Living with type 1 diabetes (T1D) takes a lot more than just watching food intake and injecting insulin. Unlike type 2 diabetes, it needs constant attention — a 24-hour job that the patient did not sign up for.
“It is a life-changing condition that has many lifelong implications. Once diagnosed, management of T1D needs to fit in with life, whether it is studying, forming relationships or pursuing careers,” said Dr Daphne Gardner, Senior Consultant, Department of Endocrinology, Singapore General Hospital (SGH).
T1D is a big challenge that needs understanding and support from family and friends, she added.
In Singapore, one in nine people have diabetes, of which under five per cent have T1D. It is important to know that T1D is different from the more common and better understood T2D.
In T1D, insulin replacement is most important in its management, aiming to mimic the body’s production to keep glucose levels within a healthy range, and to minimise sudden dips (hypoglycaemia) or spikes (hyperglycaemia).
Our body cells need glucose for energy production, and the insulin hormone acts like a key to open the door for glucose to enter the cells. In T1D, the pancreas no longer produces insulin. Without insulin, glucose levels in T1D patients rise in the bloodstream. Insulin replacement is therefore needed to keep blood glucose levels in check.
Some amount of insulin is always present in the body. During meals, more insulin is produced to react to the carbohydrates (which contain glucose) consumed. T1D patients need to inject background or basal insulin once or twice a day, and three quick-acting insulin to cater to the three meals.
“The patient has to learn how to calculate the bolus, or mealtime insulin, dose based on the amount and type of carbs being eaten. They also have to take into account the amount of insulin pre-existing in the body. So, they have to pick up skills like carbs-counting and blood glucose self-monitoring,” said Ms Lim Huee Boon, Diabetes Nurse Educator, SGH.
Further fine-tuning of the doses is needed when exercise, sick days, menstruation, alcohol intake, and stress come into the picture, noted Dr Suresh Rama Chandran, Consultant, Department of Endocrinology, SGH.
Mastering insulin use takes time, requiring the patient to stay the course. Participating in SGH’s five-day diabetes education programme (DAFNE), as well as using insulin pumps, continuous glucose monitoring devices and other aids can help.
“As patients get better and become more confident in their self-care, T1D will become less restrictive, allowing patients some normalcy in their lives,” Dr Suresh said.
Managing T1D is demanding, and can put emotional and psychological pressures on patients who feel anxious and helpless. Setting realistic targets and celebrating small successes can encourage patients. Social stigma concerns can also lead many to hide their condition from others, such as skipping their injections when in public.
“These are all very real concerns. Some patients may find comfort in online or physical peer support groups. Having friends and family who understand the condition and are empathetic to their situation can go a long way, too, in helping them better navigate the challenges,” said Dr Suresh.
Dr Gardner, Dr Suresh and Ms Lim spoke at a webinar on diabetes.
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