Type 1 Diabetes Management

Author: The American Diabetes Association
Excerpt from: The Complete Guide to Diabetes

Because your body no longer makes insulin, insulin injections play a big role in your diabetes care plan. How much insulin you need to take depends on what your body’s level of blood glucose is, or what you predict the level will be after a meal. Naturally, food also plays an important role in your diabetes management plan, because it contributes glucose to your blood. Usually, physical activity can lower your blood glucose level, decreasing your need for insulin. So, you’ll need to account for exercise and physical activity in your diabetes management plan.

Insulin Therapy

Most people with type 1 diabetes take insulin by injecting it with a standard needle and syringe. The goal is to mimic normal insulin release as closely as possible. Normally. a low level of insulin is available in the blood at most times. This is a background, or basal, level of insulin. After meals, insulin release goes up, just enough to clear the glucose in the meal from the blood. To imitate this sequence, you can develop a regular schedule of insulin injections using the fast-acting form of insulin or combinations of both slower-acting and fast-acting forms of insulin.

Some people use insulin pumps to dispense fast-acting insulin at a steady background, or basal, rate and to provide extra insulin to cover meals. Although most insulin pumps in use today are carried around on a belt, researchers are working to develop a pump that is placed inside the body. Ideally, scientists would like to make a pump that senses the amount of glucose in the blood and delivers the right amount of insulin, as needed. So far, the most difficult part has been creating a glucose sensor. No matter what method is used, the goal is still the same- to deliver insulin to cells so they can take in glucose.

Your type of insulin therapy should relate directly to your health and your lifestyle choices. Your chosen therapy may be as simple as keeping your blood glucose levels from shooting too high after meals or falling too low between meals. Or your therapy may be more challenging: trying to keep after-meal blood glucose levels as close as possible to those of someone without diabetes.

A common type of insulin therapy is taking your insulin in one or two shots a day. This means using long-acting insulins, or a combination of long- and short-acting insulins. Most diabetes doctors would tell you that type 1 diabetes cannot be successfully controlled with one or two shots a day. Under this plan, there are many hours at different times of the day that your blood glucose level is high.

An insulin plan that includes three to four, or even more, injections of insulin per day leads to fewer times when blood glucose levels are high. People who take shots this many times each day usually use a long-acting insulin to control background blood glucose levels and fast-acting insulin to cover meals. They inject fast-acting insulin before meals to lower the blood glucose rise that occurs as food is digested.

The food you eat and the exercise you get go hand-in-hand with your insulin therapy. To know how much insulin you’ll need at each shot, it helps to know what your blood glucose level is now (you know this by blood glucose testing), what you’re planning to eat (so you’ll be able to estimate how much your blood glucose will increase), and what glucose-lowering physical activities you’ll be doing. Of course, healthy eating and regular exercise are a part of anyone’s healthy living plan. But for you, knowing how these two daily features move your blood glucose level up and down is essential.