T1D Education Center

What Are Target Ranges?

Target blood sugar ranges vary by age and individual circumstances. Work with your diabetes team to determine your specific targets.

General targets (mg/dL):

• Children (under 6): 100-180 before meals, <200 bedtime
• Children (6-12): 90-180 before meals, 100-180 bedtime
• Teens & Adults: 80-130 before meals, <180 after meals
• A1C Target: Generally <7% (discuss with your team)

What Affects Blood Sugar?

Things that RAISE blood sugar:

• Carbohydrates in food (bread, pasta, rice, fruit, sweets)
• Stress hormones (cortisol, adrenaline)
• Illness and infection
• Some medications (steroids, some antibiotics)
• Growth hormones (especially in teens)
• Menstrual cycle (in some people)
• Dawn phenomenon (early morning rise)

Things that LOWER blood sugar:

• Insulin (injected or from a pump)
• Physical activity and exercise
• Skipping or delaying meals
• Alcohol (delayed effect, especially dangerous at night)
• Hot weather or hot baths

Pattern Recognition

One of the most powerful skills in diabetes management is recognizing patterns in your blood sugar data:

• Dawn Phenomenon: Blood sugar rises in early morning (typically 4-8 AM) due to hormones released during sleep
• Somogyi Effect: Low blood sugar during the night causes rebound high in the morning
• Post-meal spikes: How different foods affect your blood sugar
• Exercise effects: How different activities impact your levels (some raise, some lower)
• Stress patterns: How your blood sugar responds to stress

Types of Insulin

Rapid-Acting (Bolus Insulin):

• Examples: Humalog, Novolog, Apidra, Fiasp
• Onset: 10-15 minutes
• Peak: 1-2 hours
• Duration: 3-5 hours
• Use: Taken with meals to cover carbohydrates and correct high blood sugar

Long-Acting (Basal Insulin):

• Examples: Lantus, Levemir, Tresiba, Basaglar
• Onset: 1-2 hours
• Peak: Minimal to no peak
• Duration: 12-24+ hours
• Use: Provides steady background insulin to keep blood sugar stable between meals and overnight

Insulin-to-Carb Ratios (I:C)

Your insulin-to-carb ratio tells you how many grams of carbohydrate one unit of rapid-acting insulin will cover. For example:

• 1:10 ratio: 1 unit of insulin covers 10 grams of carbs
• 1:15 ratio: 1 unit of insulin covers 15 grams of carbs

How to use it: If you're eating 45 grams of carbs and your ratio is 1:15, you need 3 units (45 ÷ 15 = 3).

Important notes:

• Ratios often vary throughout the day (breakfast, lunch, dinner may all be different)
• Children typically have higher ratios (1:20, 1:30) because they're more sensitive to insulin
• Ratios need adjustment as you grow, gain/lose weight, or change activity levels

Correction Factors (Sensitivity Factor)

Your correction factor tells you how much one unit of rapid-acting insulin will lower your blood sugar. For example:

• 1:50 factor: 1 unit drops blood sugar by 50 mg/dL
• 1:100 factor: 1 unit drops blood sugar by 100 mg/dL

How to calculate a correction: If your blood sugar is 200 mg/dL, your target is 100 mg/dL, and your correction factor is 1:50:

200 - 100 = 100 (points above target)
100 ÷ 50 = 2 units needed

Timing Matters

Pre-bolusing: Taking rapid-acting insulin 10-20 minutes before eating can help prevent post-meal spikes. The insulin starts working when the food starts digesting.

Extended bolus: For high-fat or high-protein meals that digest slowly, some pumps allow you to deliver insulin over an extended period (useful for pizza, pasta, etc.).

What Are Carbohydrates?

Carbohydrates are nutrients in food that turn into glucose (sugar) in your blood. They're found in:

• Grains: Bread, pasta, rice, cereal, crackers
• Fruits: All fruits (fresh, dried, juice)
• Dairy: Milk, yogurt (not cheese or butter)
• Starchy vegetables: Potatoes, corn, peas
• Sweets: Candy, cookies, cake, soda
• Legumes: Beans, lentils

NOT significant sources of carbs: Meat, fish, eggs, cheese, most vegetables, fats/oils

Reading Nutrition Labels

The most important line: Total Carbohydrate

• Look at "Total Carbohydrate" not "Sugars" alone
• Check the serving size (you may eat more or less)
• Fiber can be subtracted if >5g per serving
• Sugar alcohols can be divided by 2 and subtracted

Understanding Glycemic Index (GI)

Not all carbs affect blood sugar the same way!

The Glycemic Index measures how quickly foods raise blood sugar after eating. It's ranked on a scale from 0 to 100, where pure glucose = 100.

Why it matters for Type 1 Diabetes:

• High GI foods spike blood sugar faster → you may need to take insulin earlier before eating
• Low GI foods digest slowly → blood sugar rises more gradually over time
• Understanding GI helps you predict how your blood sugar will respond and time insulin better

The Three GI Categories:

• 🟢 Low GI (55 or less) - Slow & Steady:
  Most non-starchy vegetables, beans, lentils, chickpeas, whole grain pasta, steel-cut oats, most nuts, plain yogurt, most fresh fruits (apples, berries, oranges)
• 🟡 Medium GI (56-69) - Moderate:
  Brown rice, whole wheat bread, sweet potatoes, regular oatmeal, bananas, raisins, couscous, ice cream
• 🔴 High GI (70+) - Fast & Spiking:
  White bread, white rice, sugary cereals, crackers, pretzels, instant mashed potatoes, candy, juice, sports drinks, watermelon

Important: You still count ALL carbs the same way! 30 grams of carbs from white bread = 30 grams from lentils for insulin dosing. But the timing and speed of the blood sugar rise will be different.

Practical Tips for Using GI:

• Lower the GI: Choose whole grains instead of refined grains when possible
• Slow it down: Add protein or healthy fat to high-GI foods (e.g., peanut butter on white bread lowers the overall impact)
• Timing matters: For high-GI meals, consider giving insulin 10-15 minutes before eating; for low-GI meals, you may dose right when eating
• Portion control: Smaller portions of high-GI foods = smaller spikes
• Real-world example: Whole wheat pasta (low GI) vs. white rice (high GI) — both are carbs you count, but pasta will cause a slower, longer rise

Bottom line: GI is a helpful tool for understanding blood sugar patterns, but every person responds differently. Track your own responses and work with your care team to adjust insulin timing based on what you eat.

Restaurant Strategies

• Many chain restaurants have nutritional info online or on apps
• Learn to estimate: A fist = ~30g carbs (potato, rice)
• Ask for sauces on the side (many have hidden sugar)
• It's okay to guess—you can always correct later
• Over time, you'll get better at estimating portions

Continuous Glucose Monitors (CGMs)

What they are: Small sensors that sit under the skin and measure glucose levels continuously, sending readings to a receiver or phone every 1-5 minutes.

Major brands:

• Dexcom G6/G7: No fingersticks needed, 10-day sensor, works with pumps and phones
• FreeStyle Libre: 14-day sensor, scan to view (Libre 2/3 have alarms)
• Medtronic Guardian: Integrates with Medtronic pumps

Benefits:

• See blood sugar trends and arrows (rising, falling, steady)
• Alarms for highs and lows
• Better A1C outcomes
• Reduced fingersticks
• Share data with family members remotely

Insulin Pumps

What they are: Devices that deliver rapid-acting insulin continuously through a small tube (catheter) inserted under the skin.

Popular models:

• Tandem t:slim X2: Touchscreen, integrates with Dexcom
• Omnipod: Tubeless pod worn on body
• Medtronic 770G/780G: Automated insulin delivery

Advantages over injections:

• More precise dosing (0.05 unit increments)
• Flexible basal rates throughout the day
• Extended/combo boluses for tricky foods
• No need to carry pens and needles
• Can pause insulin delivery (for exercise)

Automated Insulin Delivery (AID) / Closed-Loop Systems

Also called "artificial pancreas" systems—these combine a CGM and insulin pump to automatically adjust insulin delivery based on glucose readings.

Available systems:

• Tandem Control-IQ: Works with Dexcom G6, adjusts basal and gives auto-corrections
• Medtronic 780G: Auto mode adjusts every 5 minutes
• Omnipod 5: Tubeless automated insulin delivery

Benefits:

• Dramatically increases time-in-range (often 70-90%)
• Reduces burden of constant decision-making
• Better overnight control
• Still requires carb counting for meals

Exercise & Physical Activity

Why it matters: Exercise makes cells more insulin-sensitive and helps with long-term health. But it also affects blood sugar in complex ways.

• Aerobic exercise (running, biking, swimming): Usually lowers blood sugar during and after activity
• Anaerobic exercise (weight lifting, sprints): May temporarily raise blood sugar due to adrenaline
• Check before, during, and after: Blood sugar can drop hours after exercise
• Have fast-acting carbs available: Glucose tabs, juice, or sports drinks
• Consider reducing basal insulin or eating extra carbs before planned exercise

Sick Day Management

When you're sick, blood sugar can be unpredictable: Illness and stress hormones often raise blood sugar, even if you're not eating.

Sick day rules:

• Never stop insulin: You need insulin even if not eating
• Check blood sugar every 2-4 hours
• Check for ketones if blood sugar is over 250 mg/dL
• Stay hydrated: Drink water or sugar-free fluids
• Have a sick day plan from your doctor: Know when to give extra insulin or call for help
• Contact doctor if: Vomiting, large ketones, blood sugar won't come down, difficulty breathing

School & Work

School accommodations (504 Plan or IEP):

• Check blood sugar and treat in classroom (no need to go to nurse)
• Eat snacks when needed
• Access to water and bathroom
• Extra time on tests if blood sugar is high/low
• Field trip and sports participation without restrictions
• Trained staff available to help younger children

Work rights (Americans with Disabilities Act):

• Right to test blood sugar and take insulin at work
• Right to eat/drink when needed
• Right to reasonable break accommodations
• Cannot be discriminated against in hiring or promotions

Travel Tips

• Pack double supplies: Keep backup insulin, pump supplies, test strips
• Carry medical letter for airport security (insulin, needles, devices)
• Insulin storage: Keep insulin cool but not frozen; use cooling cases for hot climates
• Time zone changes: Adjust basal insulin gradually; ask doctor for guidance
• Never pack insulin in checked luggage: Temperature extremes can ruin it
• Research medical facilities at your destination in case of emergency

Diabetic Ketoacidosis (DKA)

What it is: A life-threatening emergency when your body breaks down fat for energy instead of glucose, producing toxic acids called ketones.

Causes:

• Missed insulin doses
• Illness or infection
• Pump failure or bad insulin
• Sometimes the first sign of undiagnosed diabetes

Warning signs:

• High blood sugar (often >250 mg/dL)
• Large ketones in urine or blood
• Nausea, vomiting, stomach pain
• Fruity breath smell
• Rapid, deep breathing
• Confusion or difficulty staying awake

Prevention: Never skip insulin, check ketones when sick or blood sugar is high, have a sick day plan.

Treatment: Call doctor immediately. May need ER for IV fluids and insulin. This is a medical emergency.

Severe Hypoglycemia

What it is: Blood sugar drops so low that you need help from another person to treat it.

Causes:

• Too much insulin
• Not enough food after taking insulin
• Exercise without adjusting insulin or eating
• Alcohol without food

Warning signs:

• Shakiness, sweating, fast heartbeat
• Confusion, irritability
• Difficulty speaking or concentrating
• Seizures or loss of consciousness (severe)

Emergency treatment:

• If conscious: 15g fast-acting carbs, recheck in 15 minutes
• If unconscious or seizing: Glucagon injection, call 911
• Never give food/drink to unconscious person (choking risk)

Long-Term Complications

High blood sugar over time can damage:

• Eyes (retinopathy): Damage to blood vessels in retina; can lead to vision loss
  Screening: Dilated eye exam annually
• Kidneys (nephropathy): Reduced kidney function
  Screening: Urine albumin test annually
• Nerves (neuropathy): Numbness, tingling, pain in feet/hands
  Screening: Foot exam at each visit
• Heart & blood vessels: Increased risk of heart disease, stroke
  Screening: Blood pressure, cholesterol checks
• Feet: Poor circulation and nerve damage can lead to ulcers, infections
  Prevention: Daily foot checks, proper footwear

Recommended Screening Schedule

• A1C test: Every 3 months
• Eye exam (dilated): Annually starting 5 years after diagnosis
• Kidney screening (urine albumin): Annually starting at puberty or 5 years after diagnosis
• Cholesterol panel: Starting at age 10, then as recommended
• Blood pressure: Every doctor visit
• Thyroid (TSH): At diagnosis, then periodically (T1D increases thyroid risk)
• Celiac screening: At diagnosis, then as needed (T1D increases celiac risk)

Diabetes Burnout

What it is: Feeling overwhelmed, exhausted, and frustrated by the constant demands of diabetes management. It's not laziness—it's emotional exhaustion from a disease that never takes a break.

Signs of burnout:

• Skipping blood sugar checks or insulin doses
• Feeling angry, resentful, or hopeless about diabetes
• Avoiding diabetes-related appointments or tasks
• Ignoring high or low blood sugars
• Feeling like diabetes controls your life
• Isolating from friends, family, or diabetes community

What helps:

• Talk to your diabetes team: They've seen this before and can help
• Set small, achievable goals: Don't try to fix everything at once
• Take a mental break: It's okay to do "good enough" diabetes care sometimes
• Connect with other T1Ds: Online communities, local groups, diabetes camps
• Consider therapy: Diabetes-specialized therapists exist and can help
• Use technology: CGMs and pumps can reduce daily burden

Anxiety & Depression

Why T1D increases risk:

• Constant fear of hypoglycemia or complications
• Blood sugar fluctuations affect mood directly
• Sleep disruption from alarms and blood sugar management
• Social isolation or feeling "different"
• Financial stress from supplies and medications

When to seek professional help:

• Persistent sadness, hopelessness, or loss of interest in activities
• Panic attacks or excessive worry about blood sugar
• Disordered eating or insulin restriction for weight control
• Thoughts of self-harm or feeling life isn't worth living
• Substance abuse to cope with diabetes stress

Building Your Support System

Support comes in many forms:

• Family & friends: Educate them so they can support you effectively
• Diabetes care team: Endocrinologist, diabetes educator, dietitian, social worker
• Mental health professional: Therapist or counselor familiar with chronic illness
• Online communities: Facebook groups, Reddit (r/diabetes_t1), Instagram T1D accounts
• In-person groups: JDRF chapters, local diabetes support groups
• Diabetes camps: Especially powerful for kids and teens

Self-Care Strategies

• Set boundaries: It's okay to say no or take breaks from diabetes talk
• Celebrate small wins: Every good blood sugar, every day managed is worth acknowledging
• Practice self-compassion: Talk to yourself like you'd talk to a friend
• Stay physically active: Exercise helps mood and blood sugar
• Prioritize sleep: Even when blood sugar makes it hard
• Find non-diabetes identity: Hobbies, interests, and goals beyond diabetes
• Give yourself permission to not be perfect: "Perfect" diabetes control doesn't exist

Emerging Technologies

Next-generation devices coming soon:

• Fully automated systems: "Smart" pumps that adjust to meals without carb counting
• Implantable CGMs: Sensors lasting 6-12 months (Eversense already approved for 6 months)
• Dual-hormone systems: Pumps delivering both insulin and glucagon for tighter control
• Non-invasive glucose monitoring: Research into measuring glucose through skin, light, or other methods (still experimental)
• Smaller, smarter devices: Miniaturized pumps, CGMs integrated into clothing/jewelry

Beta Cell Replacement

Approaches to replace destroyed beta cells:

• Islet transplantation: Transplanting insulin-producing cells from donors
  Challenge: Requires immunosuppression; limited donor supply
• Stem cell-derived beta cells: Creating beta cells from stem cells in the lab
  Progress: Multiple trials showing insulin production; working on eliminating immunosuppression need
• Encapsulation devices: Protecting transplanted cells from immune attack without immunosuppression
  Status: Several approaches in clinical trials (ViaCyte, Vertex)
• Gene therapy: Reprogramming other cells to produce insulin
  Status: Early research phase

Immune Interventions

Stopping the autoimmune attack:

• Teplizumab (Tzield): FDA-approved 2022 to delay T1D onset in at-risk individuals
  Delays diagnosis by average 3 years in Stage 2 T1D
• Prevention trials: Studying ways to prevent T1D in high-risk individuals before beta cells are destroyed
• Honeymoon preservation: Therapies to protect remaining beta cells at diagnosis
• Immune reset: CAR-T therapy and other approaches to "retrain" the immune system
  Status: Promising early results; ongoing trials

How Clinical Trials Work

Why participate:

• Access to cutting-edge treatments before they're available publicly
• Close monitoring and care from research teams
• Advance science and help future generations
• Often includes free study devices/medications and compensation

Trial phases:

• Phase 1: Safety testing in small group (10-30 people)
• Phase 2: Efficacy testing in larger group (100-300 people)
• Phase 3: Large-scale confirmation (1,000+ people); compared to standard treatment
• Phase 4: Post-approval monitoring

Things to know:

• You can withdraw at any time for any reason
• Informed consent explains all risks and benefits
• Some trials use placebo/control groups
• Travel may be required for study visits

Notable Recent Breakthroughs

• 2022: Teplizumab (Tzield) becomes first drug approved to delay T1D onset
• 2023: Vertex Pharmaceuticals reports patient insulin-independent for over a year after stem cell transplant
• 2024: Multiple automated insulin delivery systems achieve 80%+ time-in-range in real-world use
• Ongoing: CAR-T therapy showing promise in "resetting" immune system
• Ongoing: Encapsulation devices allowing transplanted cells to survive without immunosuppression