Type 1 diabetes - self-care
Description
Type 1 diabetes is a life-long (chronic) disease in which there is a high level of sugar (glucose) in the blood. If you have type 1 diabetes, your body makes little to no insulin. Insulin is a hormone made by the pancreas that controls blood sugar. Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. This buildup can lead to high blood sugar (hyperglycemia).
Type 1 diabetes can occur at any age. It is most often diagnosed in children, teens, and young adults.
Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your health care provider about seeing a certified diabetes care and education specialist (often called a diabetes educator). Working with your diabetes care team can help you manage type 1 diabetes.
Alternative Names
Type 1 diabetes - managing
Symptoms of Type 1 Diabetes
Symptoms of type 1 diabetes can occur when your blood glucose levels go too high or too low.
HIGH BLOOD SUGAR
High blood sugar can occur for several reasons:
- You did not give yourself enough insulin
- You ate more than you planned to
- You have been less active than usual
- You are sick with an illness
- You are under stress
- Some medicines, such as steroids or certain mood-stabilizing agents, can cause your blood sugar to spike
Symptoms of high blood sugar include:
- High blood glucose readings
- High glucose in the urine
- Being very thirsty
- Urinating more often (including urinating at night or bedwetting in children who were dry overnight before)
- Feeling sluggish
- Blurred vision
LOW BLOOD SUGAR
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms usually appear when a person's blood sugar level falls below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L).
Watch for these common symptoms:
- Feeling shaky
- Nervousness, irritability
- Fast or strong heartbeat (palpitations)
- Sweating, chills
- Irritability
- Lightheadedness or dizziness
- Hunger
More severe symptoms include:
- Sleepiness
- Weakness
- Confusion
- Poor coordination
- Blurred vision
- Seizures
Practicing self-care can help you manage type 1 diabetes and help keep your blood glucose level in a healthy range.
Check Your Blood Sugar Regularly
People with type 1 diabetes need to check their blood sugar level at least 4 times a day. You can check your blood sugar at home using a blood glucose meter to track your glucose levels before, between, or after meals and at other times when needed. A continuous glucose monitor (CGM), is a device you can wear that will track your blood sugar in real time and give you updates.
Be sure to follow the home testing schedule your provider has set up for you. This will help you stay within your blood sugar goals. Keep a record for yourself and your provider.
Learn what to do if your blood sugar goes too high or too low. You can treat early signs of hypoglycemia at home by drinking orange juice, eating sugar or candy, or taking glucose tablets. If you experience high or low blood sugar very often, talk with your provider. You may need to make changes to your diabetes management plan.
Taking Insulin
Everyone with type 1 diabetes needs to take insulin every day. There are different types of insulin based on how fast they work, when they peak, and how long they last. Your provider will work with you to find the best types of insulin for you. Most people with type 1 diabetes take more than one type of insulin. You will also learn how and when to use insulin.
Most commonly, insulin is injected under the skin using a syringe, insulin pen, or insulin pump. Inhaled insulin is another form of rapid-acting insulin that can be used. Insulin cannot be taken by mouth because the acid in the stomach destroys insulin.
You will learn how to adjust the amount of insulin you are taking:
- When you exercise
- When you are sick
- When you will be eating more or less food and calories
- When you are traveling
Meal Planning with Type 1 Diabetes
To help keep your blood sugar level in your target range, you will need to follow a meal plan. Meal planning helps you maintain a balance between your food and insulin intake. Testing your blood sugar helps you see how food can raise or lower your blood sugar.
Your meal plan should include:
- Food from all the food groups
- Few added sugars and processed foods
- More high-fiber foods
- More nonstarchy vegetables such as leafy greens
- About the same amount of carbohydrates at each meal and snack
- Healthy fats, such as olive or canola oils and corn and safflower oils
Eating your meals and snacks at the same time each day can help you manage your blood sugar.
Everyone has individual needs. Work with your provider to develop a meal plan that works for you.
HOW CARBOHYDRATES AFFECT BLOOD SUGAR
Carbohydrates in food give your body energy. The main kinds of carbohydrates (commonly called "carbs") are starches, sugars, and fiber. Your body needs all types of carbs to function properly. Your body quickly turns starches and sugars into glucose for energy. This raises your blood sugar level. Fiber does not raise blood sugar. In fact, fiber can help you manage your blood glucose.
Knowing the kind and amount of carbohydrates in your food will help you plan your meals.
Your provider will explain how to calculate how much insulin you should take to manage your blood sugars after eating.
COUNTING YOUR CARBS
You can use a technique called "carb counting" to track how many carbohydrates you should be eating in your meals and snacks in a day to keep your blood sugars within the target range. You need to match your insulin dose to the total amount of carbs you take in through food or drinks.
If you take a fixed dose of insulin, you should take in the same amount of carbs at each meal every day.
Tracking carbs at each meal will help you to manage your blood sugar levels. Packaged foods have nutrition facts labels that tell you the type and amount of different nutrients in the food item. Learn how to read food labels to count the carbs that you eat. The carb count for a food includes sugar and starch plus fiber.
Carbs are measured in grams. When you are carb counting, a serving (sometimes also called "a carb") equals an amount of food that contains 15 grams of carbohydrates. Check for the "total carbohydrate" count and the serving size on the nutrition facts label of the food item to decide the amount of food you can eat.
Foods such as fresh fruits and vegetables do not have food labels on them. There are several apps and tools available to help you calculate the amount of carbs in them. Your provider can also help.
When you count carbs in foods that you cook, you will have to measure the portion of food after cooking it. The total amount of carbohydrates you eat in a day is the sum of the carbohydrates in everything you eat.
Manage Your Blood Glucose While Exercising
With type 1 diabetes, you need to learn how to balance diet, insulin intake, and physical activity to keep your blood sugar in the target range. Getting regular exercise is important for your overall health. It can also help you manage diabetes. However, it's not always easy to predict how blood sugar will respond to exercise. Different types of exercise can make blood sugar go up or down. Most of the time, your response to any specific exercise will be the same. Testing your blood sugar before, during, and after a workout session will help you know which activities raise or lower your blood sugar level the most.
When you plan to exercise:
- Talk with your provider or diabetes educator before starting a new exercise program.
- Consider light to moderate exercises such as speed walking, biking, or swimming.
- Strenuous physical activities may lead to hypoglycemia, check your blood glucose often until you know how they affect you.
- Keep a snack or a drink rich in carbs nearby that can raise your blood sugar quickly if it drops down during activity. You may also consider keeping a snack in your car or bedside if your blood sugar drops later in the day.
- Avoid exercise if your blood glucose levels are above 300 mg/dL.
- Have a small carbohydrate rich snack (about 15 grams) before your workout session if your blood glucose levels are less than 100 mg/dl.
- Learn from your provider or diabetes educator how to adjust insulin dose before and after exercise. This may depend on whether you are doing exercise before or after a meal and also on the intensity level and duration of your workout session.
- Do not inject insulin in a part of your body that you are exercising, such as the shoulders or thighs.
- Try to exercise at the same time of day, for the same amount of time, and at the same level.
Exercise can cause your blood sugar to decrease for up to 12 hours after you are done. If exercise frequently causes your blood sugar to be low, talk with your provider or diabetes educator. You may need to lower the dose of your insulin.
It's a good idea to wear a diabetes ID bracelet. In case of an emergency, it will let people know you have diabetes so you can get the right medical attention.
Get Regular Exams and Tests
Having high levels of sugar in the blood may affect your nerves, eyes, skin, kidneys, heart, or other organs. You must get regular exams and tests to help detect and prevent long-term complications of diabetes.
To monitor symptoms and prevent long-term problems of type 1 diabetes:
- Check your feet every day.
- Look for signs of reactions to insulin or any firm areas at your insulin injection sites.
- Have your blood pressure checked at least once a year. For most people, the goal should be below 130/80 mmHg.
- Have an A1C test done every 6 months if your diabetes is well controlled. Have the test done every 3 months if your diabetes is not well controlled.
- Have your cholesterol and triglyceride levels checked once a year or as recommended by your provider.
- Get tests once a year to make sure your kidneys are working well. These tests include checking levels of urine albumin (microalbuminuria) and serum creatinine.
- Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease, once you have had type 1 diabetes for 5 years.
- See your dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
When to Call the Doctor
If you have type 1 diabetes, you should see your provider every 3 months, or as often as your provider recommends to keep your diabetes well controlled.
Contact your provider if:
- You think you may need to change your insulin routine
- You have any problems taking insulin
- Your blood sugar is too high or too low and you do not understand why
If you have symptoms of diabetic ketoacidosis (DKA), go to the emergency room or call 911 or the local emergency number. DKA is a medical emergency. Symptoms include:
- Decreased alertness
- Deep, rapid breathing
- Nausea and vomiting
- Stomach pain
References
American Diabetes Association Professional Practice Committee. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes-2024 [published correction appears in Diabetes Care. 2024 Feb 05]. Diabetes Care. 2024;47(Suppl 1):S77-S110. PMID: 38078584 pubmed.ncbi.nlm.nih.gov/38078584/.
American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: Standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S111-S125. PMID: 38078586 pubmed.ncbi.nlm.nih.gov/38078586/.
Dhatariya KK, Umpierrez GE, Crandall JP. Diabetes Mellitus. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 210.
Egan AM, Dinneen SF. Classification and diagnosis of diabetes mellitus. In: Robertson RP ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 42.
Moore TR, Powe CE, Catalano P. Diabetes in pregnancy. In Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy & Resnik’s Maternal-Fetal Medicine. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 59.
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
