Type 1 Diabetes: Living With the Disease

Topic Overview

Is this topic for you?

This topic provides information for teens and their parents and for adults who have type 1 diabetes. Before reading this topic, you may want to read Type 1 Diabetes: Recently Diagnosed.

If this topic does not answer your questions, see:

• Type 1 Diabetes, if you want to learn about type 1 diabetes but do not have the disease.
• Type 1 Diabetes: Recently Diagnosed, if you have been told recently that you or your child has type 1 diabetes.
• Type 1 Diabetes: Children Living With the Disease, if your child age 11 or younger has type 1 diabetes. Before reading this topic, you may want to read Type 1 Diabetes: Recently Diagnosed.
• Type 1 Diabetes: Living With Complications, if you have complications such as eye, kidney, heart, nerve, or blood vessel disease caused by diabetes.

What is type 1 diabetes, and what is it like to live with the disease?

Type 1 diabetes is a lifelong disease that develops when the pancreas stops making insulin. Your body needs insulin to let sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.

Everyone experiences type 1 diabetes differently. But the treatment is the same. You need to take insulin, eat a balanced diet that spreads carbohydrate throughout the day, and exercise. Part of your daily routine also includes checking your blood sugar levels regularly, as advised by your doctor.

The goal is to keep your blood sugar in a target range. You and your doctor may decide to keep your blood sugar at a normal or near-normal level. This is called tight control. It is the best way to reduce your chance of having more problems from diabetes. These are called complications.

Taking care of your diabetes takes time and energy every day. It is a big part of your life. But it will help you feel better and may prevent, or at least delay, complications. If your teen has diabetes, tight control of blood sugar levels may help prevent complications from developing in early adulthood.

What symptoms do you need to watch for?

It’s important to watch for signs of low and high blood sugar:

• Early symptoms of low blood sugar are sweating, weakness, shakiness, and hunger. But your symptoms may vary. After you have had diabetes for a long time, you may not notice these symptoms anymore. Low blood sugar happens quickly. You can get low blood sugar within 10 to 15 minutes after you exercise or take insulin without eating enough.
• Early symptoms of high blood sugar are increased thirst, increased urination, increased hunger, and blurred vision. High blood sugar usually develops slowly over a few days or weeks.

Both low and high blood sugar can cause problems and need to be treated. Check your blood sugar often during the day.

What are the complications of diabetes and their symptoms?

Over time, high blood sugar can damage blood vessels and nerves throughout your body. This can cause problems with your eyes, heart, blood vessels, nerves, and kidneys. Complications can lead to blindness, kidney failure, amputation, and death. High blood sugar also makes you more likely to get serious illnesses or infection. It's hard to know if you will have complications. Some people are more likely to have problems than others. The longer you have diabetes, the greater your risk of complications. You are not likely to have signs of complications until you have had diabetes for about 5 years.

Watch for early symptoms of problems. Tingling and numbness in your feet may be a sign of early nerve damage. Eye problems and kidney damage do not have early symptoms. Make sure you have regular screening tests for both eye and kidney problems.

Is it possible to prevent complications?

You may be able to prevent, or at least delay, problems from diabetes by keeping your blood sugar level as close to normal as you can. Treatment of high blood pressure and high cholesterol can also help. Not smoking can also lower your risk of complications.

See your doctor every 3 to 6 months. During these visits, your doctor will review your treatment and do tests and exams to see if your blood sugar is staying within your target range and if you have developed any complications.

Some exams and tests need to be done at every visit. Others are done once a year, such as eye exams and tests for protein in your urine. Other tests may be done only if there is a problem.

How will your treatment change over time?

Your insulin dose, possibly the types of insulin, and the way you give it may change over time to fit your changing needs. This is especially true for teens because they are still growing.

The goal of treatment is to always keep your blood sugar level as close to your target range as you can. To meet this goal, take care of yourself, get regular checkups, and keep learning about how to care for yourself.

Frequently Asked Questions

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

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	Diabetes: Should I get an insulin pump?
	Diabetes: Should I get pregnant?
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	Diabetes: Checking your blood sugar
	Diabetes: Coping with your feelings about your diet
	Diabetes: Counting carbs if you use insulin
	Diabetes: Dealing with low blood sugar from insulin
	Diabetes: Giving yourself an insulin shot
	Diabetes: Living with an insulin pump
	Diabetes: Preventing high blood sugar emergencies
	Diabetes: Taking care of your feet
	Diabetes: Using a food guide
	Pregnancy and diabetes: Planning for pregnancy

Cause

You have type 1 diabetes because your pancreas can no longer produce insulin. When your pancreas was working, it adjusted the amount of insulin it made based on your changing blood sugar. But insulin injections cannot control your blood sugar moment to moment, as your pancreas would. As a result, you will have high and low blood sugar levels from time to time.

Causes of high blood sugar

• Skipping a dose of insulin.
• Eating more food than usual.
• Stress and being ill (such as with severe flu) or having an infection, especially if you are not eating or drinking enough
• Taking medicines that can raise blood sugar levels, such as those for sleep, some decongestants, and corticosteroids (such as prednisone)
• The dawn phenomenon or the Somogyi effect, which can cause early-morning high blood sugar
• Adolescence, because of hormone changes and rapid growth

Causes of low blood sugar

• Taking too much insulin
• Skipping or delaying a meal or snack
• Exercising more than usual without eating enough food
• Drinking too much alcohol, especially on an empty stomach
• Taking medicines that can lower blood sugar, such as aspirin and medicines for mental disorders
• Starting your menstrual period, because hormonal changes may affect how well insulin works

Symptoms

Treating type 1 diabetes with insulin injections means you may have high and low blood sugar from time to time.

• Symptoms of high blood sugar include increased thirst, increased urination, and blurred vision.
• Symptoms of low blood sugar include sweating, weakness, and hunger. Severe low blood sugar may cause loss of consciousness and seizures.

High blood sugar usually develops slowly over hours or days, so you can take steps to correct it before your symptoms become severe and require medical attention. On the other hand, your blood sugar level can drop to dangerously low levels within 10 to 15 minutes of exercising or taking insulin without eating enough. You also can get low blood sugar if you have previously taken intermediate- or long-lasting insulin and skip a meal.

Signs of complications

The longer you have diabetes, the more likely you are to develop complications. You are not likely to develop signs of complications from diabetes until you have had the disease for about 5 years. Still, you should watch for complications. Signs may include:

• Burning pain, numbness, or swelling in your feet or hands. These symptoms may signal damage to the nerves that affect sensation and touch. This complication is called peripheral neuropathy. If one nerve is affected (focal neuropathy), you may have symptoms in one area of your body, such as double vision.
• Blurred or distorted vision; seeing floaters, flashes of light, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in your eyes. These symptoms may indicate diabetic retinopathy. You are also at risk for other eye diseases, such as glaucoma and cataracts.
• A wound that won't heal or that looks infected. This may mean you have damage to the blood vessels that supply that area. It also can happen because your body's white blood cells do not fight infection well when blood sugar is high.
• Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These are signs of gastroparesis, or slow emptying of the stomach. It happens when the nerves that control your internal organs and systems are damaged (autonomic neuropathy).
• A lot of sweating (especially after meals) or reduced sweating; feeling dizzy or weak when you sit or stand up suddenly; not being able to tell when your bladder is full or to empty your bladder completely; erection problems or vaginal dryness; or difficulty knowing when your blood sugar is low (hypoglycemia unawareness). These also may indicate autonomic neuropathy.

You will not have symptoms of kidney problems (diabetic nephropathy) until severe damage has developed. Then you may notice swelling in your feet, legs, and throughout your body. Having regular tests for protein in your urine is the only way to detect kidney damage before symptoms develop.

What Happens

Your experience with type 1 diabetes will be different from that of other people. But your treatment will be the same: taking insulin, eating a balanced diet that spreads carbohydrate throughout the day, getting regular exercise, and checking your blood sugar levels.

If you work closely with your doctor and follow your treatment, you will feel better and more in control of your life. You also may prevent or delay complications.

Not everyone with diabetes develops complications from the disease. Keeping blood sugar levels within a normal or near-normal range may prevent or delay complications. If your adolescent with diabetes controls his or her blood sugar, he or she can avoid developing complications in young adulthood.

Injected insulin cannot perfectly match the action of a working pancreas, so you will have high and low blood sugar levels from time to time. If your blood sugar stays above your target range for a long time, your blood vessels and nerves may be damaged. This damage can lead to:

• Microvascular disease, which affects your eyes or kidneys. Diabetic retinopathy and diabetic nephropathy develop without early signs. For more information, see the topics Diabetic Retinopathy and Diabetic Nephropathy. You are also at risk for other eye diseases, such as cataracts and glaucoma.
• Macrovascular disease, which affects your heart and your body's large blood vessels. Diabetes damages the lining of large blood vessels. They become clogged with hard, fatty deposits called plaque. This process, called atherosclerosis, narrows the vessels. A heart attack or stroke may occur when the blood vessels that supply your heart and brain are affected. Peripheral arterial disease develops when the large vessels in your legs are affected. This leads to problems with blood circulation in your legs and feet and causes changes in the skin color, decreased sensation, and leg cramps. For more information, see the topics Heart Attack and Unstable Angina and Peripheral Arterial Disease of the Legs.
• Diabetic neuropathy, which affects the nerves in your body. Diabetic neuropathy can decrease or block the movement of nerve signals through your organs, legs, arms, and other parts of your body. Nerve damage can affect functioning of internal organs, such as the stomach (gastroparesis), and your ability to feel pain when injured. When blood vessels and nerves are affected, bone and joint deformities can develop, especially in your feet (Charcot foot). For more information, see the topic Diabetic Neuropathy.

People with diabetes often already have other health problems. These may include high blood pressure and high cholesterol. Or they may develop other health problems as diabetes progresses. These conditions, along with smoking, can cause diabetes complications or can make existing ones worse. Not smoking and controlling your blood pressure and cholesterol level can help prevent or help slow complications.

Other health problems in adolescents

Studies have found that adolescent girls are at higher risk than other people for diabetic ketoacidosis: they may skip insulin doses to lose weight.¹

Eating disorders are also common among adolescents and young adults with diabetes. Eating disorders and the tendency to skip insulin injections can cause swings in blood sugar levels outside the target range. Eating disorders need to be diagnosed and treated as quickly as possible to prevent serious health problems.

What Increases Your Risk

Type 1 diabetes puts you at risk for high and low blood sugar and complications.

Risk factors for high and low blood sugar

• Age. Adolescent girls are at great risk for high blood sugar, which can lead to diabetic ketoacidosis. Girls are often concerned about their weight and body image, and they may skip insulin injections to lose weight.¹
• Tight blood sugar control. Tight control of blood sugar helps prevent complications, such as eye, kidney, heart, blood vessel, and nerve disease. But it does put you at risk for frequent low blood sugar levels. Tight control means keeping your blood sugar at a normal or near-normal level.
• Adolescence. The rapid growth spurts and changing hormone levels of adolescence can make it difficult to keep blood sugar levels within your target range. This is the blood sugar goal you set with your doctor.
• Psychiatric conditions. Eating disorders, depression, anxiety disorder, panic disorder, and addiction to alcohol or drugs increase the risk of frequent high and low blood sugar levels.¹

Risk factors for complications

It is hard to know why some people develop complications and others do not. Factors that contribute to the risk of complications include:

• Having one complication. If you have one complication from diabetes, you have a greater chance of getting other complications.
• Ongoing high blood sugar over time. If your blood sugar levels are high most of the time, you have a higher chance of getting complications.
• Length of time you have the disease. The longer you have diabetes, the more likely you are to develop complications, even if you control your blood sugar levels.
  • Diabetic retinopathy. About 60% of people with type 1 diabetes get diabetic retinopathy after 10 years. Almost all have it to some degree after 20 years.² About 25% get the advanced stage (proliferative retinopathy) after 15 years.²
  • Diabetic nephropathy. Diabetic nephropathy eventually occurs in 20% to 30% of all people with type 1 and type 2 diabetes.³ Without treatment to slow kidney disease, most people with diabetic nephropathy will move from the early stage to the advanced stage of nephropathy in 10 to 15 years.³ Children who get nephropathy usually show the first signs of the condition after puberty.
  • Heart and large blood vessel disease. About 73% of adults with diabetes have high blood pressure. People with diabetes are 2 to 4 times more likely to die from heart disease or to have a stroke.⁴
  • Diabetic neuropathy. Most people with diabetes develop some diabetic neuropathy over the years. But only about 13% to 15% of people with diabetes have symptoms of neuropathy.⁵
• Other risk factors. Other factors that can raise your chance of getting complications include:
  • Smoking.
  • High blood pressure.
  • High cholesterol.
  • Family history of heart disease.
  • Peripheral arterial disease.
  • Psychiatric disorders (such as depression) which can affect how much you want to take care of your diabetes.
  • Family history of diabetic complications.
  • Not having health insurance for supplies and other medical expenses related to diabetes.

When To Call a Doctor

Call 911 or other emergency services immediately if you or your child is:

• Unconscious or becomes very sleepy unexpectedly. You or your child may have low blood sugar, called hypoglycemia. While waiting for emergency help, follow:
  • Emergency care for low blood sugar.
  • Emergency care for low blood sugar in a child.
• Drowsy, confused, breathing fast, and your or your child’s breath smells fruity. You or your child may have high blood sugar, called hyperglycemia. A life-threatening condition called diabetic ketoacidosis could be present.

Call a doctor immediately if you or your child is vomiting and cannot keep down liquids and:

• Your blood sugar is 300 mg/dL or higher.
• Your child’s blood sugar is 250 mg/dL or higher.

Call a doctor if you or your child:

• Is sick for more than 2 days (unless it is a mild illness, such as a cold), and you or your child:
  • Has been vomiting or had diarrhea for more than 6 hours.
  • Has followed the doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
  • Has blood sugar levels that are often above 300 mg/dL and urine tests for ketones show more than 2+ or moderate or higher ketones.
• Has a blood sugar level that stays below the target range after eating some quick-sugar food.
• Has a blood sugar level that stays high after taking a missed dose of insulin or taking an extra dose of insulin (if prescribed by the doctor).
• Has frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
• Is having difficulty knowing when blood sugar is low (hypoglycemia unawareness).
• Has problems following the meal plan or getting physical activity, and you want help.

Watchful Waiting

Watchful waiting (or surveillance) is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. It is not appropriate if you have frequent high or low blood sugar levels. See your doctor. Your treatment may need to be changed.

Also see your doctor if you begin to notice symptoms of complications. Early treatment can prevent complications or keep them from getting worse.

Who To See

Health professionals involved in your treatment may include:

• An endocrinologist or pediatric endocrinologist.
• A family medicine physician.
• A general practitioner.
• An internist.
• An adolescent medicine specialist.
• A pediatrician.
• A nurse practitioner.
• A physician assistant.
• A certified diabetes educator (CDE).
• A registered dietitian.

Who to see for complications

If you begin to have symptoms of complications from diabetes, you may be referred to:

• A cardiologist or vascular specialist, for treatment of heart and circulation problems.
• A nephrologist, for treatment of kidney disease.
• An ophthalmologist for diagnosis and treatment of eye disease, or an optometrist for diagnosis of eye disease. Ophthalmologists treat retinal complications from diabetes.
• A neurologist, for treatment of nerve damage.
• A gastroenterologist, for treatment of problems in the stomach and intestines.
• A urologist, for treatment of problems with sexual function or the urinary tract.
• A podiatrist, pedorthist (a certified technician who can make special shoes or shoe inserts), or orthopedic surgeon, for foot and ankle problems.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

You need to see your doctor about every 3 to 6 months throughout your life for tests and exams to see how you are doing and to adjust your treatment for type 1 diabetes.

After you have had diabetes for 3 to 5 years, you will need annual tests to look for signs of eye damage (diabetic retinopathy), kidney damage (diabetic nephropathy), and less feeling in your feet (diabetic neuropathy).

Other possible tests

You may also need:

• Continuous glucose monitoring, if your doctor recommends it. You wear a monitor that checks your blood sugar level continuously for 24 to 72 hours. The results are stored in the monitor and can show your blood sugar level pattern. The monitor also can be used to spot low or high blood sugar levels. These devices may use an alarm to warn you of low or falling blood sugar. Also, someday they may be used with insulin pumps to automatically change your insulin dose as needed.
• An electrocardiogram (ECG or EKG) if you have had a heart attack or have heart disease.
• A stress test before you begin a vigorous exercise program. Your doctor may want you to have this test to see whether you have signs of heart disease. Your doctor may use an EKG along with a test called a nuclear scan to measure the blood flow in your heart. These tests together may be especially useful for finding heart problems in people who have diabetes.
• An examination by a cardiologist, if you develop heart problems related to diabetes.
• A thyroid-stimulating hormone (TSH) test when type 1 diabetes is diagnosed and then every 1 to 2 years. This test checks for thyroid problems, which are common among people with diabetes.

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:

• Try to do at least 2½ hours a week of moderate exercise. 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.

Prevention

Preventing high and low blood sugar

Taking insulin for type 1 diabetes helps keep your blood sugar at normal levels. But insulin by injection cannot exactly match the minute-by-minute adjustments your pancreas would make on its own. So you will have low and high blood sugar from time to time.

You can prevent many of these episodes by:

• Taking your insulin as prescribed.
• Eating meals according to your meal plan.
• Having a daily routine where you eat and exercise about the same amounts and at about the same times every day.
• Checking your blood sugar level several times a day and whenever you think it may be high or low.
• Recognizing and treating high or low blood sugar quickly.

For more information, see:

Diabetes: Dealing with low blood sugar from insulin.

Diabetes: Preventing high blood sugar emergencies.

Preventing complications

Keeping your blood sugar levels carefully within a normal or near-normal range is the most effective way to prevent complications. The higher your blood sugar level, the greater your risk for developing complications. An adolescent who keeps his or her blood sugar levels as close to normal as possible can prevent complications from developing in early adulthood.¹⁰

You can also help prevent these complications by:

• Having yearly screening for protein in your urine after you have had diabetes for 5 years. This is the only way to detect early kidney damage (diabetic nephropathy). If kidney damage is found, medicine can help slow, or possibly reverse, the damage.
• Having yearly exams by an ophthalmologist or optometrist after you have had diabetes for 3 to 5 years. This is the only way to check your eyes for signs of damage (diabetic retinopathy), glaucoma, and cataracts.
• Treating high blood pressure and high cholesterol. These conditions increase your risk for developing diabetic complications, especially heart and blood vessel diseases.¹¹
• Taking aspirin. If you are age 40 or older, talk with your doctor about whether you should take a low-dose aspirin to help prevent complications.¹² People with diabetes are 2 to 4 times more likely than people who don't have diabetes to develop fatal heart and blood vessel diseases. If you have had a heart attack, stroke, or other large blood vessel disease, you may need to take aspirin, unless there are other health reasons why you cannot take it. Do not give aspirin to anyone younger than age 20. It has been linked with Reye syndrome.
• Not smoking. Smoking increases your risk for diabetes-caused damage to the blood vessels.¹³ Smoking could increase your adolescent's risk for developing complications in early adulthood.
• Limiting your alcohol intake to no more than two drinks a day for men and one drink a day for women (none, if you are pregnant).
• Keeping your immunizations up to date. Diabetes affects your immune system, increasing your risk for developing a severe illness, such as influenza or pneumonia. See the topic Immunizations for the recommended immunization schedule.
• Caring for your feet. Wearing padded, absorbent socks and cushioned shoes can reduce injury to your feet. You also should check your feet every day for sores, hot spots, and cuts.

  Diabetes: Taking care of your feet

• Wearing medical identification to let medical personnel know that you have diabetes. You can buy medical identification bracelets, necklaces, or other forms of jewelry at your local pharmacy or on the Internet.

Home Treatment

Type 1 diabetes requires daily attention to diet, exercise, and insulin. You may have times when this job feels overwhelming, but taking good care of yourself will help you will feel better, have a better quality of life, and prevent or delay complications from diabetes.

Eat well and count carbohydrate grams

Follow one of these meal-planning methods to help you eat a healthful diet and spread carbohydrate through the day. This will help prevent high blood sugar levels after meals. For more information, see:

Diabetes: Using a food guide.

Diabetes: Counting carbs if you use insulin.

Focusing on the type of carbohydrate as well as the amount might help you maintain your target blood sugar level. Foods with a low glycemic index (GI) may have a small but helpful role in preventing spikes in blood sugar. It is not yet known if these foods have a role in preventing complications.¹⁴ Low glycemic foods do not raise blood sugar as quickly as high glycemic foods. Foods with a low GI include high-fiber whole grains, lentils, and beans. High GI foods include potatoes and white bread.

Using fat replacers—nonfat substances that act like fat in a food—may seem like a good idea, but talk with a registered dietitian before you do. Some people may eat more food, and therefore more calories, if they know a food contains a fat replacer.

Take insulin

Make sure you know how to give yourself insulin.

Diabetes: Giving yourself an insulin shot

If you are using an insulin pump or an insulin pen, make sure you know how to use them properly.

Should I get an insulin pump?

Diabetes: Living with an insulin pump

Exercise

Try to do at least 2½ hours a week of moderate activity. One way to do this is to be active 30 minutes a day, at least 5 days a week. Be sure 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?).

Monitor your blood sugar

Checking your blood sugar level is a major part of controlling your blood sugar level and keeping it in a target range you set with your doctor. For more information, see:

Diabetes: Checking your blood sugar.

Handle high and low blood sugar levels

Be sure you:

• Recognize and treat high and low blood sugar levels. For more information, see:

  Diabetes: Dealing with low blood sugar from insulin.

  Diabetes: Preventing high blood sugar emergencies.

• Always wear medical identification to let medical personnel know that you have diabetes.
• Take precautions when you are driving and do not drive if your blood sugar is below 70 milligrams per deciliter (mg/dL).

Control your blood pressure and cholesterol

• Blood pressure in people who have diabetes should be less than 130/80 millimeters of mercury (mm Hg). 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
• 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, or "good," cholesterol 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

Limit alcohol

Limit your alcohol intake to no more than two drinks a day for men and one drink a day for women (none, if you are pregnant).

Take an aspirin every day

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

Deal with your feelings

A chronic illness creates major change in your life. You may need to grieve the loss of your old life from time to time. Also, you may feel resentful, deprived, or angry about having to pay attention to what and how much you eat. For more information, see:

Diabetes: Coping with your feelings about your diet.

Protect your feet

Daily foot care can prevent serious problems. Foot problems caused by diabetes are the most common cause of amputations. For more information, see:

Diabetes: Taking care of your feet.

Learn more about diabetes

Diabetes is a complex disease and there is a lot to learn, such as:

• How to better care for your skin and your teeth and gums. For example, using a humidifier in your house or wearing gloves when gardening can keep your skin from becoming dry and cracking. Daily flossing and brushing can reduce the risk of gum disease.
• Precautions to take when you are sick. You need to drink more fluids than usual to prevent dehydration and test your urine for ketones when you are sick.
• How to prevent problems while traveling. You may want to take extra insulin with you and have plenty of snacks on hand in case you are in an area where you cannot get food.
• Where to find a support group for people with diabetes. Camps are also available for adolescents who have diabetes.
• How to stop smoking, or how to prevent your adolescent with diabetes from starting.
• What immunizations you need. For more information, see the topic Immunizations.
• How to deal with a rebellious adolescent who has diabetes. Ideas for helping your teen include letting him or her use an insulin pen or pump and letting your teen meet alone with his or her diabetes educator. This may help your teen feel more in control of his or her diabetes care.
• When it's a safe time to try to get pregnant. For more information, see:

  I have diabetes. Should I get pregnant now?

Medications

Everyone with type 1 diabetes needs to take insulin. You are probably taking more than one type of insulin, either as an injection or by using an insulin pump.

The amount and type of insulin you take will likely change over time, depending on changes that occur with normal aging, changes in your exercise routine, and hormonal changes (such as during rapid growth of adolescence or pregnancy). You may need higher doses of insulin when you are ill or experiencing emotional stress. A woman needs much more insulin than usual during the last part of pregnancy.

You should:

• Know the dose of each type of insulin you take, when you take the doses, how long it takes for each type of insulin to start working (onset), when it will have its greatest effect (peak), and how long it will work (duration).
• Never skip a dose of insulin without the advice of your doctor.

Medication Choices

Insulin

Amylinomimetics, such as pramlintide (Symlin)

What To Think About

You may need other medicines at some point in your life.

• If small amounts of protein are found when your urine is tested (microalbuminuria), you may be in the early stage of diabetic nephropathy. You may be given an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB). An ACE inhibitor may reverse early kidney damage.¹⁵
• If you have had a heart attack, stroke, or other large blood vessel disease, you need to take aspirin, unless there are health reasons why you cannot. If you are age 40 or older and are at risk for heart and blood vessel disease, you also may want to take aspirin to help prevent these complications.¹² Do not give aspirin to anyone under 20 years old, because it has been linked with Reye syndrome.
• If you have high blood pressure or high cholesterol, you may need other medicines to treat these conditions. Adequate treatment may help prevent complications from diabetes. You may need one or more medicines to lower blood pressure. You also may need to take statins to lower your cholesterol. Statins are medicines that can reduce LDL levels and the risk of heart disease in people who have diabetes.⁸ They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.¹⁶

Surgery

Surgery is not a routine way of treating type 1 diabetes. You are eligible for surgery only if you meet specific criteria.

• You may have a pancreas transplant surgery if you have had or plan to have a kidney transplant or, in rare cases, if you meet other requirements.
• You may have islet cell transplant surgery if you meet the rules for being in a study. Islet cells transplanted into the liver make insulin.

Surgery Choices

Pancreas transplant surgery

Pancreatic islet cell transplantation

What To Think About

Pancreas and islet cell transplants are very expensive. After having one of these surgeries, you must take immunosuppressive medicines for the rest of your life to prevent your body from rejecting the new tissue.

The success rate for pancreas transplants has improved with new surgical techniques and new immunosuppressive medicines. Islet cell transplants may replace pancreas transplants in the future but for now they are experimental.¹⁷

Other Treatment

You will hear about products that promise a “cure” for type 1 diabetes. Avoid them. No such cure exists. Also avoid products for treating diabetes that are advertised only by testimonials from satisfied customers. These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting other forms of treatment that have been proved to work. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

You may hear of people with diabetes following other types of meal plans or using low glycemic index foods to prevent high blood sugar levels after meals. Low glycemic diets may have a small but helpful role in keeping blood sugar in a normal range.¹⁴ Talk with a registered dietitian before choosing one of these to plan your meals.

Complementary therapies

Other types of treatment for diabetes are provided by therapists or others who do not operate within mainstream medical practice. Their unconventional approaches may be attractive, particularly if you are not having much success with conventional medical treatments. None of these complementary therapies are proved to effectively treat diabetes.

But you may benefit from safe, nontraditional therapies that complement conventional medical treatment for your disease. Complementary therapies, such as acupuncture, massage, or biofeedback, for instance, may help reduce stress, relieve muscle tension, and improve your overall well-being and quality of life.

You should not use complementary therapies alone to treat your diabetes.

Talk with your doctor if you are using the following or other complementary or alternative therapies:

• Acupuncture
• Massage therapy
• Biofeedback
• Chiropractic therapy
• Herbal medicines and natural substances, such as antioxidants, vanadium, magnesium, or chromium. Studies indicate that soluble fiber may help you keep your blood sugar levels within your target range.
• Osteopathy

Related Information

• Diabetic Nephropathy
• Diabetic Neuropathy
• Diabetic Retinopathy
• Type 1 Diabetes
• Type 1 Diabetes: Children Living With the Disease
• Type 1 Diabetes: Living With Complications
• Type 1 Diabetes: Recently Diagnosed
• Type 2 Diabetes in Children

References

Citations

1. Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511–2518.
2. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.
3. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.
4. American Diabetes Association (2008). All About Diabetes. Available online: http://www.diabetes.org/about-diabetes.jsp.
5. Zochodne DW (2001). Peripheral nerve disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 466–487. Hamilton, ON: BC Decker.
6. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.
7. American Diabetes Association (2004). Hypertension management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S65–S67.
8. American Diabetes Association (2004). Dyslipidemia management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S68–S71.
9. American Diabetes Association (2004). Hyperglycemic crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94–S102.
10. Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group (2001). Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). Journal of Pediatrics, 139(6): 804–812.
11. Sigal R, et al. (2006). Prevention of cardiovascular events in diabetes, search date November 2004. Online version of Clinical Evidence. Also available online: http://www.clinicalevidence.com.
12. American Diabetes Association (2008). Standards of medical care in diabetes. Clinical Practice Recommendations 2008. Diabetes Care, 31(Suppl 1): S12–S54.
13. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.
14. American Diabetes Association (2003). Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 26(8): 2261–2267.
15. ACE Inhibitors in Diabetic Nephropathy Trialist Group (2001). Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors? Annals of Internal Medicine, 134(5): 370–379.
16. Collins R, et al. (2003). MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A randomised placebo-controlled trial. Heart Protection Study Collaborative Group. Lancet, 361(9374): 2005–2016.
17. Sutherland DE, et al. (2001). Lessons learned from more than 1,000 pancreas transplants at a single institution. Annals of Surgery, 233(4): 463–501.

Other Works Consulted

• American Diabetes Association (2000). Role of fat replacers in diabetes medical nutrition therapy. Clinical Practice Recommendations 2000. Diabetes Care, 23(Suppl 1): S96–S97.
• American Diabetes Association (2004). Influenza and pneumococcal immunization in diabetes. Position statement. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S111–S113.
• American Diabetes Association (2008). Nutrition recommendations and interventions for diabetes. Diabetes Care, 31(Suppl 1): S61–S78.
• Anderson JW (2006). Diabetes mellitus: Medical nutrition therapy. In ME Shils et al., eds., Modern Nutrition in Health and Disease, 10th ed., pp. 1043–1066. Philadelphia: Lippincott Williams and Wilkins.
• Campbell A (2006). Glycaemic control in type 1 diabetes, search date December 2005. Online version of Clinical Evidence. Also available online: http://www.clinicalevidence.com.
• Campbell AP, Beaser RS (2007). Designing a conventional insulin treatment program. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 281–323. Boston: Joslin Diabetes Center.
• Campbell AP, Beaser RS (2007). Medical nutrition therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 81–125. Boston: Joslin Diabetes Center.
• Chalmers KH (2005). Medical nutrition therapy. In Joslin's Diabetes Mellitus, 14th ed., pp. 611–631. Philadelphia: Lippincott Williams and Wilkins.
• Cheng AYY, Zinman B (2005). Principles of insulin therapy. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 659–670. Philadelphia: Lippincott Williams and Wilkins.
• Gerstein HC, et al. (2001). Cardiovascular disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488–514. Hamilton, ON: BC Decker.
• Levine BS, et al. (2001). Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. Journal of Pediatrics, 139(2): 197–203.
• Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414–2423.
• Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593–598.
• Weir GC (2005). Pancreas and islet transplantation. In Joslin's Diabetes Mellitus, 14th ed., pp. 757–776. Philadelphia: Lippincott Williams and Wilkins.

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