Managing type 1 diabetes
Type 1 diabetes takes a lot of work, but it is manageable. Here are facts about type 1 diabetes:
1. What should I keep with me at all times?
Everyone has a different level of comfort and need for preparedness when it comes to what to have with you at all times. Many people with diabetes want a sense of freedom and don’t want to be overly burdened or controlled by their diabetes. These individuals would likely prefer the short list below:
- Meter and test strips
- A snack (or glucose tablets)
- Medical ID
Others prefer to be prepared for an emergency and wouldn’t leave home without:
2. What should my A1C be?
- Glucagon kit
- Emergency contact phone list
- First-aid kit
Glycosylated hemoglobin (hbA1C), or often referred to as just A1C, is a blood test that measures average blood glucose (sugar) over the past 2 to 3 months. Red blood cells have a protein in them called hemoglobin. Glucose (sugar) in our blood enters the red blood cell and connects (glycates) with hemoglobin. The more glucose in the blood the more glycation will occur resulting in a higher A1C test result.
Choosing an A1C Goal – A Patient-Centered Approach
We know that a lower A1C lowers your risk for diabetes related complications. However, when choosing an A1C goal we believe in a patient-centered approach. This means we take into consideration your age, your diabetes management plan, any complications or other health conditions you may have and if you have severe hypoglycemia (low blood sugar) or hypoglycemia unawareness (a condition when a person is unable to recognize symptoms of hypoglycemia until they become severe).
6.5 percent or Less
For some, this is considered tight control. It is appropriate for those recently diagnosed and without other medical conditions.
This is a moderate goal that is reasonable to achieve for most adults (non-pregnant). Achieving and sustaining an A1C of 7 over time reduces risks of complications such as diabetic retinopathy (diabetic eye disease) and neuropathy (nerve damage). This is also a reasonable goal for children (0-18 years) if it can be achieved without frequent hypoglycemia.
This is a safe goal for children with diabetes, particularly for those under 6 years of age. Hypoglycemia is always a concern for parents. Although an A1C of less than 7 is optimal, parents must consider the risks and benefits of tighter blood sugar control.
This goals is only acceptable for those who have suffered frequent and severe hypoglycemia, have hypoglycemia unawareness or are not expected to live much longer due to other health issues or advanced diabetes related complications.
3. What kind of complications are people with type 1 diabetes susceptible to?
Diabetic complications can be a result of years living with diabetes, poorly controlled diabetes and genetics. By keeping blood sugars on target you can prevent or delay complications. People with type 1 diabetes are at higher risk for the following conditions:
Glaucoma occurs when pressure builds up in the eye. In most cases, the pressure causes drainage of the aqueous humor to slow down so that it builds up in the anterior chamber. The pressure pinches the blood vessels that carry blood to the retina and optic nerve. Vision is gradually lost because the retina and nerve are damaged. People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. Risk also increases with age.
With cataracts, the eye's clear lens clouds, blocking light. Many people without diabetes get cataracts, but people with diabetes are 60% more likely to develop this eye condition. People with diabetes also tend to get cataracts at a younger age and have them progress faster.
The longer you've had diabetes, the more likely you are to have retinopathy. There are 3 conditions of the eye that you may hear of in relation to type 1 diabetes: non-proliferative retinopathy, macular edema and proliferative retinopathy. Almost everyone with type 1 diabetes will eventually have non-proliferative retinopathy. And most people with type 2 diabetes will also get it. But the retinopathy that destroys vision, proliferative retinopathy, is far less common.
In non-proliferative retinopathy, the most common form of retinopathy, capillaries in the back of the eye balloon and form pouches. Non-proliferative retinopathy can move through three stages (mild, moderate, and severe), as more and more blood vessels become blocked.
Fluid can leak into the part of the eye where focusing occurs, the macula. When the macula swells with fluid, a condition called macula edema, vision blurs and can be lost entirely. Although non-proliferative retinopathy usually does not require treatment, macular edema must be treated, but fortunately treatment is usually effective at stopping and sometimes reversing vision loss.
With this more severe kind of retinopathy the blood vessels are so damaged they close off. In response, new blood vessels start growing in the retina. These new vessels are weak and can leak blood, blocking vision, which is a condition called vitreous hemorrhage. The new blood vessels can also cause scar tissue to grow. After the scar tissue shrinks, it can distort the retina or pull it out of place, a condition called retinal detachment
Nerve damage from diabetes is called diabetic neuropathy.
Peripheral neuropathy can cause tingling, pain, numbness, or weakness in your feet and hands. Autonomic neuropathy affects the nerves in your body that control your body systems.