with diabetes, because it has been linked with Reye's syndrome.
• If you have high blood pressure or high cholesterol, you may need other medications to treat these conditions. Adequate treatment may help prevent complications from diabetes. You may need one or more medicines to lower blood pressure. You also may need to take statins to lower your cholesterol. Statins are medications that can reduce LDL levels and the risk of heart disease in people with diabetes.⁷ They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.¹⁴

Surgery is not a routine way of treating type 1 diabetes. You are eligible for surgery only if you meet specific criteria.

• You may have a pancreas transplant surgery if you have had or plan to have a kidney transplant or, rarely, if you meet other requirements.
• You may have islet cell transplant surgery if you meet the rules for being in a study. Islet cells in the pancreas make insulin.

Surgery Choices

Pancreas transplant surgery

Pancreatic islet cell transplantation

What To Think About

Pancreas and islet cell transplants are very expensive. After having one of these surgeries, you must take immunosuppressive medications for the rest of your life to prevent your body from rejecting the new tissue.

The success rate for pancreas transplants has improved with new surgical techniques and new immunosuppressive medications. Islet cell transplants may replace pancreas transplants in the future, but for now they are experimental.¹⁵

You will hear about products that promise a “cure” for type 1 diabetes. Avoid them. No such cure exists. Also, avoid products for treating diabetes that are advertised only by testimonials from satisfied customers. These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting other forms of treatment that have been proven to work. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

You may hear of people with diabetes following other types of meal plans or using low glycemic index foods to prevent high blood sugar levels after meals. Low glycemic diets may have a small but helpful role in keeping blood sugar in a normal range.¹² Talk with a registered dietitian before choosing one of these to plan your meals.

Complementary therapies

Other types of treatment for diabetes are provided by therapists or others who do not operate within mainstream medical practice. Their unconventional approaches may be attractive, particularly if you are not having much success with conventional medical treatments. None of these complementary therapies are proven to effectively treat diabetes.

However, you may benefit from safe, nontraditional therapies that complement conventional medical treatment for your disease. Complementary therapies, such as acupuncture, massage, or biofeedback, for instance, may help reduce stress, relieve muscle tension, and improve your overall well-being and quality of life.

You should not use complementary therapies alone to treat your diabetes.

Talk with your doctor if you are using the following or other complementary or alternative therapies:

• Acupuncture
• Massage therapy
• Biofeedback
• Chiropractic therapy
• Herbal medicines and natural substances, such as antioxidants, vanadium, magnesium, or chromium. Studies indicate that soluble fiber may help you keep your blood sugar levels within your target range.
• Osteopathy

Organizations

• Diabetic Nephropathy
• Diabetic Neuropathy
• Diabetic Retinopathy
• Type 1 Diabetes
• Type 1 Diabetes: Children Living With the Disease
• Type 1 Diabetes: Living With Complications
• Type 1 Diabetes: Recently Diagnosed
• Type 2 Diabetes in Children

Citations

1. Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511–2518.

2. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.

3. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.

4. Zochodne DW (2001). Peripheral nerve disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 466–487. Hamilton, ON: BC Decker.

5. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.

6. American Diabetes Association (2004). Hypertension management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S65–S67.

7. American Diabetes Association (2004). Dyslipidemia management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S68–S71.

8. American Diabetes Association (2004). Hyperglycemic crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94–S102.

9. Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group (2001). Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). Journal of Pediatrics, 139(6): 804–812.

10. Malcolm J, et al. (2003). Cardiovascular disease in diabetes. Clinical Evidence (9): 621–650.

11. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.

12. American Diabetes Association (2003). Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 26(8): 2261–2267.

13. ACE Inhibitors in Diabetic Nephropathy Trialist Group (2001). Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors? Annals of Internal Medicine, 134(5): 370–379.

14. Collins R, et al. (2003). MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A randomised placebo-controlled trial. Heart Protection Study Collaborative Group. Lancet, 361(9374): 2005–2016.

15. Sutherland DE, et al. (2001). Lessons learned from more than 1,000 pancreas transplants at a single institution. Annals of Surgery, 233(4): 463–501.

Other Works Consulted

• American Diabetes Association (2000). Role of fat replacers in diabetes medical nutrition therapy. Clinical Practice Recommendations 2000. Diabetes Care, 23(Suppl 1): S96–S97.

• American Diabetes Association (2004). Influenza and pneumococcal immunization in diabetes. Position statement. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S111–S113.

• Bazian Ltd. (2003). Glycaemic control in diabetes. Clinical Evidence (10): 667–675.

• Gerstein HC, et al. (2001). Cardiovascular disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488–514. Hamilton, ON: BC Decker.

• Hill JV, Beaser RS (2001). Carbohydrate counting and Necessity of carbohydrate counting for patients using an insulin pump sections of Medical nutrition therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 90–92. Boston: Joslin Diabetes Center.

• Levine BS, et al. (2001). Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. Journal of Pediatrics, 139(2): 197–203.

• Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414–2423.

• Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593–598.

Author:	Marianne Flagg	Last Updated March 23, 2005
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Alan C. Dalkin, MD - Endocrinology
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