Diabetes, type 1 - Treatment 

As type 1 diabetes occurs because your body cannot produce any insulin, you will need to have regular insulin treatment for life to keep your glucose levels normal.

Insulin comes in several different preparations, each of which works slightly differently. For example, some last up to a whole day (long acting), some last up to eight hours (short acting) and some work quickly but do not last very long (rapid acting). Your treatment may include a combination of these different insulin preparations.

Insulin injections

In most cases of type 1 diabetes, you'll need to have insulin injections. Insulin must be injected because if it were taken as a tablet, it would be broken down in your stomach, just like food, and wouldn’t be able to enter the bloodstream. When you are first diagnosed, your diabetes healthcare team will help you with your insulin injections, before showing you how and when to do it yourself. They will also show you how to store your insulin and dispose of your needles properly.

Insulin injections are given using a syringe or an injection pen, which is also called an insulin pen or auto-injector. Most people need two to four injections a day. Your GP or diabetes nurse may also teach one of your close friends or relatives how to inject the insulin properly.

Insulin pump therapy

This is an alternative to injecting insulin. An insulin pump is a small device, about the size of a pack of playing cards, that holds insulin.

The pump is attached to you by a long piece of thin tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms.

The pump allows insulin to flow into your bloodstream at a rate that you can control. This means you no longer need to give yourself injections, although you will need to monitor your blood glucose levels very closely to ensure you are receiving the right amount of insulin.

Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 1 diabetes. However, it may not be suitable for everyone. Your diabetes healthcare team may suggest pump therapy if you often have hypoglycaemia (low blood glucose).

Want to know more?

• Diabetes UK: Insulin.

Monitoring your own blood glucose levels

An important part of your treatment will be making sure your blood glucose level is as normal and stable as possible.

You will be able to manage this using insulin treatment and by eating a healthy diet, but you'll also have to regularly check your blood glucose levels to make sure they are not too high or too low.

Exercise, illness, stress, drinking alcohol, taking other medicines and (for women) changes to hormone levels during your period can all affect your blood glucose levels.

In most cases, you'll need to check your blood glucose levels at home using a simple finger prick blood test. You may need to do this up to four or more times a day, depending on the type of insulin treatment you are taking. Your diabetes healthcare team will talk to you about your ideal blood glucose level.

The normal blood glucose level is 4.0-7.0 mmol/l before meals and less than 9.0 mmol/l two hours after meals. Mmol/l means millimoles per litre, and is a way of defining the concentration of glucose in your blood.

Find out how to test your glucose levels.

Having your blood glucose levels checked

While you need to monitor your own blood glucose levels every day, your GP or diabetes healthcare team will also do a special blood test every two to six months. This shows how stable your glucose levels have been over the past six to twelve weeks, and how well your treatment plan is working.

This is known as the HbA1c test. Unlike the finger prick test that measures blood glucose at a single time, the HbA1c test gives an idea of blood glucose levels over time. 

It measures the amount of haemoglobin, the oxygen-carrying substance in red blood cells, that has glucose attached to it. A high HbA1c level can mean that your blood glucose level is consistently high and your diabetes treatment plan may need to be altered.

Want to know more?

• Diabetes UK: Glucose level.

Hypoglycaemia can occur when your blood glucose level becomes very low. It is likely that you will develop hypoglycaemia from time to time.

Mild hypoglycaemia (or a 'hypo') can make you feel shaky, weak and hungry, and can be controlled by eating or drinking something sugary, such as a fizzy drink (not a diet version), sugar cubes or raisins. You may also be able to take pure glucose in a tablet or fluid, if you need to control the symptoms of a hypo quickly.

If you develop severe hypoglycaemia, you can become drowsy and confused, and you may even lose consciousness. If this occurs, you will need to have an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels.

If you have type 1 diabetes, you may need to carry glucagon with you at all times. Your diabetes healthcare team may show several of your family members and close friends how to inject the glucagon into your muscle, should you need it.

Once you begin to come round, you will need to eat something sugary when you are alert enough to do so. If you lose consciousness as a result of hypoglycaemia, there is a risk that it may happen again within a few hours, so you will need to rest afterwards and have someone with you.

If the glucagon injection into your muscle does not work and you are still drowsy or unconscious 10 minutes after the injection, you will need urgent medical attention.

You'll need to have another injection of glucagon straight into a vein, which must be given by a trained healthcare professional.

Want to know more?

• Diabetes UK: Hypoglycaemia.

Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin.

If hyperglycaemia occurs, you may need to adjust your diet or your dosage of insulin to keep your glucose levels normal. Your diabetes healthcare team will advise you about the best way to do this.

However, if hyperglycaemia is not treated, it can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death.

Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build-up of acids in your blood. See Type 1 diabetes - symptoms for the warning signs of diabetic ketoacidosis.

If you develop diabetic ketoacidosis, you will need urgent treatment in hospital. You will be given insulin directly into a vein (intravenously). If you are dehydrated, you may also need to have other fluids given by a drip, including salt solution and potassium.

Want to know more?

• Diabetes UK: Diabetic ketoacidosis.

Type 1 diabetes can lead to long-term complications. If you have type 1 diabetes, you have an increased risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:

• anti-hypertensive medicines to control high blood pressure
• a statin, such as simvastatin, to reduce high cholesterol levels
• low-dose aspirin to prevent stroke
• angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease

Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. It is often reversible if treated early enough.