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Type 1 diabetes Q&As

Published by Bupa's health information team, July 2009.

Answers to questions about type 1 diabetes

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

How important is it that I treat my low blood glucose level?

Having a low blood glucose level can be very serious. It's vital that you manage your condition well and keep your blood glucose levels as stable as possible. It's also important that you and your family and friends can recognise the signs of low blood glucose and take the right action. Doing this can reduce your risk of becoming seriously ill or dying as a result of low blood glucose levels.

Explanation

One of the main parts of treatment for type 1 diabetes is looking after your blood glucose levels and keeping them as near to normal as possible. Your 'normal' range will be specific to you but a general guide for adults is:

  • before meals: 4 to 7mmols/litre
  • after meals: less than 9mmols/litre

If your glucose level drops to below 4mmols/litre, it's important to get treatment straight away. The medical word for a low level of glucose in your blood is hypoglycaemia or a 'hypo'. Without treatment you could become very ill. Most people get warning signs and can treat hypos quickly. Rarely, if a hypo isn't treated, you may have a fit or fall into a coma. This may seem frightening but by knowing the warning signs and then taking action you can make sure you stay well.

Some of the early warning signs can include:

  • feeling faint
  • sweating
  • feeling your heart pounding
  • anxiety
  • feeling sick

Other signs that happen later when your blood glucose level has dropped further include:

  • slurred speech
  • confusion
  • irritability
  • blurred vision
  • hunger

Most people treat their hypos before they become serious. However, some of the later signs of a hypo can be difficult to spot and are easy to miss. For example, you may say you're definitely not having a hypo, but are actually saying this because you're confused. This is why it's important for your family and friends to know what you're like and how you behave when you have a hypo, because you may not be able to help yourself. Sometimes you can start to lose the warning signs of a hypo, or they can become less obvious. This can happen to people who have had diabetes for some time.

Anyone who takes insulin as a treatment for their diabetes could have a hypo and sometimes it's impossible to prevent them, no matter how well your condition is controlled. In fact, you can have hypos that your body deals with without you doing anything, when you're asleep for example. A hypo isn't actually caused by your diabetes, but by the treatment you take for it.

There are a number of different reasons why you might develop a hypo including:

  • taking too much insulin or not eating enough food - this can happen easily, if you accidentally miss a meal or have it later than usual, or if you forget that you have taken your dose and take it again
  • taking part in unplanned or very vigorous exercise without eating to compensate - your body needs more glucose than it usually would and if you aren't able to get that glucose, the levels in your body will drop
  • drinking alcohol - alcohol can have some unusual effects on your body's glucose levels as your blood glucose levels rise at first but then fall
  • illness - this can alter your body's need for glucose
  • injecting your insulin continually into the same site, which then becomes scarred - this can delay the release of insulin into your body

When you start to feel a hypo coming on, follow these three steps.

  • Have something sugary to eat such as glucose tablets or drink a sugary drink.
  • After this eat some longer-lasting carbohydrates such as a sandwich, toast or fruit.
  • Test your blood glucose level to see whether it's getting better. If it's not and you can't seem to come out of the hypo, call for emergency help straight away.

If your low blood glucose level isn't treated in the early stages, you may need to have glucose given to you by injection or through a drip.

Further information

Sources

  • National service framework for diabetes. Department of Health. www.dh.gov.uk, 2001
  • Hypoglycaemia. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. National Institute for Health and Clinical Excellence (NICE). www.nice.org.uk, 2004
  • Hypoglycaemia. Insulin Dependent Diabetes Trust. www.iddtinternational.org, accessed 11 February 2009
  • Hypoglycaemia. GP Notebook. www.gpnotebook.co.uk, accessed 11 February 2009
  • Types of diabetes. World Health Organization. www.who.int, accessed 11 February 2009
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How will type 1 diabetes affect my work?

Although being diagnosed with type 1 diabetes can leave you feeling worried about the future, it shouldn't stop you leading an active and full career. However, you may need to plan well and make some changes to your activities.

Explanation

Type 1 diabetes can potentially have an impact on many areas of your life, including work. How you manage your condition and control your diabetes can influence how well you cope with work and the choices you make. Your doctor or specialist nurse can give you more information and advice about your individual circumstances.

You can't join or continue to serve in the armed forces if you have diabetes. In addition, you can't hold an HGV licence or scuba dive. Otherwise, there are very few jobs that you're unable to do but you may need to make some adjustments.

If you do a job that is potentially hazardous, it makes sense for you to be as fit and well as possible. This means having well-controlled blood glucose levels, minimal complications of diabetes, good eyesight and taking your insulin as planned. You may need to make changes to your treatment if you work shifts and if food isn't readily available. You will need to plan ahead to make sure you keep your blood glucose levels stable.

Although most people with diabetes wouldn't see themselves as being disabled by their condition, they are protected at work by the Disability Discrimination Act (DDA). The DDA protects people from being discriminated against at work because they have a disability. Your employer has to make "reasonable adjustments" to enable you to access the recruitment process or to do your actual job. You don't have to tell your employer that you have diabetes, but if they know it may help them to help you, by being flexible with things such as doctor's appointments.

Further information

Sources

  • Diabetes and work. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • Disability Discrimination Act 1995. Office of Public Sector Information. www.opsi.gov.uk, accessed 11 February 2009
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Can I drive if I have type 1 diabetes?

If your condition is well managed, you should be able to drive a car or ride a motorcycle, but you won't be able to drive a heavy goods vehicle or passenger vehicle (such as a minibus). You need to contact the Driver and Vehicle Licensing Agency (DVLA) to inform them about your condition and also take certain considerations into account.

Explanation

In the interests of road safety you must be sure that you can safely control a car at all times. The DVLA will contact your doctor for more information about how your condition is managed, how well controlled it is and whether you have any complications that might make you unsafe to drive.

You will need to be able to recognise the signs of a hypo coming on and show you know how to treat it if one occurs while you're driving. You will need to show that you have good eyesight to be able to continue to drive. You will be given a licence that lasts for one, two or three years and have your condition assessed each time you re-apply. You also need to tell your car insurer about your condition. Having a hypo while you're driving can be dangerous for you, your passengers and other drivers. To help prevent a hypo:

  • check your blood glucose before you start a journey
  • don't drive with a blood glucose level of less than 4mmol/litre
  • don't drive for more than two hours without stopping for a snack
  • always keep glucose tablets where you can reach them quickly
  • keep some kind of carbohydrate, such as sweets and a sugary drink, in the car

If a hypo starts while you're driving:

  • pull over and stop somewhere safe
  • take glucose tablets or some other form of fast-acting carbohydrate immediately
  • leave the driver's seat and take the keys out of the ignition to make it clear that you're no longer in charge of the car
  • don't start driving again until all your symptoms have gone

Further information

Sources

  • For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency. www.dvla.gov.uk, accessed 11 February 2009
  • Information: driving and diabetes. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
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Can I go on holiday if I have type 1 diabetes?

Yes, it's fine to go abroad on holiday if you have diabetes so long as you are well prepared.

Explanation

People with diabetes travel all over the world and take the same kinds of holiday as people without the condition. However, it makes sense to plan well. Bear the following in mind when you go on holiday.

  • You, and the people you travel with, should know how you behave when you have a hypo and should know what to do about it.
  • Consider carrying or wearing some form of medical identification bracelet, tag or similar stating you have diabetes, particularly if you're travelling alone.
  • If you're travelling across time zones, you may need to adjust your insulin. Get advice from your doctor or nurse.
  • If you become unwell while you're away, drink plenty of fluids and if you can't eat, make sure you have sugary drinks. If you can't eat or drink anything, go to hospital for treatment.
  • Security issues at airports may mean you have to make special arrangements to travel with insulin. Carry diabetes identification and a letter from your doctor, and check with the airline you're flying with before you go.
  • Declare your condition when you buy travel insurance and never travel without it.

If you have any questions or concerns about travelling, speak to your doctor or specialist nurse.

Further information

Sources

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What are the different kinds of insulin?

There are three groups of insulin - animal, human (insulin that's produced synthetically to match human insulin) and analogue. Within these groups there are types that act at different speeds and for different lengths of time - fast, medium and long-acting.

Explanation

There are three groups of insulin.

  • Animal insulin comes from pigs and, very rarely, from cows. A small number of people use animal insulin, usually because they find it works better for them if they are losing their awareness of a hypo.
  • Human insulin is a synthetic version of insulin that is designed to match insulin naturally made in your body.
  • Human analogue insulin is a modern, synthetic variation of human insulin that works more like naturally occurring human insulin.

There are a number of types of insulin available and these act at different speeds and stay in your body for different lengths of time.

  • Short - or rapid-acting insulin - is available in two forms. You need to inject soluble insulin 30 minutes before meals. It acts for between six and eight hours. You can take short-acting analogue insulin at the start of a meal. It works more quickly and lasts for four to six hours.
  • Medium insulin lasts for 12 to 18 hours.
  • Mixed insulin is a mix of medium and short-acting (soluble or analogue ) insulin.
  • Long-acting analogue insulin only needs to be taken once a day and can last for up to 24 hours.

When you're first diagnosed, your doctor and diabetes specialist nurse will suggest what type of insulin you need and help you to adjust the type and amount of insulin you need to treat your condition. You will learn to adjust your insulin dose yourself from day to day to keep your blood glucose levels stable and to fit in with your lifestyle.

You can look after your insulin by doing the following.

  • Keep your stock of insulin in the fridge.
  • Keep any insulin for immediate use in a cool, dry place (below 25ºC).
  • If your insulin has been out of the fridge for 28 days or more, throw it away.
  • Keep at least one cartridge of insulin spare at all times, in case you break or lose one.
  • Don't freeze insulin - discard it if this happens.
  • Check the expiry date on the insulin before you start a new cartridge. If it has expired, don't use it.

Further information

Sources

  • Drugs used in diabetes. Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
  • Insulin. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009

Type 1 diabetes factsheet

 

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