Type I Diabetes, part 2 — Treatment and Monitoring
Treatment
At the time of diagnosis, the goal is to stabilize the metabolism by
treating diabetic ketoacidosis (also called DKA) and high blood glucose levels (hyperglycemia). Hospitalization may be required, due to the severity of symptoms.
Long-term goals of treatment are to prolong life, improve quality of life,
and prevent diabetes-related complications such as blindness, kidney failure
and amputation of limbs. Achievement of these goals is through diet, education,
exercise, medication and monitoring of blood glucose levels.
Blood glucose should be monitored on a consistent basis. A small drop
of blood is tested to indicate the blood glucose level. This process enables
the person with diabetes to determine how well diet, medication and exercise
are working together to control diabetes. Adjustments can be made in meals,
activity or insulin to keep blood sugar levels within the normal range.
Treatment of Type I diabetes includes several different components, including
insulin injections, diet, physical activity, self-testing, foot care,
treatment of low blood sugar, treatment of high blood sugar or high ketones,
monitoring of diabetes status, and education regarding these components.
Each of these is explained in detail below.
Insulin
Insulin lowers the blood sugar by allowing it to leave the blood stream
and enter cells. Insulin is required to support life, and since persons
with Type I diabetes do not produce their own insulin, they must take
insulin every day. Treatment of this type of diabetes is with insulin
injections. Insulin is injected directly under the skin, or may be administered
through a pump. Each person’s insulin dosage, schedule and type
of insulin utilized are based on individual needs. Most persons with juvenile
onset diabetes take injections 1 to 4 times per day. Adults typically
give their own injections. Children may be given injections by parents
or another adult, until they are able to master giving their own injections.
Diet
Blood glucose levels are regulated by ensuring that food and insulin
are consistent and working together at all times. When insulin administration
and food intake are out of balance, it is likely that blood glucose levels
will vary greatly. Both the American Diabetes Association and the American
Dietetic Association recommend balanced meals from 6 food exchange groups.
A registered dietitian or nutrition counselor is an excellent resource
for helping the person with Type I diabetes plan meals.
Physical Activity
In addition to insulin and diet, physical activity can help maintain
normal blood sugar levels in a person with diabetes. Exercise and activity
help control the amount of sugar in the blood, help burn excess calories
and fat, and aid in achieving optimal weight. Individuals with Type I
diabetes should take special precautions before, during and after participating
in strenuous physical activity, intense exercise or sports. Therefore,
medical approval should be obtained before beginning any exercise program.
Glucose Self-Testing
Even when the person follows a regimen of appropriate diet, exercise
and insulin injections, blood glucose can sometimes be unstable. The only
way to know if alterations or adjustments need to be made is to regularly
check blood glucose levels. This is done by checking the glucose content
of a small drop of blood, obtained by pricking the individual’s
finger with a needle called a lancet. The blood glucose level generally should be
between 80 and 120. If it is higher or lower than that, the person knows
that insulin, diet and/or exercise should be modified. Blood glucose readings
also provide valuable information to the health care provider to determine
changes that will improve care and treatment. By regular testing of blood
glucose levels, the individual can identify high and low blood sugar levels
before serious health problems have a chance to develop.
Foot Care
Diabetes can result in damage to nerves and blood vessels, especially
in the foot. As a result, individuals with diabetes are more likely to
have a foot injury that goes unnoticed until a serious infection develops,
or have a decreased ability to sense trauma or injury to the foot which
may result in complications. In addition, diabetes affects the body’s
immune system and decreases the body’s ability to fight infection.
Minor infections may result in death of skin and other tissues (necrosis),
resulting in the need for an amputation of the affected limb. The health
care provider can recommend a daily foot care routine that will help prevent
serious foot problems.
Treatment of Low Blood Sugar
Hypoglycemia, or low blood sugar, is something that can occur when too
much insulin is used, too much exercise has occurred, or if the individual
has not eaten enough food. In a person with diabetes, hypoglycemia may
occur very quickly and unexpectedly. When the blood sugar falls below
70, symptoms of hypoglycemia may occur. Typical symptoms include weakness,
confusion, shaking, sweating, headache, nervousness and hunger.
If such
symptoms occur, the person’s blood sugar should be tested immediately.
Assuming the individual is alert and able to consume food, he should eat
something with sugar, such as fruit juice, several teaspoons of sugar,
a cup of skim milk or a regular soda. Within 15 minutes, symptoms should
subside. If they do not, give more sugar and retest the blood glucose
level.
After symptoms have subsided, the person can eat a meal or more substantial
food. Simple sugars, however, should be eaten first to bring the blood
sugar level up quickly. “Real” food, or a regular meal, takes
too long to digest and will not bring the blood sugar levels up fast enough.
It will, however, help to keep the levels up after the simple sugar has
been ingested.
Low blood sugar is a very serious matter, and the person with symptoms
of low blood sugar should be monitored very closely. If the person becomes
very confused, disoriented, unconscious, or has a seizure, a shot of glucagon
should be given. If no glucagon is available, 911 should be called immediately.
Glucagon should be stored for emergencies, and everyone in the home or
responsible parties at school should be trained in how to use it. Periodically,
a review of the use of glucagon should be done and the expiration date
of the glucagon should be checked. Glucagon usually works within 15 minutes.
If improvement is not seen during that time, call 911. Always monitor
the person very closely to make sure that they do not choke.
Treatment of High Blood Sugar or High Ketones
In a person without diabetes, glucose acts as fuel for energy.
When a person has diabetes, there is not enough insulin to move glucose
into the cells and it builds up in the blood. When that occurs, the body
seeks other forms of energy, and uses fat as a fuel source. Acids, called
ketones, are produced as the fat breaks down. Ketones build up in the
blood and in the urine, and can be toxic when they are present in large
amounts, a condition known as ketoacidosis.
Ketones can be detected by a simple urine test. The test, available at
pharmacies, consists of checking urine every 4-6 hours. This should be done whenever the person
with diabetes:
- has a blood glucose reading of 240 or above
- is sick
- is
unusually thirsty or has a dry mouth
- is urinating frequently
- is vomiting.
Other indications that ketnes might be elevated include:
- flushed face
- dry skin or mouth
- nausea or vomiting
- stomach pain
- deep
or rapid breathing
- fruity breath odor
If an individual with diabetes has any of these symptoms or
has a high ketone reading in his urine, call the doctor or go to the emergency
room immediately. High ketones, left untreated, may lead to coma or death.
Monitoring Diabetes
There are many ways that a person with diabetes can help control the
disease. Monitoring one’s status is an important part of maintaining
good health. An individual with diabetes should be sure to:
- Visit the doctor at least 4 times per year
- Have your glycosylated hemoglobin (HbA1C) checked 2-4 times per
year to determine overall glucose control. Your doctor will tell you exactly
how often you should have your HbA1C evaluated.
- Have yearly evaluations of cholesterol, triglyceride levels and
kidney functioning.
- Visit the ophthalmologist at lease yearly, more often if there
are any signs of diabetic retinopathy.
- Dental cleaning and examinations should occur every 6 months,
and you should ensure that your dentist knows that you are a diabetic.
- Do good foot care and make sure your doctor checks your feet at
each visit.
- Stay up-to-date on immunizations and flu shots.
Part 2 — Treatment and Monitoring