27th May 2025

Management

Short term and long term management is complicated but extremely important as T1DM can reduce life expectancy by up to 13 years and vascular complications can be life changing. Management requires a multi-disciplinary approach and mainly involves strict glycaemic control and insulin therapy. Short term management of T1DM with insulin is potentially life saving by preventing diabetes ketoacidosis. Long term management of T1DM aims to prevent the development of chronic vascular complications by controlling blood glucose levels to as close to normal as possible. 

HbA1c

Glycosylated haemoglobin (HbA1c) is an indicator of glucose control over the past three months and is used to guide treatment. The National Institute for Health and Care Excellence (NICE) recommends a target HbA1c level of 48mmol/mol (6.5%) or lower. Target levels are individualised to patients and factors to be considered include the patient age, life expectancy, advanced vascular complications, activities, aspirations, likelihood of complications, co-morbidities, occupation and history of hypoglycaemia

Optimising glucose control involves lifestyle changes including diet and exercise and insulin therapy. HbA1c levels should be measured every 3 months in those under 18 years of age and every three to six months in adults. In addition to this, self glucose monitoring is also an essential part of management.

Self-monitoring of blood glucose 

Patients should be taught self-monitoring skills at the time of diagnosis and initiation of insulin therapy, these should be reviewed at least once a year. They should be taught how to measure their blood glucose, how to interpret the results and what action to take.

Patients with T1DM should test their blood glucose at least four times a day including before meals and before bed. A higher frequency of monitoring is recommended if patient’s agreed HbA1c target is not met, the frequency of hypoglycaemia episodes increases, during illness, before during and after sport, when planning pregnancy, during pregnancy, while breastfeeding, there is a legal requirement to do so (e.g. before driving), if the patient has impaired awareness of hypoglycaemia.

Blood glucose targets

• On waking: fasting plasma glucose 5-7 mmol/L.
• Before meals at other times of day: a plasma glucose of 4-7mmol/L.
• After meals: plasma glucose level 5-9mmol/L.
• Bedtime: plasma glucose should be personalised to the individual considering the timing of their last meal and the insulin dose required and achieve the recommended fasting plasma glucose on waking.