Lee NJ, Norris Diabetez, Thakurta S. Type diabetes management insulin, for example, is designed to Beetroot juice for natural hydration Type diabetes management or throughout manageent day diaetes keep blood sugar levels stable. Manaegment call high blood glucose hyperglycemia. Target A1C goals vary depending on age and other factors. With the help of your health care team, you can create a diabetes self-care plan to manage your diabetes. A second approach is to match insulin doses according to variable amounts of carbohydrates that one plans to consume. Eat a meal after your blood sugar level returns to normal.

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The effectiveness of continuous glucose monitoring devices depends on adherence and does not completely eliminate the need for capillary testing, which is still required for device calibration and to confirm abnormal levels. Compared with conventional self-monitoring, continuous glucose monitoring has been associated with improved glycemic control.

Consensus guidelines recommend intensive treatment with a combination of multiple mealtime bolus and basal injections or continuous insulin infusion through an insulin pump. The unit can be clipped onto a belt or waistband.

A soft plastic cannula at the end of the tubing inserts under the skin to deliver the insulin. Alternatively, a patch pump attaches an entire unit directly to the skin, does not require a line of plastic tubing to deliver the insulin to the cannula, and receives insulin delivery programming via a wireless handheld unit.

Regardless of the type of pump used, the cannula insertion site is rotated every two to three days. Despite the risks of lipodystrophy, cannula site discomfort, and increased cost, many patients still prefer the pump to performing multiple daily injections.

Basal-bolus regimens, whether through a pump or injections, are considered more physiologic because they attempt to mimic normal β-cell secretion. This is in contrast to the conventional insulin therapy used before the Diabetes Control and Complications Trial in which patients used mixed short- and intermediate-acting insulins in twice-daily dosing.

However, studies have not shown better effectiveness universally for either approach. Therefore, the decision between multiple daily injections or continuous pump therapy should be individualized.

Most patients who use the pump use rapid-acting insulin e. Rapid-acting insulin boluses can be administered immediately before meals to allow more flexibility.

Depending on pump type, basal rates can be titrated as low as 0. Intensive glucose control requires knowing the various factors affecting a patient's insulin sensitivity and dosing requirements Table 2. Puberty, pregnancy, and illness are physiologic states that often require extra insulin titration.

Before dosing of pre-meal insulin, consideration needs to be made regarding planned carbohydrate intake, planned exercise or activity levels, and current blood glucose levels eTable A.

Choice of insulin type needs to account for duration of action, cost, and route of administration 15 , 21 eTable B. Rapid- or short-acting insulin administered with meals to cover carbohydrate intake or administered one time to correct for hyperglycemia.

The amount of carbohydrates g that, when eaten, will require 1 unit of insulin e. The drop in blood glucose level expected to be achieved by administering 1 unit of insulin e. Adjunctive therapies for patients with type 1 diabetes are under investigation but are not currently recommended.

Pramlintide Symlin —a synthetic analogue of human amylin that reduces postprandial glucose via slowed gastric emptying, inhibition of glucagon secretion, and satiety promotion—is approved by the U. Food and Drug Administration for use in type 1 diabetes and may have an association with improved glycemic control; however, long-term benefits remain unclear.

Additionally, a recent well-designed double-blind randomized controlled trial of adults with type 1 diabetes taking metformin did not show significant improvement in glycemic control.

All patients with type 1 diabetes should participate in continuous diabetes self-management education, which works to empower patients to understand how diet, physical activity, and insulin affect their glucose levels and how glycemic levels relate to acute and chronic complications Table 3.

May be lower e. If not using contraception: prescribe prenatal vitamin, discontinue potentially teratogenic medications, and maximize glycemic control. Consider immunoglobulin A antibody testing for tissue transglutaminase if symptoms suggestive of celiac disease.

Give a second dose if the patient is older than 65 years, received a dose five or more years ago, and was younger than 65 years at that time.

If 60 years or older, administer based on risk of acquiring disease and likelihood of immune response to vaccination. Commonly indicated vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis Tdap ; varicella or age-appropriate zoster; age-appropriate human papillomavirus; and measles, mumps, rubella MMR.

Elective vaccines: meningococcal quadrivalent and B vaccines, pneumococcal conjugate vaccine Prevnar 13 , hepatitis A, and Haemophilus influenzae type b Hib vaccine. Motivational interviewing techniques can be an effective strategy for improving glycemic control. One randomized controlled trial demonstrated that adolescents with newly diagnosed type 1 diabetes were able to decrease their A1C level by an average of 0.

Nutritional therapy should be individualized and supervised under the care of a dietitian. Matching carbohydrate intake with insulin therapy and activity level is a complex practice. One approach to managing mealtime insulin is to eat a set amount of carbohydrates with each meal and use a fixed insulin dose.

A second approach is to match insulin doses according to variable amounts of carbohydrates that one plans to consume. Alcohol intake should be restricted to no more than one drink per day for women and two drinks per day for men. The American Diabetes Association suggests that adults with type 1 diabetes should engage in minutes of moderate- to vigorous-intensity physical activity per week with no more than two consecutive days without activity.

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality among persons with diabetes. Clinically significant hypoglycemia is defined as a plasma glucose level less than 54 mg per dL 3.

Severe hypoglycemia is defined as a hypoglycemic event in which a patient requires the assistance of another individual for treatment. A blood glucose level of less than 70 mg per dL 3. Hypoglycemia symptoms vary in severity, and range from hunger and confusion to loss of consciousness, seizure, and death.

An individual's physiologic response to hypoglycemia depends on the frequency of hypoglycemic events. Patients must maintain a tight balance between providing sufficient iatrogenic exogenous insulin to prevent hyperglycemia but not so much as to cause hypoglycemia.

Regardless of the amount of insulin administered, the risk of recurrent hypoglycemia is exacerbated by decreased glucose counter regulation epinephrine and glucagon response and hypoglycemic unawareness.

Recommended treatment for hypoglycemia is 15 g of oral glucose. Any type of carbohydrate can increase blood glucose levels; however, complex carbohydrates and increased fat content can delay acute resolution of a hypoglycemic event.

Repeat administration of glucose may be required. Glucagon Glucagen can be delivered by injection to an unconscious patient with hypoglycemia. Patients and their caregivers should understand the symptoms of hypoglycemia and how to administer proper treatment with glucagon.

One of the most serious acute complications of type 1 diabetes is diabetic ketoacidosis DKA. Precipitating factors of DKA include infection, discontinuation or inadequate administration of insulin including insulin pump failure , myocardial infarction, and other drugs.

Prevention strategies for DKA include ensuring adequate access to supplies and prescriptions, and education regarding sick-day management.

Patients often require increased amounts of insulin during acute illness. Patients experiencing acute illness should increase the frequency of glucose testing and should not self-discontinue insulin Table 5.

In the setting of vomiting or hyperglycemia, ketone testing can help guide management. Patients and caregivers should contact their physician as soon as DKA is suspected.

Technologic advances have helped improve the usability of continuous glucose monitors and insulin pumps. Various models and manufacturers allow for choice based on size, insertion type, and tubing. Current research is focused on improving communication between devices and more automation of insulin delivery based on recorded blood glucose levels.

In addition to the closed-loop system, an automated, bihormonal insulin and glucagon bionic pancreas is under development. Studies of the bihormonal system have shown improved glycemic control and reduced hypoglycemia during testing. Pancreas and islet cell transplantation has also been effective in restoring insulin production and normalizing glucose levels.

However, it requires lifelong immunosuppressive therapy. Therefore, it is currently recommended only for patients who also require renal transplantation. Several recent advances in type 1 diabetes research have been driven by improved patient databases.

The T1D Exchange, which includes more than 30, registry participants, manages the largest registry of patients with type 1 diabetes in the United States. Table 6 provides a list of key findings from the T1D Exchange registry. This article updates previous articles on this topic by Havas and Donner 41 and Havas.

Data Sources: A literature search was completed in Medline via Ovid, EBSCOhost, DynaMed, and the Cochrane Database of Systematic Reviews using the following keywords: type 1 diabetes, management of diabetes, insulin therapy, and glucose monitoring.

Additionally, the Essential Evidence Plus evidence summary literature search sent by the AFP medical editors was reviewed.

Search dates: July 3 and August 21, , and May Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.

N Engl J Med. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol.

Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. Diabetes Care. Orchard TJ, Nathan DM, Zinman B, et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes— Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. Miller KM, Beck RW, Bergenstal RM, et al.

Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants.

T1D Exchange. Better, faster research: the value of the T1D Exchange Clinic Registry. Accessed August 30, Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data.

Tamborlane WV, Beck RW, Bode BW, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. More than million Americans are living with diabetes Skip directly to site content Skip directly to search. Español Other Languages.

Diabetes Basics. Español Spanish Print. Minus Related Pages. What is Diabetes? Diabetes Risk Factors. Diabetes Symptoms. Type 1 Diabetes. Last Reviewed: April 18, Source: Centers for Disease Control and Prevention.

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