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.
The role of insulin
We all need insulin to live. Insulin delivers glucose from the food we eat to the cells in our bodies, which then use the glucose for energy.
In people without diabetes, the pancreas makes the right amount of insulin at the right time. Before people develop diabetes, their pancreas releases a low level of background insulin throughout the day. Additionally, the pancreas would also produce surges of insulin in response to food.
For people with T1D, the pancreas no longer makes insulin. Without insulin, the cells cannot receive the fuel they need, and in time, the cells can no longer function. This extra glucose in the bloodstream can cause serious medical conditions over time.
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.
Types of insulin
There are five main types of insulin that are used in managing type 1 diabetes in Australia. Each type differs with respect to how quickly it begins to act and how long its effect persists. Most people with type 1 diabetes need to use more than one kind of insulin preparation to mimic the role of the pancreas as closely as possible.
- Rapid acting insulin analogues
- Short acting insulin
- Intermediate acting insulin
- Long-acting insulin analogues
- Pre-mixed insulin
No single regimen, or combination of insulin, works well for everyone. The type of insulin, how much is used and how often will depend on the individual. The right insulin regimen for you is the one that helps maintain your blood glucose level as close to normal as possible without experiencing hypoglycaemia.
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.
An increasing number of people with type 1 diabetes are using insulin pumps for insulin delivery.
An insulin pump is a small computerised device, about the size of a compact mobile phone, that delivers a slow continuous level of rapid-acting insulin throughout the day and night.
JDRF administers the Federal Government’s Insulin Pump Program, which provides insulin pumps to families who have children (under 18 years of age) with T1D and meet the income threshold. This life changing technology would otherwise be out of reach for these children.
Learn more about insulin pumps and the Federal Government’s Insulin Pump Program.
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
Sensor augmented pumps
Some insulin pumps now come with the capacity to be augmented with CGM. The pump receives the glucose data which can then be accessed via the pump screen.
Most pumps can’t automatically change rates based on the data received but they will alarm at pre-set levels so the wearer can change rates to avoid very low or very high blood glucose levels.
One pump currently available in Australia has the capacity to suspend the flow of insulin for up to two hours if the sensor glucose drops below a programmed level or if it is predicted to reach a programmed level within the next 20 to 30 minutes (predictive low glucose suspend). Basal insulin delivery is resumed after 2 hours or earlier if the sensor glucose has risen above a safe level.
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.
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