Diabetes Type 1

As well as making lifestyle changes, people with Type 1 and Type 2 diabetes often need additional treatments such as medication like insulin to control their diabetes, blood pressure and blood fats. This section helps to explain more about some of the more common treatments for people with diabetes.

The information in this section is general, so it is important that you discuss any concerns or problems you may have with your medications and treatments with your diabetes healthcare team.

Medication is not a substitute for following a healthy diet and taking regular physical activity – you will still need to carry on with this.

Insulin

Insulin is a hormone made by your pancreas, which helps you body to use the glucose in the blood. Everyone with Type 1 diabetes and some people with Type 2 diabetes need to take insulin to control their blood sugar levels. 

Injecting insulin 

Insulin is injected using a syringe and needle, or an insulin pen or needle. The needles used are very small as the insulin only needs to be injected under the skin (subcutaneously) – not into a muscle or vein. Once it’s been injected, it soaks into small blood vessels and is taken into the bloodstream. As your confidence grows and you become more relaxed, injections will get easier and soon become second nature.  

The most frequently used injection sites are the thighs, buttocks and abdomen. You may be able to inject into your upper arms, but check with your diabetes team first as this isn’t always suitable. As all these areas cover a wide skin area, you should inject at different sites within each of them. It is important to rotate injection sites, as injecting into the same place can cause a build up of lumps under the skin (also known as lipohypertrophy), which make it harder for your body to absorb and use the insulin properly.

Islet transplants for Type 1 diabetes 

Type 1 diabetes results from the destruction of insulin-producing cells in the islets of the pancreas. Islet cell transplantation involves extracting islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1. This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic.

In 2008, the UK launched the first government-funded islet transplant programme in the world. As of March 2015, 152 islet transplants had been performed in the UK since the launch. Islet cell transplants are now available through the NHS for people who satisfy the criteria given below.

When are islet transplants needed?

About one third of people with Type 1 diabetes each year will experience a ‘severe’ hypo – meaning that they need someone else to help them. Severe hypos can occur in anyone taking insulin, but they are more likely to occur in people who have had diabetes for more than 15 years and those who are unable to recognise when their blood glucose is low (a problem known as hypoglycaemic unawareness). For these people, an islet transplant can be a life-changing, and sometimes a life-saving, therapy.

Who might be suitable for an islet transplant?

• People with Type 1 diabetes who have experienced two or more severe hypos within the last two years, and have impaired awareness of hypoglycaemia.

• People with Type 1 diabetes and a functioning kidney transplant who experience severe hypos and impaired hypoglycaemia awareness or poor blood glucose control despite the best medical therapy.

Who might not be suitable for an islet transplant?

• People who need a lot of insulin (e.g. more than 50 units per day for a 70kg person).

• People who weigh over 85kg.

• People with poor kidney function.

 

What are the potential benefits?

Islet transplants have been shown to reduce the risk of severe hypos. Results from UK islet transplant patients showed that the frequency of hypos was reduced from 23 per person per year before transplantation to less than one hypo per person per year afterwards.

Islet transplants usually also lead to improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose, improved quality of life and reduced fear of hypos. Long-term results are good and are improving all the time. For example, the majority of transplant patients can now expect to have a functioning transplant after six years and some people have had more than 10 years of clinical benefit.

What risks are involved?

Islet transplants involve a small but increased risk of certain cancers, severe infections and other side effects related to the medication needed to prevent the islets from being rejected by the body (which is the same medication used by people who receive other kinds of transplants).

Islet transplants are unsuitable for people who are desperate to stop their insulin injections. If freedom from insulin injections is achieved, this is usually short-lived, and most people who receive an islet transplant continue to take low-dose insulin therapy. Therefore, islet transplants should not be seen as a cure for diabetes.