There's a lot more to navigating diabetes successfully than staying on top of your insulin injections. It is also important to manage your stress levels, educate yourself about the disease and be diligent about monitoring your blood sugar levels. The proper management of Type 1 diabetes is crucial to preventing major health complications later in life.
When the body is under stress blood sugar levels increase. This can be especially challenging for someone with Type 1 diabetes because they do not have the proper amount of insulin to bring the blood sugar into balance. Therefore, people with Type 1 diabetes who are stressed should engage in activities that reduce stress, such as deep breathing, meditation, yoga and other forms of exercise. Also, depression is very common in those with Type 1 diabetes, therefore counseling is usually necessary. Of course these activities do not take the place of insulin, but they may help in the overall management of the condition.
An important aspect of the treatment of diabetes involves education. This is usually done at the time of diagnosis and at scheduled follow-up visits (e.g., at one week, one month and then every three months). Education is usually done by a certified diabetes educator, a physician, a dietitian and a social worker or psychologist. Initial survival skills — such as blood sugar testing, learning to draw and give injections of insulin, education about foods, measuring ketones and how to detect and treat low blood sugar — are essential at the time of diagnosis.
Further education is then covered either in the hospital or in an outpatient setting. All family members, including anyone who will be caring for the person, should be included in the education. It includes insulin dose adjustments, further education about foods, the handling of exercise, management of feelings and stress, treatment of high and low blood sugars and elevated ketones, sick-day management and when to contact the diabetes care providers. In addition, youth will need a plan on how to manage their diabetes while at school.
Blood Sugar Checking/Continuous Glucose Monitoring (CGM)
Blood sugar testing and, more recently, the use of continuous glucose monitoring (CGM), are used to manage diabetes on a daily basis. For people with Type 1 diabetes, we recommend a minimum of checking blood sugar levels before meals (and snacks) and at bedtime. Additional blood sugar/CGM checks may be needed with exercise, before driving and on sick days. The 2015 ADA Position Statement on Type 1 diabetes states: “Checking blood sugars six to10 times daily may be needed to safely achieve HbA1c goals.” However, fewer checks may be needed if a CGM device is worn.
There are many reasons why measuring blood sugars or using a CGM has become a cornerstone of diabetes management.
Reasons for Checking Blood/CGM Glucose Levels:
• For safety (especially before driving a car) • To prevent hypoglycemia and diabetic ketoacidosis (DKA) • To improve sugar control • To adjust the insulin dosage • To manage illnesses • To understand the effects of various foods, insulin doses, exercise or stress • To discriminate a rapid fall in blood sugar from a truly low blood sugar value • To know the blood sugar level immediately • To give people a sense of control • To indicate a need to check for urine or blood ketones
Standard blood sugar measurements are initially used in diabetes management. When the patient is ready, a CGM device can be initiated. CGM measures subcutaneous glucose levels rather than blood sugar levels. The CGM has the advantage that glucose levels are provided every five minutes throughout the day. Values from the CGM can now be transmitted to an insulin pump to automatically administer insulin when needed. Values can also be transmitted to an Apple iPhone® so that a family member may also monitor the values, such as a mother monitoring her child’s blood sugar level.
Use of a CGM requires sensor placement under the skin, attachment of a transmitter and the availability of a receiver (sometimes an insulin pump or iPhone). The CGM and insulin pump are essential components of the upcoming artificial, or “bionic,” pancreas, which is estimated to be commercially available in 2017.
All people with Type 1 diabetes need daily insulin. Insulin is not a cure, but allows survival. Insulin is administered by subcutaneous injections or cannulas (plastic tubes connected to an insulin pump). When a patient starts to need multiple insulin injections per day, oftentimes they switch to insulin pump therapy.
A diabetes educator trains the patient and their family members on how to use the pump and/or CGM. The HbA1c level (measured every three months as part of management) usually improves with insulin pump and/or CGM therapy. Likewise, the frequency of abnormal blood sugar levels usually declines with insulin pump and/or CGM therapy.