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Am Fam Physician. 1999;60(7):1997-1998

See related article on type 1 diabetes.

What is type 1 diabetes?

Type 1 diabetes is sometimes called juvenile diabetes, or insulin-dependent diabetes. It means that your body can't make insulin. Insulin helps your body use the sugar it makes from the food you eat. Your body uses this sugar for energy. We need insulin to live. Without insulin, your blood sugar level goes up, you get thirsty and you urinate a lot.

What problems can type 1 diabetes cause?

People with type 1 diabetes are more likely to get heart disease, stroke, kidney failure, high blood pressure, blindness, nerve damage and gum disease. These things happen two to four times more often in people with diabetes than in people without diabetes. When you have type 1 diabetes, blood may not move as well through your legs and feet. If left untreated, this might lead to amputation of your feet. Untreated type 1 diabetes can cause coma. It can even kill you. The good news is that treatment can help you prevent these problems.

How can these problems be prevented?

To help prevent these problems, keep your blood sugar under tight control, eat a healthy diet, exercise regularly, don't smoke and keep your blood pressure and cholesterol levels low. If you do all of these things, your risk of complications can be cut by more than 75 percent.

How do I keep my blood sugar under tight control?

Insulin helps people with type 1 diabetes keep the level of sugar in their blood at a normal level. Many people with type 1 diabetes take short-acting insulin before each meal. You can adjust the amount of insulin you take for each meal based on how many calories you eat and how physically active you plan to be in the next 3 to 4 hours. Most people with type 1 diabetes need to take about 8 to 10 units of insulin for every 500 calories they eat. (An average daily diet has about 2,000 to 2,500 calories a day.) You may need slightly less or slightly more insulin, depending on how your body reacts to insulin. Take enough insulin so your blood sugar level is usually between 80 and 120 mg and doesn't go above 180 mg after meals.

To keep their blood sugar levels from rising during the night, most people with type 1 diabetes need to take 4 to 8 units of an intermediate-acting insulin before they go to sleep. If you carry a syringe of short-acting insulin wherever you go, you'll always be ready if you need more insulin.

How will I know if my blood sugar is too high?

Even with treatment, people with type 1 diabetes sometimes have blood sugar levels that are too high. The best way to check your blood sugar level and to see how sensitive you are to insulin is to test your blood sugar level at least three times each day, including at bedtime. If it's too high, take some extra short-acting insulin. If your level is too low, eat some food.

What should I do if my blood sugar level is too high?

If your blood sugar level goes higher than it should, you may need to take an extra dose of short-acting insulin to return your blood sugar to the normal range. Depending on how you react to insulin, you'll need 6 to 10 units of short-acting insulin to lower your blood sugar by about 100 mg.

What should I eat?

The best diet for you is low in fat, low in salt and low in added sugars. It has lots of complex carbohydrates (like whole-grain breads, cereals and pasta), fruits and vegetables. This diet will help you control your blood pressure and cholesterol levels too. It's important not to eat too much, so you don't gain weight. You can eat something sweet once in a while but, when you do, take enough insulin to keep your blood sugar level in the normal range.

What are the signs of low blood sugar?

People who take insulin may have times when their blood sugar level is too low. This low blood sugar is called hypoglycemia. It can show up in any of the following ways:

  • Feeling tired for no reason

  • Yawning a lot

  • Being unable to speak or think clearly

  • Losing muscle coordination

  • Sweating

  • Twitching

  • Seizures

  • Suddenly feeling like you're going to pass out

  • Becoming very pale

If you have any of the problems listed above, you should eat or drink something sweet right away. Juice, soda, jam, candy, cake or anything else with a lot of sugar will work. Try not to eat or drink too much of it, though, or your blood sugar level will get too high.

Be sure you teach your friends, work colleagues and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon at home. Glucagon is another medicine you inject in a shot. It will raise your blood sugar level. If you are unconscious or can't take food or fluids by mouth, another person can give you a shot of glucagon. This will bring you back to normal.

How else can I prevent complications?

The tips below can help you stay healthy:

  • Keep your blood pressure below 130/85 mm Hg (and lower if you have kidney disease).

  • Keep your cholesterol level under 200 mg.

  • Take one aspirin a day.

  • Take care of your feet and check them every day for signs of infection.

  • See an eye doctor every year to check your vision.

  • See your dentist twice a year to check your teeth and gums.

Can I have a normal life with diabetes?

Yes, you can live a normal life. Remember, many successful athletes and members of all professions have type 1 diabetes. You can stay healthy if you control your diabetes. Only you have the power to control it.

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