Type 1 Diabetes

Type 1 Diabetes Treatments

Both type 1 and type 2 diabetes are serious conditions with serious associated complications.

There are several similarities between these two types of this condition, although there are also some key differences.

One of the main differences is the available treatments for type 1 diabetes. While some people with type 2 diabetes may end up taking insulin injections, this is not the case for people with type 1 diabetes – they will all require lifelong insulin therapy.

Yet, several other treatments are available to help people administer this insulin and monitor their blood glucose levels to help them achieve optimal control. In this article, we will discuss some of the treatments for type 1 diabetes, allowing the reader to learn more about the different types of insulin and how it can be delivered, as well as other treatments with increasing usage.

Some cutting edge technology will be covered, as well as some lifestyle changes that may help some people to help manage their risk of complications. Read on to find out more about the various treatment options for people living with type 1 diabetes. 

What is type 1 diabetes?

Type 1 diabetes is an autoimmune disease that is usually diagnosed in childhood.

An autoimmune disease is a condition whereby your immune system mistakenly attacks your body. In those without autoimmune diseases, their immune system protects against illnesses such as those caused by germs and bacteria.

Yet, in those who have an autoimmune disease, this does not happen, and a person’s immune system begins ‘attacking’ their own body. In type 1 diabetes, insulin-producing beta cells in the pancreas eventually become worn out and stop producing insulin.

It is not fully understood what causes type 1 diabetes, and research is ongoing. According to data from Diabetes UK, type 1 diabetes affects around 8% of those with diabetes. Although type 1 diabetes is far less common than type 2 diabetes, most children with diabetes have type 1.

In type 1 diabetes, how the body attacks your insulin-producing beta cells leads them to produce any more insulin no longer. This is when symptoms of diabetes begin to show, which, in type 1 diabetes, typically happens in childhood.

A person with undiagnosed type 1 diabetes may experience the following diabetes symptoms when the disease has taken hold: 

  • Extreme thirst 

  • Hunger 

  • Frequent need to urinate

  • Tiredness 

  • Weight loss 

  • Mood changes 

These symptoms typically happen quickly. You can learn more about the symptoms of type 1 diabetes in this article

What is the difference between type 1 and type 2 diabetes?

Unlike type 1 diabetes, type 2 diabetes is relatively common. Type 2 diabetes is thought to affect around 90% of people with the condition (1).

Figures from the World Health Organisation (WHO) in 2014 showed that diabetes affects an estimated 422 million people worldwide and was the seventh leading cause of death in 2016 (2).

There are some similarities between type 1 and type 2 diabetes. Both are serious conditions characterized in part by high blood glucose levels (hyperglycemia). High blood glucose levels (also called blood sugar levels) can, over time, lead to serious complications, regardless of whether you have type 1 or type 2. 

While some people with type 2 diabetes will go on to need insulin injections, this is not a ‘possible’ eventual treatment for people with type 1 diabetes – the primary treatment is to take insulin injections to ensure your blood glucose levels are controlled. The healthy functioning of the pancreas would usually do this job in people without diabetes.  

Your pancreas is the organ that is responsible for producing insulin. When you consume food or drink containing carbohydrates, your body converts it into glucose (a sugar) and then sends it into your bloodstream to be utilized for energy. Glucose is the body’s, and particularly the brain’s, preferred source of energy. 

Having too much glucose in your bloodstream can lead to problems. It can hinder your cells’ ability to absorb and use this glucose for energy, called insulin resistance. When someone has insulin resistance, the pancreas becomes overworked over time as it is continuously trying to battle with a raised blood sugar level.

It attempts to manage these increased blood sugar levels by producing more insulin. Eventually, the pancreas’ overworked beta cells stop producing enough insulin to manage blood sugar levels effectively, or the insulin they do produce does not work properly. This leads to prediabetes and then commonly, on to type 2 diabetes (3,4). 

We have briefly introduced some of the differences between type 1 and type 2 diabetes, although there are more to cover. It is well known that body weight is a risk factor for developing type 2 diabetes, whereas it is not well understood what causes type 1 diabetes.

Unfortunately, there is no cure for type 1 diabetes at the moment, and while this is the same for type 2, there is evidence showing us that it can be prevented and even put into remission in many cases. There has been a brief overview of type 1 diabetes symptoms in the first section of this article, although it is essential to note that the presentation of these symptoms differs in type 2.

Whereas in type 1 diabetes, the symptoms usually appear quite quickly, in type 2 diabetes, this is not usually the case. As such, symptoms of type 2 diabetes can be easy to miss, and diagnoses are often made at routine blood tests rather than during appointments, specifically for the presence of symptoms (5).

Insulin and other medications

As previously mentioned, insulin is the required treatment for type 1 diabetes. There are several different types of insulin and different modes of delivery, and we will outline them in the following sections of this article.

As well as insulin therapy, people with type 1 diabetes may need to take other medications to manage the additional risks of living with the condition. We have briefly mentioned how people living with type 1 diabetes are at an increased risk of complications, and cardiovascular disease is one of those key complications.

It is widely agreed and referenced that people with diabetes fall into a particularly high-risk group in terms of their predisposition to cardiovascular disease (6). Before we take a look at which types of medications are commonly taken among people with type 1 diabetes, we will look in some more detail at the types of insulin. 

Types of insulin

Insulin types can be broadly categorized into three groups. Each of these three types of insulin varies based on the time in which it takes them to begin working. The three types of insulin we will be exploring in a little more detail are:

• Short-acting insulin

• Intermediate-acting insulin

• Long-acting insulin

Additionally, mixed insulin is a mixture of short and long-acting insulin. It is taken before meals but takes away the need for a basal (background) or intermediate-acting insulin.

Short-acting insulins are available as soluble insulin or rapid-acting insulin. Short-acting insulins have a short duration period and are relatively quick to start working. This fast action aims to replicate the insulin normally produced by a healthy pancreas in response to the glucose (sugar) absorbed from a meal.

The soluble form of short-acting insulin is thought to be the most appropriate to use in a diabetic emergency, e.g., in the case of diabetic ketoacidosis (DKA). A rapid-acting insulin is usually taken alongside intermediate or long acting insulin. It works quickly, and the decided dose will depend on how many carbohydrates have been consumed in food and/or drinks. 

Intermediate-acting insulin is usually taken once or twice per day and can also be referred to as background or basal insulin. 

Long-acting insulin is slow to take effect and is usually taken once per day, at the same time each day (4,7).  

Artificial pancreas

The artificial pancreas was a breakthrough for the management of diabetes, and the hope is that one day it will become widely available. Also called a closed-loop insulin delivery system, the artificial pancreas mimics the job of a healthy pancreas by delivering the correct level of insulin via a pump, based on results received from a continuous glucose monitor (CGM).

Insulin pumps are small, electronic devices that deliver the insulin your body needs throughout the day and night. This will include your mealtime delivery and your background insulin (your bolus does and your basal dose). The amount of insulin delivered will depend on your blood glucose levels and can be controlled by the person wearing the pump.

With the addition of a CGM alongside the insulin pump, the decision on the delivery amount is based on your blood glucose readings, taken minute-by-minute, making them very accurate.

Yet, many people still find taking their blood sugar level readings manually more accurate, so do speak with your specialist team to get some support on what could work best for you. 

Scientist Roman Hovorka tested the prototype of the artificial pancreas. The results of the study became available in 2014. They showed that the 24 people involved in the trial spent 13.5% more time with optimum blood sugar levels compared to those using standard insulin therapy. Additionally, the participants using the artificial pancreas experienced lower average overnight blood glucose levels, but this did not lead to increased hypoglycemia episodes.  

Other medications

Aside from insulin injections, people with type 1 and type 2 diabetes may be required to take additional medicines to manage associated complications—for example, blood pressure medications such as ACE inhibitors or cholesterol-lowering drugs such as statins.

For people with type 1 diabetes, blood pressure targets are tight, and they must be closely monitored to help prevent the micro and microvascular complications of diabetes. The aim is typically for a blood pressure of 135/85 mmHg or less, although, as always, your specialist team will be able to guide you toward your specific clinical and treatment goals.

The first-line medication for high blood pressure (hypertension) in type 1 diabetes is a renin-angiotensin system blocking drug. Other possible medications include beta-blockers, thiazides, or calcium channel blockers. The treatment decision will be based on various clinical factors such as the type of insulin you use, your blood glucose levels, and symptoms and side effects (8). 

In the UK, the National Institute for Clinical Excellence (NICE) recommends the following in terms of statin therapy for people with diabetes:

  • Patients with type 1 or type 2 diabetes should be offered 20mg atorvastatin for primary prevention of CVD

  • Patients with established CVD may need to be offered 80mg atorvastatin

Doctors should also be encouraging their patients with diabetes to make healthy lifestyle changes where necessary, to help manage hypertension and high cholesterol levels. However, this may be in addition to statin therapy for those at high risk, and not instead of.

Blood sugar monitoring

Ensuring that you monitor your blood glucose levels and aim for optimum results is a key part of treatment for type 1 diabetes and type 2 diabetes.

Not only do you need to manage high blood glucose levels (hyperglycemia), but you also need to aim to avoid low blood sugar levels (hypoglycemia). Severe hypoglycemia can be dangerous, and in rare cases, can lead to death.  

Everyone with diabetes will choose to monitor their blood sugar levels slightly differently, but you may wish to check your levels:

  • Before meals

  • Before snacks 

  • Before bed and when you wake up

  • Before exercise (and during if it is intensive/long)

  • Before driving 

  • Always if you suspect you are experiencing hypoglycemia 

Careful monitoring is the best way to help your levels stay in the ideal range, and as laborious as it can be, it can also help achieve better HbA1c levels. 

Lifestyle changes

As for those without diabetes, people with the condition need to consider if they could benefit from making some lifestyle changes. This is particularly important for people with a high risk of cardiovascular disease (additionally to the risk that diabetes presents). 

Lifestyle changes that can help include regular exercise, enjoying a healthy diet, quitting smoking, reducing alcohol intake, and maintaining a healthy weight. Speak with your doctor or specialist diabetes team if you would like to focus on any of these lifestyle changes, as they should be able to guide you toward an appropriate approach. 

Strategies that they may support you to adopt include including more exercise in your daily routine. Ideally, you should aim for 150 minutes of moderate-intensity activity per week and be completing some exercise on most days. However, choose an achievable goal and remember that some exercise is better than none. In terms of positive dietary changes you can make, it is also important to choose achievable goals again.

On the whole, most people would benefit from eating more fruit and vegetables, more wholegrain foods, more oily fish, fewer foods high in saturated fat, and fewer added sugars. Many people with type 1 diabetes also choose to learn carbohydrate counting.

There are courses available to support you on this journey, and a registered diabetes specialist dietitian can help you learn more about this type of management. Yet, learning to carb count is not intended to be used to eat a low carb diet for people with type 1 diabetes.

There is no strong evidence that a low-carb diet is safe or necessary for people with type 1 diabetes, nor is there any current evidence that a low-carb diet can delay or prevent the disease’s onset. Additional caution is needed around using a low carb diet in type 1 diabetes because of the risk of DKA, the potential for worsened cholesterol levels, and, in children, the unknown impact on growth (9). 

Potential future treatment

Diabetes is an exciting area of research. Many fantastic scientists and charities are working toward a future where cutting-edge technology or treatments can help everyone with diabetes better manage the condition. Of the treatments being researched, two fascinating areas are the pancreas transplant and islet cell transplants. 

Some organ transplants, such as kidneys, are a relatively common medical procedure. Following a successful pancreas transplant, the recipient would no longer need insulin injections. There are, however, significant risks involved, and these can be more dangerous than diabetes itself.

Usually, a pancreas transplant would be carried out on someone with diabetes who was already having a kidney transplant or had severe hypoglycemia problems. There are many factors to consider that would disqualify someone from being eligible for a pancreas transplant, and in the UK, only around 200 are performed per year (10).  

Researchers are also looking into and carrying out islet cell transplantation. This procedure provides islet cells taken from a donor and then implanted into the liver of someone with type 1 diabetes. This is considered a minor procedure, and it is usually carried out twice for each eligible person.

The UK was the first to launch an islet transplant program, which happened in 2008. As work in this area moves on, the hope is that the procedure will become more successful and will have a lesser risk of rejection of the donor islet cells. 

Conclusion 

Treatment for type 1 diabetes is complex, and there are many different routes a person may choose to take to help them to manage their condition. It is essential that you discuss any concerns or changes with your diabetes specialist team, as having more information can empower you to manage your diabetes.

Consider asking about your eligibility for more sophisticated diabetes treatment such as pumps, and remember that there are many groups of people working on research into the area of exciting treatments such as artificial pancreases, to work toward the vision that one day, everyone with diabetes, will have these options open to them. 

Sources

  1. Diabetes UK. Type 2 diabetes. (Online). Available at: https://www.diabetes.org.uk/diabetes-the-basics/what-is-type-2-diabetes accessed on 23/11/2020
  2. World Health Organisation. Diabetes. (Online). Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes%2520accessed%2520on%252017/05/20 accessed on 22/11/2020
  3. National Institute of Diabetes and Digestive and Kidney Diseases. (2018). (Online). Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#causes accessed on 23/11/2020
  4. Diabetes UK. Insulin and Diabetes. (2020). (Online). Available at: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin accessed on 25/11/2020
  5. Diabetes UK. Differences Between Type 1 and Type 2 Diabetes. (Online). Available at: https://www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes accessed on 23/11/2020
  6. Trevor J. Orchard, Kimberly Y.-Z. Forrest, Lewis H. Kuller, Dorothy J. Becker. Lipid and Blood Pressure Treatment Goals for Type 1 Diabetes. Diabetes Care Jun 2001, 24 (6) 1053-1059; DOI: 10.2337/diacare.24.6.1053
  7. National Institute of Clinical Excellence (NICE). 2020. insulin. (Online). Available: https://bnf.nice.org.uk/treatment-summary/insulin-2.html accessed on 24/11/2020
  8. 2020. (Online). hypertension. Available: https://bnf.nice.org.uk/treatment-summary/hypertension.html accessed 24/11/2020
  9. Bolla AM, Careto A, Laurenzi A, Scavini M, Piemonte L. low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. N 2019;11(5):962. Published 2019.
  10. 2019. Pancreas Transplant. https://www.nhs.uk/conditions/pancreas-transplant/why-its-done/ accessed 24/11/2020

 

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