Type 1 Diabetes
Glycaemic Control – Type 1 Diabetes
Newly diagnosed Type 1 Diabetes
- All patients with newly diagnosed type 1 must be referred to the Consultant Diabetologist and their team urgently
- This should be through the diabetes team directly,(Endocrine Registrars carry bleep 7018 or 7021, or bleep 7221/7881 Diabetes Liaison Nurse, (DLN) RUH
- If ketones are severe and/or the patient is acutely unwell they may need hospital admission
- The patient will be commenced on insulin immediately (DLN’s will manage this process alongside the Diabetologist)
For diagnosis criteria click on the link below
Click on the link below for patient information for
Type 1 newly diagnosed and ongoing with poor glycaemic control
An HbA1c > 7.5% indicates poor glycaemic control and is associated with an increased risk of developing complications of diabetes
Click on the following links for additional information
What is good glycaemic control?
Why achieve good glycaemic control?
There are a number of factors to consider and review when glycaemic control is poor. Click on the links below for further information:
- Diet
- Activity
- Weight
- Injection sites
- Blood glucose monitoring (SMBG)
- Hypoglycaemia
- Psychological factors
Insulin Adjustment
Patients with type 1 diabetes should be encouraged to adjust their own insulin doses in response to blood glucose levels. The recommended targets for blood glucose are 4-6mmol/l before meals (pre-prandial) and ≤ 10 mmol/l 2 hours after meals.
Further information on insulin self-management is provided as part of our structured education programme Freedom for Life (please ask your Diabetes Specialist Nurse or consultant for more information).
click here to link to structured educationIntensified Insulin Management
- Structured Education
Self-management is central to good diabetes care. Structured patient education provides information on all aspects of diabetes in a group setting to help patients develop a skills-based approach to self-management.
Freedom for Life is a 5 weeks structured education course for patients with type 1 diabetes on MDI covering all aspects of self-management with an emphasis on carbohydrate counting and matching insulin to carbohydrate intake.
For further details of the course and referral criteria click here to link to structured education - Continuous Glucose Monitoring
- Insulin Pump Therapy
- Other Autoimmune Disorders
- Patients with Type 1 diabetes are more likely to develop other autoimmune diseases such as thyroid dysfunction, Addison’s disease and coeliac disease. These may present with an unexplained deterioration in glycaemic control or unexplained hypoglycaemia. Consider referral to a Diabetologist for further investigation.
This provides continuous measurements of glucose up to 72 hours. It is useful for patients on insulin who are struggling to understand their gluocose levels despite expert advice. Referral is made through the diabetes team. See leaflet for patient information.
Continuous subcutaneous insulin infusion (CSII) is a treatment option for patients with type1 diabetes. It has benefits over multiple daily injections (MDI) in terms of glycaemic control, hypoglycaemia and quality of life. National Institute for Clinical Excellence (NICE) guidance recommends insulin pump use when a patient is experiencing repeated disbling hypoglycaemia or when MDI has failed to achieve an HbA1c of < 8.5% and the patient is willing and able to use pump therapy effectively.
For further information on insulin pump therapy and the Bath Diabetes Centre pump service click here to link to Insulin Pumps