Treatment of type 1 diabetes

Type 1 diabetes

Treatment for type 1 diabetes consists of controlling blood sugar levels and taking insulin. With insulin, the cells can absorb the sugar contained in the blood. A large part of the treatment is also to understand how the blood sugar value is affected by what you eat and do.

You need to take insulin for the rest of your life because type 1 diabetes does not pass. Treatment should be started as soon as possible after you have been diagnosed.

In the short term, the goal of treatment is to avoid symptoms that occur at too high or too low blood sugar levels. The long-term goal is to prevent complications, such as damage to small and large blood vessels.

Read more about diabetes:

  • Type 1 diabetes
  • Type 1 diabetes in children
  • Treatment of type 1 diabetes in children

Check your blood sugar value

An important part of the treatment is to measure the blood sugar value, since the insulin is dosed based on it.

The blood sugar value is indicated by mmol/l, an abbreviation for millimol per liter. A person without diabetes has a blood sugar value of 4–5 mmol/l in the morning before breakfast, and a value of 5–7 mmol/l one to two hours after a meal.

The goal is to achieve a blood sugar value as close as the value of people without diabetes. But it is also important to see how the average blood sugar level has been for a longer period of weeks and months.

There are various tools to measure blood sugar levels:

  • Small sensors that attach to the subcutaneous fat and that measure all the time.
  • Measure stick and blood sugar meter, with them you measure the blood sugar value by sticking your finger.

Sensors

It is becoming more common to have a sensor that continuously measures the blood sugar value in the subcutaneous fat. The sensor is about a centimeter long and you attach it yourself to the subcutaneous fat, for example on the outside of the upper arm or on the front of the stomach. The sensor is changed about once every two weeks.

Small sensors can also be operated into the subcutaneous fat of the forearm.

The sensor can transfer the blood sugar values ​​to a small portable monitor or to an app on a mobile phone. The monitor or app can then save the values ​​so you can see how they have varied over days, weeks or months. It is good to have the saved values ​​when you see your doctor.

Almost all sensors can alert if the blood sugar value becomes too low. There are also models where you can set at what values ​​the sensor should alarm.

Sometimes a sensor may be paired with an insulin pump. Then the pump can shut off the insulin supply if the blood sugar value becomes too low or increase the dose of insulin if the blood sugar value rises. The pump may also suggest insulin doses when you are eating or if you have a high blood sugar and need more insulin.

Blood sugar meters and measuring sticks

You measure your blood sugar value yourself with a blood glucose meter and measuring sticks. You need to stick your finger in to measure blood sugar levels.

You need to have and be able to use a measuring stick and blood glucose meter, even if you use a sensor. There are several different models of blood sugar meters and measuring sticks that you can use. The diabetes nurse can show you the different models.

For visually impaired people there are talking blood glucose meters.

The blood sugar value determines the insulin dose

The insulin dose is determined based on your blood sugar value. The blood sugar value, in turn, depends on how much you eat and how much energy you waste, for example through physical activity. For example, you may need to change your insulin dose if you start exercising more than before.

Measure your blood sugar value more often if you change your lifestyle and adjust the dose when needed. Talk to your doctor or diabetes nurse if you need help with this.

Write Diabetes Diary to understand blood sugar levels

It may take some time before you learn what affects blood sugar levels and how to dose your insulin. In the beginning, you may want to test yourself by checking your blood sugar value frequently.

Write your values ​​in a diary or download the values ​​from your meter. Then you can see how the values ​​vary in different situations and over the clock. It can make it easier to understand how they are affected and by what.

There are special software programs where you can save the values ​​and make your own notes.

Here are examples of what you can note:

  • Your blood sugar level before a meal and an hour and a half afterwards, to see how different types of food affect blood sugar.
  • What and how much you have eaten.
  • How much insulin you have taken.
  • Your blood sugar level before and after physical activity, to see how it lowers the value.
  • What kind of physical activity you did.
  • What blood sugar value you have before going to sleep for the night.

You can also communicate with your diabetes team through the software.

The insulin is taken with insulin pump or insulin pens

Insulin is destroyed if it comes into contact with the stomach contents. Therefore, the insulin must be injected into the body by means of insulin syringes or with an insulin pump. The syringes almost always look like pens and are therefore called insulin pens.

There are several different manufacturers of insulin pens and insulin pumps.

Insulin pen treatment

There are two variants of insulin pen:

  • Disposable pens that are filled with a certain amount of insulin and are discarded when they run out.
  • Insulin pens that you load with ampoules containing insulin. The ampoules are replaced when empty.

At one end of the insulin pen, attach a needle. Insulin needles are very thin and the injection is therefore almost not felt at all. Replace the needle on the insulin pen before each new injection.

At the other end of the pen is a dosing button. You turn the knob to set the amount of insulin to take. The pen has a scale that clearly shows how much insulin is injected into the body. Some pens have a memory feature. Then you can see how much insulin you took last.

The insulin is usually injected into the subcutaneous fat on the stomach or thigh. The effect is usually a little faster if you take the syringe in the stomach compared to taking it in the thigh. Therefore, it is better to take the meal insulin in the stomach.

Easy to take yourself

At first, you may find it uncomfortable to stab yourself. But taking the syringes is necessary and most people get used to it.

Take the injection in different places

It is good to take the injections in different places. Otherwise, a fat build-up can be formed in the subcutaneous skin if you take the insulin at the same place many times. Fat accumulation makes the absorption of insulin worse.

Treatment with insulin pump

An insulin pump is a small insulin container that dispenses insulin to the body in small doses, around the clock. With an insulin pump you get an even supply of insulin all the time and you don’t have to stab yourself every time you take insulin.

The basal dose of the insulin pump is controlled by a schedule that you program into the pump. You can increase or decrease the dose when you need more or less insulin. For example, you need to take extra insulin when eating or if your blood sugar level is too high.

Many pumps are waterproof and can be disconnected when showering or bathing.

Two variants of insulin pump

There are two variants of insulin pumps:

  • One that you can wear in a belt without being visible on the clothes.
  • One in the form of a small capsule that is attached to the subcutaneous fat with a thin needle.

Insulin pump that you wear in a belt

The insulin is passed from the pump to the body through a thin plastic tube called a catheter. On the catheter is a small needle attached to the stomach. You change the needle at least twice a week.

The pump is about the same size as a smaller mobile phone, about 5 centimeters wide and 8 centimeters long.

Insulin pump in the form of a capsule

In the insulin pump, which is in the form of a capsule, the insulin is fed directly into the body through a thin needle. The capsule is first adhered to the skin, then the needle is automatically inserted into the subcutaneous fat using a remote control.

The capsule can be placed on the outside of the upper arm, abdomen, thighs or in the lower back.

The insulin pump is controlled wirelessly with the remote control. The insulin pump should be changed every three days.

It is important to check the blood sugar value and pump settings

You must monitor your blood sugar level carefully if you are using a pump. The reason is that you can get a ketoacidosis faster if the insulin supply is broken, for example if the pump’s catheter slides out or if the needle has slipped out of position.

Ketoacidosis is when the blood sugar value becomes too high due to insulin deficiency. It is a serious condition that can be life-threatening if left untreated.

It is also important to frequently check the pump settings so that you get the right dose of insulin at the right time.

When can you use a pump?

You and your diabetes team together decide whether you should get an insulin pump. This can be, for example, if you have severe diabetes, for example if you have very high and low blood sugar levels.

An insulin pump can also be good if you have trouble perceiving symptoms of insulin sensitivity. Then the pumps that are connected to a blood glucose meter and which can shut off the insulin supply in severe insulin sensitivity are often used. Insulin sensation is when you get low blood sugar value.

Insulin

There are different types of insulin. They differ in how fast the effect comes and how long it lasts.

  • Meal insulin is taken in conjunction with a meal and acts quickly. Meal insulin can be divided into direct-acting and fast-acting insulin.
  • Basinsulin is more long-acting and should be taken once or twice daily. The basal insulin provides a low base level of insulin in the blood between meals. Basal insulin can be divided into medium-long and long-acting insulin.

The most common insulin therapy when using an insulin pen is to take basal insulin once or twice a day, usually in the evening. In addition, a fast-acting or direct-acting insulin is needed before each meal.

Only direct-acting insulin is used for an insulin pump.

Meal insulin – fast-acting insulin

Fast-acting insulin contains human insulin, which is the same as the body’s own insulin. It works fast and has a slightly longer effect than direct-acting insulin. You need to take this insulin about 15 to 30 minutes before you start eating.

Meal insulin – direct-acting insulin

Direct-acting insulin contains a so-called insulin analogue. In an insulin analogue, the structure of the insulin is slightly changed, compared to the body’s own insulin.

The effect comes faster but lasts shorter, compared to the effect with fast-acting insulin. This insulin takes you about 15 minutes or immediately before eating. Time varies slightly between different types of insulin.

Basinsulin – Medium-acting insulin

The medium-acting insulin is a basic insulin containing human insulin. The effect can last up to 24 hours.

Basinsulin – long-acting insulin

A long-acting insulin contains an insulin analogue. It seems smoother throughout the day and the effect lasts for up to 28 hours.

Insulin sensation if you have taken too much insulin

You may get a so-called insulin sensation if your blood sugar becomes very low. This may happen if you have taken too much insulin, have eaten less than usual or been very physically active. An insulin sensation is a serious condition.

Insulin sensation is also called hypoglycemia or sensation.

You may need to talk to your doctor if you often get low blood sugar levels and do not understand why. Low blood sugar lowers vision and makes you react more slowly. For example, it can be dangerous if you drive a car. You should then always measure your blood sugar before you start driving.

Diabetes team

You will be treated and checked at a diabetes clinic if you have type 1 diabetes. At the diabetes clinic, there are so-called diabetes teams with healthcare professionals who have specialized knowledge of the disease.

The team helps you understand your illness and how you can affect it yourself. They also provide support, encouragement and advice on how to handle various situations in everyday life.

Several professional groups are part of a team

A team always includes a doctor in charge of the treatment and a diabetes nurse who, among other things, shows how to take your insulin and blood sugar tests. Often, the team also has access to people from other professions:

  • A psychologist you can talk to.
  • A dietician who tells how food affects blood sugar value and gives advice on food issues.
  • A curator who answers questions about financial and social support.
  • A physiotherapist.
  • A foot therapist.

You shape the treatment together

At the beginning of the treatment, you go through the different types of insulin and the doses with your doctor and diabetes nurse. Together you design the treatment that suits you best. For example, it may be what insulin doses and how many injections per day you need. You will also learn how to use an insulin pen.

That the treatment works well is a prerequisite for you to be able to maintain your blood sugar value as well as possible.

You have regular contact

You will primarily be in contact with the doctor and the diabetes nurse, initially several times a year. For example, it can be a visit to see how the treatment is going or through telephone or email if you have questions.

You can also communicate with your doctor and diabetes nurse through the software if you use it to save the blood sugar values ​​from the sensor. They can also see your values ​​through the software.

The others in the team will meet you if you need to. How often you have a return visit to the diabetes team changes over time, but it is important that you have regular contact.

At the return visits, the doctor looks at how the treatment works

You and your doctor or diabetes nurse will meet regularly to see how the treatment works. The frequency of treatment depends on the treatment.

You will talk about the following when you meet:

  • How the treatment works and how to take the insulin if you use insulin pens.
  • If you have any insulin feelings.
  • About your eating habits.
  • About physical activity.
  • If you are taking other medicines.
  • About any smoking habits.

You also discuss whether you should continue to use insulin pen or if you should start with insulin pump. This depends, among other things, on whether you often have high and low blood sugar values.

You may also have blood and urine tests. Then the doctor can see how your blood sugar value has been for the last two to three months and how your kidneys are working. Your doctor or diabetes nurse will also examine your feet and skin where you take your insulin.

About once a year you will have your blood pressure and your blood fat checked.

Important to understand

In order to be active in your care and to make decisions, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. You can also ask to have the information printed out to read it peacefully.

If you do not speak English, you have the right to get the information in your own language, for example with the help of a language interpreter. You may also have the right to receive interpreting assistance in the event of hearing loss.

What can I do for myself?

Blood sugar value is affected by many things. It increases as you eat and fall in conjunction with physical activity. It is also affected by how you feel, for example if you get a fever, an infection or if you feel very stressed for a shorter or longer time.

Here are various tips on what you can do yourself to feel as good as possible. You can always talk to your diabetes team if you have questions or want to learn more.

Eat regularly

Good food in diabetes is no different than good food for everyone. Depending on what you usually eat, you may need to change your eating habits by both reducing the total amount of calories and spreading them on more targets.

It is good to eat regularly and try to distribute the meals as evenly as possible throughout the day. Eat food before eating sweets.

Be physically active

Physical activity is good for everyone, but extra good for people with diabetes. Physical activity allows some muscle cells to absorb sugar from the blood without insulin.

Physical activity thus lowers blood sugar levels without insulin, and you can reduce your insulin dose. How much you can reduce depends, among other things, on how intensely you move, and how long. The effect can last for several hours after the activity.

Talk to your diabetes team about how to reduce insulin during physical activity. It can take time to learn how it lowers blood sugar levels and thus the need for insulin, both at the time of exercise and afterwards. The diabetes team also gives advice on what you may need to eat, whether you exercise intensely or for a long time.

If you drink alcohol

Preferably drink water for meals. If you drink alcohol, you should preferably do so when eating. Check blood sugar levels periodically.

If you have been drinking a lot of alcohol, you may need to eat something before going to bed and reduce the dose of insulin you take at night. Otherwise, you may be at risk of low blood sugar and insulin sensitivity while you sleep. You may also find it more difficult to perceive your body’s warning signals at a low blood sugar value if you are intoxicated. Therefore, always check your blood sugar before going to bed.

The fact that the blood sugar value goes down is because the liver becomes busy breaking down the alcohol in the body. Then the liver is unable to simultaneously add new sugar to the blood.

Do not smoke

You should not smoke at all if you have diabetes. Smoking increases the risk of most complications that can occur in diabetes, for example:

  • The risk of heart attack increases three to five times if you have diabetes and smoke, than if you do not smoke and do not have diabetes.
  • The risk of stroke is greater if you have diabetes, smoking further increases the risk.
  • The risk of getting fat in the large blood vessels of the bones increases. The fatty tissue impairs blood circulation in the bones and can lead to angina in the bones, so-called window titer disease.
  • Hard-to-heal wounds to the legs and feet, as a result of impaired blood circulation in the legs. It can lead to a fire, but it is very unusual.
  • Increased risk of kidney damage that can lead to dialysis or kidney transplantation.

There is help to get if you smoke and want to quit.

It is unclear if snuff increases the risk of complications in diabetes.

Check your blood sugar value more often if you get sick or get hurt

You may need to change your insulin dose when you get sick or if you are seriously injured. Depending on what the illness or injury is, you may need to increase or decrease your insulin dose. Therefore, it is important that you test your blood sugar value more often than usual, especially if it is a disease or serious injury that you have not had before.

You may need to increase your insulin dose if you have an infection, such as a cold or urinary tract infection. If you have a fever, it is extra important to increase your insulin dose.

You may also need to increase the dose of insulin if you are seriously injured. For example, you may be breaking a bone in your body and having difficulty touching the broken body part.

You may need to take less insulin if you get stomach upset with diarrhea and vomiting, as it can be difficult to get enough food. But your body’s reaction to stomach disease can also cause your blood sugar levels to rise and you will then need more insulin.

Never stop using your insulin

You should never stop taking insulin, no matter how little you eat or if you vomit everything you eat. Instead, measure your blood sugar frequently and adjust your insulin dose based on that value.

Always check your blood sugar level if you are vomiting. These may be signs of high blood sugar and you are getting ketoacidosis.

Take care of wounds

Diabetes impairs blood circulation. This means that wounds can heal more slowly and they can be infected more easily. Take care of the wounds that occur, and pay attention if they heal slowly or become infected. Then you should contact your diabetes team.

Shot the feet

Diabetes can impair the sensation and blood circulation in the feet. Therefore, it is good if you take care of your feet. For example, you can do the following:

  • Wear clean socks and shoes that are not too tight.
  • Regularly check that you have not received any hardening or abrasions.
  • Feel free to lubricate your feet with softening cream to avoid dry cracks.

It is especially important to take care of your feet if you feel worse in them. This can cause the skin to not moisturize normally. Your feet then become dry and you can get cracks in your skin that can develop into wounds.

An infected wound that is not taken care of can lead to a fire, although it is very rare.

Shot the teeth

You should visit a dentist or dental hygienist regularly. The reason is that an elevated blood sugar value for a long time can make it easier to get tooth decay or tooth decay. Inflammation of the gums can also raise blood sugar levels.

Tell your dentist or dental hygienist that you have diabetes. They can then give you information on how to care for your teeth and what to think about.

You may be entitled to a special dental allowance, STB. The dental allowance means that you do not have to pay full price for a dentist visit.

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