Type 1 Diabetes: Living With The Disease: Treatment Overview

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Treatment Overview

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.

Daily care

Your daily care includes:

• Giving yourself insulin shots or using an insulin pump.
• Checking your blood sugar.
• Dealing with low blood sugar from insulin.
• Preventing high blood sugar emergencies.
• Counting carbohydrate grams or using a food guide for diabetes.
• Taking care of your feet.
• Coping with your feelings about your diet.

You will also need to:

• Get at least 30 minutes of active physical exercise on most, preferably all, days. 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.
• Take precautions when you are driving and not drive if your blood sugar is below 70 milligrams per deciliter (mg/dL).
• Take care of your skin and your teeth and gums.
• Know what to do when you are sick.
• Learn how to prevent problems while traveling.
• Grieve the things you feel that you have lost because you have diabetes.
• Limit your alcohol intake to no more than one drink a day for women (none, if you are pregnant) and two drinks a day for men.

You may also want to know:

• What needs to be done if you want to become pregnant, such as changing your treatment or getting additional screening tests.
• Where to find a support group or camp for people with diabetes.
• What immunizations you need. For more information, see the topic Immunizations.
• How to deal with a rebellious adolescent who has diabetes.

How often should I see my doctor?

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.

Last updated:	October 03, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC