Type 1 diabetes

Type 1 diabetes is an autoimmune condition. Your normal immune system mistakes the cells in your pancreas as harmful and attacks them.

Without insulin, your body will break down its own fat and muscle, which makes you lose weight. This can lead to a serious short-term condition called diabetic ketoacidosis.

In Type 1 diabetes, you also need insulin to move glucose out of your blood and into your cells to be used for energy.

Type 1 diabetes is normally diagnosed with urine and blood tests.

Your urine sample will be tested to see whether it contains glucose. If you have diabetes, some glucose can overflow through your kidneys and into your urine. Your urine may also be tested for ketones (the broken down products of fats).

Your doctor may do a finger prick blood test. This will test for glucose and ketones. A sample will be sent to a laboratory to confirm the diagnosis.

If there is a concern that you have type 1 diabetes, your results will be discussed with the specialist diabetes service.

Glycated haemoglobin (HbA1c)

The glycated haemoglobin (HbA1c) test is a blood test that can be used to diagnose diabetes. It can also be used to monitor your long-term blood sugar levels.

The HbA1c test gives your average blood glucose level over the previous 2 to 3 months. The results can show whether the steps you are taking to manage your diabetes are working.

If you have been diagnosed with diabetes, doctors recommend that you have your HbA1c measured at least once a year. However, you may need to have it measured more often if:

• you have recently been diagnosed with diabetes
• your blood glucose remains too high
• your treatment plan has been changed
• you are planning a pregnancy

Your target HbA1c will be individual to you, but a target of 53mmol/mol is often recommended. Mmol/mol is a unit of measurement that shows the concentration of glucose in your blood.

If you have diabetes and use continuous glucose monitoring, you will have an estimate of your current HbA1c available from your meter readings.

Treatment for type 1 diabetes

It’s important that diabetes is diagnosed as early as possible. If left untreated, type 1 diabetes is a life-threatening condition. It’s essential that treatment is started early.

Type 1 diabetes can’t be cured at the moment. Treatment aims to keep your blood glucose levels as normal as possible. This will help control your symptoms. It’ll also help to prevent health problems developing later in life.

If you’re diagnosed with type 1 diabetes, you’ll be referred to a diabetes care team. That team will provide specialist treatment and monitoring.

You’ll need regular insulin injections or insulin pump to keep your glucose levels normal. You’ll be helped to understand how to do this. You’ll also learn how to match the insulin you inject to the food (carbohydrate) you eat. You’ll also take into account your:

• blood glucose level
• how much exercise you do

Insulin

Insulin injections come in several different forms. Each one works slightly differently. You’ll most likely need a combination of different insulin preparations.

Insulin is given to some patients by a by an insulin pump. This means you’ll get a programmed flow of insulin. This will either be controlled by you or by glucose monitoring values. Both of these methods replace long-acting insulin injections.

There are alternatives to insulin injections and pumps. They’re only suitable for a very small number of patients. This is because they need very strong drugs to suppress your immune system.

They alternatives to insulin injections and pumps are:

• islet cell transplantation – where healthy insulin-producing cells are implanted into the liver of someone with type 1 diabetes
• a complete pancreas transplant

Reporting side effects

You can report suspected side effects of vaccines, medicines and medical devices through the Yellow Card Scheme.

This can be done by:

• visiting the Yellow Card Scheme website
• phoning the free Yellow Card hotline on 0800 731 6789 (available Monday to Friday, 9am to 5pm)

Living with type 1 diabetes

Type 1 diabetes is a life-long condition. But, its’ possible to live well with it if you have the right:

• support
• input
• knowledge

If you have type 1 diabetes there are things you’ll need to do. These are:

• check your blood glucose levels regularly
• take insulin regularly each day
• look out for the signs of hypos
• attend your check up appointments

There are also things you’ll need to think about like driving and becoming pregnant.

An important part of your treatment is to make sure that your blood glucose level is as normal and stable as possible.

It’ll also help to know your blood glucose levels to make sure they’re not too high or too low.

You’ll be able to manage this using insulin treatment and by eating a healthy, balanced diet.

Your blood glucose levels can be affected by:

• exercise
• illness
• stress
• drinking alcohol
• taking other medicines
• changes to your hormone levels during your period, if you have periods

Most people with type 1 diabetes do this with a continuous glucose monitoring (CGM) device. This allows you to monitor the levels day and night.

Read more about continuous glucose monitoring on MyDiabetesMyWay

Your care team will advise of the best figures for you. Often people with type 1 diabetes would aim for values on their CGM to be between 3.9 and 10 mmo/l 70% of the time or more

Diabetes UK has more information on testing your glucose levels.

You should have received instructions about looking after yourself if you’re ill. These are known as your sick day rules like this example from MyDiabetesMyWay.

Contact your diabetes team for advice if you’re uncertain of haven’t received these.

Many women with diabetes will have successful pregnancies. About 1 in 100 women in Scotland have been diagnosed with diabetes before becoming pregnant.

High blood sugars very early in pregnancy can affect your baby’s early development. Care teams will be keen to discuss plans before you become pregnant. They’ll help you achieve a safe blood glucose level for early pregnancy.

They’ll help you keep your blood sugar as normal as possible before and during your pregnancy. They’ll talk to you about whether changes to other treatments are needed. These could be treatments like blood pressure or cholesterol treatments. These often need to be changed or stopped before pregnancy.

Talk to your diabetes team as soon as possible if you find out you’re pregnant.

Your care team will talk to you about the different ways to help you:

• monitor your blood glucose
• deliver insulin

Read more about diabetes and pregnancy:

• Diabetes UK
• My Diabetes My Way
• JDRF

Any parent whose child is diagnosed with type 1 diabetes may need extra help and support.

Type 1 diabetes involves treatment and monitoring. The aim of this is to help your child have a normal, healthy life.

Diabetes UK has information and advice about your child and diabetes.

You should always tell your insurer that you have type 1 diabetes. Having type 1 diabetes may affect your insurance policy.

You should also refer to the DVLA guidelines. But most people with well treated type 1 diabetes should be able to have a Group 1 licence.

It’s important that you check your blood sugar before driving. Diabetes UK have more information about driving with diabetes.

Check ups and screening are really important ways you can:

• stay healthy with type 1 diabetes
• find and treat complications of type 1 diabetes early

You’ll have regular check ups with your diabetes team. These may be yearly. You’ll have more check ups in the first year of your diagnosis.

You’ll also be offered:

• diabetic eye screening – this will help detect if you’re starting to develop an eye condition called diabetic retinopathy
• foot check ups – this is to check to make sure your feet are healthy

Help and support

Many people find it helpful to talk to others in a similar position. You may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others who’ve been diagnosed with the condition.

Silvercloud offer courses in

Diabetes UK can help you to find your local diabetes support group. To contact a trained counsellor directly:

• phone Diabetes UK’s Helpline Scotland on 0345 123 2399
• email helpline.scotland@diabetes.org.uk

Further information on Helpline Scotland

Read more on the complications of type 1 diabetes

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