Treatment

Insulin

Insulin injections

If you have type 1 diabetes, you'll probably need insulin injections. Insulin must be injected, because if it were taken as a tablet, it would be broken down in your stomach ( like food) and would be unable to enter your bloodstream.

When you're first diagnosed, your diabetes care team will help you with your insulin injections, before showing you how and when to do it yourself. They'll also show you how to store your insulin and dispose of your needles properly.

Insulin injections are usually given by an injection pen, which is also known as an insulin pen or auto-injector. Sometimes, injections are given using a syringe. Most people need two to four injections a day.

Your GP or diabetes nurse may also teach one of your close friends or relatives how to inject the insulin properly.

Insulin pump therapy

Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device that holds insulin and is about the size of a pack of playing cards.

The pump is attached to you by a long, thin piece of tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms.

The pump allows insulin to continuously flow into your bloodstream at a rate you can control. This means you no longer need to give yourself injections, although you'll need to monitor your blood glucose levels very closely to ensure you're receiving the right amount of insulin.

Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 1 diabetes. However, it may not be suitable for everyone. Your diabetes care team may suggest pump therapy if you have frequent episodes of low blood glucose (hypoglycaemia) .

Monitoring blood glucose

If you have type1 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months.

This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working.

The HbA1c test is used to measure blood glucose levels over the previous two to three months.

HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it.

A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed.

Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 59mmol/mol (7.5%). However, it can be as low as 48mmol/mol (6.5%) for some people.

It can be useful for detecting high blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia) .

If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low.

Blood glucose meters aren't currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if you're unsure.

Regularly monitoring your blood glucose levels will ensure your blood glucose is as normal and stable as possible.

As your blood glucose level is likely to vary throughout the day, you may need to check it several times a day, depending on the treatment you're taking.

In home testing, blood glucose levels are usually measured by how many millimoles of glucose are in a litre of blood.

A millimole is a measurement used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l for short.

A normal blood glucose level is 4-6 mmol/l before meals (preprandial) and less than 10 mmol/l two hours after meals (postprandial), although this can vary from person to person.

Your diabetes care team can discuss your blood glucose level with you in more detail.

Treating hyperglycaemia (high blood glucose)

Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin.

If you develop hyperglycaemia, you may need to adjust your diet or your insulindose to keep your glucose levels normal. Your diabetes care team can advise you about the best way to do this.

If hyperglycaemia isn't treated, it can lead to a condition called diabetic ketoacidosis , where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood.

Diabetic ketoacidosis is very serious and if not addressed quickly, it can lead to unconsciousness and eventually death.

The signs of diabetic ketoacidosis include:

• frequently passing urine
• thirst
• tiredness and lethargy (lack of energy)
• blurry vision
• abdominal (stomach) pain
• nausea and vomiting
• deep breathing
• smell of ketones on breath (described as smelling like pear drops)
• collapse and unconsciousness

You'll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if you're dehydrated, including salt solution and potassium.

Treating hypoglycaemia (low blood glucose)

If you have type1 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia .

Hypoglycaemia is where your blood glucose levels become very low.

Mild hypoglycaemia (a "hypo") can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary.

If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets.

This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit.

In most cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours.

If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness.

If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels.

Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one.

Other treatments

Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease , stroke and kidney disease . To reduce the chance of this, you may be advised to take:

• anti-hypertensive medicines to control high blood pressure
• a statin, such as simvastatin, to reduce high cholesterol levels
• low-dose aspirin to prevent stroke
• angiotensin-converting enzyme (ACE) inhibitor such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease

Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. It's often reversible if treated early enough.