Managing type 1 diabetes

Managing type 1 diabetes


So, type 1 diabetes is a condition where the
body can no longer produce insulin. Insulin is a hormone that controls the level of glucose
within the blood. And it’s really important that that level stays within a normal range
as much of the time as possible. Because if not, then over time that can lead to some
of the complications associated with having diabetes. Now, in type 1 diabetes, the body
cannot produce insulin so it has to be given by injection. However, the amount of insulin
you give will depend on the food that you eat. And so, it really isn’t the case that
you can just eat whatever you like if you have type I diabetes regardless of knowing
what it is, because while in theory you can eat all sorts of different things, what’s
really important is you need to know how much carbohydrate is in each meal that you’re eating.
Because that will determine how much insulin you need to inject. And that’s really important
because if you inject too much insulin, there’s a risk that your blood glucose level will
go too low. And anyone with type 1 diabetes will know that a low blood glucose or a hypo
is really quite unpleasant. On the other hand, if you don’t inject enough insulin, then your
blood glucose level will go too high. And as a result of what you’ve eaten not being
covered by the insulin injected. So, first and foremost it’s really important you know
how many carbohydrates are in what you’re eating. And that means that each person with
type 1 diabetes needs to understand, needs to learn how to assess the carbohydrates in
each meal. In each and every meal. Because every single meal will have an effect. Now,
some people will choose to have some meals without any carbohydrates. And that’s fine.
But of course, in order to do that you need to know the foods that don’t have carbohydrates
and that all in is encompassed in what we call the dietary management of type 1 diabetes. So if you have type 1 diabetes I really do think that restricting your carbohydrate intake
is a very good idea. The reason for saying that is that it’s the carbohydrates in the
food that make the blood glucose level go up. And that’s what we want to avoid. Now
of course you treat that– you treat type 1 diabetes with insulin and you take insulin
with each meal to cover the carbohydrates. And in fact, there was a vogue some years ago
to say that if you’ve got type 1 diabetes with the modern insulin that we have available
now, you can pretty much eat what you like as long as you give the right amount of insulin.
Now, over the years since then I’ve really come to believe that that just doesn’t seem
to make sense. And why is that? Well, firstly if you’re having a meal with a large amount
of carbohydrates, you have to inject a large amount of insulin. That’s obvious. That isn’t
necessarily such a good idea. If you have too much in your insulin in your system then
there is of course a greater risk of having a hypo which someone with type 1 diabetes
we’ll know can be a very unpleasant experience to say the least. Secondly, a meal which has
a large amount of carbohydrates can raise the blood glucose level for sometimes many
hours. And that may not correlate with the the length of time that the insulin is acting
particularly the shorter acting insulins that we tend to use nowadays. And again, if there’s
a large amount of insulin in the system, there is an increased risk of the insulin working
at a time when the carbohydrate is– there’s a mismatch if you like. So type 1 diabetes requires treatment with insulin and there are lots of different insulins
available. Nowadays, I really feel that someone with type I diabetes should be treated with
what is called a basal-bolus regimen. That means having two different types of insulin.
The first is a basal insulin there’s some long-acting insulin which is usually given
once or twice a day depending on the type of insulin and how long it lasts. And there
are a number now that are available on the market. The ones that we tend to favour are
those that are called long-acting analogues. That means that actually they’ve been, if
you like, modified so that their effect on the glucose level is sustained and is stable
over a long period of time. And that has huge benefits compared with the older longer-acting
insulin where from one injection to the next you really couldn’t predict whether the peak
effect would happen two hours after injection or four hours after the injection. And then
the bolus element of the basal-bolus regimen is the boluses of insulin that are given with
meals. And usually now we use what are called fast-acting analogues that have, again, have
been modified so that they can be absorbed really quickly from when they’re injected
so that they can begin to work as you’re eating your meal. And again, there are a number of
those that are available now. To be honest, I don’t think there are significant differences
between them and any one of the newer fast-acting analogues should work well for most people.
Now, one thing that I do recommend is that in injecting your mealtime insulin it’s so
important to inject before you eat. There was a vogue a few years ago when these incidents
came out to say that actually they work so quickly you can even eat and then inject afterwards.
The problem there is that sometimes people would just forget to inject, but more commonly
by the time you finish your meal your blood glucose level could always already be really
quite high. And so rather than always having to play catch-up, it does make sense to inject
before you eat. Insulin pump therapy is something that can
be really helpful to a number of people with type 1 diabetes. So essentially what this
means is that instead of injecting insulin through the skin several times a day, the
user of an insulin pump has a pump which is connected to a little cannula that sits beneath
the skin and delivers, pumps a very low flow rate of insulin continuously throughout the
day and throughout the night. Now, the great advantage of insulin pump therapy is that
the amount of insulin that is infused can be varied automatically; can be pre-programmed
to deliver more insulin during certain hours of the day and less at other times of day.
This is particularly useful for people who find that they are a risk of having hypos
or their blood glucose level going low overnight. It’s also useful people for people whose activity
levels vary quite a lot. And the great thing about an insulin pump is unlike an injection
where once you’ve injected it’s working and you can’t take it out again, with a pump you
can switch it off. And so, if you find that your blood glucose levels going too low or
suddenly you’re having to be more active which risks it going to low, you can simply suspend
the infusion which means that it will allow your blood glucose level to rise without having
a hypo and without having to take extra carbohydrate, for example to keep the level up. Now some
people are under the impression that if you have an insulin pump it does all the work
for you. Well, we’re not quite there yet. You still need to monitor your blood glucose
and you still need to give the boluses of insulin before each meal. Now the insulin
is in the pump so you don’t need to inject but what you do need to do is calculate the
dose you need for each meal based on the carbohydrate intake and then tell the pump by means of
burning up and pressing a few buttons to give just that amount of insulin for you. In many
people it can be transformational using an insulin pump and it’s something that I recommend
for a number of people where using injections just doesn’t quite lead to the level of control
that they aspire to.

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