Type 1 diabetes

Type 1 diabetes is a condition where your body cannot make a hormone called insulin. This causes the level of glucose (sugar) in your blood to get too high.

What is type 1 diabetes?

• Type 1 diabetes is a condition where your body cannot make a hormone called insulin.
• Insulin helps your body use glucose (sugar) for energy. Without insulin the level of glucose in your blood becomes too high.
• If you have type 1 diabetes, you'll need to take insulin every day to manage your blood glucose levels.
• Type 1 diabetes often starts in children and young adults, but it can happen at any age.
• There's currently no cure for type 1 diabetes, but it can be managed by checking your blood glucose regularly, tracking what you eat and drink, and adjusting how much insulin you take.
• It's not possible to prevent type 1 diabetes. It's caused by a problem with your immune system (autoimmune condition).
• Type 1 diabetes is different from type 2 diabetes, which is more common in older people and people who are overweight.

Symptoms of type 1 diabetes and how it's diagnosed

Symptoms of type 1 diabetes

The most common symptoms of type 1 diabetes are:

• peeing more than usual
• feeling very thirsty
• feeling very tired
• losing weight quickly without trying to

Other symptoms can include:

• blurred vision
• breath that smells sweet or fruity (like nail polish remover or pear drop sweets)
• cuts and wounds taking longer to heal
• getting frequent infections, such as thrush

The symptoms develop quickly, over a few days or weeks.

If it's not treated, it can lead to a serious condition called diabetic ketoacidosis.

Type 1 diabetes usually starts in children and young adults, but it can happen at any age.

You're more likely to get it if you have other problems with your immune system (autoimmune conditions), or if others in your family have type 1 diabetes or other autoimmune conditions.

The symptoms are similar to type 2 diabetes, but type 2 diabetes usually develops more slowly and is more common in older people.

Call 112 or go to A&E if:

You or your child have been peeing more, feeling very thirsty and tired, and:

• your symptoms are getting worse quickly
• you have stomach pain, diarrhoea, or you're feeling or being sick
• you're feeling sleepy or confused
• you're breathing faster and more deeply than usual

These could be signs of diabetic ketoacidosis, which can be life threatening if not treated quickly.

Do not drive to A&E. Ask someone to drive you or call 112 and ask for an ambulance.

Bring any medicines you take with you.

How type 1 diabetes is diagnosed

If a GP thinks you could have type 1 diabetes, they'll do some blood tests by taking a blood sample or pricking your finger to check for high blood glucose. They may also test a sample of your pee.

If tests show you might have type 1 diabetes, you'll need to be referred to a specialist in hospital for more tests and to start treatment. You'll usually be seen urgently, the same day.

Doctors will usually confirm whether you have type 1 diabetes or another type of diabetes based on your age, weight and symptoms.

But if it's not clear which type you have, you may need extra blood tests.

If you're told you have type 1 diabetes

If you or your child are diagnosed with type 1 diabetes, it can feel overwhelming. You may be feeling anxious about how it will affect you.

A team of specialists will help you get the right treatment and support. You can ask them any questions you may have.

A diabetes nurse in hospital or at a clinic will show you the things you need to do to start managing the condition.

Treatment for type 1 diabetes

Main treatments for type 1 diabetes

When you're first diagnosed with type 1 diabetes you'll be treated in hospital by a specialist diabetes team. They'll show you how to treat your condition once you leave hospital.

The main treatment for type 1 diabetes is taking a medicine called insulin to manage your blood glucose (sugar) levels.

To stay well, you'll need to try to keep your blood glucose levels within a target range. You'll be taught how to do this by checking your blood glucose regularly and adjusting your insulin doses.

Your diabetes care team will work with you to develop a care plan.

This will include:

• advice and courses to help you learn about type 1 diabetes, including how to match your insulin dose to what you eat and drink (counting carbohydrates, or carb counting)
• what type of insulin is best for you, and how and when to take it
• how and when to check your blood glucose and what your targets are
• reviews 2 to 4 times a year of your HbA1c level, which is your average blood glucose level for the last 2 to 3 months
• how to recognise and treat low blood glucose (hypoglycaemia, or hypos) and high blood glucose (hyperglycaemia)
• advice about things like diet, alcohol, driving, exercise and what to do when you're ill (called sick day rules)
• checking for and treating any complications
• support for your wellbeing and mental health

You'll be given the equipment you need to treat your diabetes, such as a blood glucose meter and equipment for taking insulin.

You'll have regular tests and check-ups with your diabetes team.

Insulin

Insulin is a medicine that reduces your blood glucose (sugar).

There are different types of insulin, taken at different times. You'll need to calculate how much you need and inject it several times a day using an insulin pen, or use an insulin pump.

Too much insulin causes hypoglycaemia, or hypos. You'll be taught how to recognise the symptoms and how to treat a hypo.

Your diabetes care team will help you find the insulin routine that's best for you.

If you have type 1 diabetes, you're entitled to free prescriptions for all your medicines.

Insulin pumps

An insulin pump is a small device you attach to your skin and wear all the time. It gives you tiny amounts of insulin throughout the day and night. This can reduce hypos and improve your blood glucose levels, compared to insulin injections.

• you cannot reach your target average blood glucose level (HbA1c level) without having serious problems with hypos
• your HbA1c levels are too high despite carefully trying to manage your diabetes

Pumps are also recommended for children under 12 years old who cannot easily have injections several times a day.

Hybrid closed loop systems

Some types of insulin pump work with a continuous glucose monitor to automatically give you the right amount of insulin based on your blood glucose levels. This is called a hybrid closed loop system.

A hybrid closed loop system can reduce hypos, improve your blood glucose levels and reduce the burden of managing diabetes.

You may be able to have one if:

• you're under 18 years old
• you're pregnant or planning to get pregnant
• an insulin pump or continuous glucose monitor on its own is not working well enough to reduce your blood glucose or prevent serious problems with hypos

Living with type 1 diabetes

Managing your blood glucose

If you have type 1 diabetes, you'll need to:

• check your blood glucose (sugar) regularly
• check how much carbohydrate is in your food and drink (called carb counting)
• take insulin several times a day
• watch out for signs of hypoglycaemia (hypos) and know how to treat it

Checking your blood glucose

Checking your blood glucose is quick and easy for most people.

You'll be offered a blood glucose meter, small needles (lancets) and test strips to do finger-prick tests.

You should also be given a continuous glucose monitor (CGM). This gives you readings at any time and reduces the number of finger-prick tests you need to do.

It's recommended that you check your blood glucose at least 4 times a day (or at least 5 times for children), including before meals and before bed.

Check it more often when you're doing things that can affect it, such as exercise or drinking alcohol, or when you're unwell.

Blood glucose targets

Your diabetes team will discuss with you what blood glucose levels to aim for.

As a guide, the ideal range is:

• when you wake up, before you've eaten: 5 to 7mmol/L for adults, or 4 to 7mmol/L for children
• before meals at other times of the day: 4 to 7mmol/L
• at least 90 minutes after meals: 5 to 9mmol/L

It's not possible to achieve these recommended ranges all the time. But if you can keep your blood glucose levels within these ranges for around 70% of the time, this will reduce your chance of getting complications in the future.

Diabetes and driving

If you drive, you'll need to tell the DVLA you have diabetes and take insulin. The DVLA will not usually stop you driving, but you'll need to show you can manage hypos safely. Most people with diabetes can continue to drive.

You must also follow the DVLA's rules about checking your blood glucose before driving and during your journey, and stopping straight away if you get signs of a hypo.

Carb counting

Knowing how many carbohydrates (carbs) you're eating and drinking helps you manage your blood glucose levels by matching your insulin dose to your food. This means you can be more flexible in what you eat.

You can learn about carb counting by doing a type 1 diabetes course, such as DAFNE (Dose Adjustment for Normal Eating). There are also apps that can help.

Taking insulin

You'll take insulin using an insulin pen or an insulin pump. It does not usually hurt, as the needles are very small.

You'll need to adjust your dose depending on your food and drink, your blood glucose and things like how much exercise you do.

Your diabetes nurse will show you how to use your pen or pump. It's important to change where you inject or put your pump each time, and use the right technique, to help prevent problems.

Recognising and treating hypoglycaemia (hypos)

Hypoglycaemia (a hypo) happens when your blood glucose level is too low. It usually needs to be treated if it's below 4mmol/L.

Mild hypos are common and do not usually cause any lasting problems.

They can happen when you have not had enough carbohydrates or you've taken too much insulin.

You'll need to be aware of the symptoms, such as feeling hungry or dizzy, sweating and shaking.

It's important to treat a hypo quickly, before it gets worse, by having a sugary drink or snack.

Things you can do to help manage type 1 diabetes

If you have type 1 diabetes, there are things you can do to help manage your blood glucose levels and avoid any problems.

Do

• always carry something with you that will raise your blood glucose quickly, such as sugary drinks, sweets or glucose tablets

• make sure your family and friends know how to recognise a hypo and what to do

• carry medical ID, such as a bracelet or a card that lets people know you have type 1 diabetes

• be aware of when you may need to check your blood glucose more often, such as in hot weather or during your period

• check your blood glucose before, during and after exercise – you may also need to eat more carbohydrate and reduce your insulin dose to prevent hypos

• ask your care team about getting a continuous glucose monitor if you do not already have one

• follow guidelines from your care team about what to do when you're ill and how to adjust your insulin dose (sick day rules)

• if you need to go to hospital, or have any surgery or procedures, tell the staff treating you that you have type 1 diabetes and you take insulin

• if you're going abroad, take a letter about your diabetes from your GP or diabetes team, and follow advice about travelling with insulin

• contact your diabetes team if you have any questions or concerns

Don’t

• do not drink too much alcohol – keep to the recommended guidelines of no more than 14 units of alcohol a week, spread over 3 days or more

• do not drink alcohol on an empty stomach

How type 1 diabetes affects your life

Managing type 1 diabetes can be a challenge and take time to get used to. Constantly trying to meet blood glucose targets can lead to a feeling of burnout.

You'll need to do more planning for things like school or work, travel, eating out and exercise.

But with the right treatment and support, you can eat normally, continue with your usual work and still do all the things you enjoy.

Type 1 diabetes can increase your chance of getting other health problems (long-term complications), such as heart disease, nerve damage and problems with your eyesight. But you'll be given care to help prevent these.

You can also lower your chance of getting complications by managing your blood glucose levels as well as you can.

People with type 1 diabetes also have a higher chance of getting other conditions caused by problems with your immune system (autoimmune conditions), such as thyroid disease, coeliac disease and Addison's disease.

Diabetes treatments and technologies are improving, so people diagnosed with type 1 diabetes today should be able to expect a better quality of life than was possible before.

Many people with type 1 diabetes are able to avoid complications and have long, healthy lives.

Pregnancy and type 1 diabetes

You can have a healthy pregnancy if you have type 1 diabetes. But managing diabetes might be harder while you're pregnant.

Planning a pregnancy can reduce the chance of problems for you and your baby.

It's important to manage your blood glucose levels as well as you can before and during your pregnancy to keep you and your baby well.

Speak to your diabetes team if you're planning to get pregnant. You'll be offered extra appointments and tests, and help with your diabetes treatment.

Complications of type 1 diabetes

Long-term complications of type 1 diabetes

Having type 1 diabetes can increase your chance of getting other health problems. These can develop over time and are linked to high blood glucose (sugar).

You can lower your chances of complications by managing your blood glucose as well as you can and making healthy lifestyle changes, such as eating a balanced diet, exercising and not smoking.

Your diabetes team will work with you to keep you as well as possible.

Important

It's important to go to all of your diabetes appointments and make sure you do not miss any tests, as these can help find and treat any complications as soon as possible.

Heart disease and stroke

Type 1 diabetes can damage your blood vessels, which can lead to coronary heart disease and stroke.

As well as managing your blood glucose, you can reduce the risk by looking after your cholesterol level and blood pressure.

Adults will have tests every year to check for high cholesterol, and both adults and children will have tests for high blood pressure.

Foot problems

Diabetes can damage your nerves (called neuropathy) and reduce the blood supply to your feet, causing a loss of feeling. This means injuries do not heal well and you may not notice if you've hurt your foot.

This can lead to problems such as ulcers and infections. If these get worse, you could need surgery.

You can help to avoid problems by:

• checking your feet every day
• keeping your feet clean and dry
• wearing shoes that fit well
• having a foot check-up at least once a year
• getting medical help quickly if you injure your feet

See a GP or diabetes nurse if:

• you have any pain, tingling, numbness or blisters in or on your feet

Sight problems

Diabetes can damage the blood vessels in your eyes. This can cause sight problems (diabetic retinopathy) and in severe cases can lead to blindness, although this is uncommon.

People with type 1 diabetes are also more likely to get cataracts and glaucoma.

Adults and children aged 12 or over will be offered diabetic eye screening every year.

Changes to your eyes usually have no symptoms at first, so it's important to have this check to help find and treat any damage before it affects your sight.

Ask for an urgent GP appointment or speak to your diabetes team if:

You notice changes to your sight, including:

• your vision getting worse
• finding it more difficult to see in low light
• shapes floating in your vision (floaters)

Nerve damage

Diabetes can cause damage to nerves, called diabetic neuropathy.

This can lead to problems such as:

• numbness
• pain or tingling
• problems with sex
• constipation or diarrhoea

Speak to your GP or diabetes team if you get any of these symptoms.

There's no cure for nerve damage, but treatments can help with the symptoms and help stop it getting worse.

Kidney problems

Over time, high blood glucose can damage your kidneys, leading to kidney disease.

Kidney disease usually has no symptoms at first, so it's important to have a test every year to check for kidney problems.

There are treatments that can help with symptoms and may help stop it getting worse.

Gum disease

High blood glucose can increase your chance of gum disease and infections.

It's important to keep your mouth healthy by brushing your teeth twice a day and having regular dental check-ups.

See a dentist as soon as possible if you notice problems in your mouth, including soreness, bleeding gums or bad breath.

Complications of high or low blood glucose

If your blood glucose gets too high or too low, this can also cause problems that get worse quickly. These can be emergencies, so it's important to recognise the symptoms and know what to do.

Find out more about:

• hypoglycaemia (hypos) – when your blood glucose is too low
• hyperglycaemia (hypers) – when your blood glucose is too high
• diabetic ketoacidosis (DKA) – a serious condition caused by lack of insulin and very high blood glucose