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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. 


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.