Type 1 diabetes: causes, symptoms, prognosis, complications and treatment
What is Type 1 diabetes?
Type 1 diabetes is the second most common chronic childhood disease and is also the second most common form of diabetes. Type 1 diabetes is caused by the fact that the body’s immune system destroys certain cells of the pancreas. The cells that are destroyed are called beta cells and they make the hormone insulin. This means that type 1 diabetes is the result of the body’s immune system making a big mistake and destroying the beta cells that make the vital hormone insulin.
If you are to understand diabetes, you have to learn a number of medical terms. The first term you need to learn is blood sugar, which is the level of glucose (glucose) in the blood. If you have type 1 diabetes, you have high blood sugar, which in medical language is called hyperglycaemia. The fact that type 1 diabetes leads to high blood sugar is due to a lack of insulin, which makes the body’s cells unable to absorb glucose from the blood and then the concentration of glucose in the blood rises. High blood sugar is not good. This involves several risks in the short and long term.
This type of disease, caused by the attack of the immune system by the body, is called autoimmune disease. Type 1 diabetes is therefore an autoimmune disease.
Before proceeding, we make a quick review of important terms:
Pancreas: Also called pancreatic and contains beta cells that produce insulin.
Insulin: vital hormone that enables the body’s cells to absorb glucose (glucose) from the blood.
Glucose: Glucose is the primary energy source of the human body and is also called grape sugar.
Carbohydrates: Carbohydrates found in food and drink. Most carbohydrates are broken down to glucose, which allows us to use them as an energy source.
Blood sugar: the level of glucose in the blood.Hyperglycemia: too high blood sugar.Hypoglycemia: too low blood sugar
Why do you get type 1 diabetes?
Today, we know that type 1 diabetes is due to the fact that the body’s immune system attacks pancreatic beta cells. Unfortunately, we don’t know why the immune system is doing this, which means we don’t really know why some people get type 1 diabetes.
However, we know that those who get type 1 diabetes usually have some genetic features, compared to those who do not get type 1 diabetes. This means that there are genes that increase the risk of having type 1 diabetes.
Currently, we have identified about 50 genes that are subject to an increased risk of type 1 diabetes. Unfortunately, there are very large gaps in knowledge in this area.
Feel free to read: The history of type 1 diabetes
When do you get type 1 diabetes?
The majority of all cases with type 1 diabetes occur in childhood. The onset of the disease is highest among children aged 10 to 14 years and approximately 60% of the affected are boys. In recent years, we have learned that you can actually get type 1 diabetes at any time of life. This means that type 1 diabetes is not just a childhood illness. Today, some scientists believe that it is actually just as common for adults to suffer as children.
Is there any evidence that the immune system is attacking pancreatic disease?
Our immune system works partly by producing antibodies against bacteria and viruses. The antibodies attach to bacteria and viruses and lead to their destruction. So antibodies are a protection we have against bacteria and viruses.
People who develop type 1 diabetes actually have antibodies that are directed at specific structures on the beta cells, causing these cells to be destroyed. This is, of course, a big mistake because the immune system should not attack healthy cells belonging to our own body.
People who develop type 1 diabetes may actually have these antibodies for months, or even years, before the disease breaks out. That means it’s a long process that ultimately leads to type 1 diabetes.
How is Type 1 diabetes treated?
To survive, you have to get insulin. Today, there are many good methods of getting insulin and the treatment is constantly getting better. The treatment is that you have to dose insulin yourself during the day. Insulin can be injected into the skin using a syringe. Insulin can also be pumped into the skin using a pump (see picture below).
The above picture shows an insulin pump on the left and an insulin pen on the right. These two can inject insulin into the skin. From the skin, the insulin is taken up and then it enters the bloodstream so that the cells of the body can use it.
- Treatment with Insulin
- Blood sugar and long-term blood sugar (HbA1c)
- Insulin pump
The goal of treating type 1 diabetes is to have as low blood sugar as possible, without making it too low. High blood sugar is harmful to the body and therefore strives to have as low blood sugar as possible. However, blood sugar should not be too low as it is also harmful. You can actually become unconscious and at worst die if your blood sugar gets too low. Treatment of type 1 diabetes is thus a constant balance between high and low blood sugar. We know today that the lower the blood sugar, the less the risk of diabetic complications.
To measure how good the treatment is, you can measure the following:
- Fasting blood sugar: blood sugar in fasting simply means measuring the level of glucose in the blood after 8 hours of fasting. However, fasting blood sugar only shows the level at the moment when the measurement is made.
- Long-term sugar (HbA1c): is a blood test that shows how blood sugar has been on average in the last 6 weeks and this gives a picture of how blood sugar has been over a longer period.
What are diabetic complications?
Diabetes increases the risk of certain diseases and these diseases are called diabetic complications. Among the complications are kidney damage (nephropathy), eye damage (retinopathy), nerve damage (neuropathy), cardiovascular disease and others. The higher the blood sugar you have, the higher the risk of these complications.
Read more: Complications of type 1 diabetes
Can I cure type 1 diabetes?
We can’t cure type 1 diabetes today, but most likely we’ll be able to do it in the future. There are many possible ways to cure and, at the moment, intensive research is being carried out to succeed in one of these. Until then, we improve the treatment technique. Today, treatment is very sophisticated, effective and at the same time convenient.
With technical aids such as insulin pump and continuous glucose measurement (CGM), life with type 1 diabetes is much easier. The most modern devices can actually handle the dosing of insulin and the measurement of blood sugar automatically, which is amazing.
Type 1 diabetes A och B
Egentligen finns två typer av typ 1 diabetes.
- Type 1a diabetes: this type represents almost 90% of all cases with type 1 diabetes. In type 1a diabetes, the immune system has attacked pancreatic beta cells. This is, therefore, an autoimmune disease, which means that it occurs as a result of the immune system attacking the body’s own cells.
- Type 1b diabetes: This type represents about 10% of all cases with type 1 diabetes. In type 1b diabetes, one can not prove that there is an autoimmune process in the body. It is believed that these cases are caused by genetic factors (i.e. factors related to our genetic predisposition).
Today we don’t know much about type 1b diabetes. We know all the more about type 1a diabetes. However, we treat the diseases in exactly the same way and all recommendations (treatment, follow-up, etc.) are identical. In fact, healthcare does not distinguish between type 1a and type 1b diabetes, but classifies all of them as type 1 diabetes.
Autoimmune type 1 diabetes (type 1a diabetes)
In type 1a diabetes, you have an autoimmune reaction in the body, which means that the body’s immune system attacks the body’s own cells. The cells that become infected are located in the pancreas (pancreas) and they are called beta cells. These cells are vital because they make insulin.
People who have type 1 diabetes therefore have some antibodies in their blood. The antibodies have been directed at structures (proteins) found on beta cells. This is, of course, a gigantic mistake of the immune system. Normally, the immune system should fight infections caused by bacteria, viruses, parasites, etc. The immune system should not attack healthy cells in the body, which unfortunately happens when you get type 1 diabetes.
More about the antibodies
The antibodies directed to the body’s own cells are called autoantibodies. These antibodies have actually been identified and they are found in the blood of people with type 1 diabetes. The following antibodies have been identified:
- Antibodies to insulin
- Antibodies to GAD65
- Antibodies tot IA-2
- Antibodies to ZNT8
These structures (insulin, GAD65, IA-2 and ZNT-8) are found in or on the beta cells.
How fast does it go when you get type 1 diabetes?
Probably, it’s going very slowly. We know today that from the moment you can detect antibodies in your blood until you get type 1 diabetes, it can take a year or longer. This means that this process is going very slowly, which also gives hope that a way of preventing this development will be found in future.
The immune system thus destroys the beta cells gradually. As the number of beta cells becomes smaller, you have less insulin (beta cells make insulin). When you’ve lost about 90% of your beta cells, you can’t make enough insulin to have normal blood sugar. Then your blood sugar rises and you get symptoms of type 1 diabetes. High blood sugar is called hyperglycaemia in medical language. The following picture shows how the number of beta cells gradually decreases until you get diabetes.
How common is type 1 diabetes?
According to the International Diabetes Association, about 10% of the adult population worldwide have diabetes and 10% of these individuals have type 1 diabetes. Type 1 diabetes is the second most common type of diabetes. Annually, almost 90,000 are diagnosed with type 1 diabetes around the world.
Population studies on type 1 diabetes
Population studies show that the incidence of type 1 diabetes among children is highest in Scandinavia (Sweden, Finland, Norway, Denmark), followed by the United Kingdom, North America, Australia and Saudi Arabia. The disease is much lower in Asian countries such as China, Korea and Japan.
The fact is that Sweden and Finland have the highest incidence in the world. It is not known why type 1 diabetes is so common in Sweden and Finland. Nor is it known why there are such large variations globally, but most likely this is due to differences in environmental factors, lifestyle and genetics. The greatest importance probably has lifestyle and environmental factors. This conclusion can be drawn because the incidence of type 1 diabetes has increased very rapidly over the last 40 years, despite the fact that our genes have not changed significantly during that time. What has changed, however, is our lifestyle and environment.5 Please read the history of type 1 diabetes.
A population study investigating young individuals from Finland and Russia with the same “genetic risk” for type 1 diabetes showed that children from Russia had a lower risk of developing type 1 diabetes if they had fewer infections, while children in Finland with the same “genetic risk” had significantly higher risk of contracting type 1 diabetes if they have suffered many infections (with bacteria or viruses).
It has been discussed for many years whether infections trigger the disease by infections starting the autoimmune process, but this is still unclear. 6
Type 1 diabetes is about as common among boys and girls but girls get sick earlier, which is believed to be due to girls entering puberty earlier. 8.9
The map below shows the prevalence of type 1 diabetes globally.
When is it most common to get sick with type 1 diabetes?
The onset of the disease is highest at the age of 10 to 14 years. The following picture shows how many people get sick with type 1 diabetes in Sweden aged 0 to 34 years. The onset of the disease is highest in the age group 10 to 14 years. The onset of the disease is longer before and after 14 years of age.
People may suffer from type 1 diabetes in adulthood
In the past, type 1 diabetes was called “child diabetes”. This term is no longer used because we know today that you can suffer from type 1 diabetes at any time of life, even at the age of 90! However, among adults, type 2 diabetes is significantly more common than type 1.
More about antibodies in type 1 diabetes
Research shows that those people who have two or more antibodies have a greatly increased risk compared to people who have only one antibody. Thus, it seems that the more different antibodies you have, the higher the risk of developing type 1 diabetes. There are several reasons why, despite the knowledge of these antibodies, we do not screen for type 1 diabetes among children:
- There is uncertainty about the importance of antibodies and how to interpret different levels.
- We have no method of stopping the development of type 1 diabetes, even when we know that there are antibodies in the blood. So we cannot stop the disease from progressing.
Research shows that people who have 1, 2 and 3 antibodies have 11%, 36% and 47% respectively risk of developing type 1 diabetes within 5 years.11, 10
Among those who have antibodies in the blood, the risk of developing diabetes rises by 10% every year. The development of type 1 diabetes is somewhat faster in girls compared to boys.
In the TrialNet study, researchers reported that antibodies of this kind were present in 5% of all family members of a person with type 1 diabetes.12
Several groups have also studied the prevalence of these antibodies in the adult healthy population and reported that approximately 0.8% to 1.1% of the population have such antibodies without ever developing type 1 diabetes.
Antibodies to insulin usually occur at the age of 1-2 years.13 Individuals who develop an antibody (of the above) usually get more antibodies and then the risk of type 1 diabetes increases.
Is type 1 diabetes hereditary?
How heredity and genes affect the risk of developing type 1 diabetes
Type 1 diabetes is a disease that is partly due to genes but also environmental factors are important. Today we know a large number of gene variants (variants of genes) that increase the risk of type 1 diabetes. This means that certain types of genes present an increased risk of type 1 diabetes. But these genetic variants are not so powerful that they guarantee getting type 1 diabetes. We know that very many people in the population have such gene variants, but very few people develop type 1 diabetes. So more than just a genetic risk is needed to develop type 1 diabetes. Genes, however, are important. If one identical twin is affected by type 1 diabetes, the second twin is at a 30% risk of being affected.
A known mutation associated with type 1 diabetes is a chromosome 6 mutation (called HLA-DR-DQ). Such mutations are fairly common in Sweden and Europe, but the vast majority of those who have these mutations do not develop type 1 diabetes.
Epidemiological studies investigating different genetic variants associated with increased risk of type 1 diabetes have shown that there are more than 50 different genetic variants in addition to the above-mentioned mutations (HLA complex on chromosome 6) .14
Several of the genes that increase the predisposition to type 1 diabetes are expressed in immune cells, suggesting that the development of type 1 diabetes is greatly affected by things that generally affect the immune cells in the body. Children who have parents with type 1 diabetes are more likely to suffer from type 1 diabetes than children of parents without type 1 diabetes.
Research from several different population groups shows that a risk of a child being affected is 5% if one parent has type 1 diabetes and 10-20% if both parents have the disease.
Although children with parents who have type 1 diabetes have an increased risk of developing the disease, 90% of children have type 1 diabetes who do not have a close relative to the disease. Many environmental factors are believed to have a role in the development of type 1 diabetes. If one identical twin gets type 1 diabetes, the risk of the second twin being getting somewhere between 20 and 50 percent. For type 2 diabetes, the same sphere is about 90 percent.
Environmental factors affecting the development of type 1 diabetes
Several factors have been proposed as the trigger for autoimmunity in type 1 diabetes, such as viral infections and various events during pregnancy such as infections. These studies require all additional validation in order to be able to interpret the meaning of external factors and their impact on the development of type 1 diabetes.
Complications in type 1 diabetes
Type 1 diabetes causes many complications that first occur when the individual misbehaves their illness by not keeping track of their risk factors, particularly risk factors such as high blood sugar, poor kidney function, elevated blood lipids and blood pressure, active cigarette smoking and low physical activity. Complications are divided into two larger groups, namely microvascular and macrovascular.
Microvascular complications include changes that occur in the smaller blood vessels, these vascular changes most often affect organs such as the eyes (retinopathy), nerves (neuropathy) and kidney (nephropathy). Macrovascular complications are manifested in large blood vessels, for example, arteries and arterioles, macrovascular complications lead to known diseases such as myocardial infarction (coronary heart disease), stroke (disease of the vessels of the brain) and even the development of the disease in our vessels of the legs (peripheral artery disease).
Read more about Complications of Type 1 Diabetes
These diseases are not specific to individuals with type 1 diabetes or type 2 diabetes, but are also seen in individuals without diabetes, but the risk of micro- and macrovascular diseases is greatly increased compared to individuals without diabetes. which occurs more in individuals with diabetes.16
Cognitive function is also believed to be affected by prolonged elevated blood sugar levels (hyperglycaemia). According to studies, high blood sugar levels affect mainly the smaller vessels affecting the retina of the eye, nerves in the limbs and blood vessels in the kidney (microvascular complications).
This is probably due to the fact that the cells in these structures have an inability to downregulate the absorption of sugar. When specific cells are exposed to elevated blood sugar levels and do not have the properties to regulate the uptake of blood sugar, an overproduction of sugar metabolism residues and energy recovery in each cell, these metabolic residues (MRs, mitochondrial reactive oxygen species) accumulates and is harmful to tissue. 17.18
Monitoring of complications in type 1 diabetes
Type 1 diabetes was inevitably a fatal disease before 1921, when insulin therapy was introduced. Insulin treatment reduced the risk of the life-threatening metabolic complication ketoacidosis and also alleviated other metabolic disorders associated with type 1 diabetes arising from rapid loss of insulin-producing beta cells.
Nowadays, people with type 1 diabetes experience almost exclusively chronic complications such as cardiovascular diseases. Individuals with type 1 diabetes have two to fourfold increased risk of cardiovascular diseases compared to people without type 1 diabetes, and life expectancy is also shorter among individuals with type 1 diabetes, mainly due to cardiovascular diseases.
Since the increased risk is mainly caused by high blood sugar (hyperglycaemia), it is important to monitor blood sugar regularly by measuring HbA1c, as a marker for long-term blood glucose control (glycaemic control) .19
Individuals with type 1 diabetes need to be aware of the meaning of optimal blood sugar levels and strive for good control of blood sugar as well as improved risk factor profile overall. The disease is associated with a high risk of vascular changes in the eyes and therefore these individuals should regularly undergo a fundus examination and laser photocoagulation is very effective in preventing the development of these vascular changes.
Vascular changes in the kidney and changes in the ability of the kidneys to filter blood eventually lead to renal failure (nephropathy). The condition is diagnosed after the degree of protein in the urine (albuminuria), the risk of cardiovascular diseases increases markedly with deterioration of kidney function, that is, an increase in albuminuria. Scientific studies based on individuals with type 1 diabetes show that renal function is an incredibly important factor and impaired renal function is a serious risk factor for future complications in people with type 1 diabetes.
A significant proportion of all subjects with type 1 diabetes develop impaired renal function, i. e. elevated levels of albumin in urine (macroalbuminuria) but the condition can be reversed if the person manages his diabetes well and optimizes blood sugar levels as well as other factors such as high blood pressure and blood lipids.
In addition, changes occur in the nervous system, especially in the legs, as well as the part of the nervous system involved in automatic processes such as gastrointestinal function, circulatory system, respiration and other functions, these conditions are called peripheral and autonomic neuropathy.
The complication occurs in the nerves due to poor blood circulation to the nerves and high levels of blood sugar (hyperglycaemia), the patient experiences this as impaired sensation or impaired motor force in the legs, also the balance deteriorates and hair loss sometimes appears on the lower leg. In the end, there is a risk that individuals with type 1 diabetes develop foot ulcers and other complications in the legs that can have devastating consequences, such as infection or blood clot.
Patients often come into contact with the care due to complications from small- vascular disease. The nervous system that controls our autonomic functions takes damage from vascular disease resulting in disturbances of the circulatory system and the nervous system that become worse at controlling sudden changes in blood pressure leading to a drop in blood pressure when changing body position (orthostatism), the nervous system becomes worse at controlling blood pressure at night and the electrical system of the heart is affected, which leads to palpitations and reduced ability to manage fluctuations in heart rate.
These changes are seen mainly in elderly people and only in case of pronounced vascular changes in the body. Several elderly people with diabetes often experience dizziness and falls due to impaired coordination and balance due to vascular and nerve disorders in the legs.
For individuals with type 1 diabetes, there is clear evidence that optimal control of blood sugar levels is associated with a significantly lower risk of cardiovascular diseases and therefore these individuals should seek optimal blood sugar levels (long-term blood sugar, HbA1c). Of all the variety of cardiovascular diseases, most often the coronary arteries suffer first, i.e. the blood vessels that supply the heart muscle with blood (coronary heart disease, myocardial infarction).
The reason for this is believed to be due to elevated blood sugar levels which are particularly harmful to the blood vessels that supply the heart muscle and accelerate the atherosclerosis (atherosclerotic process) in these blood vessels. The risk of atherosclerosis of the blood vessels of the brain is also elevated in individuals with type 1 diabetes.
Read more about Atherosclerosis (atherosclerosis, dilatation of veins).
Treatment of type 1 diabetes
Treatment goals for blood sugar (HbA1c) in type 1 diabetes
Over the past two decades, treatment in type 1 diabetes has been aimed at reducing blood sugar levels by administering insulin, with the aim of maintaining sugar levels as close to normal physiological levels as possible while avoiding sudden blood sugar falls (hypoglycaemia) .20
In follow-up studies, it has also been observed that the risk reduction resulting from improved blood sugar control is prolonged, and the effect lasts several years after intensive treatment. DCCT (Diabetes control and complications trial) was the first study to demonstrate the clear efficacy of treating high blood sugar (hyperglycaemia) in these patients.
The American Diabetes Association (ADA) has decided that individuals with type 1 diabetes should strive for 7.5% while other organizations have proposed 6.5% or 7%, in Sweden the treatment targets for type 1 diabetes are 52 mmol/mol (6% Mono-S). People with type 1 diabetes need to check their blood sugar frequently, before meals, before bedtime and before exercise.
When individuals with type 1 diabetes suffer from another disease such as infection, more frequent blood sugar controls are required because sugar metabolism changes under certain special conditions.
All individuals with diabetes should strive for optimal blood sugar levels (HbA1c), good blood sugar variability, i.e. blood sugar does not vary too much during the day and have events with severe blood sugar falls or blood sugar rises (hypoglycaemia and hyperglycaemia).
Insulin treatment in type 1 diabetes
In 1921, insulin was discovered by Dr. Frederick Banting and medical student Charles Best and already the following year the first patient was treated with insulin, shortly after that the drug was mass-produced. Before this, individuals with type 1 diabetes were treated with strict calorie restriction. Insulin is given as syringes under the skin (subcutaneously) or by insulin pumps.
In order for the external insulin administration to mimic pancreatic physiological secretion of insulin, short-acting insulin is often given to meals while long acting is given, sometimes it is an advantage to use mix-insulins consisting of a mixture of long-acting and short-acting insulin. insulin.
When patients first develop type 1 diabetes, higher doses of insulin are initially required, eventually the insulin doses are reduced as inflammation around the beta cells decreases. After this, long-acting insulin analogues can be used as a treatment, for example, Tresiba, Lantus or Levemir, these insulins operate for 20-42 hours in the body depending on the type of insulin.
Factors affecting insulin
Several factors affect insulin activity and duration of action, the factors vary depending on the type of insulin, the amount of insulin, body temperature, stress and other bodily factors. Insulin is absorbed more quickly if injected into the abdomen compared to the thigh and by massaging the injection site before injecting, the insulin is absorbed more quickly.
Learn more about Insulin
An insulin regimen must be designed for each individual in such a way that it meets the insulin requirements of the individual depending on its activities during the day and between meals. The daily insulin requirement for an adult is normally 0.5-0.8 E/kg, during adolescence this need can rise to above 1 E/kg.
Insulin resistance is a condition that occurs when the molecular receptor for insulin no longer responds properly when stimulating insulin, if individuals with diabetes require more than 1 E/kg to maintain good levels of blood sugar, insulin resistance is spoken. Individuals with high fat mass, central abdominal obesity or high body mass (BMI) and sedentary activity require more insulin than lean individuals with good physical activity. Under special conditions such as stress, infections and cardiovascular events, such as heart attack or stroke, insulin requirements change.
The traditional 4-dose programme is to give short-acting insulin before breakfast, lunch and dinner, as well as one dose of medium-acting insulin at night. When treated with direct-acting insulins such as Humalog, Novorapid or Apidra, more injections of insulin per day are usually required. Multi-dose regimen requires greater patient involvement and also brings several benefits as treatment is more flexible, patients have the ability to better control the treatment and optimize their blood sugar by continuously measuring the sugar in the blood.
Patients are advised to design a treatment algorithm together with their doctor to agree on an adapted dose to fend off blood sugar rises, this helps the patient to self-control and treat elevated blood sugar levels: a general rule of thumb is about blood sugar rises above 10-12 mmol/L, given a dose equal to 5% of the daily dose of the individual, and if blood sugar is 15 mmol/L, an additional dose equivalent to 10% of the daily dose is necessary, after each additional dose it is important that the person check for his blood sugar.
When the patient develops fever or is in hot countries where you lose a lot of body fluid due to heat, insulin requirements usually rise by a significant percentage, some suggest that insulin requirements rise by about 25%.
|Insulin preparations for use in type 1 Diabetes|
|Short acting insulin||Actrapid,
|Medium acting insulin||Insulatard
|Mix-insulin||Humalog Mix 25, Mix50
Pump treatment in type 1 diabetes (insulin pump)
Insulin pump appears to be more effective in treating type 1 diabetes than daily insulin injections with insulin pen. To receive treatment with insulin pump, the individual with diabetes should have at least 6 months experience in insulin therapy with injections, be experienced with blood glucose measurement, be able to manage the pump and vary the dose according to their own measurements.
Some observational studies show that insulin pump has better results than daily insulin injections, the reason for this is believed to be that patients with pump have less variability in blood sugar during the day. Technological progress has enabled smaller and better insulin pumps to be developed as well as continuous glucose meters and the development of a true artificial pancreas (pancreas).
Hypoglycaemia (blood sugar fall)
People with type 1 diabetes may experience severe blood sugar cases (hypoglycaemia) due to insulin administration. Serious blood sugar falls result in a lack of sugar (glucose) to the brain which can lead to nerve cells dying. Blood sugar drops (hypoglycaemia) that give rise to symptoms are usually treated with about 15 g of simple sugar from such as juices, sweets, sugar cubes and other sweets may increase blood sugar levels quickly but this may need to be repeated several times, serious blood sugar falls usually require hospital supervision first day. .
Other causes of blood sugar fall (hypglycaemia) include certain diseases, heavy exercise or excessive insulin supply. A glucagon syringe can quickly treat a blood sugar drop.
Read more about Low blood sugar (hypoglycaemia)
Other treatments in type 1 diabetes
Apart from insulin therapy, every individual with type 1 diabetes should strive to eat a healthy diet to reduce the risk of cardiovascular disease, low-calorie diet, increased exercise and physical activity. To optimize the risk factor profile, these individuals should also improve their blood lipids and blood pressure. Frequent self-monitoring with continuous glucose meters are important and have been shown to result in improved glycaemic control.
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