Insulin Therapy

Type 1 diabetes is primarily managed through insulin therapy. People with T1D must work closely with their medical team to find the best insulin types and delivery method for them.

Types of insulin include short-acting, intermediate-acting, long-acting, and ultra-long-acting. Learn more about the different types of insulin.

Insulin can be delivered via syringes or pens, inhaler, pumps, or artificial pancreas/automated insulin delivery systems.

Syringes and Pens

Syringes and pens are used for multiple daily injection (MDI) therapy. This typically involves a combination of both short-acting (bolus) and long-acting (basal) insulin. Injections are administered to the thigh, buttocks, abdomen, or upper arms.

Inhaler

Afrezza, a quick acting inhaled insulin, can be an alternative to injectable pre-meal insulin. It is inhaled immediately before a meal. It is FDA-approved for people 18 and over who have type 1 or type 2 diabetes. There are other criteria for use that your physician and diabetes care team can provide. Learn more about a current clinical trial for Afrezza use in children under 18.

Insulin Pumps

Insulin pumps are small devices that deliver a continuous supply of insulin through a tiny tube (cannula) inserted under the skin, typically in the upper thigh, abdomen, lower back, or tricep. The pump itself is worn outside the body and is programmed to deliver basal (long-acting) insulin continuously, mimicking the normal background insulin secretion of a healthy pancreas. Additionally, it allows the user to deliver bolus (short-acting) doses of insulin during meals. Learn more about insulin pumps.

Artificial Pancreas/Automated Insulin Delivery Systems

Artificial pancreas (AP)/automated insulin delivery (AID) systems combine the technology of a pump with that of a continuous glucose monitor (CGM) to adjust insulin delivery based on real-time glucose readings. By automating insulin delivery and closely monitoring glucose levels, it can help regulate blood sugar more effectively than traditional methods that rely on manual injections or pump adjustments. Learn more about AP/AID systems.

Daily Monitoring and Lifestyle

In addition to insulin, type 1 diabetes treatments also include monitoring and lifestyle choices. Each plays a role in the management and mitigation of T1D’s effects.

Blood sugar monitoring

Regular blood sugar monitoring is essential for managing T1D. This involves checking blood glucose levels multiple times a day using a glucose meter or a continuous glucose monitor (CGM). CGMs provide real-time glucose readings and can alert the individual when their levels are too high or too low.

Carbohydrate counting

People with type 1 diabetes must count the carbohydrates they consume to determine the amount of insulin they need to take. This helps maintain stable blood sugar levels by matching insulin doses to carbohydrate intake.

Your endocrinologist will work with you to determine your proper insulin-to-carb ratio (I:C). This ratio is the amount of insulin needed to balance the intake of a certain amount of carbohydrates (typically measured in grams). For example, if your I:C is 1:12 and you have an apple that contains 24g carbs, you would take two units of insulin. Taking those two units of insulin prior to eating the apple helps to avoid a high or low blood-sugar fluctuation post-snack. Get tips on carb counting.

Healthy eating

Following a balanced and nutritious diet is paramount to the health of a person living with T1D. Ensuring proper nutritional intake and keeping a healthy weight help curb the effects of T1D wear on the body. Learn more about food and diet with T1D.

Regular exercise

Physical activity can help regulate blood sugar levels and improve overall health. Keep in mind that monitoring insulin and carbohydrate intake is essential when exercising to prevent hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Learn more about exercise and T1D.

Regular medical check-ups

People with T1D regularly meet with a team of medical professionals, including an endocrinologist, retinal specialist, and dietitian, to help manage their disease and to prevent and treat complications.

Adjunctive Medications

Adjunctive therapies are treatments that complement insulin to achieve glucose control and to help manage additional metabolic conditions experienced by people with T1D, including insulin resistance and obesity. Improved control of glucose and metabolism also plays an important role in slowing progression of long-term complications associated with T1D.  

Pramlintide

Pramlintide is a synthetic amylin analog administered via syringe. It is approved for people with T1D who use mealtime insulin and do not achieve their glycemic targets despite optimal insulin therapy. Pramlintide limits glucose fluctuations after meals. Pramlintide therapy can also lead to weight-loss and improvements in risk factors for cardiovascular disease. 

Metformin

Originally developed for the treatment of type 2 diabetes (T2D), metformin, administered via a pill, can be prescribed to people with T1D in addition to insulin therapy, diet, and exercise to help improve insulin sensitivity and reduce insulin dose requirements.  People with insulin resistance, of higher weight, and at risk for cardiovascular disease may be more likely to experience metabolic benefits with metformin. 

GLP-1 receptor agonists   

Glucagon-like peptide-1 (GLP-1) receptor agonists are commonly used to treat T2D. Though not approved for T1D, GLP-1 agonists, administered both orally and through injections, have been shown to have glycemic and metabolic benefits in people with T1D. They can lead to reduced insulin needs, weight loss, and may reduce risk of cardiovascular disease.  

SGLT2 inhibitors

Sodium-glucose co-transporter (SGLT) inhibitors lower blood sugar levels by preventing glucose reabsorption in the kidneys and increasing glucose excretion through the urine. In addition to glycemic control, SGLT inhibitors, which are taken orally, also have metabolic benefits in weight loss and improved cardiac and kidney function. These benefits have led to approval of SGLT inhibitors for T2D, chronic kidney disease, and heart failure. SGLT inhibitors are not approved for glycemic control in T1D due to the elevated risk of diabetic ketoacidosis (DKA). A key JDRF priority is to find ways to mitigate this risk so people with T1D can also take advantage of the SGLT cardiovascular and renal benefits.

Blood pressure and cholesterol medications  

In T1D, hyperglycemia (high blood sugar) and poor glycemic control impact cardiovascular outcomes, including blood pressure and cholesterol levels. Long disease duration and increased risk of microvascular complications in T1D also contribute to the high prevalence of cardiovascular disease in T1D. Therapies such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), statins, and other lipid-lowering drugs may be prescribed to manage cardiovascular disease and reduce the risk of cardiovascular complications.   

Editor’s note: How you manage your type 1 diabetes is a personal decision that should be made by you and your healthcare team. JDRF content is for informational purposes only and is not a substitute for professional medical advice. Please contact your doctor or other qualified health provider with any questions you may have regarding type 1 diabetes treatments or any medical condition.