According to the Centers for Disease Control and Prevention, nearly 1.6 million Americans have Type 1 diabetes. Unlike Type 2 diabetes, which is usually brought on by being overweight and eating an unhealthy diet, Type 1 diabetes is the result of the inability to produce insulin from the pancreas. This hormone is essential for breaking down carbohydrates and turning them into glucose, the blood sugar that provides the energy to keep your cells and organs running.
Type 1 diabetes occurs “at every age, in people of every race, and of every shape and size,” according to the American Diabetes Association. But Type 1 diabetes can be managed, the ADA adds, by following a healthy eating plan, adhering to a medication regimen, exercising regularly and working with your doctors.
That’s not to say it’s always simple. “How easy or hard it is to live well with Type 1 diabetes really depends on the person who is living with it,” says Jeremy Beaulieu, a nurse practitioner with Joslin Diabetes Center in Boston. “I would say on the whole that it affects every facet of your life, though, and so while some people handle it very well, it is also something they have to constantly think about and take into account when planning any activity.”
[See: 10 Myths About Diabetes.]
Medication for Type 1 Diabetes
The only medication typically needed for Type 1 diabetes is insulin, which is used to replace the hormone that the pancreas cannot make.
The ADA lists four types of insulin medications:
— Rapid-acting insulin begins working about 15 minutes after injection, reaches its peak effectiveness in about one hour and continues to work for two to four hours.
— Regular or short-acting insulin usually starts working within 30 minutes, peaks from two to three hours after injection and is effective for three to six hours.
— Intermediate-acting insulin gets into the bloodstream in about two to four hours, peaks four to 12 hours later and lasts about 12 to 18 hours.
— Long-acting insulin takes effect several hours after injection and lowers glucose levels fairly evenly over a 24 hours.
Some patients need a mix of two types, and can talk to their doctor about acquiring a premixed supply.
There are two ways to get insulin:
— Wear an insulin pump that continuously injects insulin throughout the day.
— Give yourself multiple daily injections of insulin.
It can be a challenge to manage multiple daily injections because you have to carry at least your short-acting insulin with you whenever you go out, Beaulieu says. “As we all know, life can be unpredictable. I typically see people have a much easier time managing their blood sugars by using an insulin pump because it is always with them, and it can provide a lot more flexibility in their routine and allow for unexpected outings without worrying about when they’ll get to take their insulin.”
Beaulieu says he generally doesn’t tell patients what they can and can’t eat. “I am a big believer that when you have diabetes, whether it be Type 1 or Type 2, that no food is ‘off limits.’ Just like for people without diabetes, there are healthy choices and less healthy choices,” he says. “No food is all good or all bad — it’s all about moderation.”
That said, however, it is important to consider carbohydrates. The ADA says that knowing what kind and how many carbs to eat is important because eating too much can raise blood glucose too high and eating too little can drop blood glucose too low.
There are three main types of carbohydrates in food:
The ADA recommends choosing nutrient-dense carbs that are rich in fiber, vitamins and minerals, and low in added sugars, sodium and unhealthy fats, such as:
— Whole, unprocessed non-starchy vegetables like lettuce, cucumbers, broccoli, tomatoes and green beans.
— Fruits like apples, blueberries, strawberries and cantaloupe.
— Whole intact grains like brown rice, whole wheat bread, whole grain pasta and oatmeal.
— Starchy vegetables like corn, green peas, sweet potatoes, pumpkin and plantain.
— Beans and lentils like black beans, kidney beans, chickpeas and green lentils.
— Peanuts and nuts like walnuts and almonds — but eat small portions, as they contain a lot of calories in a small portion.
Foods to avoid include:
— Refined, highly processed carbohydrate foods and those with added sugar.
— Sugary drinks like soda, sweet tea and juice drinks.
— Refined grains like white bread, white rice and sugary cereal.
— Sweets and snack foods like cake, cookies, candy and chips.
“People should have a healthy relationship with food and be educated on what choices are healthier and what they should be eating most of the time, but being strict and never allowing yourself to deviate from a plan is what causes diets to fail because it’s unsustainable to be so rigid all of the time,” Beaulieu says. “I’ve seen patients do well on vegan or vegetarian diets, Paleo, Keto, intermittent fasting, low carb-high protein and others. The biggest thing is finding a healthy diet that works for you specifically and going from there.”
Working with a registered dietitian or nutritionist is always a good idea too, the ADA says.
Exercise is important for everyone, but especially for people with diabetes. “Exercise is medicine! Exercise makes your body more sensitive to insulin, meaning you can use less total insulin during the day to achieve the same results and it changes the way your body works in a positive way,” Beaulieu says.
Strength and resistance training, either with body weight exercises, free weights or resistance bands, helps build muscle strength and bone density, which can increase your resting metabolic rate. That can help lead to weight loss or healthy weight maintenance. Cardio exercise — including walking, running, swimming and biking — is good for the heart and lungs.
“Doing both is the best way to reap the benefits, and it’s important to choose something you actually like doing,” Beaulieu advises. “If you hate a particular exercise routine but are doing it because it is supposedly the best thing, it isn’t going to be sustainable. An exercise routine that you enjoy is the most important thing.”
Beaulieu recommends 30 minutes of exercise three to four times a week to start and ramping it up from there. “And the 30 minutes don’t have to be all at once. They can be spread throughout the day,” he says.
Work with your doctors before starting any new exercise regimen.
People with Type 1 diabetes are at a higher risk for mental health issues, the ADA says, including:
— Diabetes distress.
— Disordered eating.
The work and stress of tracking blood glucose?levels, taking insulin and planning meals can be emotionally tiring. “It is normal to be bummed out or tired of managing diabetes. It is a sign of strength to ask for help,” the ADA says. Without good mental health, it is hard to maintain good physical health. Talk to your doctors, find a diabetes support group or seek the help of a mental health professional to deal with stress, sadness, anger and denial before they cause more serious depression.
“It is a mental game,” Beaulieu says. “People can have Type 1 diabetes, but Type 1 diabetes doesn’t have to have them or define them. It is a huge learning curve, but great control and a good quality of life are definitely possible. There are celebrities such as Nick Jonas who have type 1 diabetes and are very open about it. He has acted in movies and goes on tour promoting his music and is able to manage his diabetes using a continuous glucose monitor and insulin pump and he’s an incredibly busy guy. So it definitely is possible to gain control over diabetes and manage it effectively.”
Patients with Type 1 diabetes typically see their primary care physician yearly and their endocrinologist every three months. Your doctors will monitor how well you are controlling your blood glucose with a blood test called the A1C test.
“People who have well-controlled diabetes for many years sometimes only need to be seen every six months or so unless something goes wrong, but getting their A1C checked every three months is still a good idea,” Beaulieu says. Those newly diagnosed or having a difficult time controlling their diabetes may need weekly to monthly followup, either in person or by phone, to check in and see how they’re doing and adjust insulin doses if needed, he says.
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