Everyday factors that affect control of type 1 diabetes

Controlling type 1 diabetes involves thinking about all the factors that impact on blood glucose, including the carbohydrate you eat, and the amount of insulin you need for it, the exercise you have recently done and the exercise you are planning to do, and learning how your body responds to different circumstances.

Young people also talked to us about everyday things which were not always straightforward in their lives such as leaving home, cooking their own meals and going out with friends. They also talked to us about other things that affected blood glucose levels. Those who felt they had reached a good understanding of what to do and when to do it said they gradually accepted they needed to think ahead and plan their lives, but that once they had done so, they got better. But others said they found forward thinking and planning about everyday matters was difficult and that they needed more support and help.

Physical exercise and insulin-control

Exercise brings down blood glucose levels and those who play sport have to learn the particular ways different kinds of exercise affect their insulin and carbohydrate balance. Some found that it took quite a while for them to work out the amount of insulin that suited them, particularly those who played energetic games like football or rugby. Several suggested that a good way to manage blood glucose levels when exercising is to start with higher levels than usual so as to avoid having a hypo.

She explains why rugby is not an easy sport to play when you have diabetes. But she is proud of…

Age at interview 22

Gender Female

Age at diagnosis 9

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Getting control over blood glucose levels long-term

The young people we talked to were clear that they needed to have ‘good’ HbA1c test results. (HbA1c means glycated haemoglobin.) An HbA1c test measures average blood glucose over several weeks.

Most young people defined ‘good control’ as having HbA1c levels between 6 and 7% (42-52 mmol/mol). Levels around 8 or 8.5 % (64–69 mmol/mol) was seen as doing ‘all right’, and most people said that anything above 9%(75 mmol/m was ‘bad control’. Very few young people said they had been able to maintain ‘good’ HbA1c results over several years. National data suggests that it is hard for everyone with type 1 diabetes to hit these targets. According to the National Diabetes Audit 2015–16, only 29.2 % of people with type 1 diabetes in the UK have an HbA1c below 7.5% (58mmol/mol).

He tried to maintain his HbA1C’s between 5 and 6 per cent and was experiencing lot of hypos…

Age at interview 26

Gender Male

Age at diagnosis 18

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His approach is that he is his own doctor, nurse and pharmacist and does what he is supposed to…

Age at interview 24

Gender Male

Age at diagnosis 16

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HbA1c results were given as a percentage e.g. 6.5%, but from 31 May 2011 in the UK, HbA1c will be given in millimoles per mol (mmol/mol) instead of as a percentage (%).

To help make this transition as easy as possible, all HbA1c results in the UK will be given in both percentage and mmol/mol from 1 June 2009. Some young people attributed their more balance blood glucose levels to their use of an insulin pump and a Continuous Glucose Monitoring (CGM) device (see also ‘Insulin Pumps‘ and ‘Continuous Glucose Monitoring‘.)

Avoiding fluctuations in levels

The majority of the young people we talked to said that they have gone through ‘good and bad patches’ and that it was not always possible to maintain stable blood glucose levels. Some people preferred to not think about controlling their diabetes in too much detail in case they got ‘obsessed’ by the illness, and many felt they could afford to be relaxed about fluctuating levels at this point in their lives and that eventually levels would stabilise.

Says that if you let it, diabetes can rule your life and she doesn’t like that. Her control is…

Age at interview 17

Gender Female

Age at diagnosis 12

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Says that her HbA1c is alright but that as a student she has other responsibilities and that she…

Age at interview 20

Gender Female

Age at diagnosis 11

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Periods and hormones

For people who menstruate (have periods) the monthly menstrual cycle and periods can cause blood glucose to change. Many of the young women we interviewed said that their blood glucose levels tend to fluctuate between low and high before and after their periods.

External factors that can affect diabetes

Everyday illnesses such as colds, flu, tummy bugs can affect glucose levels especially if you lose your appetite and stop eating normally. Young people said that having regular sips of energy drinks and eating toast had helped them. Others wondered if warm weather and hay fever had a bad effect on them and their control. (For young people’s experiences of the effects of diet and alcohol see ‘Diet and diabetes’ and ‘Drinking and alcohol‘).

Some people found that stress during exams could raise blood glucose levels; while others felt that physical inactivity of revision for exams caused them to go high. Young people said that their levels tended to fluctuate between low and high during exam times, and that coping with blood glucose levels could be difficult and add to overall stress levels. A few young people considered themselves lucky because stress had not affected their blood glucose levels at all.

She finds that exams and stress affect her blood glucose control the most. Her care team has…

Age at interview 16

Gender Female

Age at diagnosis 7

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Going to university and leaving home also tended to be an unsettled time and many people had been warned by their diabetes medical team that their blood glucose level might be up and down for a few weeks while they were adjusting to a new life style.

Other kinds of emotional highs and lows, particularly arguments with parents, boy/girlfriends and others could result in a high blood glucose reading.

She is newly diagnosed and explains which factors she had noticed affect her blood glucose level,…

Age at interview 18

Gender Female

Age at diagnosis 18

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