Type 1 diabetes is a disease requiring ongoing commitment and active patient participation in treatment management.
The goal is to achieve an acceptable compromise between ensuring the highest possible quality of life for the patient and the prevention of acute or chronic complications of the disease. Therapeutic education, aimed at the maximum empowerment of the patient, is therefore an important step after diagnosis and psychological support remains paramount as for any chronic illness.
The standard treatment for type 1 diabetes is insulin delivery several times a day in an attempt to mimic the normal physiological secretion, that is to say a massive diffusion at the time of meals and continues outside.
Currently the most common means is subcutaneous injection with a pre-filled pen of human insulin analogues (genetically modified insulin) of which there are two major complementary types:
- so-called "fast", having an almost immediate action (10 minutes) and short duration (2 to 4 hours), useful for quickly lowering the glucose level after a meal.
- of slow action called "basal" which remain active for 24 hours and ensure the permanent presence of insulin in the blood throughout the day, as in a non-diabetic individual.
"Optimized" or "basal-bolus" insulin therapy
So-called "optimized" or "basal-bolus" insulin therapy thus includes three to four daily injections of insulin and at least four blood glucose controls, hence the need for close medical follow-up at the start of treatment. Injections can be done on the stomach, thighs, buttocks or arms.
Functional insulin therapy
A personalized method called "functional insulin therapy" can also be proposed and aims to educate the diabetic patient so that he can adapt his dose of insulin to his lifestyle (type of physical activity, composition of the meal, stress ..) to improve the stability and balance of his diabetes.
Insulin can also be delivered through an insulin pump that continuously infuses via a subcutaneous catheter connected to a miniaturized syringe pump (the size of a cell phone attached to the belt or bra) especially when diabetes is very unstable, patients with significant schedule variability or requiring strict control of their diabetes (ocular or renal complications, women wanting to start a pregnancy).
There may be several barriers to good adherence to treatment:
- fear of hypoglycemia (especially nocturnal);
- the fear of gaining weight;
- the refusal of constraints (self-monitoring, diet, injection), especially at the time of adolescence;
- insulin regimens unsuited to physiology or lifestyle;
- technical errors: injections too deep or too superficial, always performed in the same place and responsible for lipodystrophies (subcutaneous nodules) that hinder the good absorption of insulin.
At present, we no longer speak of a "diabetic diet" but of a balanced diet adapted to diabetics, combining starchy foods (sources of carbohydrates), vegetables (fiber sources) and proteins.
In order to limit the hyperglycemia that follows a meal, are to be favored:
- Carbohydrates with a low glycemic index are to be preferred: legumes alternating with potatoes, pasta, rice, semolina, chickpeas and cereals;
- in combination with the fibers that slow down their absorption, lower the cholesterol level and regulate intestinal transit: vegetables, fruits with skin, bread / pasta / flours / whole rice, pulses, ...
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Physical activity can be continued but makes it necessary to adjust insulin doses and diet. In general, the dose of insulin corresponding to the period of activity should be reduced as well as eating more if the exercise is not planned (or if its intensity justifies it) and always take care to have with you sugar and a additional snack.
- To read: Sport and diabetes: 8 tips to follow!
In rare cases, it may be considered in patients with end-stage renal disease whose diabetes is very unbalanced a pancreas transplant, often associated with a kidney transplant. On the other hand, it requires a heavy immunosuppressive treatment (anti-rejection), sometimes with more harmful consequences than diabetes itself.
Less expensive and less risky, islet transplantation is still experimental, but the procedure is complex because it is difficult to protect beta cells in an environment that is not intended for them.
Future prospects still under study
- very long acting insulin analogues (several days)
- inhaled insulin or percutaneous patch
- disposable or "smart" patch pumps retro-controlled by a subcutaneous glucose sensor (artificial pancreas)
- stem cell transplantation
Read also :
> Choosing the right foods
> What diet for diabetes?
> Play sports when you have diabetes