Treatment of T1D

Managing type 1 diabetes

It’s a big change, but people with type 1 diabetes can live long, full and happy lives. Advances in medication and technology make life easier, safer and better.

Treating type 1 diabetes means replacing the insulin that your pancreas doesn’t make along with monitoring your blood glucose levels.

A balancing act: managing type 1 diabetes

Most people don’t think about their pancreas and what it does, but people with T1D must be mindful of their blood sugar levels all the time. To maintain their blood sugar at a healthy level, they must balance food intake with exercise and insulin.

Food tends to make glucose levels rise; exercise and insulin tend to make glucose levels fall. This means injecting the right type and amount of insulin at the appropriate time is essential. People with T1D work closely with their medical team to find the right insulin treatment for them. Insulin can be delivered via syringes or pens, insulin pumps or the new artificial pancreas (closed-loop) systems.

The majority of people who are injecting insulin follow a basal-bolus regime. A basal-bolus regime involves taking a long-acting form of insulin once or twice a day to keep blood glucose levels (BGLs) stable when you are not eating. This is known as the ‘basal’ injection. It also includes taking a rapid-acting insulin before each meal to prevent rises in blood glucose levels resulting from eating carbohydrates or to correct elevated blood glucose levels between meals. This is known as the ‘bolus’ injection. One of the main advantages of a basal-bolus regimen is that it attempts to mimic how the body releases insulin in people who do not have T1D. It also allows for flexibility around what is eaten and when. However, it usually involves taking between four and eight injections a day.

Blood glucose levels and type 1 diabetes

Before you developed type 1 diabetes your pancreas would produce a low level of insulin across the day to help move glucose from your bloodstream into the various cells of your body, to provide them with energy. When you ate, your blood glucose level (BGL) would rise and your pancreas would respond by producing a surge of insulin. This would help move excess glucose into your muscles and liver to be stored as glycogen. If your BGL dropped during the day, the glycogen would be broken down and released back into the blood stream as glucose.

By constantly sensing how much glucose is in the bloodstream and adjusting how much insulin it secreted, your pancreas kept your BGL between 4 and 8 mmol/L at all times.

But with T1D, you need to manage this process manually by checking your BGL and adding insulin into your body. Ideally, people with T1D aim to do at least four blood glucose checks a day. There are two devices to do this: continuous glucose monitors (CGM) and blood glucose meters.

In addition to monitoring your BGLs at home, your doctor or diabetes team will arrange for you to have a special blood test, known as a haemoglobin A1c (HbA1c) every three months.

Living with diabetes can sometimes be incredibly frustrating. Over the course of a couple of days you eat the same amount of food, take the same amount of insulin and do the same amount of exercise, but your blood glucose levels from day to day can be completely different. Sometimes, even with your best efforts, trying to keep your blood glucose level within range all the time can be impossible. But it’s important to try and manage the fluctuations as best you can.

Studies have shown that complications can be reduced by up to 76% with tight glucose management.

Continuous glucose monitoring (CGM)

Continuous glucose monitoring allows for glucose levels to be measured ‘continuously’. At present, there are two systems of continuous glucose monitoring (CGM):

• Real time CGM
• Flash monitoring

Learn more about CGMs and flash GMs.

Hybrid closed-loop pumps

Since early 2019, a hybrid closed-loop pump has also been available in Australia. This system uses feedback to and from the pump and CGM but the process is not fully automated, hence the name ‘hybrid’ closed loop pump. People using this system still need to actively engage with it (for example, inputting food intake to enable delivery of the correct bolus, or making corrections when sensor glucose rises too high), but otherwise the pump is programmed with a complex algorithm that uses data, such as average insulin usage or sensor glucose readings, to adjust basal insulin.

Since closed-loop technology is relatively new, research is being done to determine its effectiveness for different groups of people. In the next few years, it is likely that closed-loop systems will become anymore common.

Find out about JDRF’s closed-loop research, or watch a video from JDRF UK below.