Treatment for type 1 diabetes includes:
Taking insulin
Counting carbohydrates, fats and protein
Monitoring blood sugar often
Eating healthy foods
Exercising regularly and keeping a healthy weight
The goal is to keep the blood sugar level as close to normal as possible to delay or prevent complications. Generally, the goal is to keep the daytime blood sugar levels before meals between 80 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.
Insulin and other medications
Anyone who has type 1 diabetes needs insulin therapy throughout their life.
There are many types of insulin, including:
Short-acting insulin. Sometimes called regular insulin, this type starts working around 30 minutes after injection. It reaches peak effect at 90 to 120 minutes and lasts about 4 to 6 hours. Examples are Humulin R, Novolin R and Afrezza.
Rapid-acting insulin. This type of insulin starts working within 15 minutes. It reaches peak effect at 60 minutes and lasts about 4 hours. This type is often used 15 to 20 minutes before meals. Examples are glulisine (Apidra), lispro (Humalog, Admelog and Lyumjev) and aspart (Novolog and FiAsp).
Intermediate-acting insulin. Also called NPH insulin, this type of insulin starts working in about 1 to 3 hours. It reaches peak effect at 6 to 8 hours and lasts 12 to 24 hours. Examples are insulin NPH (Novolin N, Humulin N).
Long- and ultra-long-acting insulin. This type of insulin may provide coverage for as long as 14 to 40 hours. Examples are glargine (Lantus, Toujeo Solostar, Basaglar), detemir (Levemir) and degludec (Tresiba).
You'll probably need several daily injections that include a combination of a long-acting insulin and a rapid-acting insulin. These injections act more like the body's normal use of insulin than do older insulin regimens that only required one or two shots a day. A combination of three or more insulin injections a day has been shown to improve blood sugar levels.
Illustration showing an insulin pump
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Insulin delivery options
Insulin can't be taken by mouth to lower blood sugar because stomach enzymes will break down the insulin, preventing it from working. You'll need to either get shots (injections) or use an insulin pump.
Injections. You can use a fine needle and syringe or an insulin pen to inject insulin under the skin. Insulin pens look like ink pens and are available in disposable or refillable varieties.
If you choose shots (injections), you'll probably need a mixture of insulin types to use during the day and night.
An insulin pump. This is a small device worn on the outside of your body that you program to deliver specific amounts of insulin throughout the day and when you eat. A tube connects a reservoir of insulin to a catheter that's inserted under the skin of your abdomen.
There's also a tubeless pump option that involves wearing a pod containing the insulin on your body combined with a tiny catheter that's inserted under your skin.
Blood sugar monitoring
Depending on the type of insulin therapy you select or need, you may have to check and record your blood sugar level at least four times a day.
The American Diabetes Association recommends testing blood sugar levels before meals and snacks, before bed, before exercising or driving, and whenever you think you have low blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. More frequent monitoring can lower A1C levels.
Even if you take insulin and eat on a strict schedule, blood sugar levels can change. You'll learn how your blood sugar level changes in response to food, activity, illness, medications, stress, hormonal changes and alcohol.
Continuous glucose monitoring
Continuous glucose monitoring (CGM) monitors blood sugar levels. It may be especially helpful for preventing low blood sugar. These devices have been shown to lower A1C.
Continuous glucose monitors attach to the body using a fine needle just under the skin. They check blood glucose levels every few minutes.
Closed loop system
The Food and Drug Administration has approved two artificial pancreases for people with type 1 diabetes who are age 14 and older.
This is also called a closed loop system. The device, which is implanted in the body, links a continuous glucose monitor to an insulin pump. The monitor checks blood sugar levels every five minutes. The device automatically delivers the correct amount of insulin when the monitor shows that it's needed.
Other medications
Other medications also may be prescribed for people with type 1 diabetes, such as:
High blood pressure medications. Your provider may prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help keep your kidneys healthy. These medications are recommended for people with diabetes who have blood pressures above 140/90 millimeters of mercury (mm Hg).
Aspirin. Your provider may recommend you take baby or regular aspirin daily to protect your heart. Your provider may feel that you have an increased risk of a cardiovascular event. Your provider will discuss the risk of bleeding if you take aspirin.
Cholesterol-lowering drugs. Cholesterol guidelines are stricter for people with diabetes because of their higher risk of heart disease.
The American Diabetes Association recommends that low-density lipoprotein (LDL, or "bad") cholesterol be below 100 mg/dL (2.6 mmol/L). High-density lipoprotein (HDL, or "good") cholesterol is recommended to be over 50 mg/dL (1.3 mmol/L) in women and over 40 mg/dL (1 mmol/L) in men. Triglycerides, another type of blood fat, should be less than 150 mg/dL (1.7 mmol/L).
Healthy eating and monitoring carbohydrates
There's no such thing as a diabetes diet. However, it's important to center your diet on nutritious, low-fat, high-fiber foods such as:
Fruits
Vegetables
Whole grains
Your registered dietitian will recommend that you eat fewer animal products and refined carbohydrates, such as white bread and sweets. This healthy-eating plan is recommended even for people without diabetes.
You'll need to learn how to count the amount of carbohydrates in the foods you eat. By doing so, you can give yourself enough insulin. This will allow your body to properly use those carbohydrates. A registered dietitian can help you create a meal plan that fits your needs.
Physical activity
Everyone needs regular aerobic exercise, including people who have type 1 diabetes. First, get your provider's OK to exercise. Then choose activities you enjoy, such as walking or swimming, and do them every day when you can. Try for at least 150 minutes of moderate aerobic exercise a week, with no more than two days without any exercise.
Remember that physical activity lowers blood sugar. If you begin a new activity, check your blood sugar level more often than usual until you know how that activity affects your blood sugar levels. You might need to adjust your meal plan or insulin doses because of the increased activity.
Activities of concern
Certain life activities may be of concern for people who have type 1 diabetes.
Driving. Low blood sugar can occur at any time. It's a good idea to check your blood sugar anytime you're getting behind the wheel. If it's below 70 mg/dL (3.9 mmol/L), have a snack with 15 grams of carbohydrates. Retest again in 15 minutes to make sure it has risen to a safe level before you start driving.
Working. Type 1 diabetes can pose some challenges in the workplace. For example, if you work in a job that involves driving or operating heavy machinery, low blood sugar could pose a serious risk to you and those around you. You may need to work with your provider and your employer to ensure that certain adjustments are made. You may need additional breaks for blood sugar testing and fast access to food and drink. There are federal and state laws that require employers to provide these adjustments for people with diabetes.
Being pregnant. The risk of complications during pregnancy is higher for people with type 1 diabetes. Experts recommend that you see your provider before you get pregnant. A1C readings should be less than 6.5% before you try to get pregnant.
The risk of diseases present at birth (congenital diseases) is higher for people with type 1 diabetes. The risk is higher when diabetes is poorly controlled during the first 6 to 8 weeks of pregnancy. Careful management of your diabetes during pregnancy can lower your risk of complications.
Being older or having other conditions. For those who are weak or sick or have difficulty thinking clearly, tight control of blood sugar may not be practical. It could also increase the risk of low blood sugar. For many people with type 1 diabetes, a less strict A1C goal of less than 8% may be appropriate.
Potential future treatments
Pancreas transplant. With a successful pancreas transplant, you would no longer need insulin. But pancreas transplants aren't always successful — and the procedure poses serious risks. Because these risks can be more dangerous than the diabetes itself, pancreas transplants are generally used for those with very difficult-to-manage diabetes. They can also be used for people who also need a kidney transplant.
Islet cell transplantation. Researchers are experimenting with islet cell transplantation. This provides new insulin-producing cells from a donor pancreas. This experimental procedure had some problems in the past. But new techniques and better drugs to prevent islet cell rejection may improve its chances of becoming a successful treatment.
Signs of trouble
Despite your best efforts, sometimes problems will happen. Certain short-term complications of type 1 diabetes, such as low blood sugar, require care immediately.
Low blood sugar (hypoglycemia)
Diabetic hypoglycemia occurs when someone with diabetes doesn't have enough sugar (glucose) in the blood. Ask your provider what's considered a low blood sugar level for you. Blood sugar levels can drop for many reasons, such as skipping a meal, eating fewer carbohydrates than called for in your meal plan, getting more physical activity than normal or injecting too much insulin.
Learn the symptoms of hypoglycemia. Test your blood sugar if you think your levels are low. When in doubt, always test your blood sugar. Early symptoms of low blood sugar include:
Looking pale (pallor)
Shakiness
Dizziness or lightheadedness
Sweating
Hunger or nausea
An irregular or fast heartbeat
Difficulty concentrating
Feeling weak and having no energy (fatigue)
Irritability or anxiety
Headache
Tingling or numbness of the lips, tongue or cheek
Nighttime hypoglycemia may cause you to wake with sweat-soaked pajamas or a headache. Nighttime hypoglycemia sometimes might cause an unusually high blood sugar reading first thing in the morning.
If diabetic hypoglycemia isn't treated, symptoms of hypoglycemia worsen and can include:
Confusion, unusual behavior or both, such as the inability to complete routine tasks
Loss of coordination
Difficulty speaking or slurred speech
Blurry or tunnel vision
Inability to eat or drink
Muscle weakness
Drowsiness
Severe hypoglycemia may cause:
Convulsions or seizures
Unconsciousness
Death, rarely
You can raise your blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets, hard candy or fruit juice. Tell family and friends what symptoms to look for and what to do if you're not able to treat the condition yourself.
If a blood glucose meter isn't readily available, treat for low blood sugar anyway if you have symptoms of hypoglycemia, and then test as soon as possible.
Inform people you trust about hypoglycemia. If others know what symptoms to look for, they might be able to alert you to early symptoms. It's important that family members and close friends know where you keep glucagon and how to give it so that a potentially serious situation can be easier to safely manage. Glucagon is a hormone that stimulates the release of sugar into the blood.
Here's some emergency information to give to others. If you're with someone who is not responding (loses consciousness) or can't swallow due to low blood sugar:
Don't inject insulin, as this will cause blood sugar levels to drop even further
Don't give fluids or food, because these could cause choking
Give glucagon by injection or a nasal spray
Call 911 or emergency services in your area for immediate treatment if glucagon isn't on hand, you don't know how to use it or the person isn't responding
Hypoglycemia unawareness
Some people may lose the ability to sense that their blood sugar levels are getting low. This is called hypoglycemia unawareness. The body no longer reacts to a low blood sugar level with symptoms such as lightheadedness or headaches. The more you experience low blood sugar, the more likely you are to develop hypoglycemia unawareness.
If you can avoid having a hypoglycemic episode for several weeks, you may start to become more aware of coming lows. Sometimes increasing the blood sugar target (for example, from 80 to 120 mg/DL to 100 to 140 mg/DL) at least for a short time can also help improve low blood sugar awareness.
High blood sugar (hyperglycemia)
Blood sugar can rise for many reasons. For example, it can rise due to eating too much, eating the wrong types of foods, not taking enough insulin or fighting an illness.
Watch for:
Frequent urination
Increased thirst
Blurred vision
Fatigue
Headache
Irritability
If you think you have hyperglycemia, check your blood sugar. If it is higher than your target range, you'll likely need to administer a "correction." A correction is an additional dose of insulin given to bring your blood sugar back to normal. High blood sugar levels don't come down as quickly as they go up. Ask your provider how long to wait until you recheck. If you use an insulin pump, random high blood sugar readings may mean you need to change the place where you put the pump on your body.
If you have a blood sugar reading above 240 mg/dL (13.3 mmol/L), test for ketones using a urine test stick. Don't exercise if your blood sugar level is above 240 mg/dL or if ketones are present. If only a trace or small amounts of ketones are present, drink extra noncalorie fluids to flush out the ketones.
If your blood sugar is persistently above 300 mg/dL (16.7 mmol/L), or if your urine ketones stays high in spite of taking correction doses of insulin, call your provider or seek emergency care.
Increased ketones in your urine (diabetic ketoacidosis)
If your cells are starved for energy, the body may begin to break down fat. This produces toxic acids known as ketones. Diabetic ketoacidosis is a life-threatening emergency.
Symptoms of this serious condition include:
Nausea
Vomiting
Abdominal pain
A sweet, fruity smell on your breath
Shortness of breath
Dry mouth
Weakness
Confusion
Coma
If you suspect ketoacidosis, check the urine for excess ketones with an over-the-counter ketones test kit. If you have large amounts of ketones in the urine, call your provider right away or seek emergency care. Also, call your provider if you have vomited more than once and you have ketones in the urine.
