Ten steps to improving your Type 1 diabetes control
This section is a guide to help you achieve the best possible glucose results. It can be daunting to know where to start – this guide offers some suggestions on how to do this in a step-wise manner. Taking things a step at a time (sometimes over days, sometimes over weeks and months) should result in meaningful improvements – fewer highs, fewer lows and a greater feeling of being in control.
- Step 1: Avoiding overnight hypos
- Step 2: Getting the morning glucose on target
- Step 3: Sorting out the background insulin
- Step 4: Matching the quick acting dose to meals
- Step 5: Getting the timing right
- Step 6: Getting the correction factor right (and not overusing it)
- Step 7: Treating hypos appropriately
- Step 8: Dealing with exercise
- Step 9: Periodically review your patterns (and share them)
- Step 10: Use your diabetes clinic to suit you
Why is it important to achieve good blood glucose management?
Perhaps the biggest reason is that people who have more predictable, ‘on target’ blood glucose readings tend to feel better and diabetes becomes less of a burden on quality of life. In the long-term, good diabetes control results in a hugely reduced risk of developing complications, including a significantly reduced chance of developing cardiovascular disease. The beneficial effects of good diabetes control last for several decades.
Blood glucose targets should be individualised and agreed between patient and doctor/nurse specialist. Below is a suggested set of target glucose readings for patients with type 1 diabetes:
Injection sites and lipohypertrophy
It is difficult to over-emphasise the importance of rotating injection sites. Every insulin injection will deliver a slightly different amount of insulin to the body, but this variation can be even greater when patients develop lipohypertrophy (fatty lumps caused by injecting in to the same site repeatedly). Lipohypertrophy increases the risks of hypos (and unexplained highs). The photographs above are quite extreme examples and it is always worth feeling your injection areas to make sure ‘lipos’ are not developing.
It is also worth bearing in mind that insulin is absorbed faster from the abdomen (tummy) than the thighs – making the abdomen a better site for injecting quick acting insulin. It is worth considering the thighs for long-acting background insulin. Be aware that using different zones (abdomen, thighs etc.) with different insulin types (long-acting, quick-acting etc.) may result in a variation in the effect or speed of onset of the insulin. Similarly, exercise will speed up the absorption of insulin from the thigh.
How often should I check my blood glucose levels?
It is difficult to achieve good, safe control of type 1 mdiabetes with any fewer than 4 blood glucose tests per mday. Indeed, when adding in driving, sport, avoiding mhypos and stressful events, it may be difficult to achieve control with any fewer than 6 or 7 tests per day. We realise that for many people this is not something they can manage on a daily basis and, in that situation, checking frequently every now and then is better mthan not at all. This guide has been designed to help convert the information gained from regular glucose testing, into actions that will make your diabetes more npredictable and easy to manage in the long-term.
Should I keep a diary?
It can be useful, during spells of ‘intensive glucose monitoring’ to keep a detailed diary, which takes in to account exercise, food intake, insulin doses and insulin timing. For the most part, it is probably more useful to upload your glucose meter and review the results on your home computer (see step 9, page 13 for more details on how to do this).
Background insulin: the long-acting insulin (also known as basal) which tends to be given once or twice a day (the most commonly used background insulins are Lantus and Levemir).
Correction factor (insulin sensitivity): The amount your blood glucose changes with 1 unit of quick-acting insulin (e.g. correction factor of 2 means that 1 unit of insulin will change your blood glucose level by 2 mmol up or down).
Hypoglycaemia: A low blood glucose level (typically defined as less than 4 mmol/L).
Insulin carbohydrate ratio: The amount of insulin that should be taken for every 10 grams of carbohydrate ingested. A ratio of 1:10 would mean taking 4 units to cover a meal with 40 grams of carbohydrate.
Quick- acting insulin: The insulin taken 15 minutes before meals which has a fast onset of action (around 30 minutes) and lasts for approximately 4 hours. The commonest quick- acting (or bolus) insulins are Apidra, Humalog and Novorapid.