DKA is a Medical EmergencyDiabetic ketoacidosis (DKA) occurs when insulin is severely deficient. Features: vomiting, abdominal pain, fruity breath, drowsiness, rapid deep breathing (Kussmaul). Call 999/911 and do not stop insulin during illness.
Type 1 vs Type 2: Key Differences
| Feature | Type 1 | Type 2 |
|---|---|---|
| Cause | Autoimmune (GAD, IA-2, ZnT8 antibodies) | Insulin resistance + relative insulin deficiency |
| Onset | Often rapid, acute (DKA) | Gradual, often asymptomatic |
| Age | Any age; typically younger | Usually >40 (but rising in youth) |
| Body weight | Usually normal or thin at onset | Usually overweight |
| Insulin | Always required | Oral drugs first; insulin later in many |
| C-peptide | Very low/undetectable (no beta cell) | Normal or high initially |
Insulin Regimens
- Multiple Daily Injections (MDI) / Basal-Bolus: long-acting insulin (glargine/detemir) once or twice daily + rapid-acting (aspart/lispro) with each meal — most flexible
- Twice-daily mixed insulin: simpler but less flexible for lifestyle
- Insulin pump (CSII): continuous subcutaneous infusion of rapid-acting insulin — best glycaemic control in motivated patients
- Hybrid closed-loop systems ('artificial pancreas'): CGM-linked insulin pump that auto-adjusts basal insulin — now recommended by NICE for T1DM
CGM Changes EverythingContinuous glucose monitors (Dexterity/Libre/Dexcom) replace or supplement fingerprick testing. Real-time glucose trends allow earlier correction and reduce hypoglycaemia. The NHS now funds CGM for all people with T1DM.
What is the honeymoon period?
Shortly after T1DM diagnosis, residual beta cells may still produce some insulin, causing reduced insulin requirements — the 'honeymoon phase.' It lasts weeks to months; insulin is still required throughout.
How do I manage T1DM during illness (sick day rules)?
NEVER stop insulin during illness — glucose and ketones usually rise. Check glucose every 2 hours. Check blood or urine ketones. Extra rapid-acting insulin may be needed. Stay hydrated. If vomiting or ketones are high, go to hospital.
What is carbohydrate counting?
Matching rapid-acting insulin dose to the amount of carbohydrate eaten (usually 1 unit per 10g carb — but individual ratios vary). Taught by a diabetes team as part of the DAFNE (Dose Adjustment For Normal Eating) programme.
Can Type 1 diabetes be cured?
Not currently. Pancreas and islet cell transplantation can achieve remission but require lifelong immunosuppression. Encapsulated islet transplantation and gene therapy are in clinical trials.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.