Type 1 Diabetes Treatment

There currently is no cure for type 1 diabetes. Early treatment focuses on treating hyperglycemia and diabetic ketoacidosis, which need to be controlled in people first diagnosed with diabetes. The ongoing treatment is designed to control blood sugar levels, and treat any symptoms or complications that may develop.

Controlling blood sugar levels helps prevent or delay many of the long-term diabetes complications. An early diagnosis, regular monitoring of blood sugar levels and symptoms, and appropriate therapy can significantly improve a person's quality of life and life expectancy.

Throughout their treatment, people with type 1 diabetes work closely with their helathcare team, which may include:

Doctor
Diabetes educator
Eye doctor
Mental health counselor
Nurse
Social worker
Dentist
Dietitian
Foot doctor

Common diabetes treatments include:

Medications
Lifestyle changes
Non-drug therapies
Complementary and alternative medicine

Medications

Before insulin was discovered in 1921, there was no treatment for type 1 diabetes and most people with the condition only lived a few years after diagnosis. The situation changed dramatically in 1922 when insulin was extracted from the pancreas of animals, and then purified for human use.

Insulin was originally extracted from the pancreas of pigs, cows, horses, and fish. In 1982, synthetic human insulin derived from genetically engineered bacteria became available. Synthetic human insulin was the first genetically engineered pharmaceutical product approved by the Food and Drug Administration (FDA). Today all insulin available in the United States is manufactured using genetic engineering. Although animal insulins are no longer produced in the United States, the FDA allows people to import animal insulin.

Several types of insulin and insulin products are now available without a prescription. A doctor usually recommends the specific insulin therapy based on a person's individual needs and lifestyle, and how well a person's current insulin therapy is working.

When taking medications for diabetes, it's important to follow all diet and exercise recommendations, and monitor blood sugar levels regularly. Because dietary and exercise modifications may require a new dose, people should notify their doctor before making any changes.

It's also important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions. A doctor should be notified if any severe allergic reactions, or yellowing of the skin or eyes occur.

The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of highlighted medications.

Insulin allergies

Insulin allergies typically occur more often with insulin made from animals than with synthetic human insulin. Some people may develop allergic reactions to the protein found in animal insulin, as well as any bacteria and other impurities that may be present in the animal-derived insulin.

Allergic reactions to synthetic human insulin are due to differences between it and natural human insulin, as well as some of the insulin additives. Insulin additives are designed to prevent bacteria from contaminating the insulin or extend the duration of intermediate and long-acting insulins.

Insulin delivery systems

Insulin cannot be taken orally, because it is destroyed by enzymes in the stomach. Today several delivery systems are available. The delivery system used depends on a person's individual needs and preferences.

Syringe
People can use a syringe to inject insulin subcutaneously (under the skin). A syringe is an hypodermic needle attached to a hollow tube and plunger. People fill the tube with a dose of insulin.
Insulin pen
Insulin pens can also be used to inject insulin. An insulin pen is an injection system that contains a disposable needle and a cartridge that already contains insulin.
Insulin pump
An insulin pump is a small, portable device that injects insulin at programmed intervals. The pump connects to a small plastic tube and a very small needle, which is inserted under the skin for several days.
Insulin jet injector
The insulin jet injector delivers insulin using high pressure. A jet of insulin can penetrate the skin or mucous membrane without the use of a needle.
Insulin infuser
An insulin infuser is a small tube that is inserted just beneath the skin for several days. People inject the insulin into the end of the tube.

Types of insulin

Several types of synthetic insulin are available. Each type has a different speed of onset, peak of effectiveness, and duration:

Onset: How long it takes insulin to reach the bloodstream and start lowering blood sugar.
Peak: How long insulin remains at its maximum ability to lower blood sugar.
Duration: How long insulin continues lowering blood sugar.

A change in insulin type, manufacturer, or manufacturing method may require a dose change, which should only be done under medical supervision.

Rapid or ultra short-acting insulin

The following rapid-acting insulins should be taken right before meals:

insulin lispro (brand name: Humalog)
Onset 15 minutes, peak 30-90 minutes, duration 4-5 hours
insulin aspart (NovoLog)
Onset 5-10 minutes, peak 1-3 hours, duration 3-5 hours
insulin glulisine (Apidra)
Onset less than 15 minutes, 1-2 hours, duration 3-4 hours

Short-acting or regular insulin

The following short-acting insulins can be taken 30 to 45 minutes before meals:

human insulin (Humulin R, Novolin R)
Onset 30-60 minutes, peak 2-4 hours, duration 5-7 hours

Intermediate-acting insulin (human)

If taken in the morning, the following intermediate-acting insulins work all day. If taken in the evening, they last through the night.

NPH (Humulin N, Novolin N)
Onset: 1-2 hours, peak 6-14 hours, duration up to 24 hours
lente (Humulin L, Novolin L)
Onset: 1-3 hours, peak 6-14 hours, duration up to 24 hours

Long-acting insulin

Long-acting insulin lowers blood glucose levels fairly evenly over a 24-hour period. The following long-acting insulins are usually taken in the morning or before bed:

ultralente (Humulin U)
Onset 6 hours, peak 18-24 hours, duration up to 24 hours
insulin glargine (Lantus)
Onset: 90 minutes, peakless, duration up to 24 hours

Premixed insulin

Premixed insulin combines short- and intermediate-acting insulin. The following premixed insulins are especially useful for people who have trouble drawing up insulin or reading the correct directions and dosages:

Humalog Mix 75/25
Onset 15 minutes, peak 30 minutes-2.5 hours, duration 16-20 hours
Humulin 50/50
Onset 30 minutes, peak 2-5 hours, duration 18-24 hours
Humulin 70/30
Onset 30 minutes, peak 2-4 hours, duration 14-24 hours
Novolog Mix 70/30
Onset 10-20 minutes, peak 1-4 hours, duration up to 24 hours
Novolin 70/30
Onset 30 minutes, peak 2-12 hours, duration up to 24 hours

Insulin complications

Although insulin therapy is a life saver for people with type 1 diabetes, insulin therapy may cause blood sugar levels to become abnormally high or low if blood sugar levels aren't controlled. When this happens, the following complications may occur:

Hypoglycemia (low blood sugar)
Hyperglycemia (high blood sugar)
Diabetic ketoacidosis (acidic chemical balance)

It's important for people with type 1 diabetes to know the symptoms and what to do if any of these complications develop.

Symlin

Symlin (generic name: pramlintide acetate) is a new injectable drug for people with diabetes who take insulin with meals. Additional information, side effects, and drug interactions can be obtained by clicking the name of the drug.

Symlin is only used by people with type 1 diabetes who have trouble controlling their blood sugar. Symlin prevents blood sugar levels from getting too high after a meal by slowing the movement of food through the stomach. It also may decrease appetite and cause weight loss.

Symlin is taken in addition to insulin therapy. Because Symlin cannot be mixed with insulin, it must be injected separately. Some people may develop hypoglycemia (low blood sugar) while taking Symlin. It's important to know the symptoms of hypoglycemia and know what to do if it should occur.

Medications for erectile dysfunction

The following medications may be prescribed for men with diabetes who have erectile dysfunction:

sildenafil citrate (Viagra)
tadalafil (Cialis)
vardenafil hydrochoride (Levitra)

Over-the-counter medications

People who take over-the-counter medications should check with their doctor or pharmacist for possible side effects and drug interactions with their current medications. The following popular over-the-counter medications should be used with caution:

Antihistamines may cause drowsiness.
Both acetaminophen (brand name: Tylenol) and ibuprofen (Advil, Motrin) may cause kidney problems.
Decongestants may increase blood sugar levels or cause nervousness.
Products containing sugar or alcohol may alter blood sugar levels.

The following precautions should be used by people with diabetes when taking over-the-counter medications:

Decrease carbohydrates from their daily meal plan when taking medications containing sugar.
Take medications containing alcohol with food.
Use antihistamines and decongestants sparingly.
Only use acetaminophen and ibuprofen under medical supervision.

Lifestyle Changes

The following lifestyle changes can help people manage their diabetes and avoid developing complications:

Testing blood glucose

Controlling blood sugar levels helps people stay healthy and reduce the risk of developing long-term diabetes complications. People with type 1 diabetes usually test their blood sugar 3 to 10 times each day to evaluate their last insulin dose and calculate their next insulin dose. The test results also indicate if they need to adjust their food intake or activity level to keep their blood sugar within normal bounds.

A doctor typically recommends how often people should test their blood sugar, and sets the target fasting and before-meal blood sugar ranges. People should keep a record of their blood sugar readings and bring the record to all doctor visits. Doctors often change the insulin dose if the blood sugar levels are consistently too high or too low.

The normal range for blood sugar levels:

Before meals is 70 to 99 mg/dL (milligrams per deciliter).
After meals is less than 140 mg/dL

Contact a doctor if the blood sugar level reading is:

Higher than 300 mg/dL
Higher than 240 mg/dL for more than 24 hours

People originally tested their blood sugar levels by pricking a finger with a lancet, squeezing a drop of blood onto a glucose testing strip, and comparing the color of the testing strip to a chart of blood sugar levels. People now use digital blood glucose meters, which only require a small drop of blood, and quickly measure and display blood glucose levels. Specialized lancets that adjust to different skin thicknesses are also available.

The newer technologies are even faster, easier to use, and less painful. Although some may be more expensive, they are especially appreciated by people who test their blood throughout the day. Some of the newer technologies include:

Bio-implants require surgical implantation of a glucose sensor that lasts from 1 to 5 years. A recording device is worn on the body.
Combination glucose meters and insulin-injector pens simplify the process of testing blood glucose levels and administering insulin.
Continuous blood glucose monitors continuously sense blood glucose levels throughout the day and night. The GlucoWatch and the Guardian REAL-Time system use a sensor to read blood glucose levels through the skin without requiring blood samples.

Monitoring ketones

People with type 1 diabetes may also need to test their urine for ketones:

If their blood glucose level is above 240 mg/dL.
They are sick, injured, or experience symptoms of ketoacidosis (abdominal pain, nausea, and vomiting).

People dip a urine test strip into the urine for specified time, and then compare the color change of the strip to a chart. Contact a doctor if the color of the urine test strip indicates that the ketone level is moderate to high.

Administering insulin

Today most people use a needle to inject their insulin. People using insulin injections need to rotate their injection sites to avoid developing hard lumps or extra fat deposits. Typical injection sites are the abdomen, buttocks, thighs, and upper arm.

People can also use an insulin jet injector, insulin pump, insulin infuser, or inhaled insulin. More convenient delivery systems (such as an insulin pill that can be taken orally) are under development.

Controlling blood pressure and cholesterol levels

Many people with diabetes need to control their blood pressure and cholesterol levels. Although some people can control their blood pressure and cholesterol using a combination of diet and exercise, others need to take prescription medications.

People can use home blood pressure monitors and cholesterol testing kits to monitor their blood pressure and cholesterol levels in the convenience of their homes. Combination glucose and cholesterol monitors are also available.

Dental care

Many people with diabetes suffer from gum disease due to their decreased resistance to infection and increased healing time. To avoid gum infections, it's important to brush and floss teeth daily, and visit the dentist regularly.

Diet

The correct choice of foods helps people with diabetes control their blood sugar levels. Their diet should include:

Fish, lean meats, and skinless chicken or turkey
Fruits and vegetables
Legumes (dry peas or beans)
Low-fat dairy
Whole grains

A meal plan may be developed by a dietitian or other healthcare team member. People should also ask their doctor about the safe use of alcohol when taking insulin.

To regulate blood sugar levels throughout the day, people should eat the same quantities of food at the same time each day. Moderate portions help people maintain a healthy weight.

Exercise

People should try to exercise 30 minutes every day. Because exercise lowers blood sugar levels, it's important to notify a doctor before starting a new exercise plan, and regularly measure blood sugar levels before and after exercising. Some people may be provided with an exercise plan by their healthcare team.

Foot care

Because diabetes can damage the nerves in the feet, people with diabetes should examine their feet daily for blisters, cuts, discoloration, sore toenails, sores, or swelling. Notify a healthcare member immediately if any sores do not go away.

Toenails should be trimmed carefully, following the natural curve of the toes. Corns and calluses should be rubbed with a pumice stone and never be cut.

Smoking

People with diabetes are more likely to develop atherosclerosis, heart disease, and stroke, as well as peripheral nerve damage. Smoking further contributes to these conditions.

People with diabetes should not smoke. People who are unable to quit on their own, should ask their doctor for recommendations.

Vision care

Untreated eye conditions can lead to blindness. It's important to report any vision changes and visit an eye doctor yearly or more often if needed.

Non-Drug Therapies

Several non-drug therapies used in addition to prescription medications can be quite beneficial in improving symptoms and helping people with diabetes lead normal lives. Some of the therapies can also save lives.

Common non-drug therapies for diabetes include counseling, support groups, and surgery.

Counseling

People with chronic health conditions sometimes become depressed, especially when they experience setbacks. Counseling helps people with diabetes understand their abilities and limitations, reduce their emotional stress, and learn to feel good about themselves and their lives.

Support groups

Diabetes support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.

Surgery

Surgical techniques for type 1 diabetes attempt to:

Cure diabetes by enabling people to produce insulin on their own.
Treat the long-term complications of diabetes.

Pancreas and kidney transplantation

Pancreas transplantation is often performed on people with type 1 diabetes who have kidney failure. The pancreas and kidney are usually transplanted at the same time. A healthy pancreas comes from a donor who has just died or from a living relative or friend with the same tissue type. Living donor transplantation includes a partial pancreas and may include a single kidney.

People who have successful pancreas transplants no longer need to take insulin. Pancreas transplantation isn't for everyone and typically is only performed on people with type 1 diabetes who also have end-stage kidney disease. The risks of pancreas transplantation include organ rejection, infection, bleeding, and organ injury. People with transplants also need to take immunosuppressive drugs for life.

Liver transplantation

Liver transplantation is performed on people with type 1 diabetes who develop cirrhosis of the liver. The procedure replaces a diseased liver with a donor liver from a donor who has just died, or from a living donor. A living donor organ is usually obtained from a healthy family member, spouse, or friend, who is of the same blood type. Only a small portion of a living donor's liver is required, because the liver is able to regenerate.

The risks of liver transplantation include organ rejection, infection, bleeding, and organ injury. People with transplants also need to take immunosuppressive drugs for life.

Eye surgery

Although people with diabetes have a higher risk of blindness than people without diabetes, most people only experience minor eye problems. The more serious conditions are often treated using laser surgery.

Diabetic eye problems that require surgery include:

Cataracts (clouding or opacity of the lens of the eye)
Glaucoma (elevated pressure in the eye that may damage the optic nerve)
Diabetic retinopathy (blood vessel damage and fluid buildup in the eye)

Amputation

People with diabetes often develop foot problems due to poor blood circulation (peripheral vascular disease) and nerve damage (diabetic neuropathy) in their legs and feet. Poor circulation slows healing and can lead to skin infections in their lower extremities. Nerve damage makes people unaware of the skin infections. If not treated promptly, infections may spread to bone and require amputation.

More than half of all lower limb amputations in the United States are due to diabetes. Nearly half of the amputations due to poor circulation and nerve damage could have been avoided by careful foot care and monitoring.

Complementary and Alternative Medicine

Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.

The following nontraditional therapies are sometimes used to reduce diabetes symptoms:

Acupuncture

Acupuncture is a procedure in which a practitioner inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns. Acupuncture may help relieve symptoms of diabetic neuropathy (painful nerve damage).

American Ginseng

Although some studies have shown that American ginseng lowers blood glucose levels, the results are contradictory and more studies need to be done.

Gymnema sylvestre

Gymnema sylvestre has been used to treat diabetes for two thousand years. Preliminary human studies indicate that the herb may help manage blood sugar levels when used in addition to conventional drug therapy.

Magnesium

Studies indicate that a diet rich in magnesium may help lower the risk of developing type 2 diabetes.

Vanadium

Researchers are studying the ability of vanadium (a compound found in tiny amounts in plants and animals) to normalize blood glucose levels.

Vitamin D

A daily low dose of vitamin D has been associated with a reduced risk of developing type 1 diabetes later in life.

Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them.

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