Type 1 Diabetes and Insulin: A Guide for the Newly Diagnosed Being newly diagnosed with type 1 diabetes can feel overwhelming. This autoimmune conditi...

Type 1 Diabetes and Insulin: A Guide for the Newly Diagnosed

Being newly diagnosed with type 1 diabetes can feel overwhelming. This autoimmune condition, where the body stops producing insulin, requires lifelong management. One of the most crucial aspects of managing type 1 diabetes is understanding insulin – what it is, why you need it, and how to use it effectively. This guide is designed to provide you with essential information and practical advice to navigate this new chapter.

Type 1 Diabetes (T1D) in a Nutshell:

An autoimmune condition where your body’s immune system attacks and destroys insulin-producing beta cells in the pancreas.
This results in the body's inability to produce insulin, a hormone vital for converting food into energy.
Requires lifelong insulin therapy to survive.
T1D is not caused by diet or lifestyle choices.

What is Insulin and Why Do You Need It?

Insulin acts like a key that unlocks your cells, allowing glucose (sugar) from the food you eat to enter and be used for energy. Without insulin, glucose builds up in the bloodstream, leading to high blood sugar levels (hyperglycemia), which can cause serious short-term and long-term health complications.

The role of Insulin:

Transportation of Glucose: Insulin enables glucose to move from the blood into cells for energy production.
Regulation of Blood Sugar: Insulin helps to keep blood glucose levels within a healthy range.
Metabolic Functions: Insulin influences the metabolism of carbohydrates, fats, and proteins.
Prevents Ketone Production: Insulin helps prevent the liver from producing ketones, which can lead to a dangerous condition called diabetic ketoacidosis (DKA).

Without insulin, your body can't use the glucose from food, and you'll experience:

Hyperglycemia (High Blood Sugar): This can lead to symptoms like increased thirst, frequent urination, blurred vision, and fatigue. Long-term, high blood sugar can damage your organs.
Diabetic Ketoacidosis (DKA): This is a life-threatening condition that occurs when your body starts breaking down fat for energy, producing ketones (acids) as a byproduct. Symptoms include nausea, vomiting, stomach pain, fruity-smelling breath, and difficulty breathing. DKA requires immediate medical attention.
Weight Loss: Because your body can't use glucose for energy, you may experience unintentional weight loss.

Therefore, insulin is not just a medication for people with type 1 diabetes; it is essential for survival.

Types of Insulin and Their Action Times

Understanding the different types of insulin and how they work is crucial for effective diabetes management. Insulin is categorized based on how quickly it starts working (onset), how long it works (duration), and when its effect is strongest (peak). Your doctor will prescribe a combination of insulins tailored to your individual needs.

Different Types of Insulin:

Understanding the Action Times is Key:

Rapid-acting insulin is used to cover meals and correct high blood sugar. It’s typically taken 15 minutes before a meal.
Short-acting insulin is also used for meals, but it needs to be taken 30-60 minutes before eating.
Intermediate-acting insulin is longer-lasting and often taken once or twice a day to provide a background level of insulin.
Long-acting insulin provides a stable background insulin level for 24 hours or more.
Ultra-Long-Acting insulin provides a stable background insulin level for up to 36 hours or more.
Premixed insulin offers a convenient option but requires consistent meal timing and carbohydrate intake.

It's crucial to work closely with your healthcare team (doctor, diabetes educator, and registered dietitian) to determine the right insulin regimen for you. Don't hesitate to ask questions and understand why each type of insulin is prescribed and when it needs to be administered.

Methods of Insulin Delivery

There are several methods for delivering insulin. The most common methods include:

Syringes:
- Description: Traditional method using a needle to inject insulin from a vial.
- Pros: Inexpensive and easy to use.
- Cons: Requires drawing insulin from a vial for each injection, which can be inconvenient.
Insulin Pens:
- Description: Pre-filled or refillable devices with a dial to select the dosage.
- Pros: Convenient, portable, and offer more precise dosing.
- Cons: Can be more expensive than syringes.
Insulin Pumps:
- Description: A small, computerized device that delivers a continuous, controlled dose of insulin throughout the day and night through a small catheter inserted under the skin.
- Pros: Provides more precise insulin delivery, improves blood sugar control, and allows for more flexibility with meals.
- Cons: More expensive and requires more training to use effectively. Can be cumbersome. Site changes every 2-3 days.
Inhaled Insulin:
- Description: Rapid-acting insulin that is inhaled into the lungs before meals.
- Pros: Convenient and non-invasive.
- Cons: Not suitable for everyone, especially those with lung conditions.

Choosing the right delivery method is a personal decision that should be made in consultation with your healthcare team. Consider factors like cost, lifestyle, comfort level, and blood sugar control goals.

Example scenario:

Scenario: Sarah, a newly diagnosed 25-year-old with an active lifestyle, travels frequently.
Recommendation: Her doctor might recommend insulin pens due to their portability and ease of use while traveling. If Sarah wants more precise control and is willing to manage the device, an insulin pump could also be considered.

Insulin Storage and Handling

Proper storage and handling of insulin are essential to maintain its effectiveness. Insulin that has been improperly stored or handled can lose its potency, leading to unpredictable blood sugar levels.

Key Guidelines for Insulin Storage:

Unopened Insulin: Store unopened insulin vials and pens in the refrigerator (36°F to 46°F or 2°C to 8°C). Do not freeze insulin.
Opened Insulin: Once insulin is opened (in use), it can be stored at room temperature (below 86°F or 30°C) for a specific period, usually 28 to 56 days, depending on the type of insulin. Check the manufacturer's instructions for specific guidelines.
Protect from Light and Heat: Keep insulin away from direct sunlight and heat sources, as these can degrade the insulin.
Check Expiration Dates: Always check the expiration date on your insulin vials and pens. Do not use expired insulin.
Discard Damaged Insulin: If insulin appears cloudy, discolored, or contains particles, discard it.
Travel: When traveling, keep your insulin with you in your carry-on luggage, not in checked baggage, where it can be exposed to extreme temperatures. Use a cooler or insulated bag to keep your insulin at the correct temperature.
Avoid Extreme Temperatures: Never leave insulin in a hot car or expose it to freezing temperatures.
Proper Disposal: Dispose of used needles and syringes safely in a sharps container.

Practical Tips:

Keep a log of when you opened each insulin vial or pen to ensure you don't use it past its expiration date.
Use a medication organizer or travel case to keep your insulin and supplies together when traveling.

Injecting Insulin: Step-by-Step Guide

Whether you are using a syringe or an insulin pen, the injection process is similar. Here's a step-by-step guide to injecting insulin correctly:

Related reading: Are You Ignoring These 7 Signs Of Hypoglycemia Low Blood Sugar
Wash Your Hands: Wash your hands thoroughly with soap and water.
Gather Your Supplies: Gather your insulin vial or pen, syringe or pen needle, alcohol swab, and sharps container.
Prepare the Insulin:
- For Vials: If using a vial, gently roll the insulin vial between your hands to mix it (do not shake). Clean the top of the vial with an alcohol swab. Draw air into the syringe equal to your prescribed dose, insert the needle into the vial, and inject the air. Then, turn the vial upside down and draw out the correct dose of insulin. Check for air bubbles and tap the syringe gently to remove them.
- For Pens: Attach the pen needle to the insulin pen. Prime the pen by dialing up 2 units and pressing the release button to ensure the needle is clear of air and insulin flows freely.
Choose an Injection Site: Rotate your injection sites to prevent lipohypertrophy (lumps under the skin). Common injection sites include the abdomen (at least 2 inches away from the belly button), thigh, upper arm, and buttocks.
Clean the Injection Site: Clean the injection site with an alcohol swab and let it dry.
Inject the Insulin:
- Pinch a fold of skin at the injection site.
- Insert the needle straight into the skin at a 90-degree angle (or at a 45-degree angle if you are very thin).
- Push the plunger or release button on the pen to inject the insulin slowly and steadily.
- Hold the needle in place for 5-10 seconds to ensure all the insulin is injected.
- Release the pinched skin and carefully withdraw the needle.
Dispose of the Needle Safely: Immediately dispose of the used needle in a sharps container.

Injection Tips:

Avoid injecting into areas with scars, moles, or damaged skin.
Rotate your injection sites within the same general area to maintain consistency.
If you experience pain or bleeding, apply gentle pressure to the injection site with a clean cotton ball.
Never reuse needles or share insulin pens.
Use shorter needles to minimize the risk of injecting into muscle.

Blood Glucose Monitoring: The Key to Insulin Adjustment

Regular blood glucose monitoring is the cornerstone of effective insulin management. By tracking your blood sugar levels, you can understand how your body responds to insulin, food, exercise, and other factors. This information is essential for adjusting your insulin doses to achieve optimal blood sugar control.

Why Blood Glucose Monitoring Matters:

Tracks Blood Sugar Levels: Monitoring provides a snapshot of your blood sugar levels at a specific point in time.
Identifies Patterns: Over time, monitoring helps you identify patterns and trends in your blood sugar levels.
Guides Insulin Adjustments: Monitoring results inform decisions about insulin dosages, meal planning, and exercise.
Prevents Complications: Regular monitoring helps you avoid hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), which can lead to serious health complications.

How to Monitor Blood Glucose:

Blood Glucose Meter: The most common method involves using a blood glucose meter to test a small drop of blood from your fingertip.
Continuous Glucose Monitoring (CGM): A CGM is a small device inserted under the skin that continuously measures your blood glucose levels and transmits the data to a receiver or smartphone.
Frequency of Monitoring: Your healthcare team will advise you on how often to monitor your blood glucose levels based on your insulin regimen, lifestyle, and blood sugar control goals.

Ideal Blood Glucose Ranges:

Before Meals (Fasting): 80-130 mg/dL
1-2 Hours After Meals: Less than 180 mg/dL
HbA1c: Less than 7% (as recommended by your healthcare provider)

Example Monitoring Schedule:

Before each meal (breakfast, lunch, and dinner)
Before bedtime
Before and after exercise
Occasionally in the middle of the night (especially when adjusting insulin doses)

Tips for Effective Blood Glucose Monitoring:

Use a reliable and accurate blood glucose meter.
Calibrate your meter regularly with control solutions.
Keep a log of your blood glucose readings, including the date, time, meal details, insulin dose, and any other relevant information.
Share your blood glucose logs with your healthcare team to review and adjust your insulin regimen as needed.

Managing Hypoglycemia (Low Blood Sugar)

Hypoglycemia, or low blood sugar, is a common and potentially dangerous complication of insulin therapy. It occurs when your blood glucose levels drop too low (typically below 70 mg/dL). Recognizing the symptoms of hypoglycemia and knowing how to treat it promptly is crucial for preventing serious consequences.

Symptoms of Hypoglycemia:

Shakiness
Sweating
Dizziness
Hunger
Irritability or anxiety
Confusion
Rapid heartbeat
Blurred vision
Headache
Weakness
Loss of consciousness (in severe cases)

The "15-15 Rule" for Treating Hypoglycemia:

Check Your Blood Glucose: If you suspect you have hypoglycemia, check your blood glucose level with a meter.
Eat or Drink 15 Grams of Fast-Acting Carbohydrates: If your blood glucose is below 70 mg/dL, consume 15 grams of fast-acting carbohydrates. Examples include:
- 3-4 glucose tablets
- 4 ounces (1/2 cup) of fruit juice
- 1 tablespoon of honey or sugar
- 5-6 hard candies
- 1 small tube of glucose gel
Wait 15 Minutes: After consuming the carbohydrates, wait 15 minutes.
Recheck Your Blood Glucose: Recheck your blood glucose level.
Repeat if Necessary: If your blood glucose is still below 70 mg/dL, repeat the process of eating 15 grams of carbohydrates and waiting 15 minutes.
Eat a Meal or Snack: Once your blood glucose is above 70 mg/dL, eat a meal or snack to prevent another drop.

Preventing Hypoglycemia:

Consistent Meal Timing: Eat meals and snacks on a regular schedule.
Proper Insulin Dosing: Work with your healthcare team to adjust your insulin doses as needed.
Blood Glucose Monitoring: Check your blood glucose levels regularly, especially before meals, bedtime, and exercise.
Carry Fast-Acting Carbohydrates: Always carry a source of fast-acting carbohydrates with you in case of hypoglycemia.
Inform Others: Let your family, friends, and coworkers know about your diabetes and how to recognize and treat hypoglycemia.
Wear a Medical Alert: Wear a medical alert bracelet or necklace indicating that you have diabetes.

Glucagon for Severe Hypoglycemia:

Glucagon is a hormone that can raise blood glucose levels quickly.
It is prescribed for severe hypoglycemia (loss of consciousness) when a person is unable to eat or drink.
Family members and caregivers should be trained on how to administer glucagon.

Exercise and Insulin

Exercise is an essential part of a healthy lifestyle, but it can also affect your blood glucose levels and insulin needs. Understanding how exercise impacts your blood sugar and adjusting your insulin doses accordingly is crucial for safe and effective diabetes management.

How Exercise Affects Blood Glucose:

During Exercise: Exercise can lower blood glucose levels as your muscles use glucose for energy.
After Exercise: Exercise can continue to lower blood glucose levels for several hours after you finish exercising.
High-Intensity Exercise: Strenuous exercise can sometimes raise blood glucose levels due to the release of stress hormones.

Tips for Exercising Safely with Insulin:

Check Your Blood Glucose Before Exercise: Check your blood glucose level before you start exercising.
- If your blood glucose is below 100 mg/dL, eat a small snack containing carbohydrates before exercising.
- If your blood glucose is above 250 mg/dL, check your urine for ketones. If ketones are present, do not exercise until your blood sugar is under better control.
Adjust Your Insulin Dose: Depending on the type and duration of exercise, you may need to reduce your insulin dose before or after exercising. Work with your healthcare team to develop a plan for adjusting your insulin doses.
Monitor Your Blood Glucose During Exercise: If you are exercising for an extended period, check your blood glucose levels every 30-60 minutes.
Carry a Snack: Always carry a snack with you during exercise in case your blood sugar drops too low.
Stay Hydrated: Drink plenty of water before, during, and after exercise.
Exercise with a Partner: Exercise with a friend or family member who knows about your diabetes and how to recognize and treat hypoglycemia.

Insulin Adjustment Strategies:

Reduce Insulin Before Exercise: Reduce your rapid-acting insulin dose before exercise, especially for planned, prolonged activity.
Adjust Basal Insulin: If you exercise regularly, you may need to adjust your basal insulin dose to prevent nighttime hypoglycemia.
Consider an Insulin Pump: An insulin pump can make it easier to adjust insulin doses for exercise.

Examples:

Scenario: John plans to go for a 30-minute run in the morning.
Action: He checks his blood glucose before the run. If it's below 100 mg/dL, he eats a small banana. He also reduces his morning insulin dose slightly. He checks his blood glucose after the run and has a light snack to stabilize his blood sugar.

Navigating Sick Days

When you're sick, your body releases hormones to fight off the illness, which can raise your blood sugar levels and make it harder to manage your diabetes. During sick days, it's essential to monitor your blood glucose levels more frequently and adjust your insulin doses as needed.

Key Steps for Managing Sick Days:

Monitor Your Blood Glucose Frequently: Check your blood glucose levels every 2-4 hours, even if you are not eating.
Check for Ketones: Check your urine for ketones, especially if your blood sugar is high (above 250 mg/dL).
Continue Taking Insulin: Do not stop taking your insulin, even if you are not eating. You may need to adjust your insulin dose based on your blood glucose levels and ketone levels.
Stay Hydrated: Drink plenty of fluids, such as water, sugar-free drinks, or broth, to prevent dehydration.
Eat Small, Frequent Meals: If you can eat, consume small, frequent meals that are easy to digest.
Rest: Get plenty of rest to allow your body to recover.
Contact Your Healthcare Provider: Contact your healthcare provider if you experience any of the following:
- Persistent high blood glucose levels (above 250 mg/dL)
- Large ketones in your urine
- Inability to keep fluids down
- Difficulty breathing
- Severe abdominal pain
- Confusion or drowsiness

Insulin Adjustment Guidelines:

High Blood Glucose (with Ketones): Increase your insulin dose to correct the high blood glucose and clear the ketones. Consult your healthcare provider for specific guidance.
High Blood Glucose (without Ketones): Continue taking your regular insulin dose and monitor your blood glucose levels closely.
Low Blood Glucose: Treat hypoglycemia as usual, but be aware that you may need to adjust your insulin dose later in the day to prevent rebound hyperglycemia.

The Importance of a Diabetes Care Team

Managing type 1 diabetes effectively requires a collaborative effort between you and a dedicated diabetes care team. This team typically includes:

Endocrinologist: A doctor specializing in hormone disorders, including diabetes.
Certified Diabetes Educator (CDE): A healthcare professional (nurse, dietitian, or pharmacist) who provides education and support on diabetes management.
Registered Dietitian (RD): A nutrition expert who can help you develop a healthy eating plan that meets your individual needs.
Primary Care Physician (PCP): Your main doctor, who can provide general medical care and coordinate your diabetes care.
Mental Health Professional: A therapist or counselor who can help you cope with the emotional challenges of living with diabetes.

The Role of the Diabetes Care Team:

Diagnosis and Treatment Planning: The team will diagnose your diabetes and develop an individualized treatment plan.
Education and Support: They will provide education and support on all aspects of diabetes management, including insulin therapy, blood sugar monitoring, meal planning, and exercise.
Medication Management: They will prescribe and manage your insulin and other medications.
Monitoring and Follow-Up: They will monitor your blood glucose levels, HbA1c, and other health indicators and adjust your treatment plan as needed.
Complication Management: They will help you prevent and manage diabetes-related complications.

Building a Strong Relationship with Your Care Team:

Communicate Openly: Be honest and open with your care team about your challenges and successes in managing your diabetes.
Ask Questions: Don't hesitate to ask questions if you don't understand something.
Follow Recommendations: Follow your care team's recommendations to the best of your ability.
Schedule Regular Appointments: Schedule and attend regular appointments with your care team.
Be an Active Participant: Take an active role in your diabetes care by educating yourself and making informed decisions.

Long-Term Complications and Prevention

While insulin is life-saving, it is critical to manage your blood sugar levels to prevent long-term complications. Poorly controlled diabetes can lead to serious health issues affecting various organs.

Potential Long-Term Complications:

Cardiovascular Disease: Increased risk of heart attack, stroke, and peripheral artery disease.
Kidney Disease (Nephropathy): Damage to the kidneys, potentially leading to kidney failure.
Nerve Damage (Neuropathy): Numbness, tingling, and pain in the hands and feet.
Eye Damage (Retinopathy): Damage to the blood vessels in the retina, potentially leading to blindness.
Foot Problems: Increased risk of foot ulcers, infections, and amputations.

Preventing Long-Term Complications:

Achieve Good Blood Sugar Control: Aim for blood glucose levels within the target range recommended by your healthcare provider.
Manage Blood Pressure: Keep your blood pressure within the recommended range.
Control Cholesterol: Manage your cholesterol levels with diet and medication if needed.
Quit Smoking: Smoking increases the risk of diabetes-related complications.
Maintain a Healthy Weight: Achieve and maintain a healthy weight.
Get Regular Checkups: Attend regular checkups with your healthcare team to monitor your health and detect any potential complications early.
Take Care of Your Feet: Inspect your feet daily for any signs of cuts, blisters, or infections.

Living a Long and Healthy Life with Type 1 Diabetes:

Type 1 diabetes requires lifelong commitment, but with proper management, you can live a long and healthy life. By understanding insulin, monitoring your blood glucose levels, eating a healthy diet, exercising regularly, and working closely with your healthcare team, you can minimize your risk of complications and enjoy a fulfilling life. Stay proactive, informed, and connected to a supportive community, and remember that you are not alone in this journey.