Hi there,
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology. I read your mail with diligence.

Long-term complications of type 1 diabetes develop gradually, over years. The earlier you develop diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Here we take two systems to enumerate what can go wrong.

Nervous System.
Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar could cause you to eventually lose all sense of feeling in the affected limbs. Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue. If despite well controlled diabetes you are getting burning pain. Please consult your doctor: there are prescription drugs for pain available for such conditions,

Cardiovascular System:
Heart and blood vessel disease. Diabetes dramatically increases your risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure. In fact, about 65 percent of people who have type 1 or type 2 diabetes die of some type of heart or blood vessel disease, according to the American Heart Association.
Other systems can be involved.

Type I Diabetes is insulin dependent and I am sure you would be taking insulin and monitoring your blood sugar with glycated hemoglobin (HbA1C). The other things which will help you in leading a near normal life should not be ignored, To revise these. Secondary depression is common in this life long disease. But one has to fight it out, concentrating on treatment and self care is most important.
Treatment for type 1 diabetes is a lifelong commitment to:
Taking insulin
Exercising regularly and maintaining a healthy weight
Eating healthy foods
Monitoring blood sugar

The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. Although there are exceptions, generally, the goal is to keep your daytime blood sugar levels between 80 and 120 mg/dL (4.4 to 6.7 mmol/L) and your bedtime numbers between 100 and 140 mg/dL (5.6 to 7.8 mmol/L).

If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.

Insulin and other medications
Anyone who has type 1 diabetes needs insulin therapy to survive.

Types of insulin are many and include:
Rapid-acting insulin
Long-acting insulin
Intermediate options

Examples are regular insulin (Humulin R, Novolin R, others), insulin isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).

Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

An inhaled insulin (Exubera) was previously available, but the manufacturer stopped selling the drug because too few people were using it. Since it was taken off the market, this drug has been linked to an increased number of lung cancers in people with a history of smoking. However, because the additional number of lung cancer cases is so small, it's not clear if there's a link to the medication. If you used Exubera and have a history of smoking, discuss these concerns with your doctor.

Injection options to get insulin into your body currently include injection and insulin pump infusion. Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action.

Insulin injections can be done using:
A fine needle and syringe
An insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin

An insulin pump — a device about the size of a cell phone worn on the outside of your body. A tube connects a reservoir of insulin to a catheter that's inserted under the skin of your abdomen. There's also a wireless pump option that's available in most areas. You wear a pod filled with insulin on your body that has a tiny catheter that's inserted under your skin. The insulin pod can be worn on your abdomen, lower back, or on a leg or an arm. The programming is done with a wireless device that communicates with the pod.


Whichever pump you use, it's programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as your basal rate, and it replaces whatever long-acting insulin you were using. When you eat, you program the pump with the amount of carbohydrates you're eating and your current blood sugar, and it will give you what's called a "bolus" dose of insulin to cover your meal and to correct your blood sugar if it's elevated. Some research has found an insulin pump to be more effective at controlling blood sugar levels than injections are.

Oral medications are sometimes prescribed as well, such as:
Pramlintide (Symlin). An injection of this medication before you eat can slow the movement of food through your stomach to curb the sharp increase in blood sugar that occurs after meals.
High blood pressure medications. Even if you don't have high blood pressure, your doctor may prescribe medications known as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), because these medications can help keep your kidneys healthy in addition to lowering blood pressure. It's recommended that people with diabetes have blood pressures less than 130/80 millimeters of mercury (mm Hg).
Cholesterol-lowering drugs. As with high blood pressure drugs, your doctor may not wait until your cholesterol is elevated before he or she prescribes cholesterol-lowering agents known as statins. Cholesterol guidelines are more aggressive for people with diabetes because of the elevated heart disease risk. The American Diabetes Association recommends that low-density lipoprotein (LDL, or "bad") cholesterol be below 100 mg/dL (2.6 mmol/L) and that high-density lipoprotein (HDL, or "good") cholesterol be over 50 mg/dL (1.3 mmol/L). Triglycerides, another type of blood fat, are ideal when they're less than 150 mg/dL (1.7 mmol/L).

Healthy eating and counting carbohydrates
Contrary to popular perception, there's no such thing as a diabetes diet. You won't be restricted to a lifetime of boring, bland foods. Instead, you'll need plenty of:
Fruits
Vegetables
Whole grains

These foods are high in nutrition and low in fat and calories. And they mean fewer animal products and sweets. This is actually the best eating plan, even for people without diabetes.

You'll need to learn how to count the carbohydrates in the foods you eat so that you can give yourself enough insulin to properly metabolize those carbohydrates. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle.

Physical activity
Everyone needs regular aerobic exercise, and people who have type 1 diabetes are no exception. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar, often for long after you're done working out. If you begin a new activity, check your blood sugar level more often than usual until you know how that activity affects your blood sugar levels. You might need to adjust your meal plan or insulin doses to compensate for the increased activity. If you use an insulin pump, you can set a temporary basal rate to keep your blood sugar from dropping. Ask your doctor or diabetes educator to show you how.

Blood sugar monitoring
Depending on what type of insulin therapy you select or require — single-dose injections, multiple-dose injections or insulin pump — you may need to check and record your blood sugar level at least four times a day, and probably more. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Be sure to wash your hands before checking your blood sugar levels to get the most accurate reading.

Even if you take insulin and eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
Food. What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
Physical activity. Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level. To compensate, you might need to lower your insulin dose before unusual physical activity.
Medication. You need insulin to lower your blood sugar level. But other medications you take may affect your blood sugar level as well, sometimes requiring changes in your diabetes treatment plan.
Illness. During a cold or other illness, your body will produce hormones that raise your blood sugar level. This might require changes in your diabetes treatment plan.
Alcohol. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so in moderation, which means no more than one drink a day for women and two drinks or fewer daily for men.
Stress. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
For women, fluctuations in hormone levels. As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar levels, and may be most helpful for people who have developed hypoglycemia unawareness. Continuous glucose monitors attach to the body using a fine needle just under the skin that checks blood glucose level every few minutes. CGM isn't yet considered as accurate as standard blood sugar monitoring, so it's not considered a replacement method for keeping track of blood sugar, but an additional measure.

Situational concerns
Certain life circumstances call for different considerations.
Driving. Hypoglycemia can occur at any time, even when you're driving. It's a good idea to check your blood sugar anytime you're getting behind the wheel. If it's below 70 mg/dL (3.9 mmol/L), have a snack and then retest again in 15 minutes to make sure it's risen to a safe level. Low blood sugar makes it hard to concentrate or to react as rapidly as you might need to when you're driving.
Working. In the past, people with type 1 diabetes were often refused certain jobs just because they had diabetes. Fortunately, advances in diabetes management and anti-discrimination laws have made such blanket bans largely a thing of the past. However, type 1 diabetes can pose some challenges in the workplace. For example, if you work in a job that involves driving or operating heavy machinery, hypoglycemia could pose a serious risk to you and those around you. You may need to work with your doctor and your employer to ensure that certain accommodations are made, such as your having a quick break for blood sugar testing and fast access to food and drink any time so you can properly manage your diabetes and prevent low blood sugar levels. There are federal and state laws in place that require employers to make reasonable accommodations for people with diabetes.
If you any further questions or if I have misconstrued any question please ask in followup query, I will be pleased to answer.

With Best Wishes
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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