This topic provides
information for teens and their parents and for adults who have
type 1 diabetes. 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.
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. Eye problems and kidney damage do not
have early symptoms. Make sure you have regular screening tests for both eye
and kidney problems.
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. Not smoking can also
lower your risk of complications.
See your doctor every 3 to 6
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 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.
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. But 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.
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
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 double
vision.
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.
What Happens
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 doctor 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 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:
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 plaque. This process, called
atherosclerosis, narrows the vessels. 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 other health
problems 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.
What Increases Your Risk
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 doctor.
It is hard to know
why some people develop complications and others do not. Factors that
contribute to the risk of complications include:
Having one complication. If you have one complication from diabetes, you have a
greater chance of getting other complications.
Ongoing high blood sugar over time. If your blood sugar levels
are high most of the time, you have a higher chance of getting 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.
Diabetic retinopathy. About 60% of people with type 1 diabetes get diabetic
retinopathy after 10 years. Almost all have it to some degree after 20
years.2 About 25% get the advanced stage (proliferative retinopathy) after 15 years.2
Diabetic nephropathy. Diabetic nephropathy eventually
occurs in 20% to 30% of all people with type 1 and type 2 diabetes.3 Without treatment to slow kidney disease, most people with
diabetic nephropathy will move from the early stage to the advanced stage of
nephropathy in 10 to 15 years.3 Children who get
nephropathy usually show the first signs of the condition after puberty.
Heart and large blood vessel disease. About 73% of adults with
diabetes have high blood pressure. People with diabetes are 2 to 4 times more
likely to die from heart disease or to have a stroke.4
Diabetic neuropathy. Most people with diabetes develop
some diabetic neuropathy over the years. But only about 13% to 15% of people
with diabetes have symptoms of neuropathy.5
Other risk factors.
Other factors that can raise your chance of getting complications include:
Psychiatric disorders (such as
depression) which can affect how much you want to take
care of your diabetes.
Family history of diabetic complications.
Not having health insurance for supplies and other medical
expenses related to diabetes.
When To Call a Doctor
Call 911 or other emergency services immediately if you or your child is:
Unconscious or becomes very sleepy
unexpectedly. You or your child may have low blood sugar, called
hypoglycemia. While waiting for emergency help,
follow:
Drowsy, confused, breathing fast, and your or
your child's breath smells fruity. You or your child may have high blood sugar,
called hyperglycemia. A life-threatening condition called
diabetic ketoacidosis could be present.
Call a doctor immediately if you or
your child is vomiting and cannot keep down liquids and:
Your blood sugar is 300 mg/dL or higher.
Your child's blood sugar is 250 mg/dL or higher.
Call a doctor if you or your child:
Is sick for more than 2 days (unless it is a
mild illness, such as a cold), and you or your child:
Has been vomiting or had diarrhea for more
than 6 hours.
Has problems
following the meal plan or getting physical activity, and you want help.
Watchful Waiting
Watchful waiting (or surveillance) is a
period of time during which you and your doctor 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 doctor. Your treatment may
need to be changed.
Also see your doctor 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
ophthalmologist for diagnosis and treatment of eye
disease, or an
optometrist for diagnosis of eye disease.
Ophthalmologists treat retinal complications from diabetes.
You need to see your doctor about every
3 to 6 months throughout your life for
tests and exams to see how you are doing and to adjust your treatment for
type 1 diabetes.
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. 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. 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.
A stress 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
who have diabetes.
An examination by a
cardiologist, if you develop heart problems related to
diabetes.
A
thyroid-stimulating hormone (TSH) test when type 1
diabetes is diagnosed and then every 1 to 2 years. This test checks for thyroid
problems, which are common among 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 70 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 A1c 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.
Try to do at least 2½ hours a week of
moderate exercise. Take steps to
exercise safely. Drink plenty of water before, during,
and after you are active. This is very important when it's hot out and when you
do intense exercise. It may help to keep track of your exercise on an
activity log(What is a PDF document?)
.
Take an aspirin daily. If you are age 40 or older, talk to your
doctor about taking a low-dose 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.6
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
medicines-such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin
II receptor blockers (ARBs)-to achieve your goal.7
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)
or aim for keeping it at 70 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 medicines, such as statins, to reach your goals.8
Not smoke. Or, if you have a teen with diabetes, encourage him
or her not to smoke.
See your doctor
about every 3 to 6 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 (DKA), 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 and treatment to correct electrolyte
problems in your body. These electrolyte problems are typically with potassium
and phosphorous. You may have to stay in the hospital for a few days to get
your blood sugar level back into your target range.9
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. But you are also 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, improved needles, and inhaled insulin.
Ways to prevent or decrease complications from diabetes also are being studied.
Talk to your doctor if you would like to participate in these diabetes
studies.
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.
Having a daily routine where you eat and exercise about the
same amounts and at about the same times every 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.
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 as close to normal as possible can prevent complications from
developing in early adulthood.10
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, medicine can help slow, or possibly reverse, the
damage.
Treating
high blood pressure and
high cholesterol. These conditions increase your risk
for developing diabetic complications, especially heart and blood vessel
diseases.11
Taking aspirin. If you are age 40 or older, talk with your
doctor about whether you should take a low-dose aspirin to help prevent
complications.12 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 anyone younger than age 20. It has been linked with
Reye syndrome.
Not smoking.
Smoking increases your risk for diabetes-caused damage to the blood
vessels.13 Smoking could increase your adolescent's
risk for developing complications in early adulthood.
Limiting your
alcohol intake to no more than two drinks a day for men and one drink a day for
women (none, if you are pregnant).
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 or on the Internet.
Home Treatment
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:
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 these foods have a
role in preventing complications.14 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.
Try to do at least 2½ hours a week of
moderate activity. One way to do this is to be active
30 minutes a day, at least 5 days a week. Be sure to
exercise safely. Drink plenty of water before, during,
and after you are active. This is very important when it's hot out and when you
do intense exercise. It may help to keep track of your exercise on an
activity log(What is a PDF document?)
.
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 doctor. For more
information, see:
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 medicines, such as
angiotensin-converting enzyme (ACE) inhibitors or
angiotensin II receptor blockers (ARBs) to achieve
your goal.7
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) or aim for keeping
it at 70 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 medicines, such as statins, to reach your goals.8
Limit alcohol
Limit your alcohol intake to no more
than two drinks a day for men and one drink a day for women (none, if you are
pregnant).
Take an aspirin every day
If you are age 40 or
older, talk to your doctor about taking a low-dose 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.6
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.
Also, you may feel resentful, deprived, or angry about having to pay attention
to what and how much you eat. For more information, see:
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.
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.
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 40 or older and are at risk for heart and blood
vessel disease, you also may want to take aspirin to help prevent these
complications.12 Do not give aspirin to anyone under 20
years old, because it has been linked with
Reye syndrome.
If you have high blood
pressure or
high cholesterol, you may need other medicines 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
medicines that can reduce LDL levels and the risk of heart disease in people
who have diabetes.8 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.16
Surgery
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, in rare cases, if you meet other
requirements.
You may have islet cell transplant surgery if you
meet the rules for being in a study. Islet cells transplanted into the liver
make insulin.
Pancreas and islet cell
transplants are very expensive. After having one of these surgeries, you must
take immunosuppressive medicines 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
medicines. Islet cell transplants may replace pancreas transplants in the
future but for now they are experimental.17
Other Treatment
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 proved 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.14 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 proved to effectively
treat diabetes.
But 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:
The American Association of Diabetes Educators is made up of
doctors, nurses, dietitians, and other health professionals with special
interest and training in diabetes care. The Web site can supply the names of
these types of health professionals in your local area.
American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA 22311
Phone:
1-800-DIABETES (1-800-342-2383)
E-mail:
AskADA@diabetes.org
Web Address:
www.diabetes.org
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
Juvenile Diabetes Research Foundation
International
120 Wall Street
New York, NY 10005-4001
Phone:
1-800-533-CURE (1-800-533-2873)
Fax:
(212) 785-9595
E-mail:
info@jdrf.org
Web Address:
http://www.jdrf.org
The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This
organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and
treatments of type 1 diabetes.
National Diabetes Education Program
(NDEP)
1 Diabetes Way
Bethesda, MD 20814-9692
Phone:
1-800-438-5383 to order materials (301) 496-3583
E-mail:
ndep@mail.nih.gov
Web Address:
http://ndep.nih.gov
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
(www.cdc.gov/team-ndep).
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511-2518.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2008). All About Diabetes. Available online:
http://www.diabetes.org/about-diabetes.jsp.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
American Diabetes Association (2004). Hyperglycemic
crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94-S102.
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.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes, search date November 2004. Online version of
Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
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.
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.
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.
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.
American Diabetes Association (2008). Nutrition
recommendations and interventions for diabetes. Diabetes Care, 31(Suppl 1): S61-S78.
Anderson JW (2006). Diabetes mellitus: Medical
nutrition therapy. In ME Shils et al., eds., Modern Nutrition in Health and Disease, 10th ed., pp. 1043-1066. Philadelphia: Lippincott
Williams and Wilkins.
Campbell A (2006). Glycaemic control in type 1
diabetes, search date December 2005. Online version of Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Campbell AP, Beaser RS (2007). Designing a
conventional insulin treatment program. In RS Beaser et al., eds.,
Joslin's Diabetes Deskbook, pp. 281-323. Boston: Joslin
Diabetes Center.
Campbell AP, Beaser RS (2007). Medical nutrition
therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 81-125. Boston: Joslin Diabetes Center.
Chalmers KH (2005). Medical nutrition therapy. In
Joslin's Diabetes Mellitus, 14th ed., pp. 611-631.
Philadelphia: Lippincott Williams and Wilkins.
Cheng AYY, Zinman B (2005). Principles of insulin
therapy. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 659-670. Philadelphia: Lippincott Williams and
Wilkins.
Gerstein HC, et al. (2001). Cardiovascular disease. In
HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488-514. Hamilton, ON: BC Decker.
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.
Weir GC (2005). Pancreas and islet transplantation. In
Joslin's Diabetes Mellitus, 14th ed., pp. 757-776.
Philadelphia: Lippincott Williams and Wilkins.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511-2518.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2008). All About Diabetes. Available online:
http://www.diabetes.org/about-diabetes.jsp.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
American Diabetes Association (2004). Hyperglycemic
crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94-S102.
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.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes, search date November 2004. Online version of
Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
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.
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.
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.
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.
