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Type 1 Diabetes

Type 1 diabetes is a chronic condition that affects 370,000 people in the UK.1In type 1 diabetes, the levels of sugar or glucose in your blood are too high, which can impact your health, longevity and quality of life.

The experienced doctors at Virtually Healthcare can provide expert support and treatment for people with type 1 diabetes to control your blood glucose, prevent complications and help you live a full and active life.

What is type 1 diabetes?

Type 1 diabetes is a long-term condition that increases the level of glucose in the blood. Diabetes affects the way your body uses energy from the food you eat. Carbohydrates in your diet are broken down into glucose. This is absorbed into the blood and distributed around the body to provide cells in organs and tissue with the fuel they need to function.

A hormone called insulin controls glucose levels in your blood. It acts like a key, unlocking cells so that they can burn glucose for energy. It also ensures that any excess glucose is safely stored for future use.

If you have type 1 diabetes, your immune system destroys insulin-producing cells in your pancreas. As a result, your body can’t produce insulin, your cells are starved of the energy they need to fuel essential functions, and glucose builds up in your bloodstream.

If you have type 1 diabetes, you will need replacement insulin to control your blood glucose levels and provide the energy your cells need to work and stay alive.2

What are the symptoms of type 1 diabetes?

If you have untreated type 1 diabetes, your blood glucose levels will rise, known as hyperglycaemia. Hyperglycaemia or ‘hypers’ can affect your body’s fluid balance. You may feel very thirsty, have to pass water more frequently and notice problems with your vision. The lack of energy in your cells will make you feel tired, weak and unwell. The symptoms of type 1 diabetes can come on very suddenly, they include:

  • Feeling fatigued, unwell and lacking in energy.
  • Passing large volumes of urine or passing urine more frequently.
  • Feeling very thirsty.
  • Blurred vision.
  • Weight loss and loss of muscle bulk.
  • Persistent thrush, skin itching.3

If you are worried about type 1 diabetes, go to accident and emergency or make an urgent appointment with a doctor at Virtually Healthcare for assessment, advice and investigation.

What is diabetic ketoacidosis?

Diabetic ketoacidosis or DKA is a serious condition that can develop when your body doesn’t have the insulin it needs to use glucose for energy. The body breaks down fat instead, making chemicals called ketones as a by-product. If these acidic chemicals build up in your bloodstream, you can become extremely unwell, with the symptoms of a hyper, including thirst, tiredness and blurred vision.

Diabetic ketoacidosis is more common in people who have just developed type 1 diabetes, diabetic people who are unwell with an infection, and pregnant women with type 1 diabetes. DKA is a medical emergency, which needs careful management in hospital. The hospital team can effectively treat DKA with insulin and careful fluid balance. So get help urgently if you’re worried.4

Diabetes care at Virtually Healthcare

Virtually Healthcare is an innovative GP practice, providing expert care in the comfort, safety and privacy of your home. The Virtually Healthcare service is designed to fit with modern lives. Consultations are easy to access, discreet and convenient, with virtual appointments available seven days a week.

The highly skilled team includes more than 40 clinicians working together to investigate and treat disease and help you optimise your health and wellbeing. As well as experienced GPs, the team includes sexual health specialists, physiotherapists and practice nurses to offer a comprehensive primary care service.

During the pandemic, many patients have found it challenging to access healthcare. Virtually Healthcare provides rapid access video or telephone appointments, with consultations available the same day if you contact us before 3 pm. Our clinicians can provide professional assessment and advice, arrange investigations, prescribe treatment or arrange for a face-to-face review.

At Virtually Healthcare, our focus is on you. Our clinicians take an individual holistic approach to diabetes treatment. They can arrange investigations, provide support and advice, follow NICE best-practice treatment guidelines and guide you to reliable information that will help you manage your blood glucose and reduce complications.

What is the treatment of type 1 diabetes?

The GPs at Virtually Healthcare provide holistic and supportive care for patients with diabetes. They follow NICE guidelines6 and work with you and your hospital team to control your blood glucose, maintain your health and reduce the risk of long-term complications. The team will:

  • Refer you to a specialist diabetes team. You will need access to a range of professionals with skills in diabetes care. You should have open access to specialist services on a walk-in and telephone basis during working hours and a 24-hour helpline staffed by people with specific diabetes expertise.
  • Provide individualised information and support.
    Advise about diet and nutrition.
  • Help you monitor and understand your blood glucose levels and how to recognise and manage high blood glucose (hypers) and low blood glucose (hypos) levels.
  • Prescribe insulin to control your diabetes.
  • Monitor your average blood glucose using an HbA1c blood test. This reflects your average blood glucose levels over the preceding three months. Good control is indicated by a value of less than 7.5%.7
  • Advise about regular screening to check your eye, cardiovascular, kidney and foot health.

Insulin treatment

If you have type 1 diabetes, your body can’t produce insulin. You will need to inject insulin to allow your body to use and store energy from food and control your blood glucose.

You will need to take background and mealtime insulin. Your diabetes team will recommend a combination of fast, medium, slow-acting and mixed insulin formulations to meet your needs and lifestyle. Innovative technological advances such as insulin pumps and continuous glucose monitors can improve control. Your team may recommend these if you are suffering from disabling hypos ( low blood glucose levels) or are struggling to control your blood glucose levels effectively. 8

Health screening in type 1 diabetes

Type 1 diabetes affects your body from top to toe. The raised blood glucose levels can damage your eyes, kidneys, blood vessels, heart and feet. However, excellent diabetes control can reduce the risk of complications, and regular screening can identify problems at an early stage so that you can have effective treatment and protect your health.

We recommend a programme of annual screening for all adults living with diabetes. Screening should include:

  • Eye screening for diabetic retinopathy.
  • Kidney screening for diabetic nephropathy.
  • Foot examinations to check for nerve damage and circulation problems.
  • Cholesterol screening for cardiovascular health.
    Blood pressure screening.9
Hot topics in diabetes

What is carb counting?

Carbs are carbohydrates such as sugars, starches and fibre. Carbohydrates in your diet affect the amount of insulin you need. Carb counting is a way of totting up the amount of carbohydrates in your food and adjusting your insulin accordingly. Careful carb counting can improve your glucose control and is particularly important if you have an insulin pump. A dietician or diabetes nurse specialist can teach you how to count carbs and optimise your diabetes management.10

What is a ‘hypo’?

A ‘hypo’ is when your blood glucose levels drop too low. It’s short for hypoglycaemia and is more likely to happen if you inject insulin to manage type 1 or type 2 diabetes.

People experience hypos in different ways. You may feel shaky and weak, you may be grumpy and tearful, or you may show few signs. Everyone’s different, but there are a few classic clues:

  • Feeling shaky and unwell
  • Being clammy or sweaty and looking pale in colour
  • Feeling hungry and weak
  • Feeling tired and faint
  • Having visual disturbance and blurring
  • Being restless or unable to concentrate
  • Having a headache
  • Feeling moody, emotional and tearful
  • Being angry or aggressive
  • You may also appear confused and disorientated. Many people have been mistaken for being drunk and disorderly when their blood sugar was low.

Hypos are part of living with diabetes. To get excellent glucose control, sometimes your sugars may fall too low. A hypo is more likely if you’ve skipped a meal or snack, you’ve been very active, you’ve taken too much insulin or if you’ve not eaten enough.

  • A hypo needs to be treated urgently, so you should always have some glucose tablets or another easily absorbed source of glucose with you at all times.
  • Test your glucose if you can because you can get similar symptoms from a hyper. However, it’s vital to treat it as a low if you feel very unwell because that’s an emergency, whereas a high can wait a little while.
  • Take 10–15g of fast-acting glucose, like 3-5 dextrose tablets, five jelly babies or a small glass of a sweet drink. It’s better to avoid foods containing fats, like chocolate or biscuits, as this can slow the absorption.
  • Take a slower-release type of carbohydrate, like bread, an apple or banana, which will be released more slowly into your bloodstream, keeping your glucose topped up until you next eat.
  • Keep an eye on your glucose readings over the next 24 hours; you may be at risk of another hypo, so it’s essential to be vigilant.

Severe hypos

If you don’t notice your hypo or don’t act quickly, your symptoms may worsen. You may:

  • Slur and appear drunk
  • Appear confused, disorientated and agitated or aggressive

If treatment is not prompt, then you and your baby are both in danger. You may suffer fits or seizures and may slip into unconsciousness.

In this condition, you are unable to help yourself and will need help from someone around you. Your family, friends and a colleague or first-aider at work should be aware of how to restore your blood glucose to a safe level. They can:

  • Rub the inside of your cheek with a special glucose gel or some jam or honey. They shouldn’t, however, shove anything down your throat because there is a risk of choking.
  • Inject glucagon: Glucagon is a hormone that acts against insulin and raises blood glucose levels. It is helpful in the treatment of severe hypoglycaemia. You will be given a kit if you are injecting insulin. Those close to you must understand how to use it. It really could save your life. Someone can use it on you if you’re fitting or unconscious; you may also need to administer it yourself if your sugar levels are staying low, even after taking glucose or if you’ve got sickness and are unable to keep things down.

If hypos are becoming a problem or you’re getting hypos at night, you should see your doctor or diabetes specialist nurse urgently to review the way you monitor or treat your diabetes. You may need an insulin pump or continuous glucose monitor (CGM) to prevent hypos or alert you that your sugars are low11.

Find out more

https://www.nhs.uk/conditions/type-1-diabetes/

https://www.diabetes.org.uk

Diabetes UK Careline: 0345 123 2399

1 https://www.nice.org.uk/guidance/ng17/chapter/Introduction
2 https://www.nhs.uk/conditions/type-1-diabetes/about-type-1-diabetes/
3 https://www.nhsinform.scot/illnesses-and-conditions/diabetes/type-1-diabetes
4 https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis
5 https://www.nice.org.uk/guidance/ng17
6 https://www.nice.org.uk/guidance/ng17
7https://www.nice.org.uk/guidance/ng17
8 https://www.nice.org.uk/guidance/ta151/chapter/1-Guidance
9https://www.diabetes.co.uk/diabetes-complications/screening-for-diabetic-complications.html
10 https://www.diabetes.co.uk/diet/carbohydrate-counting.html
11 https://www.diabetes.org.uk/guide-to-diabetes/complications/hypos

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