Type 1 diabetes

Like all types of diabetes, type 1 diabetes is a metabolic disorder. Metabolic disorders disrupt metabolism, which is the process by which the body produces energy from the food or drink you consume. T1D is also considered an autoimmune disorder, unlike type 2 diabetes (the most common type of diabetes).

The immune system usually helps protect the body from disease and infection. But in people with T1D, the immune system mistakenly attacks and destroys beta (β) cells, which are part of a group of cells in the pancreas known as pancreatic islets (also called islets of Langerhans). Beta cells are responsible for making a hormone called insulin.

During the process of digestion, food and drinks are broken down in the body into a form of sugar called glucose. Ordinarily, insulin helps move glucose from the bloodstream into cells throughout the body where it can be used as energy to support the body’s metabolic functions. In the process, insulin helps stabilize blood sugar levels.

With T1D, however, destruction of beta cells hampers the body’s ability to make insulin. In fact, people with T1D may have too little or no insulin at all. With limited insulin, sugar in the blood can no longer enter the body’s cells. It builds up in the bloodstream instead, causing high blood sugar levels and other symptoms.

T1D was formerly known as insulin-dependent diabetes or juvenile diabetes because it occurs most often in children, teens, and young adults. But people of any age can develop the disorder. In some cases, such as when T1D first develops later in life, it may be misdiagnosed as type 2 diabetes.

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Type 1 diabetes symptoms may start off mild but can become increasingly worse. This progression may happen quickly—sometimes within days to months of their first appearance.

People with T1D may be more prone to infections, which may take longer to clear. They may also notice that wounds tend to heal more slowly.

Other T1D symptoms can depend on whether blood sugar levels are high or low. These symptoms may include:

High blood sugar in people with type 1 diabetes

Symptoms of hyperglycemia (high blood sugar) may occur in people with type 1 diabetes. In some cases, these may be the first signs of diabetes:

• Blurry vision
• Increased thirst (polydipsia) or appetite/hunger (polyphagia)
• Increased fatigue and/or weakness
• Increased and frequent urination (polyuria), which may manifest as bedwetting during sleep in children or full diapers in infants and toddlers who aren’t potty trained
• Nausea, vomiting, and/or stomach pain
• Numbness or tingling in the feet
• Weight loss for no known reason

Low blood sugar in people with type 1 diabetes

People with type 1 diabetes may also develop hypoglycemia (low blood sugar) symptoms. These symptoms may come on quickly in people taking insulin injections to manage blood sugar levels (see below):

• Fast heartbeat and/or palpitations
• Headache
• Hunger
• Mood shifts such as feeling anxious, irritable, or anxious
• Shaking and tremors
• Sweating
• Weakness

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Although the exact cause of type 1 diabetes remains unknown, there are a number of factors that may play a role.

Gene mutations may play a role in T1D development

Researchers suspect that certain gene mutations may contribute to the development of type 1 diabetes. The main ones involve the human leukocyte antigen (HLA) gene variants HLA-DQ and HLA-DR, although other gene mutations may contribute to the development of T1D. The HLA association is stronger in T1D that develops in children compared to adults.

The HLA family of genes instruct a group of proteins referred to as the HLA complex, which play a key role in regulating the immune system. HLA gene mutations have also been linked with other autoimmune disorders such as celiac disease, multiple sclerosis, psoriasis, rheumatoid arthritis, and rosacea.

Viral, bacterial, and fungal infections may trigger T1D

It’s also believed that environmental factors may trigger autoimmune destruction of beta (β) cells. These include infections caused by a wide range of factors, including:

• Viruses such as the mumps virus, flu virus (influenza B), rubella virus (which causes German measles), cytomegalovirus (which is known to cause diseases such as hepatitis and mononucleosis), Coxsackie virus (which is known to cause infections such as meningitis and hand, foot, and mouth disease), and more recently SARS-CoV-2 (the virus that causes COVID-19)
• Bacteria such as Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa
• Fungi such as Aspergillus niger and A. fumigatus

Certain diets promote T1D development

Dietary factors may also play a role in the development of T1D. For instance, diets high in sugar and fats may hasten and even trigger the changes that cause the disease.

Antibodies may prompt T1D development

People with certain pancreatic islet autoantibodies may have a higher risk of T1D or already have the disease. (Autoantibodies are immune-system proteins called antibodies that mistakenly target and react with a person’s own tissues, organs, and cells.)

These antibodies include:

• Glutamic acid decarboxylase autoantibody (GADA), specifically isoform 65 (GAD65)
• Insulin autoantibodies (IAAs)
• Insulinoma antigen 2/islet tyrosine phosphatase 2 (IA-2)
• Islet cell cytoplasmic autoantibodies (ICAs)
• Zinc transporter isoform 8 (ZnT8)

IAAs are most often found in children, whereas GAD65 is the most common autoantibody found in adults.

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In addition to having certain gene mutations, the main risk factors for type 1 diabetes include:

Age: Although people of any age can get T1D, it often develops in children and young adults. In fact, the peak onsets tend to occur in children between the ages of 4 and 7 and 10 and 14.

Family history: People who have a biological parent or sibling with T1D carry a higher risk of having the disease themselves. This risk goes up even higher if both biological parents have T1D. That said, 85 to 90 percent of people who develop T1D don’t have a known family history of the disease.

Geography: The farther away people live from the equator, the higher the rates of T1D tend to be.

Race/ethnicity: White people in the U.S. are more likely to have T1D compared to Black, Hispanic, or Latino people. Worldwide, people of European ancestry have the highest rates of the disease.

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LADA shares features common to type 1 diabetes and type 2 diabetes. Therefore, some experts call it type 1.5 diabetes.

People with LADA experience slow, progressive β-cell destruction. Insulin deficiency isn’t present right away, but instead manifests slowly.

That said, there’s no universal consensus on how to classify, diagnose, and manage LADA. Because it destroys pancreatic islet β cells, the American Diabetes Association (ADA) classifies the disorder as a subtype of T1D referred to as type 1a, describing it as a slowly evolving form of classic T1D. The World Health Organization (WHO) classifies LADA as a hybrid form of diabetes, describing it as a “slowly evolving immune-related diabetes.”

LADA shares features common to type 1 diabetes and type 2 diabetes. Therefore, some experts call it type 1.5 diabetes.

LADA is the most common type of autoimmune diabetes among all people, but it often first develops during adulthood, with the average age of onset occurring after 30 years old. Most people who have it also have a single type of islet β-cell autoantibody, the most common being GADA.

Although there’s no standard classification system for LADA, the Immunology for Diabetes Society (IDS) recommends these criteria for diagnosing the disease:

1. Age older than 35 years
2. Presence of islet β-cell autoantibodies
3. Is not dependent on insulin therapy to control blood sugar levels during the first 6 months after diagnosis

Type 1b

The ADA refers to the second type of type 1 diabetes as type 1b. Unlike type 1a, there’s no evidence in the blood of autoimmunity. That is, there are no blood markers showing β-cell destruction by the immune system, although almost complete insulin deficiency occurs.

When type 1b first develops, people often experience severe hyperglycemia (high blood sugar) with diabetic ketoacidosis (DKA). This is a serious and potentially life-threatening complication of diabetes that causes blood sugar levels to spike. The body also rapidly makes ketones that build up to dangerous levels in the body. (Ketones are acids the liver makes when it breaks down fat for energy.)

Because of the rapid onset of type 1b and the severity of DKA symptoms (see below), people with the condition often need to be hospitalized for treatment when they first develop it. Because of its features, including some that are unusual for type 1 diabetes and some that overlap with type 2 diabetes, the WHO reclassified its description of this subtype to “ketosis-prone type 2 diabetes” in 2019. It’s also been called atypical diabetes and Flatbush diabetes.

Type 1b tends to occur in people assigned male at birth (AMAB) who are middle-aged and overweight or modestly obese. (Obesity class 1 is defined by a body mass index of 30 to less than 35.) Type 1b is also more common in people of African, Asian, and European-Mediterranean descent.

The following criteria are required for diagnosis of type 1b:

1. Absence of autoimmune blood markers showing β-cell destruction by the immune system
2. Insulin therapy/replacement is needed intermittently (instead of continuously)

Diabetic ketoacidosis signs and symptoms

Diabetic ketoacidosis (DKA) is most often associated with type 1 diabetes and occasionally with type 2 diabetes. DKA may be the first sign of diabetes in some people who have yet to be diagnosed.

Early symptoms of DKA may include increased thirst (polydipsia), hunger (polyphagia), or urination (polyuria). Left untreated, other DKA symptoms may develop quickly.

These may include:

• Abdominal (stomach) pain
• Decreased or no appetite
• Flushed face
• Fruity-smelling breath (due to high levels of ketones)
• Hypotension (low blood pressure), which may be a sign of more severe DKA
• Kussmaul breathing (sometimes described as “air hunger” because it causes a rapid, deep, and labored breathing pattern in response to conditions like DKA that cause a buildup of acids in the blood)
• Muscle aches and/or stiffness
• Nausea and/or vomiting
• Signs of dehydration such as dry mouth and skin along with decreased urine output and sweating
• Signs of cerebral edema (swelling in the brain due to fluid buildup) such as confusion, hallucinations, drowsiness, decreased alertness, or a severe or persistent headache

Left untreated, DKA can lead to further complications such as seizures, diabetic coma (caused by an overload of ketones in your blood), and even death.

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In 2015, the Juvenile Diabetes Research Foundation (JDRF), Endocrine Society, and ADA issued a joint statement introducing the three stages of type 1 diabetes. The staging system helps make it easier to identify and monitor T1D earlier in the disease course, even before diabetes symptoms start.

During each stage, two or more autoantibodies associated with type 1 diabetes can be detected in the blood. In addition, the following signs and symptoms manifest during each stage:

Type 1 diabetes: stage 1

Changes in the body that cause type 1 diabetes start. Although the immune system has already started attacking pancreatic islet β cells, blood sugar levels remain normal and no diabetes symptoms are present.

Type 1 diabetes: stage 2

Although blood sugar levels are now high due to greater loss of β cells, symptoms have yet to develop.

Type 1 diabetes: stage 3

A significant number of β cells have been destroyed by the immune system by stage 3, causing type 1 diabetes symptoms. At this point, a healthcare provider (HCP) can make an official T1D diagnosis.

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To determine whether you have type 1 diabetes, your HCP will talk with you about your symptoms and personal and family health history. This includes going over any risk factors you might have, such as whether any closely related blood relatives have the disease. 

This will be followed by a thorough physical exam in which your HCP will look for signs and symptoms of T1D, which likely includes checking your blood sugar with a small device called a glucometer (also called a blood glucose meter). This meter measures how much sugar is in a small drop of your blood taken from a finger prick.

Main diagnostic tests for diabetes

Based on these results, your HCP may order a blood test to confirm or rule out T1D. If the results of the first blood test show you have diabetes, your HCP may repeat the same blood test or order another type to confirm the diagnosis. Note that some of these blood tests may also indicate that you have prediabetes, a condition in which your blood sugar is higher than normal but not high enough to be classified as diabetes.

Fasting plasma glucose (FPG) test: This test measures your blood sugar level after you’ve fasted (not eaten) for at least eight hours. Results are as follows:

• Normal: Less than 100 milligrams per deciliter (mg/dL)
• Prediabetes: 100 to 125 mg/dL
• Diabetes: 126 mg/dL or higher

Glycated hemoglobin test: Also referred to as a hemoglobin A1C (HbA1C or A1C) test, your A1C measures your average blood sugar level over the previous three months. Results are as follows:

• Normal: Less than 5.7 percent
• Prediabetes: 5.7 to 6.4 percent
• Diabetes: 6.5 percent or higher

Oral glucose tolerance test (OGTT): This involves measuring your blood sugar levels before and two hours after drinking a highly concentrated sugar drink. An OGTT can assess how well your body processes sugar. Results are as follows:

• Normal: Less than 140 mg/dL
• Prediabetes: 140 to 199 mg/dL
• Diabetes: 200 mg/dL or higher

Random plasma glucose (RPG) test: Also called a casual blood glucose test, an RPG involves measuring your blood sugar at a random time (that is, at any point) during the day when you have what appear to be diabetes symptoms (such increased fatigue, urination, and/or thirst), regardless of whether you’ve eaten or fasted. An RPG result of 200 mg/dL or higher is likely due to diabetes, but another one of the tests mentioned above will be needed to confirm the diagnosis.

Other diagnostic tests for type 1 diabetes

Although the tests mentioned above can determine whether you have diabetes, they can’t pinpoint which type you have. Your HCP may therefore test your blood for the presence of autoantibodies commonly seen with type 1 diabetes only.

If your HCP suspects you have diabetic ketoacidosis (DKA) based on your symptoms, they may test your urine or blood for ketones. The test may also be ordered if your blood sugar is greater than 240 mg/dL and/or:

• You’re pregnant
• You’ve recently had surgery or a recent heart attack, stroke, pulmonary embolism (blood clot in a lung), or traumatic injury
• You take medications that can affect blood sugar such as corticosteroids and thiazides
• You abuse alcohol
• You have a serious infection such as pneumonia or a urinary tract infection

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Type 1 diabetes treatment involves a combination of medical therapy, lifestyle changes, blood sugar monitoring, and diabetes self-management education and support (DSMES). Your HCP will work with you to customize your treatment plan based on your symptoms and severity of your condition, as well as your age, other health conditions you have, and medications you currently take.

Insulin therapy for type 1 diabetes

An essential component of type 1 diabetes treatment is insulin therapy, which involves the use of synthetic insulin to help keep blood sugar levels from rising too high. Most insulin doses are delivered subcutaneously (subQ), which means you inject the doses into the layer of fat just beneath the skin. You would typically use a small-capacity syringe with a built-in needle, an insulin pen, or an insulin pump.

An insulin pump is a small, programmable device worn on the outside of the body. It’s connected to a semi-permanent tube that’s inserted into the fatty layer under the skin, most often in the upper arm or stomach. The pump can be programmed to deliver a specific dose of insulin throughout the day or at certain times, such as right before you eat.

There are several types of insulin used to treat T1D. They differ in terms of their:

• Onset: This is how long it takes the insulin dose to start reducing blood sugar levels.
• Peak time: This is the period of time when the insulin dose has reached its maximum strength and ability to lower blood sugar.
• Duration: This is the length of time the insulin dose will continue to decrease blood sugar levels.

The timing of when insulin therapy is given, as well as its characteristics, will vary depending on the type of insulin used. For example:

• A bolus dose of a rapid- or short-acting insulin may be given shortly before mealtimes.
• A basal (background) dose of intermediate- or long-acting insulin may be given once or twice daily to keep blood sugar levels from rising between meals and during sleep.
• A basal-bolus regimen involves taking a rapid-acting insulin just before mealtimes and a long-acting insulin once or twice per day as prescribed by your HCP.

Rapid-acting insulin

A rapid-acting insulin dose is usually injected subQ before each meal. (An insulin with longer duration may also be used along with this insulin type.) The characteristics of rapid-acting insulin are:

• Onset: About 15 minutes
• Peak time: About 1 hour
• Duration: About 2 to 4 hours

Examples of rapid-acting insulin injected subQ include aspart, glulisine, and lispro. An inhaled form of rapid-acting insulin is also available.

Described as a technosphere insulin-inhalation system, the onset of this inhaled insulin is about 12 to 15 minutes, its peak is about 30 minutes, and its duration is about 180 minutes. It’s taken just before a meal. A long-acting injectable insulin may also be used with this inhaled type.

Short-acting insulin

Also called regular insulin, a short-acting insulin dose is usually injected subQ about 30 to 60 minutes before each meal. Its characteristics are as follows:

• Onset: About 30 minutes
• Peak time: About 2 to 3 hours
• Duration: About 3 to 6 hours

Various brand name formulas of regular (also referred to as human) insulin are available as injectable or intravenous solutions or as inhaled powders.

Intermediate-acting insulin

An intermediate-acting insulin dose can cover insulin needs for about half the day or during sleep. It’s usually given twice a day to keep blood sugar levels steady throughout the day. It may be used with a rapid- or short-acting insulin.

Its characteristics are as follows:

• Onset: About 2 to 4 hours
• Peak time: About 4 to 12 hours
• Duration: About 12 to 18 hours

Various brand name formulas of neutral protamine Hagedorn (NPH, also called isophane) insulin provide intermediate effects.

Long-acting insulin

A long-acting insulin dose can cover insulin needs for up to a day. A daily dose is usually given before bedtime. If needed, it can be used with a rapid- or short-acting insulin.

Its characteristics are as follows:

• Onset: Around 2 hours
• Peak time: None (doesn’t peak)
• Duration: Up to 24 hours

Examples of long-acting insulin include degludec, detemir, and glargine.

Ultra-long-acting insulin

An ultra-long-acting insulin dose provides a steady amount of insulin for extended periods. A daily dose is usually given before bedtime. Its characteristics are as follows:

• Onset: Around 6 hours
• Peak time: None
• Duration: Around 36 hours or longer

Glargine U-300 is an ultra-long-acting insulin used to treat type 1 diabetes.

Premixed insulin

These formulas combine an intermediate- and short-acting insulin. The characteristics of premixed insulins are as follows:

• Onset: Around 5 to 60 minutes
• Peak time: Varies
• Duration: Around 10 to 16 hours

A premixed insulin may be helpful for people who have a hard time drawing insulin doses from two separate vials due to issues with manual dexterity (use of their hands and fingers). It may also come in handy for people who have trouble reading labels for dosing and safety information due to vision problems. It can be a convenient option for people whose T1D remains stable with this combined dose.

Other type 1 diabetes medications

Adjunctive medications for type 1 diabetes may also be used. These complement rather than replace insulin therapy. They may help people with T1D manage blood sugar levels more effectively, as well as some of the metabolic issues that sometimes occur with the disorder, such as obesity and insulin resistance.

Also called impaired insulin sensitivity, insulin resistance occurs when muscle, fat, and liver cells build a tolerance to insulin, rendering the hormone less effective. With insulin resistance, increasing amounts of insulin are needed to facilitate the movement of glucose into fat and muscle cells and to help the liver store glucose.

One or more of the following adjunctive diabetes medications may be added to your T1D treatment plan:

Pramlintide

This is a form of medicine called a synthetic amylin analog (or agonist), which mimics the effects of amylin (a hormone released by the pancreas along with insulin). For people who take insulin before meals but are still unable to achieve target blood sugar levels, pramlintide may be added to the treatment plan for better blood sugar control. The injectable medicine may also help with weight loss and lessen the risk for cardiovascular disease (CVD).

Metformin

Although the oral diabetes medication metformin was originally used to treat type 2 diabetes, it may also be prescribed as an added treatment for people with T1D. It can help boost insulin sensitivity and lower insulin dose requirements, particularly in people who are insulin resistant and overweight or who have a higher risk for CVD.

Glucagon-like peptide-1 (GLP-1) receptor agonists

GLP-1 receptor agonists are also more commonly prescribed for type 2 diabetes, although they may also be considered for off-label treatment of T1D. (Off-label means the medication is being used as recommended by an HCP, although that purpose is not indicated on the product label or package insert as approved by the U.S. Food and Drug Administration.)

Oral and injectable forms of these medications can help support blood sugar management and decrease insulin doses. They may also help with weight loss and lower the risk of CVD.

Examples of GLP-1 receptor agonists used to treat T1D include:

• Dulaglutide
• Exenatide and exenatide extended release
• Liraglutide
• Lixisenatide
• Semaglutide

Blood pressure and cholesterol medicines

Over time, high blood sugar levels can affect heart health, including raising blood pressure and cholesterol levels. Medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) may be prescribed for people with T1D whose blood pressure levels tend to stay above 130/80 mm Hg without treatment. By controlling blood pressure, ACE inhibitors and ARBs also support kidney health.

Medications typically used to lower cholesterol such as statins may also be prescribed for certain adults, including some at higher risk of atherosclerosis (a buildup of waxy, fatty deposits called plaques), which is a major cause of CVD.

Examples of ACE inhibitors include:

• Benazepril
• Captopril
• Enalapril
• Fosinopril
• Lisinopril
• Moexipril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril

Examples of ARBs include:

• Azilsartan
• Candesartan
• Irbesartan
• Losartan
• Olmesartan
• Telmisartan
• Valsartan

Examples of statins include:

• Atorvastatin
• Fluvastatin
• Lovastatin
• Pitavastatin
• Pravastatin
• Rosuvastatin
• Simvastatin

Vaccines for people with type 1 diabetes

Diabetes can impair immune function, raising the risk for serious infections. Therefore, HCPs generally recommend the following vaccines for people with diabetes:

• Annual flu vaccine
• Hepatitis B vaccine
• Herpes zoster (shingles) vaccine
• Tetanus, diphtheria, and pertussis (Tdap) vaccine

Your HCP may also advise you get these shots if you have T1D:

• COVID-19 vaccine
• Hepatitis A vaccine
• Measles, mumps, rubella (MMR) vaccine
• Polio vaccine

If you have T1D, be sure to ask your HCP which vaccines are best for you and how often to get them.

Blood sugar (glucose) monitoring for type 1 diabetes

Monitoring your blood sugar levels lets you know how various foods and activities impact these levels and how well your type 1 diabetes treatment plan is working. Keeping your blood sugar levels within the target range as determined with your HCP can help you prevent complications associated with T1D (see below).

In general, the target range for blood sugar before meals is between 80 and 130 mg/dL, whereas one to two hours after meals the goal is to keep blood sugar levels below 180 mg/dL. Check with your HCP to see which target ranges are best for you, as these may vary based on factors such as your age, lifestyle, and other health conditions you might have.

Blood sugar monitoring devices

Keeping track of your blood sugar levels may involve the use of certain devices, including a:

Blood glucose meter: This involves pricking your finger to obtain a small drop of blood, which is placed onto a test strip. Once the test strip is inserted into the glucose meter, it measures your blood sugar level within seconds.

Continuous glucose monitoring (CGM): These wearable devices monitor glucose levels in the fluid between your cells, which is similar to that of your blood sugar levels. CGMs can track your sugar levels around the clock, providing updates via a tiny sensor that’s inserted under the skin (often the skin on your belly or arm) and kept in place with a sticky patch.

These disposable sensors are replaced depending on the type of sensor you have, often every 7 to 14 days. Some can last up to 180 days. Your blood sugar levels are wirelessly transmitted to the CGM device’s software downloaded onto your smartphone, insulin pump, or a separate device called a receiver.

Closed-loop system: This involves the use of a CGM device that’s implanted inside the body and links to an insulin pump. The appropriate dose of insulin is automatically given based on information from the CGM.

Closed-loop systems currently approved by the FDA for tracking and treating type 1 diabetes are hybrid systems, which may require user input prior to delivery of the insulin dose. For instance, you may need to enter the amount of carbohydrates you’ve eaten within a given time frame or confirm your blood sugar levels on occasion. Clinical trials involving closed-loop systems that don’t require user input are underway, although no such technologies are currently available to consumers.

Lifestyle interventions for type 1 diabetes

These include following a healthy eating plan and getting sufficient amounts of exercise on a regular basis. Doing so can help you achieve and maintain a healthy weight, lower your risk of cardiovascular complications, and manage your blood sugar levels more effectively.

Eating with type 1 diabetes

There’s no one approach to eating for people with type 1 diabetes, although certain dietary patterns have been shown to help reduce blood sugar and blood pressure levels and lower CVD risk factors more effectively. These include:

• Dietary Approaches to Stop Hypertension (DASH) diet
• Mediterranean diet
• Low-carbohydrate diet
• Low-fat diet
• Vegetarian and vegan diets

Focus on eating whole, nutrient-rich foods that are low in fat and high in fiber such as fruits, vegetables, and whole grains. Lean proteins can also be part of a wholesome eating plan, although a registered dietitian nutritionist (RDN) may recommend eating fewer animal products. You’ll also want to reduce your intake of refined carbohydrates (such as white breads and sweets) and foods and drinks with added sugars.

Along with helping you develop an eating plan for type 1 diabetes that suits your needs, preferences, and lifestyle, an RDN can also teach you how to count carbohydrates in your diet. This is an essential component of diabetes management because eating too much of this type of macronutrient can raise your blood sugar levels. Carb counting involves calculating the number of grams of carbohydrates you consume with each meal and adjusting your insulin dose based on this information.

Exercising with type 1 diabetes

Although staying physically active on a regular basis is an integral part of diabetes management, it’s important to talk with your HCP about how to exercise safely with type 1 diabetes. This is key if you’re starting a new workout plan and haven’t been active in a while or if you are making significant changes to your workout routine.

Physical activity can cause your blood sugar to drop, and some activities have a greater effect than others. Your HCP may recommend you check your blood sugar more often when starting a new exercise regimen. They can also help you with meal timing and adjusting your insulin dose based on the type, intensity, and duration of your activity.

Diabetes self-management education and support (DSMES)

DSMES services help people with type 1 diabetes learn more about the disorder and how to manage it on their own. It may involve working with an RDN, a nurse (who is likely a diabetes care and education specialist), or other HCPs who can teach you effective ways to manage T1D, including:

• Understanding which foods support healthy blood sugar levels
• Counting carbs
• Staying safe while exercising with T1D
• Learning how diet, exercise, and illness affect blood sugar levels
• Knowing how and when to take the various types of insulin, including how to give yourself a dose
• Knowing when to test your blood sugar levels and how to use your glucose monitoring device
• Coping with the stressors of living with types 1 diabetes
• Knowing how and when to test for ketones

Pancreas transplant

Although you may no longer need insulin after a successful pancreas transplant, the procedure itself poses serious risks that may be more dangerous than having T1D. Moreover, transplants aren’t always successful. For this reason, pancreas transplants are often reserved for people with severe type 1 diabetes that’s hard to manage, or for those who also need a kidney transplant.

Pancreatic islet cell therapy for type 1 diabetes

In June 2023, the U.S. Food and Drug Administration (FDA) approved the first allogeneic (donor) pancreatic islet cell therapy for type 1 diabetes. Made from deceased donor pancreatic cells, donislecel-jujn (Lantidra) may be considered for people who have trouble regulating the amount of insulin they need to prevent hyperglycemia (high blood sugar).

These patients are at risk for and experience recurrent episodes of severe hypoglycemia (low blood sugar). They may also be unaware of having hypoglycemia, which makes it harder for them to detect or treat low blood sugar levels before they drop further.

Proper insulin dosing becomes more challenging in these cases. Despite intensive diabetes education and management, people in these situations are unable to stay within target A1C levels (less than 5.7 percent).

Lantidra involves a single infusion of donor islet beta cells in the hepatic (liver) portal vein, although an additional infusion may be given based on a person’s response to this first dose. Some people who receive this T1D treatment no longer need insulin therapy for a period of time to manage their blood sugar levels, as these infused beta cells produce sufficient amounts of the hormone.

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Along with diabetic ketoacidosis (DKA), the potential complications of type 1 diabetes include:

• Cerebrovascular disease (conditions that affect blood flow to the brain). These include stroke and transient ischemic attack (TIA, which produces stroke symptoms that last for a few minutes or up to 24 hours).
• Diabetic foot diseases, including foot ulcers (sores) and amputations
• Heart disease, including coronary artery disease (narrowing or blockage of the arteries that supply blood to the heart), cardiomyopathy (disease affecting the heart muscle, causing it to be enlarged, thicker, stiff, and/or weak), and heart failure
• Hearing loss
• Nephropathy (when kidney function deteriorates due to kidney disease) and kidney failure (also called end-stage kidney or renal disease)
• Neuropathy. This includes damage to the nerves outside of the brain and spinal cord (called peripheral neuropathy) and to the nerves that control automatic body functions (called autonomic neuropathy) such as bladder function, blood pressure, digestion, sexual function, and temperature control.
• Macular edema (swelling of the macula, which is the small, round area at the center of the retina, the light-sensitive layer of tissue in the back of the eye). The condition causes blurry vision and colors that appear washed out.
• Peripheral artery disease (the narrowing or blockage of the arteries that carry blood from the heart to the legs)
• Retinopathy (damage to the blood vessels in the retina, potentially causing vision loss and blindness in people with diabetes)

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If you’ve been diagnosed with type 1 diabetes, it’s important to check in with your HCP on a regular basis to discuss how well your treatment plan is working. Follow-up testing may be needed along with adjustments along the way.

To help prevent the complications associated with T1D and to keep your condition from getting worse, it’s also important to get prompt medical attention if you experience any of the following symptoms, especially if they persist or are severe:

High or low blood sugar levels: If you have trouble staying within your target blood sugar range (as discussed with your HCP) despite sticking to your diabetes treatment plan, be sure to let your HCP know right away. They may need to make adjustments to your treatments to help you better control your blood sugar levels.

Illness or infection: Being sick can affect your blood sugar levels and you may find it harder to recover from illness when you have T1D. Seek medical care if you have persistent or severe symptoms of an infection such as fevers (higher than 101 degrees Fahrenheit) that don’t respond to temperature reduction measures (such as taking acetaminophen). Likewise, consult with an HCP if you have stomach and digestive issues like diarrhea and/or vomiting more than three times over a 24-hour period. If you’re unable to keep fluids down, it’s best to go to your nearest hospital emergency department (ED).

Nerve damage: T1D can damage the nerves, causing symptoms such as numbness, tingling, and nerve pain, especially in your hands, feet, arms, or legs. Even if these symptoms are mild or seem to come and go, be sure to let your HCP know right away. Early treatment can help prevent further damage to the affected nerves along with associated complications.

Skin infections or wounds: These may heal more slowly when you have T1D. If you notice that wounds such as cuts and sores just won’t heal or you notice these have become infected, be sure to see your HCP as soon as possible. People with T1D are at higher risk for serious skin infections such as cellulitis, which can cause pain, discoloration, and tenderness at the site along with symptoms that affect the entire body such as fever and chills.

DKA signs and symptoms: If you experience any of the signs and symptoms of diabetic ketoacidosis (DKA), be sure to call your HCP immediately or go to your nearest hospital ED. These include symptoms of cerebral edema (such as confusion and decreased alertness), Kussmaul breathing pattern, and low blood pressure that persists. Note that these symptoms often require emergency medical care to prevent further complications, which may include serious illness or death.

Create a type 1 diabetes sick-day plan

Plan ahead. Discuss DKA and other emergency symptoms of T1D with your HCP before any of these occur, along with the appropriate interventions and actions to take.

Write out a sick-day plan with guidance from your HCP. Make sure your plan includes what actions to take when you’re ill, such as:

• When to call your HCP, as well as when to go to the ED for immediate treatment
• Which foods and fluids are best to have when you’re sick
• If, when, and how you need to adjust the dose of your diabetes medicines, including your insulin
• If, when, and how to test for ketones
• Which over-the-counter cold and flu medications are best to take, as some can raise your blood sugar levels

What questions should you ask your healthcare provider?

Be sure to ask your HCP any questions you might have about type 1 diabetes. Some you might want to ask include:

• Which diabetes medicines do I need to take? What are the risks and benefits of each?
• Do I need to take diabetes medicine for the rest of my life?
• What lifestyle interventions can complement my type 1 diabetes treatment plan?
• How can I tell whether my type 1 diabetes treatment plan is working?
• What blood sugar levels do I need to aim for?
• When and how often do I need to check my blood sugar levels?
• Do I need to check my blood sugar levels even when I’m feeling well or don’t have any symptoms?
• Which type 1 diabetes signs and symptoms indicate that my blood sugar is too high or low?
• Which signs and symptoms require emergency medical care? What do I need to do in these situations?
• Where can I learn more about managing type 1 diabetes?
• When and how often do I need to schedule follow-up appointments?

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Although there’s no known way to prevent type 1 diabetes, researchers are actively studying approaches to prevent the disease, along with ways to keep it from causing further damage to islet beta cells.

This includes conducting T1D clinical trials, which are studies that investigate the safety and effectiveness of new medical tests and treatments in human volunteer participants. If you’d like to participate in a clinical trial or learn more about them, be sure to talk with your HCP. They can discuss the risks and benefits of treatments used and which trials might be appropriate for you.

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Type 1 diabetes is a lifelong disease with no known cure. Nearly half of all people with the condition eventually develop serious complications, including blindness and kidney failure.

Strict blood sugar monitoring and management can help prevent and/or minimize T1D complications, although complications can sometimes occur in people with well-controlled diabetes. The outlook tends to be positive for people who don’t experience complications after 20 years of living with the disorder.

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Living with type 1 diabetes requires careful management and planning. Along with lifestyle interventions such as eating healthy, nutrient-rich foods and staying physically active on a regular basis, the tips below may also help you better manage your T1D and the challenges that can come with it.

Commit to keeping your T1D well-controlled. This includes following your diabetes treatment plan and working with your HCP to make adjustments as needed.

Manage your blood pressure and cholesterol levels. It helps to stay active on a regular basis and follow a healthy eating plan. If needed, your HCP can also prescribe medications to treat high blood pressure and high cholesterol.

Prep for emergencies. This might include wearing a bracelet that identifies your condition. Keep a glucagon kit handy just in case your blood sugar levels dip too low, and make sure you and friends and loved ones with whom you regularly interact know how to use it. (Glucagon is a prescription hormone that prompts the liver to release stored glucose into the bloodstream.)

The ADA also recommends following the “15-15 rule” to manage hypoglycemic episodes. This entails eating or drinking 15 grams of carbs to bring your blood sugar back up. Recheck your blood sugar after 15 minutes, and if it’s still below 70 mg/dL, consume another 15 grams of carbs. Repeat these steps until your blood sugar level is at least 70 mg/dL.

If you’re experiencing hypoglycemia symptoms but are unable to test your blood sugar levels, use the 15-15 rule until your symptoms get better. Children often need fewer grams of carbs to manage hypoglycemia. It’s therefore best to check with their HCP to determine how many carbs they need to consume in these instances.

Pamper your feet. Wash your feet every day in lukewarm water, dry them gently and thoroughly, and keep them moisturized with a gentle emollient cream or lotion. Check your feet daily for wounds and other skin issues such as discoloration, swelling, blisters, cuts, and/or sores. If you notice your wounds aren’t healing or are infected, be sure to have your HCP look at them as soon possible.

Get routine physical exams and regular eye exams. In addition to getting diabetes checkups on a schedule you set with your HCP, it’s important to get regular physical and eye exams to spot complications of T1D that may affect your body and vision.

Quit smoking tobacco or never start. Smoking raises the risk of T1D complications such as a heart attack, stroke, kidney disease, and nerve damage. If needed, your HCP can help you with an effective plan to quit smoking.

Limit or avoid alcohol. Drinking alcohol can cause high or low blood sugar, depending on how much you consume and whether you’ve eaten food at the same time or shortly beforehand. If you choose to drink, try to limit how much you have. Never drink on an empty stomach. Also, be sure to recheck your blood sugar before going to bed.

Manage stress and find ways to relax. Long-term or severe stress can affect your hormone levels, which may impact how well insulin works. Try to take a mental and physical break from your stressors, if possible. You may want to find ways to help you unwind and let go of stress such as coloring to calm your mind, moving gently with yoga or tai chi, or listening to music that soothes your soul. Also, be sure to get plenty of sleep after a stressful day.

Prioritize your mental health. Living with a chronic health condition such as type 1 diabetes can sometimes feel overwhelming or make anxiety or depression worse. Consider reaching out for help from a licensed mental health provider if the stress you’re feeling has become too hard to manage on your own or you feel like it’s making mental health conditions you have even worse.

Find your community. Share your thoughts and feelings with people you trust, whether that’s a close friend, family member, or spiritual advisor. You may also want to join an online or in-person group for people living with type 1 diabetes. This may help you find common cause with others who know what it feels like to live with the condition.

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