Treatment Principles For Type 1 Diabetes

Treating type 1 diabetes medically is essential for the health and well being of the patient. Since type 1 diabetics cannot produce insulin on their own, taking insulin to manage blood glucose levels will be required throughout the patient’s life. However, with new technology and different treatment options, it may be possible to minimize the need for insulin in patients with all types of diabetes.

It is essential for the medical principles of treatment for type 1 diabetes to focus on patient education and an understanding of how diet, exercise and monitoring blood sugar is essential for quality of life. Many people with type 1 diabetes can avoid the concurrent medical conditions that are potentially life threatening by simply becoming aware of the strategies that they can use to keep blood glucose, blood pressure and metabolic functioning balanced and regulated. Without wild fluctuations in blood glucose, health conditions can be minimized or eliminated completely.

Insulin

Insulin will be required on a regular basis for all type 1 diabetics. New options in insulin types and delivery methods can provide a range of treatment options based on the specific needs of the patient. It may take several months to find the correct schedule for blood testing and insulin therapy injections. Doctors and patients need to work together to track and record the use of various insulin types. Options for insulin include rapid acting, short acting, intermediate and long acting insulin. Rapid acting insulin is often used in combination with long acting insulin.

The specific insulin therapy can also be provided by different means. Traditionally, a needle has been used to inject insulin when blood glucose readings were outside of the desirable range. Injections are appropriate for many patients but they are not always convenient and do require that the patient be able to give themselves the injection. Other options include a pre-loaded insulin pen, which is easy to administer and can be used by older children, teens and adults.

Newer options include an insulin pump, which allows a baseline amount of insulin to be provided at specific intervals throughout the day. In addition, the pump has a control device that allows the wearer to input the amount of carbohydrates consumed at a meal and the current blood glucose readings. Additional amounts of insulin are automatically supplied by the pump based on the data entered. In studies of children, adolescents and adults continuous subcutaneous insulin infusion with a pump was seen as beneficial in improved glycemic control in all age groups. 1

Oral medications can also be prescribed that help to regulate cholesterol and blood pressure. Doctors must be proactive in providing education to the patient about medications, insulin and blood sugar monitoring that stresses the overall health importance of blood glucose monitoring and regulation.

Diet and Exercise

A key component of any type of treatment for type 1 diabetes must include educating patients about the benefits of making healthy food choices and adding structured exercise to their daily routines. Unlike many fad diets, eating following a diabetic plan doesn’t mean restricting food intake and can even allow for desserts and whole grain breads, pastas and other treats.

The bulk of food intake has to include fruits, vegetables and whole grains with moderate amounts of lean proteins. In recent studies, individuals with type 1 diabetes had higher rates of self-management of their diabetes when on low glycemic diets than when using insulin therapy only.  This was true in all age groups from children to adults.  Patients need to be educated about the correct calculation of carbohydrates and the ability to choose low glycemic foods to substitute for high glycemic foods in the diet. 2

Exercise also has to be stressed, but patients need to be aware of the importance of blood glucose monitoring before exercise, especially when the body is under stress. Routine exercise that allows the patient to evaluate for any sudden drop in glycemic levels during exercise is also important, particularly if blood glucose is not well regulated. Medical professionals and therapists can work with the patient to develop healthy routines and exercise protocols that will lead to an increase in blood sugar regulation over time.

Ongoing Medical Support And Education

Patients with type 1 diabetes need to have regular medical check-ups including eye examinations, full lipid profiles, cardiovascular tests, kidney functioning tests, blood tests, neurological tests and full physical examinations. Often the symptoms of the associated health risks seen with diabetes have very few noticeable symptoms for the patient, but routine testing provides options for early diagnosis and treatment intervention.

Patients also need to be aware of the options they have for treatment and the active role they will need to play in their ongoing health care. Group education and working with age appropriate peers is seen as critical in helping diabetics learn effective self-management techniques, problem solving skills and greater levels of self-efficacy. 3 Starting this education process as soon as a diagnosis is made, including with children, is seen as a very important step in developing a lifelong understanding of diabetes control and management.

Patients also need to be educated about the very real problem of diabetic ketoacidosis and the risk involved for people with type 1 diabetes. This training is essential for parents with children diagnosed with type 1 diabetes or those that have a family history of diabetes.

Lifestyle Choices

Medical professionals need to focus in on and discuss the importance of avoiding specific lifestyle choices with a diagnosis of type 1 diabetes. These include avoiding the use of tobacco and cigarettes as well as limiting or avoiding alcohol consumption. Smoking is linked to higher rates of cardiovascular disease, which is compounded when the patient also has a diagnosis of diabetes. In a study of 3466 diabetic youth between the ages of 10 to 22, it was found that less than 50% received information from their doctor about the risk of smoking with a diagnosis of diabetes. 4

Combining education with medical treatment is considered to be the ideal way to provide the support system that is necessary for successful self-management of type 1 diabetes. Proactive annual testing for other health complications is also essential as part of the overall treatment of patients once diagnosed.

References

1 Weissberg-Benchell, J., Antisdel-Lomaglio, J., & Seshadri, R. (2003). Insulin Pump Therapy. Diabetes Care , 1079-1087.

2 University of Nottingham Malaysia Campus. (2011). A low Glycaemic Index (GI) diet is an effective, under-utilized tool in the management of type 1 diabetes mellitus (T1DM). Universitas 21 Graduate Research Conference on Food Proceedings (pp. 18-23). Smenyih: J Wiley.

3 U.S Department of Health And Human Services National Diabetes Education Program. (2009). Guiding Principles for Diabetes Care: For Health Care Professionals. NIH.

4 Reynolds, K., Liese, A. D., Anderson, A. M., et al. (2011). Prevalence of Tobacco Use and Association between Cardiometabolic Risk Factors and Cigarette Smoking in Youth with Type 1 or Type 2 Diabetes Mellitus. 594-601: The Journal of Pediatrics.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.