Currently, there is no way of preventing the decline in insulin secretion that occurs with time in those with type 1 diabetes. The honeymoon period can last only a few weeks, or it can last for more than a year or two. Generally speaking, children and young adults tend to have shorter honeymoons, whereas older individuals can maintain insulin secretion for several years. There are, however, many exceptions to this observation.
As your insulin secretion declines, you will need more insulin to control the glucose. You may find that your glucose values drift upward overnight. This is a good time to add some long-acting basal insulin. Usually only a few units (2 to 3) of insu lin glargine or detemir might be necessary to start with, but then the doses go up with time. The ratios of insulin for carbohydrate and for correction also change, and more insulin is needed. The amount of insulin that you need will vary according to your age and weight: a teenager going through puberty will need almost twice as much insulin as a man in his mid-thirties or older. Table 16-1 gives you an approximation of the amount of insulin needed at different ages.
As the honeymoon fades, not only do your insulin requirements increase, but there is increased lability in the glucose levels. Therefore, you have to measure glucose levels more frequently and do more insulin injections during this period, and you and your medical team may decide that it is advantageous for you to go on an insulin pump (see Chapter 6).
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.