Insulin my life
Type 1 Diabetes
What is Diabetes?
Diabetes mellitus occurs when the level of glucose (sugar) in the blood becomes higher than normal. There are two main types of diabetes. These are called Type 1 diabetes and Type 2 diabetes.
What is Type 1 Diabetes?
Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death.
What is Insulin and Blood Glucose?
When we eat, various foods are broken down into simple constituents in the gut. One of the main constituent is glucose. This is absorbed through the gut wall into the bloodstream. Glucose is like a 'fuel' which is used by cells in the body for energy. To remain healthy, your blood glucose level should not go too high or too low.

So, when your blood glucose begins to rise (after eating), the level of a hormone called insulin should also rise. Insulin acts on the cells of your body and makes them take glucose into the cells from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into glycogen or fat (which are stores of energy). When the blood glucose level begins to fall (between meals, or when we have no food), the level of insulin falls. Some glycogen or fat is then broken down back into glucose and some is released back into the bloodstream to keep the blood glucose level normal.

Hormones such as insulin are chemicals that are released into the bloodstream and have an action on certain parts of the body. Insulin is made by special cells called beta cells which are part of little 'islands' of cells (islets) within the pancreas.

Diabetes develops if you do not make enough insulin (Type 1 diabetes), or if the insulin that you do make does not work properly (in Type 2 diabetes) on the body's cells.
How Type 1 Diabetes happens?
In most cases, Type 1 diabetes is caused by 'autoimmune' destruction of pancreas. The immune system normally makes antibodies to attack bacteria, viruses, and other 'germs'. In autoimmune diseases the immune system makes antibodies against part or parts of the body. If you have Type 1 diabetes you make antibodies that attach to the beta cells in the pancreas. These are thought to destroy the cells that make insulin. It is thought that something triggers the immune system to make these antibodies. The 'trigger' is not known but a popular theory is that a virus triggers the immune system to make these antibodies.
What are the symptoms of Type 1 Diabetes?
The symptoms that usually occur when you first develop Type 1 diabetes are:
  • You are very thirsty
  • You pass a lot of urine
  • Tiredness, weight loss, and feeling generally unwell
The above symptoms tend to develop quite quickly, over a few days or weeks. After treatment is started, the symptoms soon settle and go. However, without treatment, the blood glucose level becomes very high and acids form in the bloodstream. This condition is called Ketoacidosis. If this persists you will become dehydrated, and if not treated it will endanger life.
How is Diabetes diagnosed?
A simple blood sugar test can diagnose diabetes. If this is high then it will confirm that you have diabetes. Some people have to have two samples of blood taken and you may be asked to 'fast' (have nothing to eat or drink, other than water, from midnight before your blood test is performed).
What are complications of Diabetes?
Very high blood glucose level
If you are not treated, or use too little insulin, a very high blood glucose level can develop. If left untreated this causes dehydration, drowsiness, and serious illness which can be life-threatening. A very high blood glucose level sometimes develops if you have other illnesses such as any infections. In these situations you may need to adjust the dose of insulin to keep your blood glucose level normal.
Long-term complications
If the blood glucose level is higher than normal, over a long period of time, it can have a damaging effect on the blood vessels. Even a mildly raised glucose level which does not cause any symptoms in the short-term can affect the blood vessels in the long-term. This may lead to some of the following complications (often years after diabetes is first diagnosed):
  • Hardening of the arteries (Atheroma) which can cause problems such as angina, heart attacks, stroke and poor circulation
  • Eye problems which can affect vision
  • Kidney damage which sometimes develops into kidney failure
  • Nerve damage
  • Foot problems. These are due to poor circulation and nerve damage
  • Impotence. Again, this is due to poor circulation and nerve damage
  • Other rare problems
The type and severity of long-term complications varies from case to case. You may not develop any at all. In general, the nearer your blood glucose level is to normal, the less is your risk of developing complications. Your risk of developing complications is also reduced if you treat any other 'risk factors' that you may have such as high blood pressure.
Complications related to treatment
Too much insulin can make the blood glucose level go too low (Hypoglycaemia, sometimes called a 'Hypo'). This can cause you to feel sweaty, confused, and unwell, and you may lapse into coma. Emergency treatment of Hypoglycemia is with Glucose (Energile, Glaxose-D), Fruit juices, soft drinks (Pepsi, Coke etc but not Diet) Then you should eat snacks that contain carbohydrates like biscuits, bread, cake-piece, Nimco, nuts etc.
What are the aims of treatment?
Although diabetes cannot be cured, it can be treated successfully. If a high blood glucose level is brought down to a normal or near-normal level, your symptoms will ease and you are likely to feel well again. However, you still have some risk of complications in the long-term if your blood glucose level remains even mildly high - even if you have no symptoms in the short-term. Studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared to those who have poor blood glucose control.

Therefore, the main aims of treatment are:
  1. To keep your blood glucose level as near to normal as possible
  2. To reduce any other 'risk factors' i.e. reduce your blood pressure if it is high
  3. To detect any complications as early as possible. Treatment can prevent or delay some complications
1. Blood glucose monitoring
It is advisable to you to check your blood glucose at home by using glucometer. If you check your blood glucose level, ideally you should aim to keep the level between recommended levels. You may be asked by your doctor to check/monitor your blood glucose at any of the following times:
  • Before every meal
  • After a meal (usually after 2 hours)
  • During and after vigorous sport or exercise
  • If you think you are having an episode of hypoglycaemia (a "hypo")
  • If you are unwell with another illness (for example, a cold or infection)
Another blood test is called HbA1c. It indicates your blood glucose control over the last 1-3 months. This test is done by your doctor.


To stay well and healthy you will need insulin injections for the rest of your life. Your doctor will give advice and instruction on how and when to take insulin. Insulin is not absorbed in the gut so it needs to be injected. There are various types of insulin. The type of insulin advised will be according to your needs.

The six main types of insulin are:
  • Rapid-acting analogue can be injected just before, with or after food. Its duration of action is 2 - 5 hours
  • Short-acting insulin should be injected 15-30 minutes before a meal to cover the rise in blood glucose levels that occurs after eating. It has a peak action of 2-6 hours and can last for up to 8 hours
  • Medium-acting are taken once or twice a day to provide background insulin or in combination with short-acting insulins/rapid-acting analogues. Their peak activity is between 4 and 12 hours and can last up to 30 hours. For example NPH insulin
  • Long-acting analogue is usually injected once a day to provide background insulin lasting approximately 24 hours
  • Mixed insulin is a combination of medium-acting and short-acting insulin. For example 70/30 of NPH and regular insulin
  • Mixed analogue is a combination of medium-acting insulin and rapid-acting analogue
Most patients take 2-4 injections of insulin each day. The type and amount of insulin you need may also vary each day, depending on what you eat and the amount of exercise you do.

Insulin pumps

Insulin pump therapy continually infuses insulin into the subcutaneous tissue (the layer of tissue just beneath the skin). Insulin pumps are new in Pakistan and very limited number of patients are using this device. Insulin pumps work by delivering a varied dose of fast-acting insulin continually throughout the day and night, at a rate that is pre-set according to your needs. These pumps are not suitable for everyone with Type 1 diabetes. Your doctor will be able to discuss this with you in more detail.

Healthy diet

You should eat a healthy diet. This diet is the same that is recommended for everyone. Basically, you should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables. However, you will need to know how to balance the right amount of insulin for the amount of food that you eat. Therefore, you will normally be referred to a dietician for detailed advice.

Balancing insulin and diet, and monitoring blood glucose levels

Monitoring your blood glucose level will help you to adjust the amount of insulin and food according to the level and your daily routine.
2. Reduce other risk factors
You are less likely to develop complications of diabetes if you reduce any other 'risk factors'. These are briefly mentioned below:

Keep your blood pressure down

It is very important to have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor for complications. Even mildly raised blood pressure should be treated if you have diabetes. Medication, often with two or even three different drugs, may be needed to keep your blood pressure down.

If you smoke - now is the time to stop

Smoking is a high risk factor for complications. It damages the small blood vessels that lead to eye and kidney damage particularly in patients who has diabetes.

Do some physical activity regularly

Regular physical activity also reduces the risk of some complications such as heart and blood vessel disease. If you are able, a minimum of 30 minutes of brisk walk at least five times a week is advised. Anything more vigorous is even better. For example, swimming, cycling, and jogging. Ideally you should do an activity till mild sweating.

Other medication

Depending on your age and how long you have had diabetes, you may be advised to take a drug to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease and stroke.
3. To detect and treat any complications
  • Regular check-up by doctors especially by the diabetes specialist
  • Checking levels of blood glucose, HbA1c, cholesterol and blood pressure
  • Advice on diet and lifestyle
  • Checking for early signs of complications; for example:
    • Eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse
    • Urine tests - these include testing for protein in the urine, which may indicate early kidney problems
    • Foot examination - helps to prevent foot ulcers
    • Blood tests - these include tests of kidney function, and other general tests. There are some other tests for some diseases which are more common in people with diabetes. For example, celiac disease and thyroid disorders
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