DiagnosisType 1 diabetes FAQsEndocrinologist Yogish Kudva, M.B.B.S., answers the most frequently asked questions about type 1 diabetes. Show
Hi, I'm Dr. Yogish C Kudva. I'm an endocrinologist at Mayo Clinic and I'm here to answer some of the important questions you may have about type one diabetes. The best current treatment for type one diabetes is an automated insulin delivery system. This system includes a continuous glucose monitor, insulin pump, and a computer algorithm that continually adjusts insulin responding to the continuous glucose monitoring signal. The patient still has to enter information about the amount of carbohydrate he or she eats at mealtimes to provide the meal time related insulin. Testing using a glucose meter is not enough because glucose measurements in people with type one diabetes, vary from normal to low and normal to high very rapidly in the course of a day, a continuous glucose monitor is needed to assess whether treatment is effective and also to determine how to improve treatment. Current guidelines recommend use of a continuous glucose monitor. The percentage of time that is spent daily with glucose between 70 and 180 milligram per deciliter is the main measurement of appropriate treatment. This percentage should be 70% or higher daily. In addition, percentage of time spent with glucose below 70 should be less than four percent and greater than 250 should be less than five percent. Clearly, hemoglobin A1C testing to evaluate adequacy of treatment is not enough. In certain people with type one diabetes transplantation can be undertaken. This could be pancreas transplantation or transplantation of insulin making cells called islet. Islet transplantation is considered research in the US. Pancreas transplantation is available as a clinical treatment. These patients with hypoglycemia unawareness may benefit from a pancreas transplant. People with type one diabetes who develop recurrent diabetic ketoacidosis may also benefit from a pancreas transplant. People with type one diabetes who have developed kidney failure, could have their lives transformed by transplantation of both the pancreas and the kidney. There is active research going on to prevent type one diabetes from happening in children and adults who are less than 45 years old. People who are eligible for such research studies are people who have a positive antibody test for type one diabetes and are willing to be in such studies. The treatment being tested is medication that suppresses the immune system. Willing participants would be randomized to receive immune suppressive treatment or placebo treatment. Placebo looks like the medication, but does not do the same thing in the body. Initial research studies have been successful in decreasing the risk of development of type one diabetes in people that have received the immune system suppressing treatment and therefore, larger studies are now being undertaken. Try to be informed about research going on and treatments that may be approved for type one diabetes. You can get this information through already available publications. Make sure that at least annually you see a physician who is an expert on your disorder. Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time and we wish well. Type 1 diabetes symptoms often start suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be easy to see, the American Diabetes Association (ADA) has developed screening guidelines. The ADA recommends that the following people be screened for diabetes:
Tests for type 1 and type 2 diabetes and prediabetes
If your provider thinks you may have type 1 diabetes, they may test your urine to look for the presence of ketones. Ketones are a byproduct produced when muscle and fat are used for energy. Your provider will also probably run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies. Your provider will likely see if you're at high risk for gestational diabetes early in your pregnancy. If you're at high risk, your provider may test for diabetes at your first prenatal visit. If you're at average risk, you'll probably be screened sometime during your second trimester. TreatmentDepending on what type of diabetes you have, blood sugar monitoring, insulin and oral drugs may be part of your treatment. Eating a healthy diet, staying at a healthy weight and getting regular physical activity also are important parts of managing diabetes. Treatments for all types of diabetesAn important part of managing diabetes — as well as your overall health — is keeping a healthy weight through a healthy diet and exercise plan:
Treatments for type 1 and type 2 diabetesTreatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. For some people with type 1 diabetes, pancreas transplant or islet cell transplant may be an option. Treatment of type 2 diabetes mostly involves lifestyle changes, monitoring of your blood sugar, along with oral diabetes drugs, insulin or both. Monitoring your blood sugarDepending on your treatment plan, you may check and record your blood sugar as many as four times a day or more often if you're taking insulin. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People with type 2 diabetes who aren't taking insulin generally check their blood sugar much less often. People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology hasn't yet completely replaced the glucose meter, it can lower the number of fingersticks necessary to check blood sugar and provide important information about trends in blood sugar levels. Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol and stress. For women, you'll learn how your blood sugar level changes in response to changes in hormone levels. Besides daily blood sugar monitoring, your provider will likely recommend regular A1C testing to measure your average blood sugar level for the past 2 to 3 months. Compared with repeated daily blood sugar tests, A1C testing shows better how well your diabetes treatment plan is working overall. A higher A1C level may signal the need for a change in your oral drugs, insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors, such as other medical conditions you may have or your ability to feel when your blood sugar is low. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7%. Ask your provider what your A1C target is. InsulinPeople with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy. Many types of insulin are available, including short-acting (regular insulin), rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your provider may prescribe a mixture of insulin types to use during the day and night. Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Insulin is often injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen. An insulin pump also may be an option. The pump is a device about the size of a small cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a tube (catheter) that's inserted under the skin of your abdomen. A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. An insulin pump, attached to the pocket, is a device that's worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to give out more or less insulin depending on meals, activity level and blood sugar level. The Food and Drug Administration has approved four artificial pancreases for type 1 diabetes. An artificial pancreas is also called closed-loop insulin delivery. The implanted device links a continuous glucose monitor, which checks blood sugar levels every five minutes, to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates it's needed. There are more artificial pancreas (closed loop) systems currently in clinical trials. Oral or other drugsSometimes your provider may prescribe other oral or injected drugs as well. Some diabetes drugs help your pancreas to release more insulin. Others prevent the production and release of glucose from your liver, which means you need less insulin to move sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates, slowing their absorption, or make your tissues more sensitive to insulin. Metformin (Glumetza, Fortamet, others) is generally the first drug prescribed for type 2 diabetes. Another class of medication called SGLT2 inhibitors may be used. They work by preventing the kidneys from reabsorbing filtered sugar into the blood. Instead, the sugar is eliminated in the urine. TransplantationIn some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But transplants aren't always successful. And these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects. Because of this, transplants are usually reserved for people whose diabetes can't be controlled or those who also need a kidney transplant. Bariatric surgerySome people with type 2 diabetes who are obese and have a body mass index higher than 35 may be helped by having bariatric surgery. People who've had gastric bypass have seen major improvements in their blood sugar levels. But this procedure's long-term risks and benefits for type 2 diabetes aren't yet known. Treatment for gestational diabetesControlling your blood sugar level is essential to keeping your baby healthy. It can also keep you from having complications during delivery. In addition to having a healthy diet and exercising regularly, your treatment plan may include monitoring your blood sugar. In some cases, you may also use insulin or oral drugs. Your provider will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin. This can lead to low blood sugar right after birth. Treatment for prediabetesIf you have prediabetes, healthy lifestyle choices can help bring your blood sugar level back to normal. Or it could keep it from rising toward the levels seen in type 2 diabetes. Keeping a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing about 7% of your body weight may prevent or delay type 2 diabetes. Drugs — such as metformin, statins and high blood pressure medications — may be an option for some people with prediabetes and other conditions such as heart disease. Signs of trouble in any type of diabetesMany factors can affect your blood sugar. Problems may sometimes come up that need care right away. High blood sugar (hyperglycemia)Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your provider. And watch for symptoms of high blood sugar, including:
If you have hyperglycemia, you'll need to adjust your meal plan, drugs or both. Increased ketones in your urine (diabetic ketoacidosis)If your cells are starved for energy, your body may begin to break down fat. This makes toxic acids known as ketones, which can build up in the blood. Watch for the following symptoms:
You can check your urine for excess ketones with a ketones test kit that you can get without a prescription. If you have excess ketones in your urine, talk with your provider right away or seek emergency care. This condition is more common in people with type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndromeHyperosmolar syndrome is caused by very high blood sugar that turns blood thick and syrupy. Symptoms of this life-threatening condition include:
This condition is seen in people with type 2 diabetes. It often happens after an illness. Call your provider or seek medical care right away if you have symptoms of this condition. Low blood sugar (hypoglycemia)If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). If you're taking drugs that lower your blood sugar, including insulin, your blood sugar level can drop for many reasons. These include skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or too much of a glucose-lowering medication that causes the pancreas to hold insulin. Check your blood sugar level regularly and watch for symptoms of low blood sugar, including:
Low blood sugar is best treated with carbohydrates that your body can absorb quickly, such as fruit juice or glucose tablets. More Information
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unsubscribe link in the e-mail. Clinical trialsExplore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Lifestyle and home remediesDiabetes is a serious disease. Following your diabetes treatment plan takes total commitment. Careful management of diabetes can lower your risk of serious or life-threatening complications.
Lifestyle recommendations for type 1 and type 2 diabetesAlso, if you have type 1 or type 2 diabetes:
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Alternative medicineMany substances have been shown to improve the body's ability to process insulin in some studies. Other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren't any alternative therapies that are currently recommended to help everyone to manage blood sugar. If you decide to try any type of alternative therapy, don't stop taking the drugs that your provider has prescribed. Be sure to discuss the use of any of these therapies with your provider. Make sure that they won't cause bad reactions or interact with your current therapy. Also, no treatments — alternative or conventional — can cure diabetes. If you're using insulin therapy for diabetes, never stop using insulin unless directed to do so by your provider. Coping and supportLiving with diabetes can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan and you'll likely see a positive difference in your A1C when you visit your provider. Good diabetes management can take a great deal of time and feel overwhelming. Some people find that it helps to talk to someone. Your provider can probably recommend a mental health professional for you to speak with. Or you may want to try a support group. Sharing your frustrations and triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management. Your provider may know of a local support group. You can also call the American Diabetes Association at 800-DIABETES (800-342-2383) or the Juvenile Diabetes Research Foundation at 800-533-CURE (800-533-2873). Preparing for your appointmentYou're likely to start by seeing your health care provider if you're having diabetes symptoms. If your child is having diabetes symptoms, you might see your child's health care provider. If blood sugar levels are very high, you'll likely be sent to the emergency room. If blood sugar levels aren't high enough to put you or your child immediately at risk, you may be referred to a provider trained in diagnosing and treating diabetes (endocrinologist). Soon after diagnosis, you'll also likely meet with a diabetes educator and a registered dietitian to get more information on managing your diabetes. Here's some information to help you get ready for your appointment and to know what to expect. What you can do
Preparing a list of questions can help you make the most of your time with your provider. For diabetes, some questions to ask include:
What to expect from your doctorYour provider is likely to ask you many questions, such as:
Oct. 25, 2022 What is a good average glucose level?A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.
What is my A1C If my average blood sugar is 140?"An A1C of 8% can correspond to an average blood sugar of 140 mg/dl in one person, while in another it could be 220 mg/dl." For looking at an individual's glucose values, CGM is a better tool for measuring average sugar levels, time-in-range, and time below range.
What is normal sugar level by age?From 90 to 130 mg/dL (5.0 to 7.2 mmol/L) for adults. From 90 to 130 mg/dL (5.0 to 7.2 mmol/L) for children, 13 to 19 years old. From 90 to 180 mg/dL (5.0 to 10.0 mmol/L) for children, 6 to 12 years old. From 100 to 180 mg/dL (5.5 to 10.0 mmol/L) for children under 6 years old.
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