This topic provides
information for teens and their parents and for adults who have
type 1 diabetes. Before reading this topic, you may
want to read Type 1 Diabetes: Recently Diagnosed.
If this topic
does not answer your questions, see:
Type 1 diabetes is a lifelong disease
that develops when the pancreas stops making
insulin. Your body needs insulin to let sugar
(glucose) move from the blood into the body's cells, where it can be used for
energy or stored for later use.
Everyone experiences type 1
diabetes differently. But the treatment is the same. You need to take insulin,
eat a balanced diet that spreads
carbohydrate throughout the day, and exercise. Part of
your daily routine also includes checking your blood sugar levels regularly, as
advised by your doctor.
The goal is to keep your blood sugar in a
target range. It is the best way
to reduce your chance of having more problems from diabetes. These are called
Taking care of your diabetes takes time and
energy every day. It is a big part of your life. But it will help you feel
better and may prevent, or at least delay, complications. If your teen has
diabetes, tight control of blood sugar levels may help prevent complications
from developing in early adulthood.
important to watch for signs of low and high blood sugar:
Both low and high blood sugar can cause problems and need
to be treated. Check your blood sugar often during the day.
Over time, high blood sugar can damage blood vessels
and nerves throughout your body. This can cause problems with your eyes, heart,
blood vessels, nerves, and kidneys. Complications can lead to blindness,
kidney failure, amputation, and death. High blood
sugar also makes you more likely to get serious illnesses or infection. It's
hard to know if you will have complications. Some people are more likely to
have problems than others. The longer you have diabetes, the greater your risk
of complications. You are not likely to have signs of complications until you
have had diabetes for about 5 years.
Watch for early symptoms of
problems. Tingling and numbness in your feet may be a sign of early
nerve damage. Eye problems and kidney damage do not
have early symptoms. Make sure you have regular screening tests for both eye
and kidney problems.
be able to prevent, or at least delay, problems from diabetes by keeping your
blood sugar level within a target range. Treatment of
high blood pressure and
high cholesterol can also help. Not smoking can also
lower your risk of complications.
See your doctor every 3 to 6
months. During these visits, your doctor will review your treatment and do
tests and exams to see if your blood sugar is staying within your target range
and if you have developed any complications.
Some exams and tests
need to be done at every visit. Others are done once a year, such as eye exams
and tests for protein in your urine. Other tests may be done only if there is a
insulin dose, possibly the types of insulin, and the way you give it may change
over time to fit your changing needs. This is especially true for teens because
they are still growing.
The goal of treatment is to always keep
your blood sugar level as close to your target range as you can. To meet this
goal, take care of yourself, get regular checkups, and keep learning about how
to care for yourself.
Frequently Asked Questions
Learning more about type 1 diabetes:
Living with type 1 diabetes:
Health Tools help you make wise health decisions or take action to improve your health.
type 1 diabetes because your pancreas can no longer
insulin. When your pancreas was working, it adjusted
the amount of insulin it made based on your changing blood sugar. But insulin
injections cannot control your blood sugar moment to moment, as your pancreas
would. As a result, you will have high and low blood sugar levels from time to
type 1 diabetes with insulin injections means you may
have high and low blood sugar from time to time.
High blood sugar usually develops slowly over hours or
days, so you can take steps to correct it before your symptoms become severe
and require medical attention. On the other hand, your blood sugar level can
drop to dangerously low levels within 10 to 15 minutes of exercising or taking
insulin without eating enough. You also can get low blood sugar if you have
previously taken intermediate- or long-lasting insulin and skip a meal.
The longer you have
diabetes, the more likely you are to develop complications. You are not likely
to develop signs of complications from diabetes until you have had the disease
for about 5 years. Still, you should watch for complications. Signs may
You will not have symptoms of kidney problems (diabetic nephropathy) until severe damage has
developed. Then you may notice swelling in your feet, legs, and throughout your
body. Having regular tests for protein in your urine is the only way to detect
kidney damage before symptoms develop.
Your experience with
type 1 diabetes will be different from that of other
people. But your treatment will be the same: taking insulin, eating a balanced
diet that spreads
carbohydrate throughout the day,
getting regular exercise, and checking your blood
If you work closely with your doctor and follow
your treatment, you will feel better and more in control of your life. You also
may prevent or delay complications.
Not everyone with diabetes
develops complications from the disease. Keeping blood sugar levels within a
target range may prevent or delay
complications. If your teen with diabetes controls his or her blood
sugar, he or she can avoid developing complications in young adulthood.
Injected insulin cannot perfectly match the action of a working
pancreas, so you will have high and low blood sugar levels from time to time.
If your blood sugar stays above your target range for a long time, your blood
vessels and nerves may be damaged. This damage can lead to:
People with diabetes often already have other health
problems. These may include
high blood pressure and
high cholesterol. Or they may develop other health
problems as diabetes progresses. These conditions, along with smoking, can
cause diabetes complications or can make existing ones worse.
Not smoking and controlling your blood pressure and cholesterol level can
help prevent or help slow complications.
found that teen girls are at higher risk than other people for
diabetic ketoacidosis: they may skip insulin doses to
Eating disorders are also common among teens and young adults with
diabetes. Eating disorders and the tendency to skip insulin injections can
cause swings in blood sugar levels outside the target range. Eating disorders
need to be diagnosed and treated as quickly as possible to prevent serious
Type 1 diabetes
puts you at risk for high and low blood sugar and complications.
It is hard to know
why some people develop complications and others do not. Factors that
contribute to the risk of complications include:
Call 911 or other emergency services right away if you are:
Call a doctor right away if:
Call a doctor if you:
Health professionals involved in your treatment may
If you begin to
have symptoms of complications from diabetes, you may be referred to:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You need to see your doctor about every
3 to 6 months throughout your life for
tests and exams to see how you are doing and to adjust your treatment for
type 1 diabetes.
After you have had
diabetes for 3 to 5 years, you will need annual tests to look for signs of eye
damage (diabetic retinopathy), kidney damage (diabetic nephropathy), and less
feeling in your feet (diabetic neuropathy).
You may also need:
The goal of treatment for
type 1 diabetes is to keep your blood sugar levels
target range and to reduce the risk for
complications. Daily diabetes care and regular medical checkups will help you
Keeping your blood sugar in a target range is the best way to reduce your chance of
A target-range blood sugar level
is 70 mg/dL to 130 mg/dL before eating or less than 180 mg/dL 1 to 2 hours
after eating. It also may be measured as a hemoglobin A1c of less than 7%. This is a test of your blood sugar control for
the past 2 to 3 months.
Your daily care includes:
You will also need to:
You may also want to know:
See your doctor
about every 3 to 6 months for the rest of your life. During these checkups,
your doctor will look at your treatment and adjust it, if needed. Other exams
and tests will be done according to a
recommended schedule. After you have had diabetes for
3 to 5 years, you will start having annual exams and tests to monitor for eye
and kidney damage.
aren't taking enough insulin, have a severe infection or other illness, or become
severely dehydrated, your blood sugar level may rise very high. This can cause
diabetic ketoacidosis (DKA), which is usually treated
in a hospital and often in the intensive care unit (ICU). There you are watched
closely and get frequent blood tests for glucose and
electrolytes. You will get insulin through a vein
(intravenous, or IV) to bring your blood sugar levels down.
also will get fluids through the IV and treatment to correct electrolyte
problems in your body. These electrolyte problems are typically with potassium
and phosphorous. You may have to stay in the hospital for a few days to get
your blood sugar level back into your target range.
Low blood sugar (hypoglycemia) means that the level of sugar (glucose) in your blood has dropped below what your body needs to function normally. When your blood sugar level drops below 70 mg/dL, you most likely will have symptoms such as feeling tired, weak, or shaky. Symptoms of low blood sugar can develop quickly.
If you eat something that contains sugar, these symptoms may only last a short time. But if your blood sugar continues to drop, you could lose consciousness or have a seizure. If you have symptoms of severe low blood sugar, you need medical care immediately.
Diabetes Control and Complications Trial (DCCT) and
follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study
showed that keeping blood sugar levels within a
target range helps decrease your chances of
developing complications from diabetes, such as eye, kidney, heart, blood
vessel, and nerve damage. As a result of this study, experts recommend that you
carefully control your blood sugar. This is often referred to as strict or
tight blood sugar control.
If you tightly control your blood sugar
levels, you reduce your risk for long-term complications. But you are also more
likely to have episodes of very low blood sugar. These episodes can be
dangerous unless you treat them early.
Studies are ongoing to find
painless ways for people with diabetes to test their blood sugar and give
themselves insulin, such as through
insulin pumps, improved needles, and inhaled insulin.
Ways to prevent or decrease complications from diabetes also are being studied.
Talk to your doctor if you would like to participate in these diabetes
type 1 diabetes helps keep your blood sugar within your target range. But insulin by injection cannot exactly match the minute-by-minute
adjustments your pancreas would make on its own. So you will have low and high
blood sugar from time to time.
You can prevent many of these
For more information, see:
Keeping your blood sugar
levels carefully within a
target range is the most effective way
to prevent complications. The higher your blood sugar level, the greater your
risk for developing complications. A teen who keeps his or her blood
sugar levels within a target range can prevent complications from
developing in early adulthood.
also help prevent these complications by:
Type 1 diabetes
requires daily attention to diet, exercise, and insulin. You may have times
when this job feels overwhelming, but taking good care of yourself will help
you will feel better, have a better quality of life, and prevent or delay
complications from diabetes.
of these meal-planning methods to help you eat a healthful diet and spread
carbohydrate through the day. This will help prevent high blood sugar levels
after meals. For more information, see:
Focus on the type of carbohydrate as well as the amount. This might help you stay at your target blood sugar level. Foods with a low
glycemic index (GI) may help prevent spikes in blood sugar. It is not yet known if these foods help prevent complications. Low glycemic foods
do not raise blood sugar as quickly as high glycemic foods. Foods with a low GI
include high-fiber whole grains, lentils, and beans. High GI foods include
potatoes and white bread.
Using fat replacers-nonfat
substances that act like fat in a food-may seem like a good idea, but talk with
registered dietitian before you do. Some people may
eat more food, and therefore more calories, if they know a food contains a fat
Make sure you know how to give
If you are using an
insulin pump or an
insulin pen, make sure you know how to use them
Try to do at least 2½ hours a week of
moderate activity. One way to do this is to be active
30 minutes a day, at least 5 days a week. Be sure to
exercise safely. Drink plenty of water before, during,
and after you are active. This is very important when it's hot out and when you
do intense exercise. It may help to keep track of your exercise on an
activity log(What is a PDF document?).
Checking your blood sugar
level is a major part of controlling your blood sugar level and keeping it in a
target range you set with your doctor. For more
information, see the topic Continuous Glucose Monitoring or see:
Limit your alcohol intake to no more
than 2 drinks a day for men and 1 drink a day for women (none if you are
pregnant). Discuss with your doctor whether you should drink alcohol.
Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke. People
with diabetes are 2 to 4 times more likely than people who don't have diabetes
to die from heart and blood vessel diseases.5
A chronic illness creates
major change in your life. You may need to
grieve the loss of your earlier life from time to time.
Also, you may feel resentful, deprived, or angry about having to pay attention
to what and how much you eat. For more information, see:
Daily foot care can prevent
serious problems. Foot problems caused by diabetes are the most common cause of
amputations. For more information, see:
Diabetes is a complex
disease and there is a lot to learn, such as:
type 1 diabetes needs to take insulin. You are
probably taking more than one
type of insulin, either as an injection or by using an
The amount and type of
insulin you take will likely change over time, depending on changes that occur
with normal aging, changes in your exercise routine, and hormonal changes (such
as during rapid growth of adolescence or pregnancy). You may need higher doses
of insulin when you are ill or experiencing emotional stress. A woman needs
much more insulin than usual during the last part of pregnancy.
Learn about insulin:
You may need other medicines at
some point in your life.
Surgery is not a routine way of treating
type 1 diabetes. You are eligible for surgery only if
you meet specific criteria.
Pancreas and islet cell
transplants are very expensive. After having one of these surgeries, you must
take immunosuppressive medicines for the rest of your life to prevent your body
from rejecting the new tissue.
The success rate for pancreas
transplants has improved with new surgical techniques and new immunosuppressive
medicines. Islet cell transplants may replace pancreas transplants in the
future but for now they are experimental.
You will hear about products
that promise a "cure" for
type 1 diabetes. Avoid them. No such cure exists. Also
avoid products for treating diabetes that are advertised only by testimonials
from satisfied customers. These products or remedies may be harmful and costly.
They also might cause you to delay or avoid getting other forms of treatment
that have been proved to work. If you have questions about a product for
diabetes, check with your local American Diabetes Association office, your
doctor, or a
Other types of treatment
for diabetes are provided by therapists or others who do not operate within
mainstream medical practice. Their unconventional approaches may be attractive,
particularly if you are not having much success with conventional medical
treatments. None of these complementary therapies are proved to effectively
But you may benefit from safe, nontraditional
therapies that complement conventional medical treatment for your disease.
Complementary therapies, such as acupuncture, massage, or biofeedback, for
instance, may help reduce stress, relieve muscle tension, and improve your
overall well-being and quality of life.
You should not use
complementary therapies alone to treat your diabetes.
your doctor if you are using the following or other complementary or
The American Association of Diabetes Educators is made
up of doctors, nurses, dietitians, and other health professionals with special
interest and training in diabetes care. The Web site can supply the names of
these types of health professionals in your local area.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This
organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and
treatments of type 1 diabetes.
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
CitationsOrr DP (2008). Diabetes mellitus. In LS Neinstein,
ed., Adolescent Health Care: A Practical Guide, 5th ed.,
pp. 170–178. Philadelphia: Lippincott Williams and Wilkins.American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.U.S. Centers for Disease Control and Prevention (2008). National Diabetes Fact Sheet 2007. Atlanta: U.S. Department of Health and Human Services. Available online: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf.American Diabetes Association (2012). Standards of medical care in diabetes—2012. Diabetes Care, 35(Suppl 1): S11–S63.Other Works ConsultedCampbell AP, Beaser RS (2007). Designing a
conventional insulin treatment program. In RS Beaser et al., eds.,
Joslin's Diabetes Deskbook, pp. 281–323. Boston: Joslin
Diabetes Center.Campbell AP, Beaser RS (2007). Medical nutrition
therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 81–125. Boston: Joslin Diabetes Center.Eisenbarth GS, et al. (2008). Type 1 diabetes
mellitus. In PR Larsen et al., eds., Williams Textbook of Endocrinology, 11th ed., pp. 1391–1416. Philadelphia: Saunders Elsevier.
Masharani U, German MS (2007). Pancreatic hormones and diabetes mellitus. In DG Gardner et al., eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 661–747. New York: McGraw-Hill.
November 5, 2010
John Pope, MD - Pediatrics & David C.W. Lau, MD, PhD, FRCPC - Endocrinology
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