“Type 1 diabetes is manageable, but there’s a lot that goes into taking care of yourself properly,” says Karen Lau, registered dietitian and certified diabetes educator (CDE) at Joslin Diabetes Center in Boston. “So people will have a lot of questions, especially if they’ve just been diagnosed.” Here, Lau answers some common questions people with type 1 diabetes have for their care team:
1. What can I eat with type 1 diabetes?
“You can eat just about anything and everything,” notes Lau. “Really, it’s about learning to balance meals and finding foods that are healthy for you.” As processed foods tend to increase blood sugar more rapidly, it’s best to avoid them, or at least try to limit consumption, Lau adds. Work with a registered dietitian or CDE to develop an eating plan that works for you.
2. Can I drink alcohol?
Yes, but in moderation, Lau says. The American Heart Association defines healthy alcohol consumption as one drink per day for women and two drinks per day for men. Make sure to have some carbohydrate to eat before or while you drink, as alcohol may cause low blood glucose.
3. Should I consider using technology like an insulin pump or a continuous glucose monitor?
Technology can help, but Lau doesn’t think you’ll necessarily need an insulin pump or continuous glucose monitor — unless you’re having trouble controlling blood sugar or believe the high-tech assistance can improve your quality of life. “Sometimes, when people are first diagnosed they’ll get overwhelmed if you suggest they need a device that constantly monitors blood glucose,” she explains. “They worry that it means they need to constantly worry about it, too.” How frequently you need to check blood glucose varies. However, you may need to check at least four times a day — before each meal and before bed. Checking one to two hours after eating may also be beneficial. Lau recommends alternating the meals you choose as a start. “For example, you can check after breakfast on Monday, lunch on Tuesday, or dinner on Wednesday,” she says. “This helps you learn how different foods affect you.” If you’re checking blood sugar and noticing a lot of highs and lows, then you may benefit from technology like an insulin pump or continuous glucose monitor, which can help you maintain levels within your target range. Talk to your doctor about how often you should test and what your target range should be.
4. Will I need other medication in addition to insulin?
In short, maybe. Although most type 1 diabetes can be managed with insulin, a healthy diet, exercise, and regular blood glucose testing, some people will need additional treatment. You may also need other medications if you’re managing other conditions in addition to diabetes. For example, since type 1 diabetes increases your risk for heart disease, your doctor may prescribe additional medication if you have high cholesterol or high blood pressure. They may also recommend daily aspirin to protect against heart attack and improve circulation.
5. What resources are available if I need help managing type 1 diabetes?
According to Lau, if you have type 1 diabetes, you should regularly consult with a care team that includes your primary care doctor, an endocrinologist, a dietitian, and a CDE. They can work with you to make sure you’re managing your condition well, and offer guidance on appropriate diet and exercise plans to keep you healthy. In addition, groups like the American Diabetes Association (ADA) offer support for those with all forms of diabetes, including type 1.
6. What can I do if I don’t experience the warning symptoms of low blood sugar (hypoglycemia unawareness)?
Low blood sugar, or hypoglycemia, affects different people differently. While there are common symptoms — weakness, fatigue, tingling in the fingers — not everyone with type 1 diabetes will experience them, according to Diabetes UK. This is especially true for people who have had the condition for a long time. More frequent blood sugar testing, or the use of an insulin pump or continuous glucose monitor can help. You should also work with your healthcare team, who may adjust your blood sugar targets to help avoid episodes of low blood sugar, notes the ADA.
7. How can I prevent my blood sugar levels from going too high after I eat?
The key here is portion size, Lau says. She and her colleagues at Joslin use the “plate system,” which says that for every meal half of the food on your plate should be “nonstarchy” vegetables (think: broccoli or spinach), while a quarter of your plate should contain a source of carbs (typically whole grains or starchy vegetables such as sweet potatoes) and a quarter of your plate should be lean protein foods like chicken or fish. “The key is balanced meals,” Lau continues. “Don’t have a heavy carb-based meal and then have a slice of cake.” Also, she adds, you should know that even certain vegetables like corn and peas are high in carbs and can raise blood sugar. “So it’s not just eating vegetables but eating the right kind of vegetables,” Lau notes.
8. How should I adjust insulin doses before, during, and after exercise?
It depends on your activity level and types of activities you’re doing, the ADA says. Aerobic exercise like jogging or bike riding can lower blood sugar, while anaerobic workouts like weight training can increase it. Work with your care team to develop an exercise plan and insulin regimen that works for you, and expect some trial and error. Using a continuous glucose monitor during exercise can help you determine how exercise affects you, and provide a guide for insulin dosing. In addition to adjusting your insulin, your care team can help you adjust your carb intake before and after exercise to maintain healthy blood glucose levels, Lau notes.
9. Will I pass type 1 diabetes onto my children?
It’s possible. While the exact causes of type 1 diabetes are still unknown, according to the ADA, genetics do play a role, particularly when both parents have it. “It’s important to note that while the lifestyle choices you make, like what you eat or how often you exercise, can affect your blood glucose with type 1 diabetes, there are a lot of other factors as well, like stress and poor sleep,” Lau notes. “But as long as you control what you can control, you’ll be fine.”
