What is Type 1 Diabetes?

Despite our knowledge of many of the mechanisms involved in type 1 diabetes, of which genetic and environmental factors play an important role, the actual cause is still unknown. While the overall risk of developing type 1 diabetes mellitus is low (1 in every 10,000 people per year), the following individuals present a higher risk:

Early symptoms that cause people to visit their doctor and which are associated with high sugar levels are: 

Diabetes is diagnosed by means of a blood test that determines a person’s blood sugar (glucose) levels. Normal blood glucose values range between 70 and 100mg/dL.

This test analyses whether the analytical indicators are:

• After fasting: equal to or higher than 126 mg/dL, in two measurements.
• At any time of the day: equal to or greater than 200 mg/dL accompanied by characteristic symptoms, such as an increased need to urinate or excessive thirst.
• Glycated hemoglobin (HbA1c): equal to or higher than 6.5%.

People with type 1 diabetes have to inject insulin, measure their capillary blood glucose before meals and follow a balanced eating plan in order to live.

Continuous subcutaneous insulin infusion (CSII) systems provide a constant infusion of insulin within the subcutaneous layer. The insulin is infused via a catheter inserted under the patient’s skin. The catheter must be changed every 3 days to avoid infections and/or saturating the subcutaneous tissue. Infusion pumps help achieve better control over your diabetes. There are 6 and 9 mm pump cannulae available for injecting at a 90° angle, and 13 and 17 mm cannulae for injecting at an angle of 45°.

The insulin is supplied by means of two totally distinct systems:

• Basal insulin. The pump administers insulin continuously, 24 hours a day and according to a programmed schedule. A certain amount of insulin is injected every hour, or time block, and can be set according to the patient’s needs at different times of the day. It is equivalent to the long-acting insulin patients administer once or twice a day using a pen.
• Bolus insulin. This insulin is administered with each meal or to correct an episode of hyperglycaemia. It is equivalent to the rapid-acting insulin patients inject before meals.

Basic concepts associated with insulin pump therapy.

• Meal bolus: insulin administered with each meal.
• Correction bolus: an additional and occasional administration of insulin taken according to capillary blood glucose levels and the insulin sensitivity factor.
• Bolus calculator or bolus Wizard: a feature included with infusion pumps that assists decision-making when administering different types of bolus.
• Insulin sensitivity factor: the decrease in blood glucose (in mg/dL) produced by 1 extra unit of insulin when taking a correction bolus. For example, if your insulin sensitivity factor is 50 mg/dL, then one extra unit will reduce your blood glucose by 50 mg/dL. Hence, if your level is 200 mg/dL before eating and the target is 150 mg/dL, you need to take a correction bolus of one extra unit.
• Basal insulin: the insulin the pump administers continuously, 24 hours a day, and according to a programmed schedule.
• Temporary basal insulin: insulin that can be temporarily increased or decreased above the programmed basal rate.
• Insulin to carbohydrate ratio: amount of insulin required for 1 portion of carbohydrates.

Recommendations for preventing and treating injection site irritations and/or infections for patients with insulin pumps

• Ensure maximum hygiene measures when inserting the catheter.
• Change the needle every 3 days, or sometimes even every 2 days.
• Make daily checks for any anomalies, redness, irritation or pain at the injection site. If after these preventive measures these symptoms still appear:
• Change the catheter and injection area.
• Get in touch with your healthcare team for a possible treatment. Remember that it could cause hyperglycaemia even if you have done everything correctly.

Recommendations for preventing and/or treating hypoglycaemia in patients wearing insulin pumps

To prevent your blood sugar level from falling below 70 mg/dL (hypoglycaemia), you have to measure your level according to your healthcare team’s instructions, at least 3 or 4 times a day, and ensure that it is:

• Not less than 80 mg/dL before eating.
• Not less than 120–140 mg/dL before going to sleep, before driving and at 3 a.m. If you have a history of severe or very frequent episodes of hypoglycaemia, then these limits could be higher.
• If you do more physical exercise than normal, then you must eat more carbohydrates (carbs) or use the temporary basal insulin bolus.
• If you wish to eat fewer portions of carbs, then you need to adjust the insulin bolus to the meal.

Recommendations for family and friends when faced with a severe episode of hypoglycaemia in patients wearing insulin pumps

• You should not attempt to give someone who has fainted anything by mouth.
• They must be injected with GlucaGen® HypoKit 1 mg glucagon (which must be stored in a refrigerator).
• The pump must be disconnected or the catheter cut at the nearest possible point to the injection site.
• When the person comes round, you should give them a fruit juice or equivalent and contact their medical team.

Recommendations for preventing and/or treating hyperglycaemia in patients wearing insulin pumps

• Monitor and/or detect anything obstructing insulin infusion early on: air bubble, a blocked catheter/needle, etc.
• Control the number of portions of carbohydrates in meals. If you wish to eat more portions, then you will have to adjust the insulin bolus.
• You will have to use the temporary basal insulin if you carry out less physical exercise.
• Remember that an infection could cause severe hyperglycaemia even though you have done everything correctly.

If, despite all the preventive measures, you still observe levels of above 250 mg/dL before meals or midnight

• Then you must always perform a ketone in urine test. If the ketone test is negative, you should administer a correction bolus of extra insulin according to your sensitivity factor or use the bolus calculation feature on your pump.
• You must then check whether the infusion system is working correctly. If you notice any bubbles, you need to purge them or change the needle.
• If after 1 or 2 hours your sugar levels are still above 250 mg/dL, or have not dropped with respect to previous measurements, then you must inject rapid-acting insulin, or an analogue, with a pen. Do not administer a second correction bolus using the pump if the first one did not produce the desired effect. You must subsequently change the infusion set.
• If after 1 or 2 hours your blood sugar levels remain high, you give a positive ketone test and have followed the above indications, then you should contact your healthcare team.