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Managing type 1 diabetes

Managing type 1 diabetes requires balancing diet, physical activity and medication to keep blood glucose as close to normal as possible.

Maintaining this balance helps replicate what happens in someone without type 1 diabetes, whose body naturally produces insulin in response to food intake so that blood glucose levels stay within a tight range of 3.5 to 7.8 mmol/L. 

Your doctor will recommend a personal target range for your blood glucose that you should aim for, although it may be hard to always achieve this target. Remember that the information below should not substitute medical advice and you should seek further guidance from your healthcare professional if necessary. 

The three main variables that affect type 1 diabetes management are:

Food and type 1 diabetes management

A suitable diet for someone with type 1 diabetes is simply a healthy diet that provides manageable and accessible energy for the body. Carbohydrate directly affects blood glucose levels but a healthy diet also includes proteins and fats as part of a balanced supply of energy and nutrients to keep the body in good condition.  Regular meals are essential to maintain energy and glucose levels constant. Your healthcare professional may give you specific personalised advise on portion sizes of food, carbohydrate counting and insulin dose adjustments. Routine blood glucose testing, especially around meals or physical activity will help to inform the need for any insulin dose or carbohydrate adjustments so that normal blood glucose levels can be maintained.

Tips for healthy eating

  • Be consistent. Daily meals should balance the intake of basic food groups such as carbohydrates, fats and proteins, and be consistent in terms of calorie intake. Your healthcare professional can give you more information about what makes an ideal meal for someone living with type 1 diabetes and advice about sweets, fizzy drinks and alcohol. 
  • Compensate for special activities and occasions. Unusual physical activity will require extra food, while eating more than usual will need extra physical activity or insulin.
  • Avoid hyperglycemia. Hyperglycemia (high blood glucose) is caused by eating rapidly absorbed simple sugars, such as those found in sweets or non-diet soft drinks. 
  • Avoid hypoglycaemia. Low blood glucose can often be avoided by eating meals at regular times and balancing food intake with insulin and exercise. 
  • Routinely test your blood glucose. Testing your blood glucose before meals will help you avoid having irregular blood glucose and provide guidance for what and how much to eat.

Physical activity and type 1 diabetes management

Regular physical activity is an important aspect of a healthy body. Unfamiliar activity, whether in frequency or intensity will put extra strain on the body and energy needs will certainly rise. Fast-acting carbohydrate should always be available before and during any exercise and longer acting carbohydrate should be included in meals after exercise to allow for extra uptake by the muscles as they replenish their energy stores. Your healthcare professional can give you extra information concerning which carbohydrates are fast, medium and longer acting.

Insulin needs during physical activity may also change and blood glucose monitoring will allow you to see whether your insulin dose needs to be changed. You should consider avoiding injecting insulin into areas where muscles are likely to be used e.g. legs if cycling, as exercise increases the absorption rate of insulin. If you are increasing the type or amount of exercise you do you may want to consult your healthcare professional.

Exercise Checklist

DO talk to your doctor about how you manage your type 1, especially if you have eye, nerve, or vascular complications, as certain exercises may have to be avoided.

DO be consistent with the time that you exercise, just as you would with meal times and insulin injections.

DO exercise soon after eating. This is when your blood glucose is at its highest.

DO test your blood glucose before exercising.

DO exercise with a friend if you can. Ensure they are aware of your signs of hypoglycemia and what to do if you need help.

DO have a small snack of fruit juice 15 – 20 minutes before exercising if your blood glucose is not too high. Keep a quick acting carbohydrate snack on you, just in case.

DO NOT inject insulin into a part of the body you’ll be exercising, as it will be absorbed much quicker there. 

DO NOT exercise when insulin is working at its peak. Remember that different insulins have different peak times.

 

Useful link

Run Sweet (www.runsweet.com)

Athletes with type 1 diabetes training at the highest levels will benefit greatly from the advice of Consultant Physician Dr Ian Gallen, who has developed a service for those at the top of their game. guidance from your doctor and healthcare professional team to help you manage your diabetes. 

Insulin

Until the cure is found, a person with type 1 diabetes will have to continually monitor their blood glucose and administer insulin injections or use an insulin pump. As everyone with type 1 diabetes has different needs, you will need personal guidance from your doctor and healthcare professional team to help you manage your diabetes

Smoking and type 1 diabetes

While everyone has known for a long time that smoking is extremely addictive, expensive and harmful to your body, people still smoke. People with type 1 diabetes smoke for the same reasons that people who don’t have type 1 diabetes smoke, but they face much more serious health consequences.

For a person with type 1 diabetes, smoking significantly increases the risk of complications such as eye disease, heart disease, stroke, nerve damage and kidney disease. It also increases the risk of impotence in men. If you don’t smoke, you shouldn’t start. If you already smoke, it’s going to be tough to quit, but there couldn’t be a better time to give it up. You should talk to your doctor or diabetes team about strategies you can use to help you become a non-smoker.

Alternatively you can call SMOKEFREE on 0800 022 4 332 or visit smokefree.nhs.uk

Alcohol and type 1 diabetes

Type 1 diabetes shouldn’t prevent you from doing things you enjoy. You can still enjoy a glass of wine or a beer with friends — or even more than one if you like! You’ll still be able to do everything you used to do. It just may require more planning.

Similar to food, some alcoholic drinks contain carbohydrates. Alcohol also affects glucose levels so you need to be aware of how many units you are consuming.

For people with type 1 diabetes, excess alcohol can increase the risk of hypoglycaemia. When you drink alcohol (which is considered a toxin to your body), the liver has to stop work to break it down and remove it. While your liver is doing this it can’t do all the other jobs it normally would such as releasing stored glucose if your blood glucose level starts to fall. This effect can last for many hours after you have been drinking and may continue overnight and into the next day.

To avoid hypoglycaemia, it’s best to avoid drinking large amounts of alcohol in one session and make sure you always have some carbohydrate to eat before or while you drink. You should also test your blood glucose level before you go to bed and eat a snack if your level is normal to low.

On occasion, you may find that your blood glucose level rises too high after drinking an alcoholic beverage which contains carbohydrate, such as spirits mixed with regular soft drink or large amounts of beer. Where possible, choose a diet soft drink as a mixer.

Tips for drinking alcohol safely

  • In general, guidelines on the level of alcohol consumption for people with type 1 diabetes are the same as that for the general population. The NHS recommends that men should not regularly drink more than three to four units of alcohol per day, and women should drink no more than two to three units regularly per day. If you have had a heavy drinking session you should avoid alcohol for at least 48 hours.
  • Of course we’re all human and on occasion you may wish to ignore the guidelines! If you are planning on having more than a couple of drinks, a bit of extra thought can ensure you have a great night and don’t alarm any of your friends
  • Check your blood glucose regularly. It can be easy to have a hypo when you’re out, particularly if you have been dancing or more active than usual. It can also be easy to end up feeling sick from high blood-glucose levels, especially with sugary drinks and mixers. The good news is that it hurts less to check your blood-glucose levels after a couple of drinks
  • When you’ve had a few drinks, it can be difficult for you to detect if you’re having a hypo. You may miss the symptoms, or be very deep into the hypo before you notice it. When you’ve had a few drinks, other people may not be able to tell you’re having a hypo because they’ll just think you’re drunk
  • Make sure at least one of the people you’re with knows you have type 1 diabetes and how to treat a hypo. You can even ask them to remind you to check your levels, depending on how you feel about people asking you about checking
  • You may find your blood glucose level rises too high after drinking an alcoholic beverage which contains carbohydrate, such as spirits mixed with regular soft drink or cordial, sweetened liqueurs or large amounts of beer. You may also find that you eat more when you drink alcohol. Where possible, choose a diet soft drink as a mixer and keep an eye on your food intake.

The following advice is just a guide and you should seek advice from your diabetes team before adjusting your insulin regime. You will also learn from your own experiences how your body reacts to drinking alcohol, but you should always aim to keep safe and avoid hypoglycaemia. Monitoring your blood glucose levels before, during and after drinking alcohol will enable you to discover your own requirements.

Alcohol with little or no carbohydrate: eg wines and spirits

These contain no carbohydrate and therefore do not cause any initial rise in blood glucose.  In large amounts they may increase the risk of delayed hypoglycaemia.

  • One or two units of wine or spirit should not increase hypoglycaemia risk, therefore requires no action. For more than this you may need to take action to reduce your risk of delayed hypoglycaemia. Discuss strategies with your diabetes team.
  • If you are exercising as well as drinking alcohol e.g. dancing at a night club, you may want to reduce your background insulin or use a temporary basal rate.

Alcohol which contains carbohydrate:  e.g. beers, lager, cider, alcopops, liqueurs

The carbohydrate in these causes an initial rise in blood glucose and in large amounts the alcohol may increase the risk of delayed hypoglycaemia. Your diabetes team can advise you whether you need to take insulin with these.

  • Monitoring your blood glucose levels before, during and after drinking alcohol will enable you to discover your own requirements.
  • You may need to take action to prevent hypoglycaemia later on. This might include reducing your background or basal insulin or basal and/or eating extra carbohydrate. Discuss strategies with your diabetes team.

If you have previously experienced problems with low blood-glucose levels over night, it may be worthwhile reducing your evening dose of insulin slightly, especially if you are planning a very active night, such as dancing, or if you have played sport during the day. However, you should discuss this with your diabetes team first.

The morning after a night out can also be a challenge. Delaying or missing your morning insulin can result in your blood glucose levels rising too high. To avoid this, set your alarm clock to wake you within an hour or so of your usual waking time. If you are hungover and don’t feel like eating, take your normal or a slightly reduced dose of your intermediate or long-acting insulin and go back to bed. If you are vomiting from overindulging you should treat this like any other occasion of vomiting and keep a close watch on your blood glucose levels and ketones. Make sure you put your usual sick plan into action. You should set your clock to wake you again in two hours so that you can check that your blood-glucose level is not too low.

Related information

Smoking and type 1 diabetes

Drugs and type 1 diabetes

Drugs and type 1 diabetes

There has been very little scientific research on the effects of ‘recreational’ or ‘party drugs’ on blood glucose. Stimulants can increase your level of physical activity, which can lower blood-glucose levels. Some drugs can cause similar sensations to the early warning signs of a hypo, while others may mask the symptoms of a hypo. Some drugs also have ‘come-downs’ which can impact your motivation to look after your type 1 in the days afterwards.

The best idea is to avoid recreational drugs altogether, but if you can’t avoid them you should talk to your doctor or diabetes team about strategies to reduce your risk of injury, such as checking more often (e.g. every two hours) and making sure you are with people who know you have type 1 diabetes and understand what to do if you have a hypo.

Related information

Smoking and type 1 diabetes

Alcohol and type 1 diabetes

 


The rule of thumb is: food makes blood glucose levels rise while physical activity and insulin makes blood glucose fall.

While managing type 1 diabetes requires you to balance insulin, food and physical activity, there are also other factors that can affect blood glucose levels that are not so easy to control. These include stress, growth spurts and illness. Usually these factors will cause the blood glucose levels to rise. If blood glucose levels become too high, it is called hyperglycaemia, and if it is too low it is called hypoglycaemia which is often shortened to ‘hypo’. For people with type 1 diabetes a blood glucose of above 10 mmol/L would be seen as hyperglycaemia and a blood glucose of below 4 as hypoglycaemia, although your healthcare professional may advise different personalised levels for you depending on how your type 1 is being managed.

People with either type 1 or type 2 diabetes can be affected by hyperglycaemia or hypoglycaemia (although hypoglycaemia is not usually normal for people with type 2 diabetes that is managed with diet and physical activity alone). 

The aim of managing your type 1 is to keep your blood glucose levels as normal as possible and to avoid hyperglycaemia and ‘hypos’.  But as even with the best control these can still sometimes happen it is a good idea to let those around you know that you have type 1 diabetes, what your personal signs of hypos or hyperglycaemia are,and what action you would like them to take if they see signs that you may need some help.