Newly Diagnosed Type Diabetes

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When you are first diagnosed with type 1 diabetes, you will meet your diabetes management team, which consists of your physician, the diabetes educator, and the nutritionist.

The physician will answer your questions about diabetes and recommend an initial insulin regimen. The nutritionist will teach you about carbohydrate counting, give you a carbohydrate exchange book (the ADA publishes a good one), and explain

how to read food labels. She will also describe how to have a balanced diet and tell you about the best sources of fast-acting carbohydrates that can be used to treat low glucose levels.

The diabetes educator will teach you how to use a glucose monitor, how to keep a logbook, and how often you should monitor your glucose levels and will set your target glucose levels. She will also teach you how to draw up insulin in a syringe and give an injection. Even if you were prescribed insulin pens from the start, you should still know how to draw up insulin in a syringe just in case a pen is not available. The educator will go over the symptoms of low glucose reactions and how to treat them. She will also show you how glucagon works and instruct you and a family member on its use. She will give you information about the resources available in your community for people with diabetes. She will explain how you can incorporate taking care of your diabetes into your day-to-day activities and how to involve family, friends, and colleagues.

Usually, newly diagnosed people with type 1 diabetes still make insulin, and initially, low doses of insulin are required and glucose control is relatively easy. This is called the honeymoon phase. During this period, the glucose levels go up with meals only, so you can start treatment with an insulin pen of a fast-acting insulin analog before each meal using insulin pens that allow you to inject half-unit doses of insulin. The initial ratio might be 1 unit of insulin for 30 to 45 grams carbohydrate. If your glucose is high, you may need additional insulin to bring down the number—this is called correction insulin. The ratio for correction might be 1 unit of insulin for every 75 mg/dl blood glucose over a target of 150. For example, if your premeal blood glucose was 225 and you were going to eat 30 grams carbohydrate, you would inject 1 unit of insulin for correction plus 1 unit for carbohydrates, or a total of 2 units fast-acting insulin analog.

Initially, your medical team will see you quite frequently (at one- to two-week intervals) to review the glucose levels and help you with insulin adjustments. If possible, you should also attend a course on diabetes self-management, with the goal of understanding all aspects of diabetes management.

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