At the diagnosis stage, the development of symptoms and person's general condition determine the urgency of treatment. If the general condition is poor, with dehydration, disrupted salt balance or ketoacidosis, the management of diabetes begins in a hospital with infusion treatment and an intravenous insulin drip. If their general condition is good, the insulin therapy can start in an outpatient clinic, and self care guidance is arranged through frequent meetings.
Diabetes specialist nurse goes through the essentials of the early stages with the newly diagnosed person to enable them to manage through the first few weeks. The information and skills required for the self-management of diabetes are gradually learned over the course of the first year.
Insulin therapy in type 1 diabetes
In the management of type 1 diabetes, long-acting basal insulin and rapid-acting mealtime insulin are required. Insulin can also be administered through an insulin pump. In type 1 diabetes, insulin must be available around the clock, and insulin delivery should never be completely interrupted under any circumstances. Insulin deficiency's replacement therapy requires long-acting basal insulin taken 1 or 2 times a day, which acts throughout the day and regulates the release of sugar into circulation from the liver at night and between meals. In insulinpump therapy the long-acting insulin is replaced by rapid-acting insulin the pump regularly administers.
Rapid-acting mealtime insulin is taken when eating, based on the meal’s carbohydrate content and the pre-meal blood sugar test result. Temporarily high blood sugar can be corrected with small doses of the same rapid-acting insulin i.e. correction insulin. When rapid-acting mealtime or correction insulin is administered in insulinpump therapy, the term 'bolus' is used.
In newly diagnosed individuals, there is usually some remaining functioning beta cells and endogenous insulin secretion. At the beginning of treatment, it may be possible to manage for a while with, for example, only mealtime insulin injections.