Symptoms
The symptoms of type 1 diabetes can develop very quickly (over a few days or weeks), particularly in children.
In older adults, the symptoms can often take longer to develop (a few months).
However, they should disappear when you start taking insulin and you get the condition under control.
The main symptoms of diabetes are:
- feeling very thirsty
- urinating more frequently than usual, particularly at night
- feeling very tired
- weight loss and loss of muscle bulk
- itchiness around the genital area, or regular bouts of thrush (a yeast infection)
- blurred vision caused by the lens of your eye changing shape
- slow healing of cuts and grazes
Vomiting or heavy, deep breathing can also occur at a later stage. This is a dangerous sign and requires immediate admission to hospital for treatment.
You should visit your GP immediately if you think you may have diabetes.
When to seek urgent medical attention
You should seek urgent medical attention if you have diabetes and develop:
- a loss of appetite
- nausea or vomiting
- a high temperature
- stomach pain
- fruity smelling breath – which may smell like pear drops or nail varnish (others will usually be able to smell it, but you won't)
Hypoglycaemia (low blood glucose)
If you have diabetes, your blood glucose levels can become very low. This is known as hypoglycaemia (or a "hypo"), and it's triggered when injected insulin in your body moves too much glucose out of your bloodstream.
In most cases, hypoglycaemia occurs as a result of taking too much insulin, although it can also develop if you skip a meal, exercise very vigorously or drink alcohol on an empty stomach.
Symptoms of a "hypo" include:
- feeling shaky and irritable
- sweating
- tingling lips
- feeling weak
- feeling confused
- hunger
- nausea (feeling sick)
A hypo can be brought under control simply by eating or drinking something sugary.
If it isn't brought under control, a hypo can cause confusion, slurred speech and, eventually, unconsciousness.
In this case, an emergency injection of a hormone called glucagon will be needed. Glucagon increases the glucose in your blood.
Hyperglycaemia (high blood glucose)
As people with type 1 diabetes cannot produce any insulin, their blood glucose levels may become very high.
When your blood glucose levels become too high, it is known as hyperglycaemia. The symptoms of hyperglycaemia may come on suddenly and include:
- extreme thirst
- a dry mouth
- blurred vision
- drowsiness
- a need to pass urine frequently
Left untreated, hyperglycaemia can lead to diabetic ketoacidosis. This is a serious condition, where the body breaks down fat and muscle as an alternative source of energy. This leads to a build-up of acids in your blood, which can cause vomiting, dehydration, unconsciousness and even death.
The Diabetes UK website has more information about diabetes symptoms.
Treatment
There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life.
If you've been diagnosed with diabetes, you'll be referred for specialist treatment from a diabetes care team. They'll be able to help you understand your treatment and closely monitor your condition to identify any health problems that may occur.
Type 1 diabetes occurs because your body doesn't produce any insulin. This means you'll need regular insulin treatment to keep your glucose levels normal.
Insulin comes in several different preparations, each of which works slightly differently. For example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). Your treatment is likely to include a combination of these different insulin preparations.
Insulin injections
If you have type 1 diabetes, you'll probably need insulin injections. Insulin must be injected, because if it were taken as a tablet, it would be broken down in your stomach – like food – and would be unable to enter your bloodstream.
When you're first diagnosed, your diabetes care team will help you with your insulin injections, before showing you how and when to do it yourself. They'll also show you how to store your insulin and dispose of your needles properly.
Insulin injections are usually given by an injection pen, which is also known as an insulin pen or auto-injector. Sometimes, injections are given using a syringe. Most people need two to four injections a day.
Your GP or diabetes nurse may also teach one of your close friends or relatives how to inject the insulin properly.
Insulin pump therapy
Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device that holds insulin and is about the size of a pack of playing cards.
The pump is attached to you by a long, thin piece of tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms.
The pump allows insulin to continuously flow into your bloodstream at a rate you can control. This means you no longer need to give yourself injections, although you'll need to monitor your blood glucose levels very closely to ensure you're receiving the right amount of insulin.
Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 1 diabetes. However, it may not be suitable for everyone. Your diabetes care team may suggest pump therapy if you have frequent episodes of low blood glucose (hypoglycaemia).
Monitoring blood glucose
If you have type 1 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months.
This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working.
The HbA1c test is used to measure blood glucose levels over the previous two to three months.
HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it.
A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed.
Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 59mmol/mol (7.5%). However, it can be as low as 48mmol/mol (6.5%) for some people.
Monitoring your own blood glucose
If you have type 1 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home.
Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels.
Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle.
A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful for detecting high blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia).
If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low.
Blood glucose meters aren't currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if you're unsure.
Diabetes UK also provides further information about the availability of blood glucose test strips (PDF, 195kb).
Regularly monitoring your blood glucose levels will ensure your blood glucose is as normal and stable as possible.
As your blood glucose level is likely to vary throughout the day, you may need to check it several times a day, depending on the treatment you're taking.
In home testing, blood glucose levels are usually measured by how many millimoles of glucose are in a litre of blood.
A millimole is a measurement used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l for short.
A normal blood glucose level is 4-6 mmol/l before meals (preprandial) and less than 10 mmol/l two hours after meals (postprandial), although this can vary from person to person.
Your diabetes care team can discuss your blood glucose level with you in more detail.
Treating hypoglycaemia (low blood glucose)
If you have type 1 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia.
Hypoglycaemia is where your blood glucose levels become very low.
Mild hypoglycaemia (or a "hypo") can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary
If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets.
This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit.
In most cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours.
If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness.
If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels.
Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one.
Treating hyperglycaemia
Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin.
If you develop hyperglycaemia, you may need to adjust your diet or your insulin dose to keep your glucose levels normal. Your diabetes care team can advise you about the best way to do this.
If hyperglycaemia isn't treated, it can lead to a condition called diabetic ketoacidosis, where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood.
Diabetic ketoacidosis is very serious and, if not addressed quickly, it can lead to unconsciousness and, eventually, death.
The signs of diabetic ketoacidosis include:
- frequently passing urine
- thirst
- tiredness and lethargy (lack of energy)
- blurry vision
- abdominal (stomach) pain
- nausea and vomiting
- deep breathing
- smell of ketones on breath (described as smelling like pear drops)
- collapse and unconsciousness
Your healthcare team will educate you on how to decrease your risk of ketoacidosis by testing your own blood for ketones using blood ketone sticks if you're unwell.
If you develop diabetic ketoacidosis, you'll need urgent hospital treatment. You'll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if you're dehydrated, including salt solution and potassium.
The Diabetes UK website has more information about diabetic ketoacidosis.
Other treatments
Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:
- anti-hypertensive medicines to control high blood pressure
- a statin – such as simvastatin – to reduce high cholesterol levels
- low-dose aspirin to prevent stroke
- angiotensin-converting enzyme (ACE) inhibitor – such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease
Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. It's often reversible if treated early enough.
Care standards for diabetes
The aim of treating diabetes is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications.
There is also a National Service Framework for Diabetes in Wales. The progressive implementation of which will lead to the improvement of the quality of care and treatment for those living with diabetes.
Complications
If diabetes isn't treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs.
Even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term.
Heart disease and stroke
If you have diabetes, you're up to five times more likely to develop coronary heart disease or have a stroke.
Prolonged, poorly controlled blood glucose levels increase the likelihood of developing atherosclerosis (furring and narrowing of your blood vessels).
This may result in a poor blood supply to your heart, causing angina (a dull, heavy or tight pain in the chest). It also increases the chance that a blood vessel in your heart or brain will become completely blocked, leading to a heart attack or stroke.
Nerve damage
High blood glucose levels can damage the tiny blood vessels of your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness, which can lead to ulceration of the feet.
Damage to the peripheral nervous system (the nervous system outside the brain and spinal cord) is known as peripheral neuropathy.
If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.
Diabetic Retinopathy
Diabetic Retinopathy is where the retina (the light-sensitive layer of tissue) at the back of the eye is damaged.
The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels and affect your vision.
Annual eye checks are usually organised by a regional photographic unit. If significant damage is detected, you may be referred to a doctor who specialises in treating eye conditions (ophthalmologist).
The better you control your blood sugar levels, the lower your risk of developing serious eye problems.
Diabetic retinopathy can be managed using laser treatment if it is caught early enough. However, this will only preserve the sight you have, rather than improve it.
Kidney disease
If the small blood vessels in your kidney become blocked and leaky, your kidneys will work less efficiently.
It's usually associated with high blood pressure, and treating this is a key part of management.
In rare, severe cases, this can lead to kidney failure This can mean treatment with dialysis, or sometimes a kidney transplant becomes necessary.
Foot problems
Damage to the nerves of the foot can mean that small nicks and cuts aren't noticed and this, in combination with poor circulation,can lead to a foot ulcer. About 1 in 10 people with diabetes get a foot ulcer, which can cause serious infection.
If you have diabetes, look out for sores and cuts that don't heal, puffiness or swelling, and skin that feels hot to the touch. You should also have a foot examination at least once a year.
If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist.
Sexual dysfunction
In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication.
Women with diabetes may experience:
- a reduced sex drive (loss of libido)
- reduced pleasure from sex
- vaginal dryness
- a reduced ability to orgasm
- pain during sex
If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel.
Miscarriage and stillbirth
Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood sugar level isn't carefully controlled immediately before and during early pregnancy, there's also an increased risk of the baby developing a serious birth defect.
Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetes clinic, ideally with a doctor who specialises in pregnancy care (an obstetrician).
This will allow your care team to keep a close eye on your blood glucose levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby.
Looking after your eyes
The Diabetic Screening Service for Wales (DRSSW) will arrange for you to have your eyes checked every year. It is a free service established for all eligible people registered with diabetes in Wales to reduce the risk of vision loss due to diabetic retinopathy. If you are diagnosed with diabetes, you will be referred by your GP and should receive an invitation to attend screening within 3 months of being placed on the DRSSW register. It is important to attend your regular eye screening to detect potential sight threatening retinopathy as timely treatment is highly effective in preventing its progression.