Living with type 1 diabetes
Few people who do not have type 1 diabetes actually appreciate the difficulty of living with a condition which requires attention every time the person wishes to eat or exercise.
To maintain the fine balance between blood glucose levels that are too high or too low requires detailed understanding of diabetes as well as hour to hour effort every single day. Adjusting insulin regimes to fit with work patterns, including shift work, is not always straightforward. In practice, individuals adopt habits which lead to average blood glucose levels which reflect a compromise that they themselves can tolerate. These are often higher than might be ideal, but considerable empathy and insight into individual circumstances is required before it can be said that control ‘must’ be better. Most other people in the diabetes team do not need to take diabetes home with them. During any minor illness the need for insulin rises and major adjustments are needed to keep control.
In order to hold a driving licence people with diabetes have to be able to recognize the early symptoms of hypoglycaemia, and have to obey the driving rules:
• test blood glucose before driving;
• always keep glucose tablets or sweets in the car;
• plan longer journeys to ensure appropriate stops for snacks.
Blood glucose testing
It is only possible to ‘know’ one’s own blood glucose level if it is either very high or very low. For this reason it is important for people with diabetes to be able to test their blood glucose level. By using a finger pricking device, a tiny drop of blood can be obtained. This is placed on a disposable strip con-
nected to a meter.
The level of glucose in blood is measured in millimoles per litre (mmol/l). The non-diabetic fasting range for blood glucose is 3.5 to 5.5 mmol/l. In type 1 diabetes blood glucose levels would ideally be between 4 and 7 mmol/l before meals, but in practice much higher numbers may be observed. For each individual, a target range will have been agreed. In very long-standing type 1 diabetes blood glucose levels may vary unpredictably and it may be necessary to aim for higher numbers in order to avoid very frequent hypos.
