Type 1 Diabetes

What to know about type 1 diabetes.

Type 1 diabetes is an autoimmune disorder. When you have type 1 diabetes, your immune system destroys the cells that make insulin in your pancreas. As a result, people with type 1 diabetes produce little or no insulin.

Insulin is a hormone that is essential for survival. Insulin allows your body’s cells to use glucose for energy. Glucose comes from the food you eat and is broken down into sugar. Your body’s cells then use the sugar in your blood for energy. When your body doesn’t make insulin, your cells cannot use sugar for energy. As a result, your blood sugar will continue to rise to dangerous and sometimes deadly levels. 

People with type 1 diabetes rely on injected insulin to allow their bodies to function properly. Type 1 diabetes is sometimes referred to as “insulin-dependent diabetes,” as this type of diabetes requires injected insulin for the rest of your life. At this time, there is no cure for type 1 diabetes. While a diagnosis of type 1 diabetes is often unexpected and intimidating, many people manage the disease and live a full life.

What Causes Type 1 Diabetes?

There are a few risk factors that increase a person’s chance of acquiring type 1 diabetes. They are:

  1. Family history – Because type 1 diabetes is thought to be caused by an autoimmune reaction, having a parent or sibling with type 1 diabetes significantly increases your chance of developing type 1 diabetes.
  2. Age – Although type 1 diabetes can occur at any age, it typically occurs in people under 20. (Type 1 diabetes was once known as juvenile diabetes because it occurs most commonly in children.)
  3. Race – White people are more likely to develop type 1 diabetes than any other race.

A closeup view of a doctor looking at DNA under a magnifying glassAlthough it is not known how type 1 diabetes develops, it is thought that a person has a genetic predisposition. This means that there is believed to be a genetic makeup in your DNA that makes you more susceptible to getting type 1 diabetes. A genetic predisposition contributes to the development of a disease but isn’t the cause of the disease.

When someone has a genetic predisposition to type 1 diabetes, an event or series of events will trigger the disease’s development. This could include events such a surgery, a change in your schedule or sleep, or a traumatic experience such as divorce, accident, or death of a loved one.

It’s important to note that these events don’t cause type 1 diabetes, but rather act as the trigger or catalyst for the onset of the disease. Some people can have a genetic predisposition and never develop type 1 diabetes.

Unlike other types of diabetes, diet and lifestyle choices do not contribute to developing type 1 diabetes.

What if Someone in My Family Has Type 1 Diabetes?

Trial Net is a global research group focused on type 1 diabetes. They have found through their research that a person with a family member that has type 1 diabetes is 15 times more likely to develop the disease. If an immediate family member has been diagnosed with type 1 diabetes, there is a 1 in 20 chance of other family members developing the disease.

Trial Net currently offers free autoantibody testing for anyone between the ages of 2.5 and 45 with an immediate family member diagnosed with type 1 diabetes. Early detection can help avoid life-threatening symptoms, and if caught early enough, may even help prevent the onset of type 1 diabetes.

Signs and Symptoms of Type 1 Diabetes

Symptoms of type 1 diabetes usually develop quickly, often over just a few weeks. By the time symptoms present themselves for type 1 diabetes, there is very little time to take action. It is life-threatening and requires immediate medical attention. Type 1 diabetes is often diagnosed in children and young people, but it can also be diagnosed in older people.

As your blood sugar rises higher and higher, your body begins to produce ketones due to your pancreas not making enough insulin. Ketones develop because your body is burning fat for fuel instead of sugar. Low levels of ketones aren’t a problem. However, high levels of ketones combined with high blood sugar can lead to diabetic ketoacidosis, which can be deadly.  

Graphic showing different symptoms of diabetesIf you, or your child, is experiencing any of these symptoms, contact your doctor immediately:

  • Increased thirst
  • Frequent urination
  • Bed-wetting in children who typically don’t
  • Dry bowel movements in diapers of young children
  • Headaches
  • Blurred vision
  • Extreme hunger
  • Fatigue or feeling weak
  • Unintentional weight loss
  • Yeast infection
  • Irritability or changes in mood

If you experience any of the above symptoms along with abdominal pain or vomiting, go to the ER immediately.

Diagnosing Type 1 Diabetes

The following simple blood tests are used to diagnose type 1 diabetes:


The HbA1C blood test, commonly referred to as an A1C, is the best method for accurately diagnosing type 1 diabetes. This test measures your average blood glucose level over the past two to three months. An A1C of 6.5% or higher on two separate tests indicates diabetes.

Random Blood Sugar Test

A random blood sugar test is, just as it sounds, a test of your blood sugar at any random time. Usually, a random blood sugar test on its own is not enough to diagnose diabetes. However, a blood sugar reading of over 200 mg/dL, especially when combined with other symptoms and ketones in your urine, is a good indication of diabetes.

Fasting Sugar Test

A blood test that is taken after fasting overnight. A reading of under 100 mg/dL is considered normal, and anything over 126 mg/dL is considered diabetes.

Man getting a blood test to check for diabetesIt is common for people diagnosed with type 1 diabetes to be admitted to the intensive care unit (ICU) at the hospital for a few nights.  This is because blood sugar levels are often dangerously high at diagnosis, and often there are also ketones present in the urine, indicating diabetic ketoacidosis. During your hospital stay, you’ll be visited by several doctors, nutritionists, and diabetes educators to help you learn about diabetes and teach you how to test your blood sugar and administer insulin.

You’ll likely feel extremely overwhelmed or shocked at diagnosis. There is a lot of information medical professionals will give you very quickly. Try not to stress about trying to learn everything immediately. Learning how to manage type 1 diabetes isn’t something you’re going to figure out in a few days or even a few weeks. Most people with type 1 diabetes will tell you that managing the disease takes quite a while to learn. 

Everybody responds differently to insulin, food, exercise, and other stressors such as sleep and stress. As such, it will take some time to learn how your body responds and how best to keep your blood sugar in your desired range.

The Honeymoon Phase of Type 1 Diabetes

The “honeymoon phase” or “honeymoon period” refers to the period when your pancreas is still producing some insulin shortly after your diagnosis. During this period, people with type 1 diabetes find their blood sugar levels easier to control. As a result, for some, it seems like your diabetes improves remarkably. 

Usually, the honeymoon phase lasts about six months to a year from diagnosis. However, it can last for a shorter or longer length of time; everyone is different. It is also possible to not have a honeymoon phase, though this is not common.

You’ll want to make sure you are working closely with your doctor during this period. You will likely require more and more inulin as your pancreas eventually stops producing insulin.

The Importance of Insulin

Because most people with type 1 diabetes do not make inulin, they typically inject insulin daily or multiple times each day. Insulin is needed to help your body use the glucose (sugar) in your blood. People with type 1 diabetes can also use a pump to administer insulin to their body, rather than injecting with a syringe multiple times a day.

Without insulin, a person with type 1 diabetes will die. They will experience hyperglycemia (too much blood sugar), and their body will quickly shut down. This is why it is so important to take immediate action if you suspect you or someone you know has type 1 diabetes.

Different Types of Insulin

There are three main categories of insulin.

Woman with type 1 diabetes standing in her kitchen injecting insulin into her stomach.Long-acting insulin, also called basal insulin, keeps glucose levels constant throughout the day/night and often remains in your body for about 24 hours. Some will last shorter or longer. Long-acting insulin takes about 1.5 to 2 hours to take effect. This type of insulin aims to provide a minimal peak after eating and help maintain blood sugar between meals.

Intermediate-acting insulin takes about 30 minutes to an hour to take effect and typically peaks 2-4 hours after injection. This type of insulin typically lasts for 6 to 8 hours after injection. This type of insulin aims to control blood sugar overnight, during fasting, or in between meals.

Fast-acting insulin is absorbed very quickly into your bloodstream. It takes about 5-15 minutes to take effect and typically peaks 1 to 2 hours after injection. This type of insulin typically lasts 5 to 6 hours after injection, but to be safe, assume the duration is 4 hours.

The typical insulin treatment for people with type 1 diabetes is a basal-bolus insulin regimen. This means long-acting “basal” insulin is injected once or twice a day to maintain blood sugar. A fast-acting “bolus” insulin is injected before each meal to keep blood sugar from spiking after eating. Most people with type 1 diabetes use an insulin-to-carbohydrate ratio (also called ICR) to calculate their bolus insulin dose. An example is 1 unit of insulin for every 10 grams of carbs.

Different Methods of Taking Insulin

Although there are many different ways of taking insulin, there are three primary methods to administer insulin. Methods include injections, inhaled insulins (for adults at least 18 years old), and insulin pumps.

Insulin injections are the most common form of administering insulin. The injections typically consist of both fast-acting insulin for meals and long-acting insulin to establish a safe baseline for blood sugar. Other types of insulin can also be injected. Pens are a common form of injections, especially for children.

Inhaled insulin is inhaled before a meal and is a type of fast-acting insulin. The FDA has approved this method for only those who are at least 18 years of age and can be taken for both type 1 and type 2 diabetes.

Insulin pumps are computerized devices that require the user to determine when and how much insulin to administer. Insulin administration is not done automatically by the device. A person typically needs to have used insulin for a while before being able to use a pump. Doctors usually won’t prescribe insulin pumps until after the honeymoon phase, approximately one year from diagnosis. This is because it is essential to know how your body reacts to insulin to be familiar with how much insulin your body needs.

Continuous Glucose Monitors (CGM)

A Continuous glucose monitor or (CGM for short) is a system that measures your blood sugar in real-time. There is typically a five-minute window between each reading; this is especially important to keep in mind during periods of hypoglycemia (low blood sugar).

Man with diabetes with a continuous glucose monitor on his stomach

There are several different brands of CGM; most work by inserting a small sensor on your abdomen, upper arm, or top of your buttocks. The sensor will last for 10-14 days, depending on the brand. Some CGMs connect to a dedicated monitoring device (usually about the size of a small smartphone), and others can connect to an app directly on your phone.

Having a CGM makes managing type 1 diabetes significantly easier. Rather than needing to prick your finger multiple times a day, you’ll always know what your blood sugar level is. In addition, most CGMs will alert you if your blood sugar is too high or too low, or if the sensor detects a rapid rise or rapid deceleration in your blood sugar. This alert system can be invaluable, especially overnight when many people with type 1 diabetes have the most difficulty controlling their blood sugar.

You can also use your CGM to determine exactly how specific foods affect your blood sugar. Since everyone responds differently to foods, this information is extremely helpful in managing your type 1 diabetes and knowing how much insulin your body needs.

Having a CGM during exercise is also very useful. People with type 1 diabetes may find their blood sugar increases or decreases during or immediately after exercise. A CGM can help you monitor and catch any lows or highs before they get out of hand.

Create a Plan

As a child or young adult, it is important that you and your parent/guardian make a diabetes management plan. If you are new to type 1 diabetes, it may be helpful to have your doctor look your plan over to make sure you haven’t forgotten anything.

Your plan should include the following items:

  1. Target blood sugar range and how to help the child check their blood sugar if needed.
  2. Symptoms of hypoglycemia (low blood sugar) and the best way to treat hypoglycemia.
  3. When and how to administer insulin.
  4. Meals and snacks for a regular day or special occasions.
  5. A plan for physical activity or sports.
  6. An emergency plan (such as an emergency glucagon pen).

Share Your Plan with Appropriate Staff, Caretakers, and Family

Teachers, coaches, caretakers, family, and anyone else providing care for your child needs to know your child has type 1 diabetes so they can help ensure a safe environment. They need to be aware of specific signs (symptoms) your child may experience to react appropriately. Establish a plan with each individual in terms of how to best respond. Examples could be raising a hand, having a friend accompany them to the school nurse, or other safe and not disruptive methods.

Consider a 504 Plan

Chalkboard showing a 504 Plan and an IEP - Individualized Education PlanIf you’re in the United States, Total Diabetes Wellness recommends having a 504 Plan set to help your child be medically safe while at school. A 504 plan is a specific plan to help ensure that your child is treated fairly and that everyone is on the same page. 504 plans are used for students from kindergarten up through 12th grade. Be sure that school staff are trained to recognize and respond to hypoglycemia and hyperglycemia. Remember, less is more in writing your 504 plan. Be sure to include enough to keep your child safe, but not too much to make it possibly confusing for caretakers to respond.

Establish a Routine

Create a checklist that you and your child can systematically use every day to ensure everything is in place to ensure a safe day. This includes making sure all necessary materials are packed. Many children with type 1 diabetes have a small bag that they keep with them or closeby that includes:

  • CGM monitor
  • Extra batteries
  • Glucometer & Testing supplies (test strips & lancets)
  • Insulin
  • Antiseptic wipes
  • Water
  • Fast-acting carbs such as a glucose tablet, juice, or candy
  • Emergency kit in case of hypoglycemia).

A to-do list can also be created that might include when to check blood sugar, who to check in with for the day, and other important reminders to help control and manage the blood sugar level.

It is important, as a parent, to consider that your child has all of their recommended immunizations and vaccines to help with this autoimmune disease. It is also important to regularly wash hands, especially before eating, after using the restroom, or handling classroom supplies.

Managing as an Adult

Establish a Good Team

It is important to find the right team to manage your type 1 diabetes as an adult. These people include your general doctor, an endocrinologist, a dietitian or nutritionist, and possibly a diabetes educator. If you start to develop complications, additional people to help you might be a podiatrist if you are experiencing feet or lower leg complications or an ophthalmologist for your eye complications.

Know Potential Complications and Their Symptoms

Be sure to know all of the potential complications you may experience so you can act quickly if any of them start to develop. It may be possible to stop or slow down the progression of the complication.

Eat Healthy

Flat lay photo of a healthy low carb diet rich in whole foodsEating healthy can better help your body regulate your blood sugar, keeping the swings to a minimum in both length of time and highs or lows. You may need to eat more often to help create a more steady blood sugar level.

Many individuals with type 1 diabetes find a low-carb, high-fat diet helps control their blood sugar better than other diets. You will always require insulin when you have type 1 diabetes; however, your insulin needs may be significantly less with a low-carb, high-fat diet

Always discuss any diet changes with your doctor before beginning. This is especially important if you are on any medications.

Learn more about the benefits of eating low-carb:


According to the American Diabetes Association, “physical activity can lower your blood sugar up to 24 hours or more after your workout by making your body more sensitive to insulin.”

Exercise is important for treating type 1 diabetes. It is vital to monitor your blood sugar levels during exercise. There are several types of blood sugar monitors on the market that can help with this. You should only exercise if your blood sugar is under 250 mg/dL (13.9 mmol/L) and over 100 mg/dL (5.6 mmol/L).

Learn more about exercising with type 1 diabetes here.

Complications of High Blood Sugar Levels

Diabetes attacks every cell in your body. If untreated, diabetes will destroy organs and systems throughout your entire body. Therefore, it is important to manage your blood sugar levels and ensure that your blood sugar is not high for extended periods.

Woman laying in a hospital bed sick from complications from diabetesBlindness – Retinopathy can cause blindness.
Stroke – Diabetes can more than double your chances of stroke.
Cancer – Higher risk of developing cancer and lower survival rates overall.
Amputation – Resulting from neuropathy in your toes, feet, fingers, and legs.
Kidney transplant – Nephropathy can lead to daily dialysis or a kidney transplant.
Heart attack – Heart disease is the number one cause of death in people with diabetes.
Alzheimer’s – Diabetes increases your risk of developing Alzheimer’s disease or other dementias.
Infections – Higher risk of common infections such as pneumonia and flu and skin, foot, and yeast infections.
Erectile Dysfunction – Stems from damage to the nerves and blood vessels due to long-term high blood sugar levels.

Learn more about complications of diabetes:

The Bottom Line

Type 1 diabetes can be fatal if not diagnosed and addressed quickly enough. Hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) are both concerns for people with type 1 diabetes. Respond to symptoms quickly to avoid serious complications.

If diagnosed with type 1 diabetes, it is important to be prepared and intentional with a plan. Use exercise and a healthy diet to help control and manage the disease. Ensure that appropriate people know how to respond in an emergency and educate yourself to help reduce or eliminate the risk of future complications. Establish a team of doctors to help you manage your type 1 diabetes.

Be sure to use Trial Net’s free test to check family members for diabetes autoantibodies, as they are at a higher risk of developing type 1 diabetes.