Type 1 Diabetes – Diagnosis and Treatment
Diagnosis
Doctors use several blood tests to find out how much sugar is in the blood and how the body is responding. These tests confirm if a person has diabetes and help identify its type.
Main Tests Used
| Test Name | What It Checks For | Normal Range | Diabetes Threshold |
|---|---|---|---|
| A1C Test | 2–3 month average blood sugar | Below 5.7% | 6.5% or higher (twice) |
| Fasting Blood Sugar Test | Blood sugar after not eating for 8 hours | Below 100 mg/dL | 126 mg/dL or higher (twice) |
| Random Blood Sugar Test | Blood sugar at any time | Varies | 200 mg/dL or higher |
A1C Test
The A1C test measures the percentage of red blood cells with sugar attached. It shows the average blood sugar level over the last two or three months. For type 1 diabetes, a number of 6.5% or above (on two tests) means diabetes is present.
Fasting Blood Sugar Test
This test checks blood sugar after fasting overnight. Healthy people have fasting sugar under 100 mg/dL. If the level is 126 mg/dL or more on two different mornings, diabetes is likely.
Random Blood Sugar Test
This test checks blood sugar at any time during the day. If the sugar level is 200 mg/dL or higher, and the person has symptoms like thirst, frequent urination, weight loss, or hunger, doctors may diagnose diabetes.
Other Checks
Autoantibody Blood Tests: The immune system attacks the beta cells in the pancreas that make insulin. Lab tests search for autoantibodies—proteins that attack healthy cells. Their presence helps separate type 1 from type 2 diabetes.
Urine Ketone Test: This test measures ketones in urine to see if the body is breaking down fat for energy. When doctors find ketones, it shows the pancreas can’t make insulin, which can lead to diabetic ketoacidosis (DKA).
What Happens After Diagnosis
After diagnosis, people need regular checkups. Healthcare providers monitor blood sugar management and help plan care.
Ongoing Checks May Include
A1C Monitoring: Doctors want A1C levels to stay under 7%. This matches an average blood sugar close to 154 mg/dL. If A1C is above this number, changes in insulin or food choices might be needed.
Other Blood Tests: Providers check cholesterol and how the thyroid, liver, and kidneys are working. These tests help find or prevent diabetes-related problems.
Urine Tests: These tests show if the kidneys are healthy and help monitor for complications.
Blood Pressure Checks: Doctors check blood pressure at every visit because high blood pressure increases the risk of diabetic problems.
Reviewing Injection Sites: Providers talk about where people test their sugar and inject insulin. Rotating sites keeps the skin healthy.
Regular visits and checks help keep type 1 diabetes under control and support healthy growth and energy.
Treatment
Insulin Treatments and Medicine
People with type 1 diabetes must take insulin every day. Different types of insulin work at different speeds and last for different times:
| Insulin Type | Starts Working | Peak Time | Lasts Up To |
|---|---|---|---|
| Short-acting | About 30 minutes | 1.5–2 hours | 4–6 hours |
| Rapid-acting | Around 15 minutes | 1 hour | 4 hours |
| Intermediate-acting | 1–3 hours | 6–8 hours | 12–24 hours |
| Long and ultra-long-acting | 1–3 hours (approx.) | No real peak | 14–40 hours |
Most people use a mix of fast- and long-acting insulin. They take several shots each day or use an insulin pump. Insulin pumps, worn outside the body, give small, steady doses all day and extra bursts with meals. Some pumps are tubeless and stick to the skin with a tiny catheter.
Insulin cannot be swallowed because the stomach would break it down and make it useless. People give insulin through shots with a fine needle, a pen device, or a pump. Many choose shots, which use a mix of insulin types at different times during the day and night. Insulin pens look like writing pens and are easy to carry.
Some people use a hybrid system that links an insulin pump with a blood sugar monitor. The monitor checks glucose regularly, and the pump can give insulin automatically when needed. Users still enter information, like how many carbs they eat.
Checking Blood Sugar and Glucose
People with type 1 diabetes must check their blood sugar several times a day. Most check before and after meals, before bed, and when they feel signs of low or high blood sugar. Careful monitoring helps keep blood sugar in the target range:
- Before Meals: 80–130 mg/dL (4.44–7.2 mmol/L)
- Two Hours After Eating: Less than 180 mg/dL (10 mmol/L)
People may use a finger-stick test to check blood sugar. Newer devices called Continuous Glucose Monitors (CGMs) can also help. A CGM sits on the skin and uses a tiny needle just under the surface. It checks blood sugar every few minutes and sends the information to a phone or reader. CGMs can help prevent both low and high blood sugar and keep the hemoglobin A1c lower and more stable.
Some people use “closed loop” or “artificial pancreas” systems that connect a CGM to an insulin pump. These systems make automatic adjustments based on glucose levels. Users still need to give information about meals and confirm blood sugar at times.
List: Times to Check Blood Sugar
- Before eating
- Two hours after meals
- Before physical activity
- Before bed
- When not feeling well
- Before driving
Additional Medications Used
Some people with type 1 diabetes need medicine besides insulin. These medicines help lower the risk of complications:
- Blood Pressure Drugs: Medicines like Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) protect the kidneys and control blood pressure. Doctors use them if blood pressure is over 140/90 mmHg.
- Aspirin: Low-dose aspirin may lower the risk of heart attack or stroke, depending on the person’s risk and after talking about bleeding risk.
- Cholesterol Medicine: Doctors recommend these because people with diabetes have a higher chance of heart disease. The goal is to keep LDL cholesterol under 100 mg/dL, HDL cholesterol above 50 mg/dL (women) or 40 mg/dL (men), and triglycerides under 150 mg/dL.
Good Nutrition and Watching Carbs
A healthy eating plan helps control blood glucose. It should include:
- Fruits
- Vegetables
- Whole grains
- Some low-fat foods
People should eat less saturated fat, fewer processed foods, less red meat, and avoid overeating sugars or white bread. Measuring and counting carbohydrates helps match insulin to the food eaten. Carbs turn into glucose, so knowing the amount eaten helps prevent high or low blood sugar.
A dietitian can help create a plan that fits each person’s tastes, habits, and health goals. Tracking carb, protein, and fat intake is part of daily care. Tip: Keeping a food journal or using an app can help with counting carbs and seeing patterns.
Regular Activity and Exercise Guidance
Physical activity is important for everyone with type 1 diabetes. People should aim for at least 150 minutes of moderate exercise each week. Aerobic activities like walking, running, cycling, or swimming work well.
Doctors check if exercise is safe before people start new routines. Exercise can lower blood sugar, so people should check their sugar levels more often when starting new activities or increasing exercise.
Knowing how exercise changes blood sugar helps adjust meals and insulin as needed. If blood sugar falls too low during exercise, stop and treat it with a fast-acting carb.
| Signs of Low Blood Sugar During Exercise | What to Do |
|---|---|
| Shaking, sweating, confusion | Stop exercising, eat 15g carbs |
| Dizziness, weakness | Sit, check glucose, treat as above |
Life Situations Requiring Extra Care
Driving
Low blood sugar can be dangerous while driving. Blood glucose should be over 70 mg/dL before starting the car. If it’s lower, eat a snack with 15 grams of carbs and check again after 15 minutes.
Working
Workplaces may have special rules or timing that affect eating, testing, or insulin doses. Talking to a supervisor about breaks or having snacks nearby can help. Some jobs, like operating machinery or driving, have extra risks.
Table: Activities to Pay Attention To
| Activity | Why It Matters | Extra Tips |
|---|---|---|
| Driving | Hypoglycemia can cause accidents. | Test glucose before driving. |
| School & Work | Schedules may delay meals/tests. | Tell staff about your needs. |
| Exercise & Sports | Activity lowers glucose. | Carry snacks and test often. |
| Travel | Time zones and new foods. | Pack supplies, adjust insulin timing. |
Promising Ideas for the Future
Researchers are studying new ways to treat and possibly prevent type 1 diabetes. Some new treatments being studied include:
| Treatment Being Studied | How It Could Help |
|---|---|
| Fully automatic insulin pumps | Less need for manual insulin adjustments. |
| Longer-lasting insulin | Fewer shots and easier blood sugar control. |
| Cell replacement | Restores insulin production. |
| Immune therapies | May delay or prevent type 1 diabetes. |
- Fully Automatic Artificial Pancreas: Machines that work like the real pancreas, needing little action from the person.
- Longer-Lasting Insulin: New insulin types that last longer and could require fewer shots.
- Cell Replacement Therapy: Transplants of insulin-producing cells or ways to help the body grow new beta cells.
- Immunotherapy: Medicines to stop the immune system from attacking insulin-making cells.
Most of these treatments are not ready for everyday use, but they could change care in the future. Clinical trials are testing how safe and helpful these treatments are.
Warning Signs and When to Get Help
Fast changes in blood sugar, whether too high or too low, can be very serious. Watch for warning signs and know what to do.
Symptoms of Low Blood Sugar (Hypoglycemia)
- Shakiness
- Sweating
- Confusion or trouble talking
- Headache
- Dizziness
- Hunger
- Weakness
If you notice any of these, quickly eat or drink something with sugar, like juice, glucose tablets, or regular soda (not diet). Severe low blood sugar can cause fainting or seizures.
Signs of High Blood Sugar (Hyperglycemia)
- Thirst
- Needing to urinate often
- Blurry vision
- Tiredness
- Dry mouth
High blood sugar can happen if you take too little insulin, eat more carbs than planned, or experience stress or illness.
Very high blood sugar can cause diabetic ketoacidosis (DKA), a dangerous condition where the body breaks down fat too quickly. Note: Always carry a fast sugar source, teach family and friends the warning signs, and wear diabetes identification.
Table: Danger Signs and Immediate Actions
| Symptom | What to Do |
|---|---|
| Severe shaking, passing out | Call emergency services (911/112) and use glucagon. |
| Trouble breathing, confusion | Call for emergency help right away. |
| Vomiting, severe stomach pain | Test for ketones and go to the hospital if positive. |
| Blood sugar stays >300 mg/dL | Contact your health team to check for ketones |
Regular checkups can catch problems early. Tracking blood sugar levels and following your care plan make living with type 1 diabetes safer.
Daily Habits and Home Practices
Managing type 1 diabetes takes daily habits and routines to balance blood sugar and avoid problems. Take prescribed medicines and monitor your blood sugar.
Stay informed about diabetes. Make smart food choices and stay active each day. Connecting with a diabetes educator or healthcare provider can offer support and guidance.
Personal Safety Steps
Wear a medical ID tag or bracelet to alert others in an emergency. Keep a glucagon kit nearby for sudden drops in blood sugar. Teach family and friends how to use the kit.
Routine Health Exams
Get annual physicals and regular eye checkups to catch problems early. Eye specialists can look for cataracts or glaucoma. Yearly exams also check cholesterol, blood pressure, and other health issues.
Vaccinations
People with diabetes face a higher risk of infections. Vaccines for flu, pneumonia, COVID-19, and hepatitis B lower this risk. Health providers can advise which vaccines are needed based on age and health.
Foot Care Table
| Step | Why It Matters |
|---|---|
| Wash feet daily. | Prevents infections and removes dirt. |
| Dry feet thoroughly. | Reduces chances of fungal infections. |
| Use moisturizer. | Keeps skin soft and prevents cracking. |
| Inspect feet daily. | Finds blisters, cuts, or sores early. |
| Report issues. | Prevents small problems from turning into big issues. |
Managing Blood Pressure and Cholesterol
Stay active and eat healthy foods to keep blood pressure and cholesterol safe. Sometimes, you may need medicine. These steps protect your heart and blood vessels.
Avoiding Tobacco and Limiting Alcohol
Smoking or using tobacco is very harmful for people with diabetes. It increases the risk of heart attacks, strokes, and nerve damage. Quitting tobacco brings many health benefits.
Alcohol affects blood sugar, so use it with caution. Drink in moderation and eat while drinking to help prevent blood sugar problems.
Stress Management
Stress hormones can make blood sugar harder to control. Set priorities, practice deep breathing, and get enough sleep each night. Managing stress is a key part of diabetes care.
Checklist for Home Diabetes Care
- Take all medicines as directed.
- Monitor blood sugar daily.
- Choose healthy foods and watch carbohydrate amounts.
- Include physical activity most days.
- Wear a medical ID and have emergency supplies ready.
- Attend all medical and eye exams.
- Stay up to date with vaccines.
- Care for feet each day.
- Avoid tobacco and limit alcohol.
- Find ways to relax and control stress.
Coping and Support
Managing diabetes involves caring for both physical and emotional health. Many people with diabetes feel frustrated or annoyed by the constant attention their health needs. Blood sugar changes can also affect mood and behavior.
Feeling overwhelmed or sad is common. People with diabetes have a higher risk of depression and stress. Having a support system can help. Diabetes care teams often include social workers or psychologists who can give advice and listen.
Connecting with others who have diabetes is helpful. Support groups, online or in-person, offer a place to share experiences and tips. These groups discuss topics like counting carbohydrates or eating out. Providers can help you find good groups or recommend resources.
Getting Ready for Your Visit
Steps You Can Take Before
Planning ahead makes appointments easier and more helpful.
Here are some steps to get ready:
List questions or worries. Writing these down helps you remember what to ask during the visit.
Keep track of personal events or stress. Note any big life changes or stress, as these can affect diabetes management.
Bring a list of medicines and supplements. Include all prescription and over-the-counter pills, vitamins, and supplements.
Record blood sugar numbers. Bring a log of glucose checks or your meter to share accurate readings.
-
List topics or concerns about management. This might include:
- How often to check blood sugar
- Insulin types and when to take them
- How to give insulin (shots vs. pump)
- Signs and fixes for low or high blood sugar
- Testing and treating for ketones
- Effects of different foods
- How to count carbohydrates
- How to adjust for exercise or sick days
Table: Example Questions to Ask
| Topic | Sample Question |
|---|---|
| Blood sugar checks | How often should I test my blood sugar? |
| Insulin schedule | When should I take my insulin? |
| Low blood sugar | What do I do if my sugar goes too low? |
| Carbs in food | How do different foods affect my levels? |
| Exercise | How do I change my dose for workouts? |
What Your Provider May Ask or Do
During the visit, the provider looks for ways to improve your care and make changes if needed.
You may hear questions like:
- How do you feel about managing type 1 diabetes?
- How often do you have low blood sugar episodes?
- Can you tell when your blood sugar is dropping?
- What do you usually eat each day?
- Do you exercise, and how often?
- How much insulin do you use on average each day?
The provider will review your blood sugar records and talk about next steps. The care team may include a diabetes educator, dietitian, pharmacist, eye doctor, foot specialist, and others. Tip: Take notes or bring someone with you to help remember what you discuss.
Tips for Between Visits
Sometimes questions or issues come up between doctor visits. It is important to contact the care team if blood sugar stays too high or too low. Reach out right away if you have urgent problems, such as not knowing how to use insulin or issues with medication.
Make notes of new questions or concerns to discuss at your next visit. Stay in touch with your health care team outside of scheduled appointments. This helps you manage diabetes more easily.
