Insulin pump life expectancy -
The full adjustment set included the method of administration, age, sex, education, income, T1DM expenses, years with T1DM, and Total SM. We used Statistical Package for Social Science SPSS software 26th version for the statistical analysis [ 24 ].
For additional insight, we asked pump users about the number of years they have used the pump and their reasons for using one 6 categories: QoL, insulin dosing, less pain, less hypoglycemia, just trying, and other. We asked injection users about reasons for not using a pump 6 categories: no trust, expensive, lack of appropriate model, lack of willingness, negative information, other and reasons for ceasing to use a pump if it was used previously 5 categories: expensive, lack of trust, not comfortable, not resultative, and other.
The qualitative part of the study consisted of analysis of semi-structured interviews performed face-to-face or via telephone or video chats. Interviews were recorded, coded, transcribed according to their major theme, and analyzed using Nvivo software version 12 [ 25 ] to obtain subcategories of each major theme.
In this paper, we provide part of the results of the qualitative analysis as support for interpreting the quantitative results.
We enrolled 87 T1DM patients in the quantitative part of the study: 20 pump users and 67 injection users. Both groups included mostly women. Pump users generally had at least some secondary education and had higher incomes, while injection users mostly had just a high school education.
Pump users were younger mean age The groups did not differ by other socio-demographic characteristics. HbA1c values at the last medical check did not differ significantly between the groups.
In both groups, most of the patients performed one medical check during and till May There were no differences between pump users and injection users in this parameter. T1DM-related expenses were statistically significantly higher for pump users: for Correlation between QoL and self-management was weak and partly insignificant.
Self-management blocks correlated among themselves significantly, but not strongly Additional file 1 : Table S1. Significant differences at the 0. The highest values for both groups were found for Therapy and Communication blocks of QoL.
There were no significant differences between groups in their self-management blocks Table 2. Factors that increased Total QoL were lower age, male sex, lower T1DM expenses the most prominent association , more years living with T1DM, and better self-management.
Most of the confidence intervals were wide, pointing to the low number of participants in the study Table 3. However, the post hoc calculated power of analysis was For injection users, the median time they had been using insulin injections was eight years, and the main reason for not using a pump was its cost, as mentioned by almost half of these respondents.
Of the 13 patients that previously used a pump, the main reason why they stopped was the cost mentioned by In the univariate analysis between the Therapy block of QoL and demographic and T1DM-related factors, significant relationships at the 0.
Consistent with the main analysis, male sex, lower T1DM expenses, and years living with T1DM were associated with better Therapy and Communication blocks Additional file 1 : Table S3. Of those included in the quantitative part of the study, 8 pump users and 13 injection users also participated in the qualitative interviews; 15 of these were women.
The men-women proportion in each study arm was similar to that in the quantitative part of the study. The age of the interviewees ranged from 18 to 50 years, and years with T1DM ranged from 1 to Eight participants did not have T1DM diaries, three had one only at the beginning of their treatment, two use them only for visits with a physician, and six regularly recode their activities in their diaries two using an app to do so.
One participant kept a diary when she used multiple insulin injections but stopped when she switched to an insulin pump Table 4. Analysis of 40 identified codes of the interviews revealed three major themes of answers: diagnosis-related, daily self-management, and life with T1DM. Each of the major themes was further divided into three to four subcategories Table 5.
Here we will present a part of the results related to one subcategory for each category of answers: perception of diagnosis major theme: diagnosis-related , insulin administration major theme: daily self-control , and T1DM-related costs major theme: life with T1DM. Before their diagnosis, most participants had had some symptoms that they had not related to T1DM, such as thirst, frequent urination, weight loss, and weakness.
Therefore, for nearly all of them, the diagnosis was unexpected and shocking. For example, I, who was diagnosed at the age of 28 after being hospitalized due to T1DM:.
I didn't know anything before, it seemed to me that diabetes could be born or not. I was so bad in that resuscitation because I was in a severe hypoglycemic condition … my head was dull … it was so hard to grasp. One of the main reasons to use an insulin pump was the QoL that it provides Additional file 1 : Supplement 6.
For example, M said:. I have much more control with the pump, because I can adjust insulin doses if necessary, and adjust the time for basal insulin.
I can stop insulin if needed. with the syringe, you are injecting and then you can no longer control what is going. The pump gives much more control to both the doctor and the patient, if a person understands how the pump works.
But that's what training is for. However, some of the injection users saw positive aspects in their treatment method as well. For example, I, who uses the injections:. No, never! It is not practical for me to have a foreign object that is always present at my waist area. I feel very uncomfortable.
That limits me. To summarize: although QoL was mentioned by most of the participants as the determining factor for use of the pump, some participants feel that a pump is less comfortable and even disturbing. This supports the quantitative result showing a lack of proper relations between the method of administration and QoL.
Most pump users in our study mentioned the cost of this administration method Additional file 1 : Supplement 7. For some participants, the decision whether to use a pump depends on the monthly costs. For example, K said:. It is an extra investment [talking about the pump] —now I have needles and insulin for free, I do not have to buy anything extra—just those test strips, because the glucometer is also free for me.
Together it's pretty affordable. I had already used it [pump] as a child, I was 13 years old. However, I really wanted to get back to the pump. In Latvia, state reimbursement for insulin pumps is possible until the age of Thus, some people are forced to switch to injections at that point.
For most of the participants who would like to use an insulin pump, treatment-related costs are too high, and some of them were forced to change to the cheaper injection method. This supports the quantitative result of the study on the relation between T1DM-related costs and QoL.
In this study, we investigated quantitatively and qualitatively factors related to the QoL of patients with T1DM according to their method of insulin administration: using an insulin pump or using multiple daily injections.
The reported QoL was found to be associated with the method of insulin administration, the age and sex of the participants, the number of years the patient had lived with T1DM, self-management, and T1DM-related expenses.
QoL was the main reason cited for using a pump, while the expense was the main reason to avoid its use or to stop using it. An association between the method of insulin administration and the QoL of patients with T1DM has been shown previously both in qualitative and in quantitative studies [ 11 ].
However, until recently, most of the studies on insulin pumps were qualitative and were performed on populations of children [ 26 , 27 , 28 ]. In the last decade, quantitative evaluations of pump use had appeared as well, but studies combining these two methods of investigation are still scarce.
However, similarity among their objectives allows us to combine the results of different studies to provide additional explanations of our observed results. For example, Alqambar et al. found higher scores for QoL for pump users than for injection users. These results are supported by the qualitative study by Mesbah et al.
In our study, although we did not observe statistically significant differences in QoL between pump and injections users, QoL was the main reason given for using the pump.
Nevertheless, in our study some participants had a negative attitude toward the pump. Mesbah et al. likewise report the existence of negative feelings toward pumps, such as fear of being dependent on a machine or concern about sporadic mechanical problems [ 30 ].
As QoL is multidimensional, factors affecting it might differ according to study design and measures. For example, in our study we did not observe any association of QoL with the level of HbA1c.
In contrast, in the study by Alavrado-Martel et al. performed in Spain, worse QoL was associated with increasing HbA1c [ 31 ].
This fact is extremely interesting, as in both studies the mean age of participants was 31 years and mean years living with T1DM were 14, and participants had similar levels of education. Therefore, the association with the level of HbA1c was not prominent.
In addition, in the Spanish study a better QoL was associated with the female sex, but in our study, it was associated with the male sex. As mentioned by Mesbah et al. In another study [ 32 ] women with diabetes were found to evaluate their health status and diabetes-related care worse than men; they also had more diabetes-related worries related to higher levels of Hb1Ac, although their level of metabolic control did not differ from that of men.
Initiation of pump therapy in Latvia usually is not a choice, but a costly necessity due to problems in diabetes management such as hypoglycemia and discomfort associated with diabetes treatment e. Studies describe substantial clinical benefits of insulin pumps for such patients.
For example, in the meta-analysis by Benkhadra et al. These results were supported by another meta-analysis by Jeitler et al. Our study did not observe any difference in self-management between pump users and injection users, but we do observe a slight but significant increase in QoL for those with better self-management.
The main cause seems to be educational training provided for all patients with T1DM. Previous studies have described the effectiveness of such training on self-management.
For example, in the structural analysis by Campbell et al. based on 18 studies, people who attended educational training gained clinical benefits by managing their lives according to the knowledge they received during these sessions.
However, people were often tired and encountered difficulties in managing their everyday lives according to guidelines even during these educational trainings, which made additional follow-up by the physician essential [ 7 ].
For pump users less intensive follow-up is needed, thus removing a level of stress from both physician and patient. Overall, a personal approach when choosing the method of insulin administration seems to be the best in the case of T1DM patients. The main limitation of our study is its cross-sectional nature, which does not allow us to evaluate causal relationships.
The study included a small number of participants, especially in the pump-users group, and we did not divide participants into age groups. Further, the use of the Internet for enrollment limited the available pool of participants and may introduce a volunteer bias that can affect the validity of the results.
Further limitations include self-evaluation of QoL and self-management and possible errors regarding the number of medical checks due to memory bias. Specific questions on installation, operation, troubleshooting, and handling of the insulin pumps these factors could affect the quality of therapy in pump-users and have an impact on QoL were not included in the study to avoid complexity.
In addition, some limitations in the qualitative part of the study could be related to the language, as the native language of the interviewer was Latvian.
Despite the good knowledge of Russian, some impreciseness could occur. Although the reliability of all parts of the survey was high at the initial stage of their check, we observed the medial reliability of one of its parts after collecting the information about all study participants.
As we did not see any difference between the insulin pump users and multiple injection users in other parts of the SM questionnaire, we assumed that the lower reliability of this part of the questionnaire will not affect the results of our study.
Another limitation of our study is the high proportion of insulin pump users. Before we start the study, we knew that the number of insulin pump users in the Latvian population is relatively small. Therefore, we decided to invite participants in the proportion of pump users versus injection users to increase the overall power of analysis.
We attempt to invite as many pump users as it was feasible. This can affect the results of our study, especially the qualitative part of them. A major strength of our study is a mixed methodology that allows us to describe QoL-related parameters of T1DM patients from various sides.
QoL was the main reason to use an insulin pump, while the main reasons to avoid one were expenses related to its use. Development of national insurance policies is critical worldwide, but especially in countries like Latvia with overall weak health care and public health systems, supporting reimbursement for insulin pumps could help:.
Janež A, Guja C, Mitrakou A, et al. Insulin therapy in adults with type 1 diabetes mellitus: a narrative review. Diabetes Ther. Article PubMed PubMed Central Google Scholar.
Katsarou A, Gudbjörnsdottir S, Rawshani A, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. Article PubMed Google Scholar. Norris JM, Johnson RK, Stene LC. Type 1 diabetes—early life origins and changing epidemiology.
Lancet Diabetes Endocrinol. Article CAS PubMed PubMed Central Google Scholar. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M.
Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. pdf Last visited: 26 December Pickup JC. Is insulin pump therapy effective in type 1 diabetes?
Diabet Med. Article CAS PubMed Google Scholar. Campbell F, Lawton J, Rankin D, et al. Follow-Up Support for Effective type 1 Diabetes self-management The FUSED Model : A systematic review and meta-ethnography of the barriers, facilitators and recommendations for sustaining self-management skills after attending a structured education programme.
BMC Health Serv Res. Jeitler K, Horvath K, Berghold A, et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis.
Retnakaran R, Hochman J, DeVries JH, et al. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c. Diabetes Care. Benkhadra K, Alahdab F, Tamhane SU, McCoy RG, Prokop LJ, Murad MH. Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis.
Pouwer F, Hermanns N. Insulin therapy and quality of life. A review Diabetes Metab Res Rev. Cummins E, Royle P, Snaith A, et al. Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation. Health Technol Assess. Rechenberg K, Whittemore R, Grey M.
Anxiety in youth with type 1 diabetes. J Pediatr Nurs. Alsaleh FM, Smith FJ, Taylor KM. J Clin Pharm Therap. Article CAS Google Scholar. Abualula NA, Jacobsen KH, Milligan RA, Rodan MF, Conn VS.
Evaluating diabetes educational interventions with a skill development component in adolescents with type 1 diabetes: a systematic review focusing on quality of life.
Diabetes Educ. Ross LJ, Neville KA. Continuous subcutaneous insulin infusion versus multiple daily injections for type 1 diabetes. J Paediatr Child Health. Thabit H, Hovorka R. Continuous subcutaneous insulin infusion therapy and multiple daily insulin injections in type 1 diabetes mellitus: a comparative overview and future horizons.
Expert Opin Drug Deliv. Salna I, Salna E, Pahirko L, Skrebinska S, Krikova R, Folkmane I, Pīrāgs V, Sokolovska JJ. Achievement of treatment targets predicts progression of vascular complications in type 1 diabetes.
Diabetes Compl. Article Google Scholar. Digital Engagement Platforms, Longenesis Curator. IBM Corp. Released IBM SPSS Statistics for Windows, Version Armonk, NY: IBM Corp. QSR International Pty Ltd. Valenzuela JM, Patino AM, McCullough J, et al.
Insulin pump therapy and health-related quality of life in children and adolescents with type 1 diabetes. J Pediatric Psychol. Al Shaikh A, Al Zahrani AM, Qari YH, et al. Increased weight. High cholesterol. It is usually associated with type 2 diabetes but has been identified in people with type 1 diabetes.
Metabolic disease can damage the vascular system, leading to cardiovascular disease. Kidney disease is characterized by impaired functioning of the kidneys. Usually, kidneys filter waste and excess fluid from the blood, so as their function becomes impaired, wastes build up.
Type 1 diabetes can lead to this if blood glucose levels are poorly controlled. This is because persistent high blood glucose levels can damage the blood vessels and the filters in the kidneys. High blood pressure can exacerbate this as it increases the pressure on the already delicate filtering system of the kidneys.
Dyslipidemia refers to abnormal levels of one kind of lipid fat in the blood. Blood contains three kinds of lipids:.
Insulin plays a critical role in lipid metabolism by inhibiting the breakdown of adipose tissue into fatty acids. Neuropathy encompasses the damage of both small and large nerve fibers and is a relatively common complication of type 1 diabetes.
Type 1 diabetes can impact both the peripheral and the autonomous nervous systems, leading to increased morbidity and mortality. People with small fiber neuropathy experience impaired sensations of pain and temperature. This can lead to undetected injuries. Large fiber damage can impact balance and touch, and in severe cases lead to difficulties in walking, hand coordination, and speech.
Early detection of neuropathy is possible, but only via a highly invasive procedure. Poor glycemic control is the key cause of diabetic neuropathy. Research directly investigating mental health issues associated with type 1 diabetes is rare, but evidence shows that younger people are particularly at risk of suicide.
Type 1 diabetes can be exhausting given the constant monitoring, calculating, troubleshooting, and experiencing the side effects of both hyperglycemic and hypoglycemic events.
This highlights the need to offer additional support, particularly in the early stages of a diagnosis, to help minimize this pressure and responsibility. Luckily, in recent years, life expectancy has been increasing due to better access to treatment.
Many steps can be taken to maximize life expectancy. Some of these are straightforward and may be easily adopted in your day-to-day life, regardless of whether you have type 1 diabetes. These include:. Staying active. Eating healthily.
Maintaining a healthy weight. Getting sufficient sleep. Maintaining tight control of blood glucose levels is the most important step to increasing life expectancy with type 1 diabetes. This can be achieved through:. Engaging in intensive insulin therapy more than three insulin injections per day.
Counting carbohydrates. Testing blood glucose levels regularly. Recognizing how stress and other external factors impact blood glucose levels. Limiting alcohol consumption. Taking care of mental health. This intensive approach to monitoring blood glucose levels helps people keep their blood glucose close to target levels.
This will limit the possibility of damage and further complications, thus extending their life expectancy. This is particularly important in children with type 1 diabetes as they will experience the disease for the longest duration.
The significant mental burden that comes with a diagnosis is important to acknowledge as mental illnesses can drastically shorten life expectancy. Diabetics need to identify appropriate support services, possibly with the help of their doctor, to alleviate the weight of this condition and resume the activities they love.
Managing type 1 diabetes and keeping it under tight control greatly increases life expectancy. The condition can be best managed through:. Consistent blood glucose monitoring. Taking insulin. Exercising regularly. Type 1 diabetes requires lifelong insulin therapy as treatment.
Insulin can be taken via regular insulin injections under the skin or via an insulin pump to provide a continuous level of insulin. When carried out correctly, insulin treatment is highly effective and allows people to keep their blood glucose levels within the target range.
Continuous pump administration has been found to result in improved glycemic control compared to multiple daily injections, making this a better option for improving life expectancy overall. This will contribute to significantly reduced diabetic complications, leading to drastic improvements in life expectancy.
Research is currently investigating various signals that the body sends when fighting disease to understand the causes and potential prevention methods for type 1 diabetes. If you have concerns about potential complications associated with type 1 diabetes, talk to your doctor about steps to maximize your life expectancy.
The earlier you do this, the better chance you have of minimizing the potential damage that poor glycemic control can have on your body. If you are experiencing a low mood, feelings of hopelessness, or a loss of interest in activities, you may want to consider checking in with your doctor to get help.
Depression and suicide are common in type 1 diabetes, so it's important to realize you aren't alone and that support is available. A person with type 1 diabetes can take many steps to manage blood glucose levels and keep them within a tightly controlled range.
In doing so and adopting other healthy behaviors, they will be able to drastically increase their overall quality of life and life expectancy. If you know someone with type 1 diabetes, reach out to them and offer support where you can, or guide them to appropriate support services.
Look for online or local support groups in the area. These are great for hearing from others going through similar experiences to see how they manage type 1 diabetes and continue to participate fully in life. Life expectancy Our World in Data.
Life expectancy of type 1 diabetic patients during — A national Australian registry-based cohort study Gender differences and temporal variation in the incidence of type 1 diabetes: Results of cases in the nationwide Diabetes Incidence Study in Sweden — Estimated life expectancy in a Scottish cohort with type 1 diabetes, Gender disparities in mortality in patients with type 1 diabetes American College of Cardiology.
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes Metabolic syndrome in type 1 diabetes: Association with diabetic nephropathy and glycemic control the FinnDiane study Risk factors for kidney disease in type 1 diabetes Lipid and lipoprotein profiles in youth with and without type 1 diabetes Differences and similarities in neuropathy in type 1 and 2 diabetes: A systematic review Suicide risk assessment in youth and young adults with type 1 diabetes Suicide risk in youth and young adults with type 1 diabetes: A review of the literature and clinical recommendations for prevention Last updated: Oct For sponsors For sponsors.
Patient insights. SCOPE Summit DEI Report.
Pimp Garlic for diabetes management have been used successfully across the Insulin pump life expectancy expectancu. Nutritional supplement dosage Insuliin not to use pmp pump is exxpectancy personal decision. You can manage Performance nutrition recipes diabetes equally well with pumps or multiple injections, so it comes down to your preference. Choosing one method over the other is not a lifelong commitment. Remember that a pump is just a tool—you can reach blood glucose goals with a pump or injections. But here are some things to consider…. Most diabetes providers and insurance companies require that you check your blood glucose at least four times per day before you go on an insulin pump.Insulin pump life expectancy -
population and life expectancy for people with type 1 diabetes. The gap dropped from 18 years for the group diagnosed in the earlier time period to just four years for the later diagnosed group. These results illustrate just how dramatic the improvement has been for people with type 1 diabetes.
As a result, the researchers who conducted the study expect life expectancy rates will continue to rise in people with type 1 diabetes, as use of these tools becomes more widespread and newer technologies are developed.
They also predict that their findings could have a practical impact, such as lower premiums for people with type 1 diabetes who wish to purchase life insurance. We value your privacy. When you visit JDRF. org and our family of websites , we use cookies to process your personal data in order to customize content and improve your site experience, provide social media features, analyze our traffic, and personalize advertising.
I Decline I Agree. Skip to content Life Expectancy for People with Type 1 Diabetes Improves Dramatically Published July 8, in Research. Also of Interest:. Your privacy We value your privacy. These devices may offer the opportunity to reduce severe hypoglycemia for those with a history of nocturnal hypoglycemia, although more clinical trials are needed.
Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing. Regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose level is safe enough for overnight sleeping.
CGM is a useful tool to reduce A1C levels in adults without increasing hypoglycemia and can reduce glycemic excursions in children. Glycemic improvements are correlated with frequency of CGM use across all ages.
School employees and caregivers should be knowledgeable about SMBG and equipped with all necessary supplies. A1C reflects average glycemia over 2—3 months 57 and strongly predicts diabetes complications 43 , Thus, A1C testing should be performed routinely in all patients with diabetes at initial assessment and as part of continuing care.
A1C is a convenient method to track diabetes control; however, there are disadvantages. However, this is controversial. Additionally, anemias, hemoglobinopathies, and situations of abnormal red cell turnover affect A1C Unstable or highly intensively managed patients e.
In patients with hemoglobinopathies that interfere with the A1C assay or with hemolytic anemia or other conditions that shorten the red blood cell life span, the A1C may not accurately reflect glycemic control or correlate well with SMBG testing results.
In such conditions, fructosamine may be considered as a substitute measure of long-term average over 2 weeks glycemic control. Perform the A1C test quarterly in most patients with type 1 diabetes and more frequently as clinically indicated i.
Point-of-care A1C testing, using a DCCT standardized assay, may provide an opportunity for more timely treatment changes. The DCCT clearly showed that intensive insulin therapy, defined as three or more injections per day of insulin or continuous subcutaneous insulin infusion CSII or insulin pump therapy , was a key part of improved glycemia and better outcomes 43 , The study was carried out with short- and intermediate-acting human insulins.
Despite better microvascular outcomes, intensive insulin therapy was associated with a high rate of severe hypoglycemia 62 episodes per patient-years of therapy.
Since the completion of the DCCT, a number of rapid-acting and long-acting insulin analogs have been developed. These analogs are associated with less hypoglycemia than human insulin while offering the same amount of A1C lowering in people with type 1 diabetes 64 , The two study groups started with the same baseline A1C of 8.
After 1 year, the group using insulin pump therapy and CGM had lower A1C levels 7. Recently, a large randomized trial in patients with type 1 diabetes and nocturnal hypoglycemia reported that the use of sensor-augmented insulin pump therapy with the threshold-suspend feature reduced nocturnal hypoglycemia without increasing glycated hemoglobin values Most individuals with type 1 diabetes should be treated with multiple daily insulin injections three or more injections per day of prandial insulin and one to two injections of basal insulin or CSII.
Most individuals with type 1 diabetes should be educated in how to match prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk.
All individuals with type 1 diabetes should be taught how to manage blood glucose levels under varying circumstances, such as when ill or receiving glucocorticoids or for those on pumps, when pump problems arise.
Therapy trials to prevent type 1 diabetes development prevention , to preserve remaining β-cells preservation , and to replace β-cells transplantation are ongoing.
Although means are available to screen and predict family members at risk for developing type 1 diabetes, efforts to delay or prevent disease onset have been largely disappointing. A variety of different immunomodulatory and immune-suppressive agents have been evaluated in patients with recent-onset type 1 diabetes, and the effects have been modest at best: for the subset of drugs that appear to have an effect, not all patients respond; for those who do, the effects are generally transient.
Many of the agents tested to date are FDA approved for other indications, but given the observations to date and potential toxicities, the recommendation is that patients should only receive these drugs after being enrolled in clinical research protocols with appropriate follow-up.
Long-term safety and efficacy data are scarce, especially in children. Investigators continue to evaluate promising new agents and combinations of drugs or cell-based therapies in an effort to safely and effectively modulate the autoimmune response β-Cell replacement may be achieved through pancreas or islet transplantation in select candidates.
Pancreas transplants are now accepted as a proven therapy, while islet transplants, though significantly improving, are still mostly done on an experimental basis. Pancreas transplants are most often performed in combination with kidney transplantation, either as a simultaneous pancreas-kidney SPK transplant or as a pancreas-after-kidney PAK transplant SPK and PAK transplants may be considered for individuals with late-stage kidney disease because the transplants can normalize glucose levels, which will prevent hypoglycemia and provide some protection for the transplanted kidney 72 , and provide other benefits, including an improvement in quality of life These recipients will already require immunosuppression for their renal transplants, which means the major additional risk is the operative procedure.
SPK transplants function for an average of 9 years, compared with 6 years for PAK transplants There has been debate about pancreas transplant alone PTA in the absence of an indication for kidney transplantation because of the risks of mortality, morbidity, and immunosuppression.
Outcomes have gradually improved 73 , such that the procedure can be cautiously considered for individuals without renal failure who have unstable glucose control and hypoglycemia unawareness. Because of the risks of pancreas transplantation compared with traditional methods for controlling blood glucose levels, all available efforts to use exogenous insulin combined with technology, education, and glucose follow-up should be exhausted before PTA is performed.
The durability of function averages 6 years, which is much better than islet transplantation but about the same as PAK and not as good as SPK A major appeal of islet transplantation is that it does not require major surgery. Moreover, outcomes have improved over the past decade such that normoglycemia without insulin is now maintained for an average of 3 years in specialized protocols Even when insulin treatment is reinstituted, residual insulin secretion can help recipients maintain good control with less hypoglycemia and a less complicated regimen for several more years.
At the present time, few islet transplants are being performed and most are experimental. However, they can be considered as a treatment option for those who are poor candidates for whole-organ transplants.
Importantly, their current success has established a proof of principle for cellular transplantation. Great progress is being made in finding an abundant source of healthy insulin-producing cells and in developing better ways to protect transplanted cells from immune destruction 75 , Potential solutions for the shortage of islets include embryonic stem cells, induced pluripotent stem cells, xenogeneic tissue, and various other potential sources—all the focus of ongoing research efforts.
Another possible way to replenish the β-cell deficiency of diabetes is through regeneration of the endocrine pancreas; this too is being worked on intensively.
Consider solid organ pancreas transplantation simultaneously with kidney transplantation in patients with type 1 diabetes who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions. Consider solid organ pancreas transplantation after kidney transplantation in adult patients with type 1 diabetes who have already received a kidney transplant.
Judiciously consider solid organ pancreas transplantation alone in adults with type 1 diabetes, unstable glucose control, hypoglycemia unawareness, and an increased risk of diabetes-related mortality, who have attempted all of the more traditional approaches to glycemic control and have remained unsuccessful, yet are judged responsible enough to manage the antirejection medication regimen, risks, and follow-up required with an organ transplant.
Consider referral to research centers for protocolized islet cell transplantation in patients with type 1 diabetes and debilitating complications of diabetes who are interested in research possibilities and fit the criteria for the research protocol.
Pramlintide, an amylin analog, is an agent that delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety. It is an FDA-approved therapy for use in type 1 diabetic patients and has been shown to reduce A1C, induce weight loss, and lower insulin dose. However, it is only indicated for adults.
There are a few small, short-term studies of pramlintide use in children with type 1 diabetes, with outcomes similar to those in the adult studies.
Clearly, larger, long-term studies are needed in pediatrics. Injectable glucagon-like peptide-1 GLP-1 agonists and oral dipeptidyl peptidase-4 DPP-4 inhibitors are increasingly being studied in the type 1 diabetic population, but are not approved by the FDA for this indication.
GLP-1 agonists delay gastric emptying, suppress the postprandial rise in glucagon secretion, and may increase satiety. Preliminary studies indicate that these agents may also facilitate weight loss.
Further long-term clinical trials in type 1 diabetic patients are needed. Sodium-glucose cotransporter 2 SGLT2 inhibitors work by inhibiting glucose reabsorption in the kidney and are also being tested in individuals with type 1 diabetes. These agents provide insulin-independent glucose lowering by blocking glucose reabsorption in the proximal renal tubule, leading to weight loss and A1C reduction in individuals with type 2 diabetes.
However, insufficient data exist to recommend clinical use of these agents in type 1 diabetes at this time. Metformin is a biguanide that decreases hepatic gluconeogenesis and is used as first-line therapy in type 2 diabetes.
It has been shown to have some benefit in reducing insulin doses and weight in small studies in patients with type 1 diabetes 79 and is now being evaluated more fully for use in patients with type 1 diabetes. Two randomized controlled trials are currently under way evaluating metformin in type 1 diabetic patients.
The first study is in adults and is using carotid intima-medial thickness as an outcome measure ClinicalTrials. gov identifier: NCT Results are currently pending. Pramlintide may be considered for use as adjunctive therapy to prandial insulin in adults with type 1 diabetes failing to achieve glycemic goals.
Current type 2 diabetes medications GLP-1 agonists, DPP-4 inhibitors, and SGLT2 inhibitors may be potential therapies for type 1 diabetic patients, but require large clinical trials before use in type 1 diabetic patients. Hypoglycemia risk is the limiting step in the treatment of type 1 diabetes at any age.
Because current methods of blood glucose detection and insulin replacement are imperfect though improved from prior eras , hypoglycemia risk is invariably present. Patient education 80 , frequent SMBG, and CGM can help detect hypoglycemia and allow for adjustments in insulin dosing and carbohydrate intake.
Severe hypoglycemia rates increase with antecedent episodes of hypoglycemia, age, and duration of diabetes; thus, this is an issue that must be reassessed frequently Hypoglycemia unawareness is related to a reduced sympathoadrenal response to hypoglycemia; it can occur in the setting of recurrent hypoglycemia or autonomic failure and can be reversed by scrupulous avoidance of hypoglycemia.
Patients should be screened to determine the threshold at which hypoglycemia symptoms occur; if the threshold is suggestive of hypoglycemia unawareness, the treatment goals and regimen should be revisited and counseling regarding appropriate self-monitoring before critical tasks should be reinforced Oral carbohydrate is the treatment of choice for self-treatment or for the treatment of hypoglycemic adults and children who are alert and able to eat.
Glucagon is used for severe hypoglycemia. In children, small studies have led to the concept of using age-based mini-dose glucagon if the child is alert but not able to eat Individuals with type 1 diabetes, or their caregivers, should be asked about symptomatic and asymptomatic hypoglycemia at each encounter.
Glucose 15—20 g is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate may be used. If the SMBG result 15 min after treatment shows continued hypoglycemia, the treatment should be repeated.
Once blood glucose concentration returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia. Glucagon should be prescribed for all individuals with type 1 diabetes.
Caregivers or family members of these individuals should be instructed in its administration. Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger reevaluation of the treatment regimen.
Insulin-treated patients with hypoglycemia unawareness or an episode of severe hypoglycemia should be advised to raise their glycemic targets to strictly avoid further hypoglycemia for at least several weeks to partially reverse hypoglycemia unawareness and reduce the risk of future episodes.
DKA see ref. Mild cases can be safely and effectively treated in an acute care setting with appropriate resources and may not require hospitalization.
Education must be provided to individuals with type 1 diabetes in order to help prevent DKA, which can have serious sequelae, particularly in children under 5 years of age.
There are multiple guidelines available for the management of DKA Individuals and caregivers of individuals with type 1 diabetes should be educated and reminded annually how to prevent DKA, including a review of sick-day rules and the critical importance of always administering insulin and monitoring both glucose and ketone levels.
Insulin omission is the major cause of DKA; therefore, individuals with type 1 diabetes must have access to an uninterrupted supply of insulin.
Patients with type 1 diabetes and their families should have around-the-clock access to medical advice and support to assist with sick-day management. Standard protocols for DKA treatment should be available in emergency departments and hospitals.
Much of the existing data on the risk of CVD in individuals with diabetes is based on people with type 2 diabetes who often have additional CVD risk factors, such as metabolic syndrome, hypertension, and dyslipidemia. How much is applicable to people with type 1 diabetes is unknown.
However, people with type 1 diabetes are at increased risk for CVD, particularly those with additional risk factors.
In type 1 diabetes, standard risk factors apply, such as hyperlipidemia, hypertension, age, family history, smoking, weight, and presence of albuminuria. As such, these should be considered when determining the need for evaluation and treatment for CVD. However, even in the absence of classic risk factors, there may be high CVD risk.
In some cases, measurement of coronary artery calcification may be a helpful method for determining CVD risk Here, as with all management issues for people with type 1 diabetes, providers need to individualize assessment and treatment options.
The Heart Protection Study HPS did include type 1 diabetic participants who appeared to experience the same degree of benefit from statins as others in the study, though the finding was not statistically significant due to low numbers Unfortunately, there are no blood pressure intervention trials with CVD end points in type 1 diabetes and only one LDL cholesterol—lowering trial Statin and aspirin therapy if not contraindicated should be considered and used as is individually indicated.
Individuals with type 1 diabetes aged 40—75 years may benefit from moderate-to-intensive statin therapy with consideration of diabetes duration and CVD risk factors. To minimize risks associated with pregnancy and type 1 diabetes, preconception counseling and care are critical.
Preconception care with tight glycemic control improves outcomes including lower cesarean rates 88 , decreased perinatal mortality 89 — 91 , and decreased congenital malformations 89 — Although there is some evidence that childbearing may be reduced 98 — , in general, fertility should be assumed to be normal, and all young women with type 1 diabetes should receive preconception counseling covering diabetes and general topics, including use of prenatal vitamin, discontinuation of potentially teratogenic medications, and the importance of glycemic control to reduce the risk of congenital malformations.
Type 1 diabetes affects approximately 0. During pregnancy, there are substantial changes in maternal insulin sensitivity that may cause profound changes in insulin requirements. Whereas insulin resistance increases markedly during the second and third trimesters, a greater proportion of total daily insulin dose must be given prandially and a lower proportion used to cover basal metabolic requirements Pregnant women with type 1 diabetes require meticulous glycemic management by experts trained in obstetrics, endocrinology, and maternal-fetal medicine.
Women who are planning pregnancy or who are pregnant may need to test blood glucose levels frequently often 10 or more times daily to reach and maintain a near-normal A1C level without excessive hypoglycemia.
Severe hypoglycemia may occur early during pregnancy This is followed by periods of insulin resistance and subsequent hyperglycemia if the increased insulin needs are not met.
Therefore, health care providers must be vigilant and frequently adjust insulin dosing throughout gestation. In a pregnancy complicated by diabetes and chronic hypertension, target blood pressure goals of systolic blood pressure — mmHg and diastolic blood pressure 65—79 mmHg are reasonable.
Lower blood pressure levels may be associated with impaired fetal growth Table 8. ACE inhibitors and angiotensin receptor blockers are contraindicated during pregnancy because they may have adverse effects on the fetus.
Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, diltiazem, clonidine, and prazosin. See refs. They are targets, but not everyone can achieve them.
There is certainly marked variability, which explains why there is greater incidence of large-for-gestational-age infants in patients with type 1 diabetes.
Eye examinations should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum because of the risk of rapid retinopathy progression during pregnancy. Those with progressive retinopathy should have more frequent screening by an ophthalmologist experienced in retinopathy management.
Therefore, all pregnant women with type 1 diabetes should be screened for thyroid disease early in pregnancy. Starting at puberty, preconception counseling should be incorporated into routine diabetes clinic visits for all adolescents and women of childbearing potential, and appropriate birth control techniques should be discussed with women who do not desire pregnancy.
As most pregnancies are unplanned, consider the potential risks and benefits of medications that are contraindicated in pregnancy in all adolescents and women of childbearing potential and counsel women using such medications accordingly.
Such medications should be evaluated prior to conception, as drugs commonly used to treat diabetes and its complications may be contraindicated or not recommended in pregnancy, including statins, ACE inhibitors, angiotensin receptor blockers, and most noninsulin therapies.
Prenatal vitamins with folate should be started with preconception planning to reduce the risk for birth defects. All pregnant women with type 1 diabetes should be screened for thyroid disease early in pregnancy. Women contemplating pregnancy should be evaluated and, if indicated, treated for diabetic retinopathy, nephropathy, neuropathy, and CVD.
Nutritional intake should be optimized and included in preconception planning according to general pregnancy guidelines. Management of individuals with type 1 diabetes in the hospital and in preparation for scheduled outpatient procedures often differs from that of individuals with type 2 diabetes.
The challenges include difficulties associated with fasting, maintaining a consistent source of carbohydrate, and facilitating inpatient blood glucose management while modifying scheduled insulin therapy.
Outpatient procedures should be performed with the awareness that individuals with type 1 diabetes may have difficulty fasting for long periods of time more than 10 h prior to a procedure. It is imperative that the entire health care team, including anesthesiologists and surgeons as well as other specialists who perform procedures, understands type 1 diabetes and how it factors into the comprehensive delivery of care.
From a practical perspective, this means that people with type 1 diabetes will be at high risk for hypoglycemia during prolonged fasting and are at risk for ketosis if insulin is inappropriately withheld. Once under anesthesia, individuals with type 1 diabetes must be carefully monitored for hypoglycemia and hyperglycemia.
For some individuals, once the most acute phase of an illness has resolved or improved, patients may be able to self-administer their prior multiple-dose or CSII insulin regimen under the guidance of hospital personnel who are knowledgeable in glycemic management.
All patients admitted to the hospital should have type 1 diabetes clearly identified in the medical record. Goals for blood glucose levels are the same as for people with type 2 diabetes or hospital-related hyperglycemia.
Insulin dosing adjustments should be made in the perioperative period and inpatient setting with consideration of changes in oral intake, recent blood glucose trends, and the need for uninterrupted basal insulin to prevent hyperglycemia and ketoacidosis, with adjustment of the long-acting insulin or basal insulin requirement to reflect true basal requirements, insofar as they may be anticipated.
Child care personnel and school staff should receive training to provide diabetes care in the absence of a school nurse or licensed health care professional. Young children often lack the motor, cognitive, and communication skills and abilities to manage their diabetes and completely depend on adult caregivers.
The management priority for younger children is the prevention, recognition, and treatment of hypoglycemia and marked hyperglycemia. A diabetes camp is an ideal place for children and youth to have an enjoyable camp experience and receive peer support from other children with diabetes under close medical oversight.
The goals for campers are to learn to cope more effectively with diabetes, learn self-management skills to gain more independence, and share experiences with other young people with diabetes. The camp medical director is responsible for the diabetes management of the children. A registered dietitian oversees dietary planning at camp.
Medical directors and staff should have expertise in managing type 1 diabetes and must receive training concerning routine diabetes management and treatment of diabetes-related emergencies at camp. Staff must follow universal precautions including Occupational Safety and Health Administration OSHA regulations, Clinical Laboratory Improvement Amendments CLIA standards, and state regulations There are practical and legal issues related to diabetes in the workplace.
Employers and employees with diabetes should work together to find solutions and educate themselves about the rights of individuals with diabetes. Individuals with diabetes are responsible for having all necessary diabetes supplies, eating properly, and being aware of safety issues and regulations at work.
Older individuals with type 1 diabetes are unique in that they have lived for many years with a complex disease. Not all older adults are alike: some may continue a rigorous regimen, with tighter control, while others may require less stringent targets.
Along with age-related conditions, older adults may develop diabetes-related complications, which make managing type 1 diabetes more challenging. Providers should be aware that insulin dosing errors, meal planning, and physical activities must be properly managed in older adults.
Severe hyperglycemia can lead to symptoms of dehydration and hyperglycemic crises. While chronic hyperglycemia is detrimental, hypoglycemia may be more of a concern in some older adults.
Declining cognition may contribute to hypoglycemia unawareness or the inability to safely manage hypoglycemia when it occurs. An individualized approach that includes the reassessment of prior targets may be warranted.
Even though this report focuses primarily on the type 2 diabetic population, there is significant overlap in the comorbidities and complications experienced by the older type 1 and type 2 diabetic populations.
Although type 1 diabetes is increasing in several ethnic and racial groups, it remains less common in people of non-European descent. A better understanding of the unique pathophysiology of type 1 diabetes is needed.
In addition, multidisciplinary diabetes teams should receive training to properly address the diverse cultural needs of these populations and to optimize health care delivery, improve glycemic control, and prevent complications.
Type 1 diabetes is an increasing global public health burden. The demands of daily management, chronicity of the disease, potential complications, paucity of diabetes specialists, and rising incidence are challenging in the U. International organizations play a major role in improving care for individuals with type 1 diabetes in the developing world, but implementable, cost-saving, and sustainable strategies are needed to make such programs successful Anderson, Florence M.
Brown, H. Peter Chase, William L. Clarke, Sheri R. Colberg, Kathleen Dungan, Steven Edelman, Martha M. Funnell, Stephen E. Gitelman, Ann E. Goebel-Fabbri, Jeffrey S. Gonzalez, Carla J. Greenbaum, Michael J. Haller, Kara Hawkins, Laurie A. Higgins, Irl B.
Hirsch, William C. Hsu, Heba Ismail, Crystal Crismond Jackson, Tamarra James-Todd, Georgeanna J. Klingensmith, David C. Klonoff, Mary Korytkowski, David Maahs, Hussain Mahmud, Medha N. Munshi, Trevor Orchard, Bruce A.
Perkins, Jeremy Hodson Pettus, Andrew M. Posselt, Michael C. Riddell, Elizabeth R. Seaquist, Janet Silverstein, Linda M. Siminerio, Peter Stock, William V. Tamborlane, Guillermo E. Umpierrez, Raynard Washington, Joseph I. Wolfsdorf, Howard Wolpert, Jennifer Ann Wyckoff, and Mary Ziotas Zacharatos.
The authors acknowledge Gordon Weir and the Steering Committee members: Belinda Childs, Richard A. Insel, Margaret A. Powers, Richard Rubin, Desmond Schatz, and Linda M.
The authors also thank Erika Gebel Berg American Diabetes Association for her invaluable editorial contribution. Duality of Interest. received research support from Novo Nordisk to the University of North Carolina for a study of an investigational drug for type 1 diabetes.
In —, L. In the past year, A. No other potential conflicts of interest relevant to this article were reported. The position statement was reviewed and approved by the Professional Practice Committee in April and approved by the Executive Committee of the Board of Directors in April Sign In or Create an Account.
Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation.
Volume 37, Issue 7. Previous Article Next Article. Incidence and Prevalence of Type 1 Diabetes. Classification and Diagnosis. Initial Evaluation and Follow-up.
DSME and DSMS. Psychosocial: Assessment and Treatment of Psychosocial Issues. Nutrition Therapy. Physical Activity and Exercise. Treatment Targets. A1C Testing.
Insulin Therapy. β-Cell Replacement Therapy. Adjunctive Therapies. CVD Screening and Treatment. Specific Settings and Populations. Article Information. Article Navigation. Position Statement June 12 Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association Jane L.
Chiang ; Jane L. Corresponding author: Jane L. Chiang, jchiang diabetes. This Site. Google Scholar. Sue Kirkman ; M. Sue Kirkman. Lori M. Laffel ; Lori M. Anne L. Peters ; Anne L.
on behalf of the Type 1 Diabetes Sourcebook Authors on behalf of the Type 1 Diabetes Sourcebook Authors. Diabetes Care ;37 7 — Get Permissions. toolbar search Search Dropdown Menu.
toolbar search search input Search input auto suggest. Figure 1. View large Download slide. A Consider measurement of pancreatic autoantibodies to confirm the diagnosis of type 1 diabetes.
Table 1 Criteria for the diagnosis of diabetes. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay. Fasting is defined as no caloric intake for at least 8 h. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
View Large. Table 2 Major developmental issues and their effect on diabetes in children and adolescents. Developmental stages ages. Normal developmental tasks. Type 1 diabetes management priorities. Family issues in type 1 diabetes management. Table 3 Medical history.
Age and characteristics of onset of diabetes e. Clinical evaluation. Quarterly follow-up. If triglycerides are elevated in a nonfasting specimen, measure a direct LDL cholesterol level. E Health care for adults should be focused on the needs of the individual throughout the various stages of their life, with age-appropriate evaluation and treatment.
E Evaluation and treatment of CVD risk should be individualized. E Consider screening for thyroid peroxidase and thyroglobulin antibodies soon after diagnosis. E Screen for thyroid dysfunction by measuring thyroid-stimulating hormone TSH concentrations soon after type 1 diabetes diagnosis and after stable metabolic control.
E Assess for the presence of additional autoimmune conditions at diagnosis and if symptoms develop. E Ongoing nutrition and diabetes self-management education DSME and support DSMS are needed to address changes in food preferences, access to food, daily schedules, activity patterns, and potential barriers to self-care, including the risk of an eating disorder.
Table 6 DSME content based on life stages. E The developing teenager must be educated about the transition to adult health care, beginning in early to mid-adolescence, with increasing efforts to establish self-reliance in diabetes care beginning at least 1 year prior to the transition.
C Health care providers should promptly address issues related to self-care capacity, mobility, and autonomy. A Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycemic control.
B If adults with type 1 diabetes choose to drink alcohol, they should be advised to do so in moderation one drink per day or less for adult women and two drinks per day or less for adult men. E Patients of all ages or caregivers of children should be educated about the prevention and management of hypoglycemia that may occur during or after exercise.
E A reduction in overnight basal insulin the night following exercise may reduce the risk for delayed exercise-induced hypoglycemia. C SMBG should be performed as frequently as needed before, during, and after exercise in order to prevent, detect, and treat hypoglycemia and hyperglycemia.
E Source s of simple carbohydrate should be readily available before, during, and after exercise to prevent and treat hypoglycemia. B Glycemic control for those of any age with type 1 diabetes should be assessed based on frequent SMBG levels and CGM data, if available in addition to A1C in order to direct changes in therapy.
B Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing.
B CGM is a useful tool to reduce A1C levels in adults without increasing hypoglycemia and can reduce glycemic excursions in children. E School employees and caregivers should be knowledgeable about SMBG and equipped with all necessary supplies.
E Capable children should be permitted to self-manage their diabetes at school. A Point-of-care A1C testing, using a DCCT standardized assay, may provide an opportunity for more timely treatment changes. A Most individuals with type 1 diabetes should be educated in how to match prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity.
E Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. A All individuals with type 1 diabetes should be taught how to manage blood glucose levels under varying circumstances, such as when ill or receiving glucocorticoids or for those on pumps, when pump problems arise.
B Consider solid organ pancreas transplantation after kidney transplantation in adult patients with type 1 diabetes who have already received a kidney transplant.
C Judiciously consider solid organ pancreas transplantation alone in adults with type 1 diabetes, unstable glucose control, hypoglycemia unawareness, and an increased risk of diabetes-related mortality, who have attempted all of the more traditional approaches to glycemic control and have remained unsuccessful, yet are judged responsible enough to manage the antirejection medication regimen, risks, and follow-up required with an organ transplant.
C Consider referral to research centers for protocolized islet cell transplantation in patients with type 1 diabetes and debilitating complications of diabetes who are interested in research possibilities and fit the criteria for the research protocol. C Current type 2 diabetes medications GLP-1 agonists, DPP-4 inhibitors, and SGLT2 inhibitors may be potential therapies for type 1 diabetic patients, but require large clinical trials before use in type 1 diabetic patients.
E Glucose 15—20 g is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate may be used. E Glucagon should be prescribed for all individuals with type 1 diabetes. E Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger reevaluation of the treatment regimen.
E Insulin-treated patients with hypoglycemia unawareness or an episode of severe hypoglycemia should be advised to raise their glycemic targets to strictly avoid further hypoglycemia for at least several weeks to partially reverse hypoglycemia unawareness and reduce the risk of future episodes.
B Insulin omission is the major cause of DKA; therefore, individuals with type 1 diabetes must have access to an uninterrupted supply of insulin. E Patients with type 1 diabetes and their families should have around-the-clock access to medical advice and support to assist with sick-day management.
C Standard protocols for DKA treatment should be available in emergency departments and hospitals. E Individuals with type 1 diabetes aged 40—75 years may benefit from moderate-to-intensive statin therapy with consideration of diabetes duration and CVD risk factors.
C As most pregnancies are unplanned, consider the potential risks and benefits of medications that are contraindicated in pregnancy in all adolescents and women of childbearing potential and counsel women using such medications accordingly.
E Such medications should be evaluated prior to conception, as drugs commonly used to treat diabetes and its complications may be contraindicated or not recommended in pregnancy, including statins, ACE inhibitors, angiotensin receptor blockers, and most noninsulin therapies. B Prenatal vitamins with folate should be started with preconception planning to reduce the risk for birth defects.
B All pregnant women with type 1 diabetes should be screened for thyroid disease early in pregnancy. B Women contemplating pregnancy should be evaluated and, if indicated, treated for diabetic retinopathy, nephropathy, neuropathy, and CVD.
B Nutritional intake should be optimized and included in preconception planning according to general pregnancy guidelines. E Goals for blood glucose levels are the same as for people with type 2 diabetes or hospital-related hyperglycemia.
E A plan for preventing and treating hypoglycemia should be established for each patient. E Insulin dosing adjustments should be made in the perioperative period and inpatient setting with consideration of changes in oral intake, recent blood glucose trends, and the need for uninterrupted basal insulin to prevent hyperglycemia and ketoacidosis, with adjustment of the long-acting insulin or basal insulin requirement to reflect true basal requirements, insofar as they may be anticipated.
Table 9 Diabetes care tasks for school personnel. Diabetes care tasks. Outcome if not treated. Hypoglycemia recognition and treatment Catecholamine effect sweating, jitteriness, tachycardia, and palpitations or neuroglycopenia behavior change Glucose, wait 15 min, recheck, give food if blood glucose is adequate based on DMMP Seizure or coma Know when and how to give glucagon Know when to contact parents or emergency medical services Have all contact information available on emergency plan Hyperglycemia recognition and treatment Polyuria, polydipsia most common , difficulty concentrating, headache, or irritability Rapid- or short-acting insulin Check for ketones.
DMMP, Diabetes Medical Management Plan. Prime Group for JDRF. SEARCH for Diabetes in Youth Study Group. Incidence of diabetes in U. youth by type. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Search ADS.
Prevalence of diabetes in U. youth in the SEARCH for Diabetes in Youth study. Adult-onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: Action LADA 7.
Jane L. ExpectahcyM. Sue Epxectancy Insulin pump life expectancy, Lori M. LaffelAnne L. Peterson behalf of the Type 1 Diabetes Sourcebook Authors; Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association.Back to Managing expecrancy. An lif pump delivers tiny amounts of Garlic for diabetes management into the blood Nutritional supplement dosage the day and night.
You attach the pump to your skin. Insulin flows into Insuljn body through a tiny tube Ihsulin your skin. The tube Garlic for diabetes management replaced Fueling timing before a race 2 to Cholesterol management tips days pkmp the Liver protection supplements is moved Garlic for diabetes management another part of Nutritional supplement dosage expsctancy.
It delivers a set amount of background insulin. You then add your extra mealtime insulin using the pump. A pump can give you more flexibility with what you eat and help you have more stable blood glucose levels. The National Institute for Health and Care Excellence NICE recommends an insulin pump if:.
Your consultant may recommend a pump if this is happening and you can show you're:. Page last reviewed: 8 July Next review due: 8 July Home Health A to Z Type 1 diabetes Managing insulin Back to Managing insulin. Insulin pumps.
This reduces hypoglycaemia hypos and can improve blood glucose levels. But a pump might not suit everyone. How to get an insulin pump You can buy an insulin pump yourself A pump costs around £2, to £3, It should last 4 to 8 years.
You'll get your insulin on prescription as normal.
: Insulin pump life expectancy| Study Estimates Average Life Years Lost from Type 1, Type 2 Diabetes | BMC Health Serv Res. This process demands a certain amount of self-management, such as treatment diaries and recording and interpretation of blood sugar levels. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Understand audiences through statistics or combinations of data from different sources. All individuals with type 1 diabetes should be taught how to manage blood glucose levels under varying circumstances, such as when ill or receiving glucocorticoids or for those on pumps, when pump problems arise. Inform type 1 diabetic patients of the opportunity to have their relatives tested for type 1 diabetes risk in the setting of a clinical research study. |
| Try these online courses | Table 2 Nutritional supplement dosage the childhood developmental Ibsulin and oump. They are targets, but not everyone can achieve Insulin pump life expectancy. Expectsncy may be considered for use as adjunctive therapy to prandial insulin in adults with type 1 diabetes failing to achieve glycemic goals. This will limit the possibility of damage and further complications, thus extending their life expectancy. Diabetes Compl. Diabet Med. |
| How to get an insulin pump | Some have issues with their infusion sites, so they go off the pump for a while to let their sites recover. Whatever works to make diabetes treatment easier and better. Look at the individual pump company sites and read bloggers who have experience using the pumps. Speak with your diabetes team. Most insurance companies will not pay for a new pump more often than every four years, so this is a device you will have for a while. Finally, remember this is not a permanent decision. You can get a pump, wear it, stop wearing it, restart it—whatever works for you. It is an option for treating your diabetes and the choice is yours. About Diabetes. A pump might be considered for: People who like the idea of a pump. If this is what you want, or you want for your child, and it can be used it safely, then it should be used. Active people, who benefit from changes in basal rates or suspending the pump when exercising. People who have frequent low blood glucose reactions. Anyone who has delays in absorption of food from the stomach gastroparesis. Women planning pregnancy. There are technical aspects to using a pump—setting it up, putting it in, interacting with it—that are more complicated in some ways than using injections. Icy fingers and toes: Poor circulation or Raynaud's phenomenon? Thanks to the introduction of insulin therapy in , and numerous advances since then, many people with type 1 diabetes now live into their 50s and beyond. But survival in this group still falls short of that among people without diabetes. A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than year-olds without it. A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. Type 1 diabetes is an autoimmune disease. The immune system mistakenly attacks and destroys cells in the pancreas that make insulin. This usually happens before age Insulin is needed to get blood sugar glucose into cells for energy. Without insulin, glucose builds up in the bloodstream. This damages cells and tissues throughout the body. People who develop type 1 diabetes need to take insulin via shots or a pump for life. Type 2 diabetes tends to occur later in life, usually among individuals who are overweight or inactive. As with type 1 diabetes, glucose builds up in the bloodstream, damaging cells and tissues throughout the body. Type 2 diabetes is initially treated with lifestyle changes such as weight loss, more exercise, and a healthier diet. Medications that make the body more sensitive to insulin and do other things to control blood sugar may also be needed. Gestational diabetes develops during pregnancy, and fades away after delivery. About 1 in 20 women develop gestational diabetes. Insulin can be a difficult drug to manage. A mismatch between insulin and food intake can cause blood sugar to drop dangerously low hypoglycemia. This can lead to symptoms such as a fast heart beat or feeling shaky. Hypoglycemia can also lead to a diabetic coma, and even death. That said, insulin works very well for most people with type 1 diabetes. Other reasons why people with type 1 diabetes are now living longer include:. Better insulins are available, and they are easier to use. Some last all day, others work very quickly. Insulin pumps make it easier to deliver insulin. Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life. New drugs and other therapies to prevent and treat complications of diabetes, such as heart disease and kidney disease. Both are major causes of early death in people with type 1 diabetes. The second JAMA study was a long-term follow-up of men and women who participated in the Diabetes Control and Complications Trial, which ran from to After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. This suggests that tight control is one way to improve survival in people with type 1 diabetes. That makes sense, because lower blood sugar means less damage to cells and tissues. But it may also mean more brushes with hypoglycemia, which poses its own set of problems. Not everyone with diabetes should strive for near-normal blood sugar levels. For example, people who are older, or frail, or who have other health issues may not be good candidates for tight blood sugar control. Beyond blood sugar control, keeping cholesterol and blood pressure in the healthy range are essential for people with diabetes. Back in , the Harvard-affiliated Joslin Clinic in Boston began giving Victory Medals to individuals who had lived with type 1 diabetes for 25 years. The program was expanded in with year medals. The first year medal was presented in In addition to honoring long-term survivors, investigators at the Joslin Diabetes Center are studying them to learn what has helped them beat the odds. |
| Life Expectancy for People with Type 1 Diabetes Improves Dramatically | Diabetes Care 1 July ; 37 7 : — Most Insuliin with type 1 Antibiotic-Free Dairy should Insulin pump life expectancy treated with multiple daily insulin injections three or Ilfe injections per day of prandial insulin and one to two injections of basal insulin or CSII. Sign In or Create an Account. The immune system mistakenly attacks and destroys cells in the pancreas that make insulin. In the range of 0—5 tests per day, A1C decreased by 0. Clin Med Insights Endocrinol Diabetes;; Obesity Management. |
Video
The ONLY MINERAL that Lowers Insulin Resistance (pretty quick) Type 1 lifr is a exxpectancy autoimmune Garlic for diabetes management in which the body attacks the insulin-producing expectacny of the pancreas. Ineulin Nutritional supplement dosage a hormone required Garlic for diabetes management expectxncy sugar from Promotes fullness to enter cells and be used for energy. Without it, our cells starve, and blood glucose remains high. Currently, lifelong insulin injection therapy is the main treatment for type 1 diabetes. We make it easy for you to participate in a clinical trial for Type 1 diabetes, and get access to the latest treatments not yet widely available - and be a part of finding a cure.
Ich biete Ihnen an, zu versuchen, in google.com zu suchen, und Sie werden dort alle Antworten finden.
die richtige Antwort
Aller ist nicht so einfach
Ich werde besser einfach stillschweigen