Type 1 diabetes

Type 1 diabetes is a lifelong condition. It makes the level of glucose (sugar) in your blood rise too high. In the short term this can leave you feeling unwell, and over the years it can seriously damage your organs.

The cause is the pancreas, which doesn't produce insulin in people with type 1 diabetes. Insulin is the hormone that controls how much glucose is in your blood.

If your blood sugar is too high, you may:

• feel very thirsty
• pee more often than usual, particularly at night
• feel very tired all the time
• lose weight and muscle bulk
• get persistent infections like thrush
• develop blurred vision caused by the lens of your eye changing shape

The symptoms of type 1 diabetes usually develop very quickly in young people, normally over a few hours or days. In adults, they often take longer to appear, over a few days or weeks.

They should disappear once you start taking insulin and bring your blood sugar closer to normal levels.

Read more about hyperglycaemia

Type 1 diabetes is an autoimmune condition. Your immune system, which normally protects you, mistakes the cells in your pancreas for something harmful and attacks them.

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

Insulin is also what moves glucose out of the blood and into your cells, where it's used for energy.

Doctors normally diagnose type 1 diabetes with urine and blood tests.

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

Your doctor may also do a finger prick blood test, which checks for glucose and ketones. A sample is then sent to a laboratory to confirm the diagnosis.

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

The glycated haemoglobin (HbA1c) test is a blood test that doctors can use to diagnose diabetes. It can also be used to keep track of your blood sugar over a long period.

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

If you've been diagnosed with diabetes, it's recommended that you have your HbA1c measured at least once a year. You may need it measured more often, though, if:

• you've recently been diagnosed with diabetes
• your blood glucose remains too high
• your treatment plan has been changed
• you're 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 which 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 the meter readings.

Type 1 diabetes needs to be diagnosed as early as possible. Left untreated, it is a life-threatening condition, so treatment must start early.

There is no cure for type 1 diabetes at the moment. Treatment aims to keep your blood glucose levels as normal as possible. This helps control your symptoms, and it also helps prevent health problems developing later in life.

If you're diagnosed, you'll be referred to a diabetes care team. The team will give you specialist treatment and monitor how you're doing.

You'll need regular insulin injections or an 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. On top of that, you'll take into account your:

• blood glucose level
• how much exercise you do

Insulin injections come in several forms, and each one works a little differently. In type 1 diabetes, you'll most likely need a combination of different insulin preparations.

Some patients are given insulin through an insulin pump. This gives you a programmed flow of insulin, which is controlled either by you or by glucose monitoring values. Both of these methods replace long-acting insulin injections.

There are alternatives to insulin injections and pumps, but they suit only a very small number of patients. The reason is that they need very strong drugs to suppress your immune system.

The 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

If you think a medicine or vaccine has caused a side effect, tell your doctor or pharmacist. In Bangladesh, suspected side effects can also be reported to the Directorate General of Drug Administration (DGDA), which runs the national adverse drug reaction monitoring programme.

Type 1 diabetes is a life-long condition. But you can 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 keeping your blood glucose level as normal and stable as possible. It also helps to know your levels, so you can tell when they're too high or too low. You can manage this with 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 keep track of this with a continuous glucose monitoring (CGM) device. It lets you monitor your levels day and night.

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

You should have received instructions on looking after yourself when you're ill. These are known as your sick day rules. If you're unsure about them or haven't received them, contact your diabetes team for advice.

Many women with diabetes 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 with you before you become pregnant, and they'll help you reach a safe blood glucose level for early pregnancy.

They'll also help you keep your blood sugar as normal as possible before and during your pregnancy. They'll talk to you about whether other treatments need to change, such as 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. Treatment and monitoring are part of type 1 diabetes, and their purpose is to help your child have a normal, healthy life.

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

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.

Check ups and screening are really important ways to:

• 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, and you'll have more of them in the first year after your diagnosis.

You'll also be offered:

• diabetic eye screening, which helps detect if you're starting to develop an eye condition called diabetic retinopathy
• foot check ups, to make sure your feet are healthy