Type 1 Diabetes: FAQ

Yes.  People with type 1 may make a little insulin during the initial period (honeymoon period) requiring lower doses of insulin or may make no insulin. The majority of people with type 1 take MDI (multiple daily injections). This may include rapid-acting insulin with meals and a long-acting insulin at bedtime (and sometimes also in the morning).  This is in an attempt to mimic the action of a normal pancreas. 

Insulin pumps are available and covered in Ontario under the Assistive Devices Program for type 1. The pump provices a continuous subcutaneous insulin infusion, and your meal doses are also given by the pump through the infusion set. This set is replaced every 3 days approximately.

Think of how a working pancreas acts, it gives insulin when we eat in just the right amount. If we eat very little carbohydrate, it gives only a little insulin, if we eat a big carbohydrate meal, it gives more.  It also gives us some background insulin all the time.

Your injections need to be handled the same way except you have the control of your doses instead of your pancreas. Learning how to adjust one’s insulin dose is not easy but is worth the effort to learn it. This is best taught by an expert who specializes in diabetes. Please get a referral from your family care provider to St. Joseph's Diabetes Education Centre.

There are many factors to consider:

• What food are you planning to eat: are any carbohydrates?
• What exercise are you going to be doing especially within 2 hours after your injection?
• What is your blood sugar currently?
• Have you noticed any patterns over the last few days to suggest you need to make a change in your doses? Never base a decision on 1 day alone.​​​​​​

Yes. 

Most people cannot tell when their blood sugars are high or at least not until they are very high. By this time you are exposing your body to potential damage and serious complications if repetitive and prolonged. 

Also, many do not feel their lows until they are too low. Therefore, it is important to always carry your meter with you, check before you take your meal insulin, before you take your bedtime insulin, before you drive (over 5 mmol/L to drive) and anytime you do not feel “right” to assess if it is blood sugar related. You may choose to download your meters which will keep a log book for you.

Carbohydrate counting is used by many people with diabetes to help balance food intake with insulin. It focuses on foods that contain carbohydrates as these raise your blood glucose the most. Counting carbohydrates allows us to predict how the food we eat may raise our blood sugar. We can then give a corresponding amount of insulin to try and keep our blood sugars in target. Counting carbohydrates is important because it takes a lot of the guesswork out of how much insulin to take and provides a flexible way to plan meals.

Counting carbohydrates is relatively simple once you understand how it works. The hardest part about learning to count carbohydrates is starting out. It can be overwhelming at first. Once you know the number of carbohydrates of some common foods, the calculations will become second nature. You can even keep a list of these common foods with the total grams of carbohydrates as well as using the internet, scales, restaurant nutrition facts etc. to help you calculate carbohydrates.

Blood glucose levels may differ considerably depending on the following factors:

• Type of activity
• Duration of activity
• Intensity of activity
• Amount and timing of insulin administration 
• Carbohydrate intake

Low to moderate-intensity exercise may lower blood glucose levels during and/or after activity. This may increase your risk of hypoglycemia.  High intensity exercise may raise your blood glucose levels during and immediately after the activity.

Also the stress of competition may affect your blood glucose control. Elevated blood glucose levels may lead to dehydration. Therefore, it is extremely important to carefully match carbohydrate intake to insulin as well as plan the timing and type of your exercise.

Self-monitoring of blood glucose before, during and, especially many hours after exercise is essential for assessing how your body responds to exercise. This information will help you make the right adjustments to exercise, insulin or carbohydrate intake to avoid hyper or hypoglycemia.

Learning basic diabetes self-management skills such as:

• How to test and record your blood sugar levels. This is called self-monitoring of blood glucose (SMBG)
• How to interpret your own blood glucose meter results and make appropriate insulin adjustments
• Proper administration of insulin
• Understanding how your insulin works
• How to recognize and treat low and high blood sugars
• What to eat and when
• Incorporating an exercise regimen into your daily routine
• Sick day management
• How to problem solve

It may take several months to learn these skills. Remember to continue to educate yourself about diabetes and its complications. Learn how to manage and live with diabetes.

Education for flexible insulin management and dietary freedom has also been shown to improve quality of life as well as glycemic control thereby reducing the risk of developing complications.

This can be serious and always requires action. Blood sugars can be much lower!  Check blood sugars often, at least every two hours. Have plenty of carb if blood sugars are running low. Remember, the extra insulin needs extra carb to prevent a low blood sugar. Take advantage of the need for extra carbohydrates!

It may be necessary to seek prompt medical attention if you believe you took too much insulin. Treatment for too much insulin may involve:

• Fluids through an intravenous line (IV)
• Glucagon injection to increase blood sugar levels
• Sugar (glucose) solution to increase blood sugar levels

There are steps you can take to protect yourself from receiving the wrong type of insulin or wrong dose of insulin:

• If you were prescribed insulin for the first time, learn the name of your insulin because there are many different types. You also need to know the dose of the insulin and how often you have to take it
• Always check your insulin before injecting to ensure it is the right one
• Make sure that you are taught how to store your insulin, how to inject yourself and how to recognize symptoms of a low blood sugar and properly treat it
• If your insulin type and/or dose has changed, be sure to confirm the changes with your doctor (or nurse) before you begin administering the new dose or new insulin type