Treatment for Type 1 Diabetes

Insulin Replacement Therapy

The main type of treatment you will be given for type 1 diabetes is insulin replacement therapy. When you are diagnosed, you will be given information by a specialist as to how best to control your blood glucose levels. Initially you will be told when to use insulin, along with how much you should take. When you are comfortable with doing so, you will be given more freedom to adjust your dose depending on your meal size and time. It is vital that you learn to control your blood glucose level as well as possible, as doing so can help prevent major complications such as eye, feet and kidney problems.

The normal concentration of glucose in our blood is within the range of 4 to 8 mmol/L (70-144mg/dL). The aim of treatment is to replace the insulin we would usually produce with a synthetic form, to keep your blood sugar as close to normal as possible. There are many ways of administering this insulin.

When you first start treatment, you will be advised as to the best way to take your insulin. Usually you will be started on two injections a day, alongside regular blood glucose tests to ensure that you are maintaining your blood sugar within adequate concentrations. Your doctor will advise you as to the concentrations you should be aiming for at different times of the day. The advice is that you should aim for:

  • Before meals = 5-7.5 mmol/L (approx 85-135mg/dL)
  • Evenings = 6-8 mmol/L (approx 110-145mg/dL)

Worried about Insulin Injections?

This level of control is easily achievable when diet and exercise are combined with insulin treatment. Many people who are started on insulin treatment are often very worried about having to inject themselves. When you start using insulin, you will be given lessons and tutorials into how to inject yourself the least painful and most effective way. You may experience some discomfort at the start of the treatment, however after a while you will become used to self injection. The most widely used device to give the insulin is the pen injection device. There are a number of different needles available for the device depending on your age and size. Usually the insulin is injected into areas on the abdomen, upper leg or upper arm to give the best results. Each area has its own characteristics, insulin injected into the abdomen is absorbed fastest, whereas absorption is slowest from the thigh. It is important that the injection site is changed frequently to prevent fat build up in the area.

All the information you will need to manage your own treatment will be explained to you by your specialist doctor. They will also provide you with charts to help you know when you need to increase or decrease your doseage. By monitoring your blood glucose up to four times a day you can adequately control the level of sugar within your body.

Basal Injection & Mealtime Injection

There are two main regimes for using insulin these are basal injection and mealtime injection. Basal insulin injections aim to give you a steady dose of insulin throughout the day to help your blood glucose concentration stay as steady as possible. The best way to do this is using an insulin pump with short acting insulin. This method is better than mealtime insulin injection, as it allows you to eat when you want, without drastically affecting your blood glucose levels.

The second regimen is mealtime injection, which involves using an insulin injection just before eating a meal. This allows the insulin to be absorbed into the blood stream just as the glucose from the meal is. The disadvantage to this method is that meals must be kept at the same time everyday and about the same size.

In 2005 a drug called Pramlintide (Symlin) was licensed to be used alongside injectable insulin for the treatment of type 1 and 2 diabetes. It is used to help control post-meal elevated blood sugar, which is known as hyperglycaemia. It is vital in helping decrease your blood sugar levels if you find your blood sugar is elevated on normal insulin treatment. Side effects of this drug can be nausea, vomiting, headaches and dizziness. You should not use this drug if you have problems with low blood sugar.

Another purely experimental treatment at the moment is CD3 antibodies. The main causative factor in type 1 diabetes is an autoimmune destruction of the β cells. This treatment acts by helping to extend the insulin producing capacity of the pancreas by up to 1.5 years. It does this by preventing part of the autoimmune response that is directed against the β cells.

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