The Beginners Guide to Type 1 Diabetes
What Is Type 1 Diabetes?
Type 1 Diabetes is an autoimmune disease where the person’s pancreas stops producing insulin. It is very different from Type 2 Diabetes, where the person still produces insulin, but its production is not enough, or the person is insulin resistant.
What Is Insulin?
Insulin is a hormone that controls blood-sugar levels on the person’s bloodstream. Insulin is not a cure, but it keeps people living with this chronic disease alive. It helps keep the blood glucose levels in range, and it helps prevents the side effects of Diabetes, like amputation, blindness, kidney failure and more.
What Is The Cause Of Type 1 Diabetes?
No one knows why Type 1 Diabetes occurs. Some theories say that it could be the food, the environment, or even genetics.
Sadly, there is no prevention or cure for Type 1 Diabetes, unlike Type 2 Diabetes, which may “go away” with diet, exercise, and oral medication. Type 1 Diabetes is a chronic condition that can occur at any age, it is sometimes called Juvenile Diabetes, but it can occur to an adult.
How Is Type 1 Diabetes Managed?
Type 1 Diabetes needs 24/7/365 days year management. In the beginning, people who are diagnosed with Diabetes Type 1, their condition is managed by multiple injections during the day, and they are prescribed two types of insulin (fast acting insulin and long lasting insulin)
Fast Acting Insulin, (i.e Novolog and Humalog), is used for correcting high blood sugars, and when you need to cover carbs in foods. This insulin needs to be injected a couple of times per day. It usually starts making an effect in 15-30 mins after injection and lasts for about 2-3 hrs.
Long Acting Insulin, (i.e Lantus), lasts for about 20-24 hours. This is what doctors call basal insulin, meaning that it acts as background insulin, and assists the fast acting insulin in controlling your blood sugars.
Diabetes can also be managed by using an Insulin pump, like Medtronic, Omnipod, and T-Slim. This basically substitutes the daily injections, and you would need to insert the infusion sites into your skin once every 2-3 days.
Warning Signs Of Type 1 Diabetes
Warning signs of T1D often appear suddenly and may include:
- Drowsiness or lethargy
- Extreme thirst
- Frequent urination
- Fruity odor on the breath
- Increased appetite
- Heavy or labored breathing
- Sudden weight loss
- Sudden vision changes
- Sugar in the urine
- Stupor or unconsciousness
If you or your child have one or more of these symptoms, please get in contact with your primary care physician, and request to be tested for diabetes. The test can be done in the office, using a glucose meter, a urine test or a blood test.
Low Blood Sugar Symptoms
At times, you or your child will have low blood sugar. Low blood sugar occurs when the glucose meter reads 70 mg/dL or below. Low blood sugar symptoms: include, but not limited to:
- fast heartbeat
- difficulty speaking
- mood changes
Treatment Of Low Blood Sugar, Use Rule of 15
1. If blood sugar is below 70 mg/dL:
- Eat or drink 15 grams of fast acting carbs.
- Recheck blood sugar in 15 mins. If blood sugar is below 70 mg/dL, repeat treatment with additional 15 g carbs.
- Test after an additional 15 mins. If glucose is not at or above target, repeat treatment until blood sugar reaches the target number.
2. If blood sugar is below 50 mg/dL, follow the same protocol of 70 mg/dL, except eat and/or drink 30 grams instead of 15 grams.
Examples of 15 grams of fast-acting carbs:
** ALWAYS read the labels on candy or any other food to determine carb amounts.
For SEVERE low blood sugar like loss of consciousness and seizure, use Glucagon, and call the Endocrinologist to see if additional treatment is needed.
High Blood Sugar Symptoms
High blood sugar symptoms: include, but not limited to:
- increased urination
- stomach ache
- a headache
- difficulty breathing
Check blood sugar. Sometimes symptoms may not be present, but you can still have high blood sugar.
Possible Reasons For Having a High Blood Sugar:
Similar to the low blood sugar, this is a symptom that will happen, especially after eating food. Possible reasons for having high blood sugars:
- missed insulin
- incorrect insulin dose
- bad pump site
- inaccurate carb counting
- medication (i.e. steroids)
- weak/expired insulin
Treatment For High Blood Sugars:
1. Check blood sugar, and also check for ketones.
2. If blood sugar is more than 250 mg/dl, give correction dose of insulin.
3. If ketones are present give ketone correction dose, (as indicated by your doctor), drink sugar-free fluids, drink water, do not exercise if ketones present. (this has been said that it increases your ketones in your blood).
Preventing Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is a possible complication of diabetes caused by extreme hyperglycemia, also known as high blood glucose. It is a serious and potentially life-threatening complication, one that you should work hard to avoid when you have diabetes. If DKA occurs, you need to go to the hospital immediately!
DKA occurs when the body does not have enough insulin, and therefore the blood sugars rise. After a period of time, the body is forced to burn fat for energy. When the body fat is used for energy, ketones develop which are a waste product of fat. Ketones accumulate in the blood and DKA can develop. DKA can occur within a few hours.
Symptoms of Diabetic Ketoacidosis (DKA)
For DKA, these are some of the symptoms that you would need to watch out for:
- high blood glucose levels
- ketones in blood and urine
- abdominal pain
- lethargy (tired, sluggish, weak)
- difficulty breathing
ALWAYS CONSULT with your Endocrinologist for treatment in managing DKA. There are some Endocrinologists that say that it can be managed at home, especially if you have low ketones. However, if you have moderate to severe ketones, the treatment plan will be different, and hospitalization might be needed. CALL YOUR DOCTOR when in doubt! DKA is a life-threatening!
Treatment for DKA:
Per doctor’s protocol, these are usually the guidelines to follow:
- check blood glucose and ketone levels
- give ketone correction
- notify your Endocrinologist or doctor that is managing your Diabetes
- drink sugar-free liquids
- drink a LOT of water
- go to the Emergency Room (ER) per doctors protocol
Sick Day Guidelines
These are good to follow when you or your child have a regular cold, nothing life-threatening.
- Check blood glucose every 2 hrs
- Check ketones each time you or your child urinates or when checking blood glucose, if using blood meter
- Always take long-acting insulin or have pump basal running
- Sick day guidelines are for: vomiting, diarrhea, fever or anytime the person who suffers from Diabetes is home sick
- Check ketones even if blood glucose is normal
- Check with provider for specific instructions and when to call for an emergency or go to the ER/hospital
Sick Day Treatment Guidelines
Blood glucose is within target range or higher and ketones are negative/trace/small or below 0.6. Continue to check blood glucose and ketones every 2 hrs. Make an appointment with Endocrinologist or primary care doctor for fever or infections.
Blood glucose is below 150 mg/dL and urine ketones are moderate/large or blood ketones above 1.5. Bring blood sugar up first. Give fluids with sugar (Gatorade or Sprite) Once blood glucose is over 150 mg/dl, give a correction dose. Check blood glucose and ketones every 2 hrs.
Blood glucose is above 150 mg/dL and urine ketones are moderate or blood ketones are above 0.6. Give 1.5 x correction factor with insulin (Novolog, Humalog, Apidra). Give carb-free foods such as water, as much as possible every hour. Check blood glucose and ketones every 2 hrs.
Blood glucose is above 150 mg/dL and urine ketones are large or blood ketones are above 1.5. Give double (2x) correction. Give carb-free fluids, and water, as much as possible. Check blood glucose and ketones every 2 hrs.
- If vomiting, wait for 2 hours after vomiting, then give sips of carb-containing fluids such as Gatorade
- Carbs are needed to prevent ketone production
- Increase the amount of fluid as tolerated. Reduce long-acting insulin by 10%. If actively vomiting and blood glucose is less than 150 mg/dL
- If blood glucose less than 70 mg/dL, refer to mini-dose Glucagon handout
- For pumpers, if blood glucose is above 250mg/dL and moderate/large urine ketones or blood ketones above 0.6, give the correction first dose of insulin with a syringe, then change infusion site. Check blood glucose and ketones every 2 hrs. If actively vomiting, reduce the basal rate by 10%, if blood glucose is less than 150.
Statistics From JDRF
- Some 1.25 million Americans are living with T1D, including about 200,000 youth (less than 20 years old) and more than 1 million adults (20 years old and older).
- 40,000 people are diagnosed each year in the U.S.
- 5 million people in the U.S. are expected to have T1D by 2050, including nearly 600,000 youth.
- Between 2001 and 2009, there was a 21 percent increase in the prevalence of T1D in people under age 20.
- In the U.S., there are $14 billion in T1D-associated healthcare expenditures and lost income annually.
- Less than one-third of people with T1D in the U.S. are consistently achieving target blood-glucose control levels.
For more information about Diabetes, please head over to the JDRF website for more information.
“Life is not over because you have diabetes. Make the most of what you have, be grateful.” – Dale Evans
** Disclaimer: I am not a doctor, nurse or any professional in the medical field. You should always consult with your doctor about any symptoms that you, any family member or your child may be feeling. The experiences detailed here in this blog, are of my own.