About Diabetes Type 1 diabetes, Conditions & Treatment
| Type 1 diabetes, Conditions & Treatment |
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Arm yourself with information about conditions associated with type 1 diabetes, and how to prevent them. Conditions associated with type 1 diabetes include hyperglycemia, hypoglycemia, ketoacidosis and celiac disease. You will also find helpful information about insulin, choosing blood glucose meters, various diagnostic tests including the A1c test, managing and checking your blood glucose, kidney and islet transplantations, and tips on what to expect from your health care provider.
In type 1 diabetes, the body does not produce insulin, which is needed to take sugar (glucose) from the blood to the cells. You can learn more about these conditions and how to prevent them in this section. You will also find helpful information about insulin, diagnostic tests and tips on what to expect from your health care provider. Hypoglycemia Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia. What are the symptoms of hypoglycemia?
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You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly. If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat. How do you treat hypoglycemia?
The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy. Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. And then, be sure you always have at least one type of sugar with you. Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again. If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment. After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up. It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out. If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital. Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it. You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it. If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose. If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help. It's a good idea to post emergency numbers by the telephone. If you pass out from hypoglycemia, people should: NOT inject insulin. How do you prevent low blood glucose?
Good diabetes control is the best way we know to prevent hypoglycemia. The trick is to learn to recognize the symptoms of hypoglycemia. This way, you can treat hypoglycemia before it gets worse. Hypoglycemia Unawareness
Some people have no symptoms of hypoglycemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This problem is called hypoglycemia unawareness. Hypoglycemia unawareness tends to happen to people who have had diabetes for many years. Hypoglycemia unawareness does not happen to everyone. It is more likely in people who have neuropathy (nerve damage), people on tight glucose control, and people who take certain heart or high blood pressure medicines. As the years go by, many people continue to have symptoms of hypoglycemia, but the symptoms change. In this case, someone may not recognize a reaction because it feels different. These changes are good reason to check your blood glucose often, and to alert your friends and family to your symptoms of hypoglycemia. Treat low or dropping sugar levels even if you feel fine. And tell your team if your blood glucose ever drops below 50 mg/dl without any symptoms. Hyperglycemia Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it. You have diabetes, which means you have to deal with some of the problems that go along with having the disease. One of those problems is hyperglycemia. Hyperglycemia happens from time to time to all people who have diabetes. Hyperglycemia can be a serious problem if you don't treat it. Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it. Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little, or not enough, insulin or when the body can't use insulin properly. A number of things can cause hyperglycemia. For example, if you have type 1 diabetes, you may not have given yourself enough insulin. If you have type 2 diabetes, your body may have enough insulin, but it is not as effective as it should be. The problem could be that you ate more than planned or exercised less than planned. The stress of an illness, such as a cold or flu, could also be the cause. Other stresses, such as family conflicts or school or dating problems, could also cause hyperglycemia. What are the symptoms of hyperglycemia?
The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia. It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: shortness of breath
Talk to your doctor about how to handle this condition
Often, you can lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do NOT exercise. Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level. Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it. How do you prevent hyperglycemia?
Your best bet is to practice good diabetes management. The trick is learning to detect and treat hyperglycemia early -- before it can get worse. Ketoacidosis Ketoacidosis (key-toe-ass-i-DOE-sis) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. Ketoacidosis may happen to people with type 1 diabetes. Ketoacidosis occurs rarely in people with type 2 diabetes. But some people -- especially older people -- with type 2 diabetes may experience a different serious condition. It's called hyperosmolar nonketotic coma (hi-per-oz-MOE-lar non- key-TOT-ick KO-ma). Ketocidosis means dangerously high levels of ketones. Ketones are acids that build up in the blood. They appear in the urine when your body doesn't have enough insulin. Ketones can poison the body. They are a warning sign that your diabetes is out of control or that you are getting sick. Treatment for ketoacidosis usually takes place in the hospital. But you can help prevent ketoacidosis by learning the warning signs and checking your urine and blood regularly. What are the warning signs of ketoacidosis?
Ketoacidosis usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. The first symptoms are: Thirst or a very dry mouth
A simple urine test can detect ketones. You use a test strip, like a blood testing strip. Ask your health care provider when and how you should test for ketones. Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl. When you are ill (when you have a cold or the flu, for example), check for ketones every 4 to 6 hours. And check every 4 to 6 hours when your blood glucose is more than 240 mg/dl. Also, check for ketones when you have any symptoms of ketoacidosis. What if you find higher-than-normal levels of ketones?
If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone. Call your health care provider at once if: Your urine tests show large ketones What causes ketoacidosis?
Ketones mean your body is burning fat to get energy. Moderate or large amounts of ketones in your urine are dangerous. They upset the chemical balance of the blood. Commonly, the flu, a cold, or other infections may sometimes bring on ketoacidosis. Here are three basic reasons for moderate or large amounts of ketones: 1.Not getting enough insulin. Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness. If there is not enough insulin, your body begins to break down body fat for energy.
Managing Your Blood Glucose Keeping your blood sugar (glucose) as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes. Checking Your Blood Glucose Tight Diabetes Control A1C Test New! Possible Interference with Blood Glucose Measurements from Certain Medical Products
The FDA wants to alert physicians, nurses, and other healthcare professionals who perform glucose monitoring of the potential for life-threatening falsely elevated glucose readings in patients who are receiving certain treatments. Specifically, patients who are receiving drug products containing maltose or galactose, or oral xylose, and who are subsequently tested using glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) based glucose monitoring systems, may receive dangerously false BG readings. There have been reports of the inappropriate administration of insulin and consequent life-threatening/fatal hypoglycemia in response to erroneous test results obtained from patients receiving parenteral products containing maltose. Cases of true hypoglycemia can go untreated if the hypoglycemic state is masked by false elevation of glucose readings. Since hypoglycemia may be life threatening, it is important that health care providers prescribing and/or administering products containing the above sugars be aware of possible interference leading to incorrect results. Products known to cause this testing interference and additional informationcan be found on this site maintained by the FDA. About Insulin and other drugs Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood. There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain. The Basics of Insulin Insulin Storage and Syringe Safety Information Insulin Routines New injectable drug recently approved by the FDA
Pramlintide injections taken with meals have been shown to modestly improve A1C levels without causing increased hypoglycemia or weight gain and even promoting modest weight loss. The primary side effect is nausea, which tends to improve over time and as an individual patient determines his or her optimal dose. Because of differences in chemistry, pramlintide cannot be combined in the same vial or syringe with insulin and must be injected separately. Pramlintide has been approved for people with type 1 diabetes who are not achieving their goal A1C levels and for people with type 2 diabetes who are using insulin and are not achieving their A1C goals. Insulin Pumps If you have been diagnosed with diabetes, you may feel overwhelmed by all the new information you have learned and will continue to learn about managing your diabetes. You already know your main goal should be to get your blood glucose (sugar) levels under control in order to increase your chances of a complication-free life. Many people know this, but need to know how to achieve good diabetes management, while balancing the day-to-day demands of diabetes with other life demands. An insulin pump can help you manage your diabetes. By using an insulin pump, you can match your insulin to your lifestyle, rather than getting an insulin injection and matching your life to how the insulin is working. When you work closely with your diabetes care team, insulin pumps can help you keep your blood glucose levels within your target ranges. People of all ages with type 1 diabetes use insulin pumps and people with type 2 diabetes have started to use them as well. How do insulin pumps work?
Basal rates Bolus doses to cover carbohydrate in meals Correction or supplemental doses Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night. When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it. You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your target range. Knowing how an insulin pump works is one thing. But you may be wondering where you are supposed to put it. You can buy a pump case or it can be attached to a waistband, pocket, bra, garter belt, sock, or underwear. You can also tuck any excess tubing into the waistband of your underwear or pants. When you sleep, you could try laying the pump next to you on the bed. You could even try wearing it on a waistband, armband, legband, or clip it to the blanket, sheet, pajamas, stuffed toy, or pillow with a belt clip. Showering and bathing are other instances when you should know where to put your insulin pump. Although insulin pumps are water resistant, they should not be set directly in the water. Instead, you can disconnect it. All insulin pumps have a disconnect port for activities, such as swimming, bathing, or showering. Some pumps can be placed on the side of the tub, in a shower caddy, or in a soap tray. There are also special cases you can buy. You can hang these cases from your neck or from a shower curtain hook. No matter what you may think, you can still have fun when you are using an insulin pump. When you exercise or play sports, you can wear a strong elastic waist band with a pump case. You can also wear it on an armband where it is visible. Women can tape the insulin pump to the front of their sports bra. Some coaches do not allow any devices to be worn because getting the pump knocked into you or falling on it can be painful. In this case, you may just need to take the insulin pump off. When you disconnect your pump, you are stopping all delivery (basal and bolus) by the pump. Here are some important tips to remember when disconnecting your pump. It is important for you to remember that if you stop your pump while it is in the middle of delivering any bolus -- it will NOT be resumed. You may need to program a new one.
Advantages of Using an Insulin Pump
Using an insulin pump means eliminating individual insulin injections
Getting Started
1.Determine how much insulin to use in the insulin pump by averaging the total units of insulin you use per day for several days. (You may start with about 20% less if you are switching to rapid-acting insulin.)
Take your insulin at a specific time, such as five minutes before you eat, so you don't forget boluses. When traveling anywhere, bring extra supplies or at least an insulin pen, in case you are unable to use your pump for some reason. With an insulin pump, when you eat, what you eat, and how much you eat is up to you. You can eat more carbohydrate and still manage your blood glucose, but weight gain can happen. Talk to a dietitian about this when you start on the pump. It's a lot easier to not to gain weight, than it is to lose it after you have already gained it. When you take the insulin pump off or turn it off, figure out a system to remember to turn it back on. Listen to the alarms on the pump or set a timer! Make a habit of recording blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them. It really helps to sit down and look over your blood glucose record at the end of every week (or even every day) to see if you have any problem areas. Reviewing your records is the key to improving blood glucose control. Your diabetes provider and insulin pump company have record forms, or you can make your own. Just be sure that you have enough room to record everything you need. Keeping daily records is best, but some people find keeping records for two weekdays and one weekend day gives enough information to see the patterns.
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