Type 1 Diabetes: Recently Diagnosed - Treatment Overview

Treatment Overview

The focus of your treatment for type 1 diabetes is to keep your blood sugar level within a normal or near-normal range. This is called tight control. It is the best way to reduce your risk of diabetes complications. However, some people—such as those whose blood sugar drops too low with tight control—may need to set a different target range with their health professional.

A normal to near-normal blood sugar level is 90 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 6% or less (normal) to 7% (near normal). This is a test of your blood sugar control for the past 2 to 3 months. If you do not have problems with low blood sugar, you may be able to tightly control your blood sugar to an A1c of 6% or less.

To keep your blood sugar as close to normal as possible, your daily treatment includes:

• Testing your blood sugar several times every day. Do additional blood sugar testing whenever you have symptoms of high or low blood sugar, and occasionally test during the night. It is possible for your blood sugar level to change while you are sleeping. Testing at night will determine if this is happening to you. If it is, your doctor may change your treatment plan. For more information, see:

  Home blood sugar monitoring.

  Home blood sugar monitoring for a child.

• Taking (several) insulin injections or using an insulin pump. Even children can use an insulin pump. For more information, see:

  Preparing and giving an insulin injection.

  Preparing and giving an insulin injection to a child. At some point your child can learn to give an insulin injection. Talk to your doctor and your child to find out when is a good time to start teaching your child to give an insulin injection.

• Spreading carbohydrate throughout the day to prevent high blood sugar levels after meals. For more information, see:

  Carbohydrate counting.

  Using the food guide for diabetes.

• Getting at least 30 minutes of physical exercise (1 hour for children) on most days of the week. Some tips for exercising safely may be helpful. It may also help to keep track of your exercise on an activity log(What is a PDF document?). Children with type 1 diabetes can participate in sports just like children without diabetes. But children who use insulin are at risk of low blood sugar. Some tips on safe exercising for your child with type 1 diabetes can help prevent low blood sugar.
• Starting a routine. Your sugar levels may be easier to control if you have a routine where you eat and exercise about the same amounts and at about the same times every day.

Chronic illnesses such as diabetes take a toll on your energy and emotions. It's normal to feel down sometimes. But if you feel seriously overwhelmed, tearful, and not yourself, you may be suffering from depression. Talk to your health professional if you feel depressed. Medicine, counseling, and other support can help you.

How often will I see my doctor?

At first, your doctor will want to talk with you daily or at least every few days while finding the treatment that best keeps your blood sugar levels within your target range. Once your blood sugar levels are staying within this range, you will continue to see your doctor about every 3 to 4 months. During these checkups, your doctor will evaluate and adjust your treatment. You will also start having exams and tests that check your blood sugar control and monitor your condition on a regular basis.

After you have had diabetes for 3 to 5 years, you will start having yearly exams and tests to monitor for signs of complications, particularly eye and kidney damage. If your child has diabetes, this testing should begin at puberty.

What if I have diabetic ketoacidosis?

If your blood sugar level was very high at the time you were diagnosed with diabetes, you may have been treated for diabetic ketoacidosis. This life-threatening condition can happen to you again if you do not take enough insulin, have a severe infection or other illness, or become severely dehydrated. Treatment for diabetic ketoacidosis requires hospitalization and includes:⁵

• Fluids given through a vein (intravenous, or IV), to replace body fluids lost from dehydration and to correct the electrolyte imbalance.
• Frequent monitoring of blood pressure, heart rate (pulse), breathing rate (respirations), and level of consciousness.
• Frequent blood tests for glucose and electrolytes.
• Insulin given through the IV fluid. Once blood sugar levels are closer to your target range and you are no longer dehydrated, you can have insulin injected under the skin (subcutaneous).

Will I need treatment during the honeymoon period?

If your blood sugar levels return to the normal range soon after diagnosis, you are in what is called the "honeymoon period." This is a time when the remaining insulin-producing cells in your pancreas are working harder to supply enough insulin for your body. Treatment during this time may include:

• Talking with your doctor every day or so until the honeymoon period is over.
• Monitoring your blood sugar level frequently to see whether it is rising.
• Taking very small amounts of insulin or no insulin. Even though you may not need insulin, some doctors prefer that you take small doses of insulin daily throughout the honeymoon period. This may decrease the stress on the pancreas. It may also help prevent your child with diabetes from thinking that the disease is gone.

What To Think About

When your child has diabetes

Talk with your child's teachers and the staff at his or her school (or child care center) to develop a plan for diabetes care at school. This plan needs to include clear instructions for dealing with low blood sugar, when to test the child's blood sugar, contents of school meals and snacks, and emergency contact information.

Allow your child with diabetes to participate in his or her daily care to the extent that is appropriate for your child's age and development. For example, your 4-year-old child cannot be responsible for testing his or her blood sugar, but he or she can get out the supplies and perform some of the simpler steps. By the time your child is an adolescent, he or she should be able to take responsibility for their diabetes care, with appropriate supervision. For more information, see the topic Type 1 Diabetes: Children Living With the Disease.

Coping with the disease

You (or your child) have just been diagnosed with a disease that requires daily attention and will last for the rest of your life. It is difficult to accept and adjust to all the lifestyle changes that you need to make, such as eating the right amount of carbohydrate at each meal and snack, giving injections every day, and coping with blood sugar variations.

Anger, resentment, or denial are normal feelings in these circumstances and can be expected because you are experiencing the loss of what your life was like before you got type 1 diabetes. Allow yourself time to deal with your feelings and grieve your loss. For more information, see the topic Grief and Grieving.