Type 1 diabetes

Type 1 diabetes | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Diabetes Type 1 diabetes Type 1 diabetes About type 1 diabetes Symptoms of type 1 diabetes Causes of type 1 diabetes Diagnosing type 1 diabetes Treating type 1 diabetes Complications of type 1 diabetes Living with type 1 diabetes About type 1 diabetes Diabetes is a lifelong condition that causes a persons blood glucose (sugar) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood. There are two main types of diabetes: Type 1  where the pancreas doesnt produce any insulin Type 2  where the pancreas doesnt produce enough insulin or the bodys cells dont react to insulin This topic is about type 1 diabetes. Read more about type 2 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear following birth. Its very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated. You should therefore visit your GP if you have symptoms, which include feeling thirsty, passing urine more often than usual and losing weight unexpectedly (see the list below for more diabetes symptoms). Type 1 diabetes Type 1 diabetes can develop at any age, but usually appears before the age of 40, particularly in childhood. Around 10% of all diabetes is type 1. In type 1 diabetes, the pancreas (a small gland behind the stomach) progressively reduces the amount of insulin (the hormone that regulates blood glucose levels) it produces until it stops producing any at all. If the amount of glucose in the blood is too high, it can, over time, seriously damage the bodys organs. Diabetes symptoms The symptoms of diabetes occur because the lack of insulin means that glucose is high but isnt used by your muscles as fuel for energy. When blood glucose is high, glucose is lost in your urine and you may become dehydrated. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired all the time weight loss and loss of muscle bulk persistent infections such as thrush The symptoms of type 1 diabetes usually develop very quickly in young people (over a few hours or days). In adults, the symptoms often take longer to develop (a few days or weeks). Read more about the symptoms of type 1 diabetes Causes of type 1 diabetes Type 1 diabetes is an autoimmune condition, where the immune system (the bodys natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them. Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis. This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated . This results in the body being unable to produce insulin, which is required to move glucose out of the blood and into your cells to be used for energy. This is called Type 1 diabetes. Read more about the causes of type 1 diabetes Treating type 1 diabetes Its important that diabetes is diagnosed as early as possible.If left untreated, type-1 diabetes is a life-threatening condition. Its essential that treatment is started early. Diabetes cant be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life. If youre diagnosed with diabetes, youll be referred to a diabetes care team for specialist treatment and monitoring. As your body cant produce insulin, youll need regular insulin injections to keep your glucose levels normal. Youll be taught how to do this and how to match the insulin you inject to the food (carbohydrate) you eat, taking into account your blood glucose level and how much exercise you do. Insulin injections come in several different forms, with each working slightly differently. Youll most likely need a combination of different insulin preparations. Insulin is given to some patients by a continuous infusion of fast (rapid)acting insulin (pump therapy). This is where a small device constantly pumps insulin (at a rate you control) into your bloodstream through a plastic tube (cannula) thats inserted under the skin with a needle. There are alternatives to insulin injections and pumps, but theyre only suitable for a small number of patients. They are: islet cell transplantation  where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes a complete pancreas transplant  this is still relatively rare and only a few centres of excellence offer this. Read more about diagnosing diabetes and treating type 1 diabetes Complications If diabetes is left untreated, it can cause a number of different health problems. Large amounts of glucose can damage blood vessels, nerves and organs. Having a consistentlyraised glucose level that doesnt cause any symptoms can have damaging effects in the long term. There is also complications that can arise if your insulin is not balanced with your food intake and exercise. Your diabetes team will work with you to manage your insulin correctly. Read more about the complications of type 1 diabetes Living with diabetes If you have type 1 diabetes, youll need to look after your health very carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications. For example, eating a healthy, balanced diet and exercising regularly will lower your blood glucose level. Stopping smoking (if you smoke) will also reduce your risk of developing cardiovascular disease . Your healthcare team will discuss this with you, and you can see your own results through My Diabetes My Way . Its important that you learn the skills to self manage your diabetes and there are people to help and support you to do this. If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if its not treated. Everyone with diabetes aged 12 or over should be invited to have their eyes screenedonce a year. Read more about living with type 1 diabetes Symptoms of type 1 diabetes The symptoms of type 1 diabetes should disappear when you start taking insulin and you get the condition under control. The main symptoms of diabetesare: feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itchiness around the genital area, or regular bouts of thrush(a yeast infection) blurred vision caused by the lens of your eye changing shape Vomiting or heavy, deep breathing can also occur at a later stage. This is a dangerous sign and requires immediate admission to hospital for treatment. When to seek urgent medical attention You should seek urgent medical attention if you have diabetes and develop: a loss of appetite nausea or vomiting a high temperature stomach pain fruity smelling breath  which may smell like pear drops or nail varnish (some people can smell this themselves) Hypoglycaemia (low blood glucose) If you have diabetes, your blood glucose levels can become very low. This is known as hypoglycaemia (or a hypo). In most cases, hypoglycaemia occurs as a result of taking too much insulin, although it can also develop if you skip a meal, exercise very vigorously or drink alcoholon an empty stomach. Symptoms of a hypo include: feeling shaky and irritable sweating tingling lips feeling weak feeling confused hunger nausea (feeling sick) A hypo can be brought under control simply by eating or drinking something sugary. If it isnt brought under control, a hypo can cause confusion, slurred speech and, eventually, unconsciousness. In this case, an emergency injection of a hormone called glucagon will be needed. Glucagon increases the glucose in your blood.Your diabetes team will advise you in more detail about avoiding, recognising and treating a hypo. Hyperglycaemia (high blood glucose) As diabetes occurs as a result of your body being unable to produce any, or enough, insulin to regulate your blood glucose, your blood glucose levels may become very high. This happens because theres insufficient insulin to move glucose out of your bloodstream and into your cells to produce energy. If your blood glucose levels become too high, you may experience hyperglycaemia. The symptoms of hyperglycaemia are similar to the main symptoms of diabetes, but they may come on suddenly and be more severe. They include: extreme thirst a dry mouth blurred vision drowsiness a need to pass urine frequently Left untreated or if you already have an infection, hyperglycaemia can lead to diabetic ketoacidosis. This is a life-threateningcondition, where the body breaks down fat and muscle as an alternative source of energy. This leads to a build-up of acids in your blood, which can cause vomiting, dehydration, unconsciousness and even death. Your healthcare team will teach you about looking out for these symptoms and how to manage your Sick Day rules . The Diabetes UK website has more information about type 1diabetes symptoms . Causes of type 1 diabetes Type 1 diabetes occurs when the body is unable to produce insulin. Insulin is a hormone thats needed to control the amount of glucose (sugar) in your blood. When you eat, your digestive system breaks down food and passes its nutrients  including glucose  into your bloodstream. The pancreas (a small gland behind your stomach) usually produces insulin, which transfers any glucose out of your blood and into your cells, where its converted to energy. However, if you have type 1 diabetes, your pancreas is unable to produce any insulin (see below). This means that glucose cant be moved out of your bloodstream and into your cells. Autoimmune condition Type 1 diabetes is an autoimmune condition. Your immune system (the bodys natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them, destroying them completely or damaging them enough to stop them producing insulin. Its not known exactly what triggers the immune system to do this, but some researchers have suggested that it may be due to a viral infection. Type 1 diabetes is often inherited (runs in families), so the autoimmune reaction may also be genetic. If you have a close relative  such as a parent, brother or sister  with type 1 diabetes, you have about a 6% chance of also developing the condition. The risk for people who dont have a close relative with type 1 diabetes is just under 0.5%. Readabout diagnosing type 1 diabetes Diagnosing type 1 diabetes If you experience the symptoms of diabetes , you should visit your GP as soon as possible. Theyll ask about your symptoms and may request a urine and blood test. Urine and blood tests Your urine sample will be tested to see whether it contains glucose. Urine doesnt usually contain glucose, but if you have diabetes, some glucose can overflow through the kidneys and into the urine. Your urine may also be tested for ketones (chemicals) that indicate type 1 diabetes. The GP may do a finger prick blood test for glucose and ketones. A sample will be sent to the laboratory to confirm the diagnosis. These results will be discussed with the specialist diabetes service if there is concern you have Type 1 Diabetes. Glycated haemoglobin (HbA1c) The glycated haemoglobin (HbA1c) test is another blood test that can be used to diagnose diabetes.nd to monitor our long-term diabetes control. In people whove already been diagnosed with diabetes, the HbA1c test is often used to show how well their diabetes is being controlled. The HbA1c test gives your average blood glucose level over the previous two to three months. The results can indicate whether the measures youre taking to control your diabetes are working. If youve been diagnosed with diabetes, its recommended that you have your HbA1c measured at least twice a year. However, you may need to have your HbA1c measured more frequently if: youve recently been diagnosed with diabetes your blood glucose remains too high your treatment plan has been changed youre planning a pregnancy Unlike other tests, the HbA1c test can be carried out at any time of day and doesnt require any special preparation, such as fasting. However, its less reliable in certain situations, such as during pregnancy. The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes. Read about treating type 1 diabetes Treating type 1 diabetes Monitoring blood glucose An important part of your treatment is to make sure that your blood glucose level is as normal and stable as possible. Youll be able to manage this using insulin treatment and by eating a healthy, balanced diet , but you will also have to regularly check your blood glucose levels to make sure theyre not too high or too low. Exercise, illness, stress, drinking alcohol, taking other medicines and, for women, changes to your hormone levels during your monthly period can all affect your blood glucose levels. In most cases, youll need to check your blood glucose levels during the day, both at home and at work or school, using a simple finger prick blood test. You may need to do this up to four or more times a day, depending on the type of insulin treatment youre taking. There are different methods of checking your blood glucose that doesnt involve pricking your finger. Discuss your options with your diabetes care team. The normal blood glucose level is 4-7 mmol/l before meals and less than 8.5 mmol/l two hours after meals. Mmol/l means millimoles per litre, and its a way of defining the concentration of glucose in your blood. There is another method to check glucose levels without pricking your finger. This is called a flash glucose monitor (Freestyle Libre). The Diabetes UK website has more information on testing your glucose levels . Having your blood glucose levels checked Youll be measuring your blood glucose yourself every day, to check your levels. Your GP or diabetes care team will also carry out a different blood test every two to six months, called the HbA1c test. This gives a clearer idea of how well your treatment plan is working, by measuring how stable your glucose levels have been over the past 6-12 weeks. It measures the amount of haemoglobin, which is the oxygen-carrying substance in red blood cells that has glucose attached to it. A high HbA1c level may indicate that your blood glucose level is consistently high and that your diabetes treatment plan needs to be altered. The ideal HbA1c target for people with diabetes is below 53 mmol/mol. Treating hypoglycaemia (low blood glucose) Hypoglycaemia can occur when your blood glucose level becomes very low. Its likely that youll develop hypoglycaemia from time to time. Mild hypoglycaemia (or a hypo) can make you feel shaky, weak and hungry, and can be controlled by eating or drinking something sugary, such as: 200ml pure fruit juice 5 to 7 Dextrose tablets 4 to 5 Glucotabs 60ml Glucojuice 5 jelly babies You may also be able to take pure glucose, in the form of a tablet or fluid, if you need to control the symptoms of a hypo quickly. If you develop severe hypoglycaemia, you can become drowsy and confused, and you may even lose consciousness. If this occurs, youll need assistance from another person who may be able to give you a glucose gel rubbed into your cheeks or an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels. Your diabetes care team may show several of your family members and close friends how to inject glucagon or give you glucose gel, should you need it. Once you begin to come round, youll need to eat something sugary when youre alert enough to do so. If you lose consciousness as a result of hypoglycaemia, theres a risk that it could happen again within a few hours. Youll need to rest afterwards and have someone with you to ensure that you eat some food to replace the glucose stores in your body. If the glucagon injection into your muscle doesnt work, and youre still drowsy or unconscious 10 minutes after the injection, youll need urgent medical attention. Youll need to have an injection of dextrose straight into a vein, which must be given by a trained healthcare professional. If you have type 1 diabetes, its recommended that you carry identification with you so that people are aware of the problem if you become hypoglycaemic. If significant hypoglycaemia is a regular problem or you have lost your awareness of hypoglycaemia your health care team may consider using a continuous glucose monitor (CGM) . Islet cell transplantation Some people with type 1 diabetes may benefit from a fairly new procedure known as islet cell transplantation. It involves implanting healthy islet cells from the pancreas of a deceased donor into the pancreas of someone with type 1 diabetes. In 2008, a government-funded islet cell transplant programme was introduced, and the procedure is now available through the NHS for people who satisfy certain criteria (see below). You may be suitable for an islet cell transplant if youve had: two or more severe hypos within the last two years and you have a poor awareness of hypoglycaemia a working kidney transplant, severe hypos and poor hypoglycaemia awareness, or poor blood glucose control even after receiving the best medical treatment You may not be suitable for an islet cell transplant if you: weigh over 85kg (13st 5.4lb) have poor kidney function need a lot of insulin  for example, over 50 units a day for a 70kg (11st) person An islet cell transplant is a minor, low-risk procedure thats carried out under local anaesthetic. The procedure has been shown to be effective at reducing the risk of severe hypos. So far, the results of islet cell transplants carried out in the UK have shown a significant reduction in the number of hypos, from 23 per person per year before transplantation to less than one per person per year afterwards. Pancreas transplant People with type 1 diabetes who are having a kidney transplant from a donor may also be offered a pancreas transplant at the same time. Others may be offered a pancreas transplant after theyve had a kidney transplant because theyre already on anti-rejection tablets. If youre having repeated, severe and life-threatening hypoglycaemic attacks, a pancreas transplant may also be recommended. During the procedure, your faulty pancreas will be replaced with a healthy pancreas from a donor. This will allow you to get a new source of insulin. Pancreas transplants are complicated operations and, like other types of major surgery, theres a risk of complications. In the UK, about 200 pancreas transplants are carried out each year, with more than 300 people on the waiting list. The waiting time for a pancreas transplant is one to two years, because theres a shortage of suitable donor organs. Treating high blood glucose (hyperglycaemia) Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin. If you develop hyperglycaemia, you may need to adjust your diet or your insulin dose to keep your glucose levels normal. Your diabetes care team can advise you about the best way to do this. If hyperglycaemia isnt treated, it can lead to a condition called diabetic ketoacidosis, where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood. Diabetic ketoacidosis is very serious and, if not addressed quickly, it can lead to unconsciousness and, eventually, death. The signs of diabetic ketoacidosis include: frequently passing urine thirst tiredness and lethargy (lack of energy) blurry vision abdominal (stomach) pain nausea and vomiting deep breathing smell of ketones on breath (described as smelling like pear drops) collapse and unconsciousness Read more about the symptoms of diabetic ketoacidosis Your healthcare team will educate you on how to decrease your risk of ketoacidosis by testing your own blood for ketones using blood ketone sticks if youre unwell. If you develop diabetic ketoacidosis, youll need urgent hospital treatment. Youll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if youre dehydrated, including salt solution and potassium. Other treatments Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease , stroke , eyeand kidney disease . To reduce the chance of this, you may be advised to take: anti-hypertensive medicines to control high blood pressure a statin  such as simvastatin  to reduce high cholesterol levels low-dose aspirin to prevent stroke angiotensin-converting enzyme (ACE) inhibitor  such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. Its often reversible if treated early enough. Care standards for diabetes The aim of treating diabetes is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications. In Scotland there is a National Diabetes Improvement Plan produced by the Scottish Diabetes Group, patients and health care professionals. The Diabetes National Service Framework has also been developed by diabetes clinical experts and patients with diabetes. Good diabetes care includes: access to information and appropriate support for people with type 1 diabetes, including access to a structured education programme an agreed care plan, helping all people with diabetes to manage their care and lead a healthy lifestyle  including a named contact for their care information, care and support to enable all people with diabetes to control their blood glucose, maintain an acceptable blood pressure and minimise other risk factors for developing complications access to services to identify and treat possible complications  such as screening for diabetic retinopathy (where high blood glucose levels damage the retina at the back of the eye) and specialised foot care effective care for all people with diabetes admitted to hospital, for whatever reason Complications of type 1 diabetes If diabetes isnt treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs. A consistently raised glucose level that doesnt cause any symptoms can have damaging effects in the long term. Heart disease and stroke If you have diabetes, youre up to five times more likely to develop heart disease or have a stroke . Prolonged, poorly controlled blood glucose levels increase the likelihood of developing atherosclerosis (furring and narrowing of your blood vessels). This may result in a poor blood supply to your heart or to your lower limbs, causing angina (a dull, heavy or tight pain in the chest) or claudication (pain in the back of your calves when walking). It also increases the chance that a blood vessel in your heart or brain will become completely blocked, leading to a heart attack or stroke. Nerve damage High blood glucose levels can damage the tiny blood vessels of your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation . Retinopathy Retinopathyis where the retina (the light-sensitive layer of tissue) at the back of the eye is damaged. Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents the light from fully passing through to your retina. If it isnt treated, it can damage your vision. The better you control your blood glucose levels, the lower your risk of developing serious eye problems. Having an annual eye check with a specialist (an ophthalmologist or optometrist) can help pick up signs of a potentially serious eye problem early so that it can be treated. Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk. If the condition hasnt reached this stage, the advice on managing your diabetes, BP and cholesterol level is recommended. The main treatments for more advanced diabetic retinopathy are: laser treatment injections of medication into your eyes an operation to remove blood or scar tissue from your eyes Read about diabetic eye screening Kidney disease If the small blood vessels in your kidney become blocked and leaky, your kidneys will work less efficiently. In rare, severe cases, this can lead to kidney failureand the need for dialysis (treatment to replicate the functions of the kidneys). In some cases, a kidney transplant may be necessary. Foot problems Damage to the nerves of the foot can mean that small nicks and cuts arent noticed, which can lead to a foot ulcer developing. About 1 in 10 people with diabetes get a foot ulcer, which can cause serious infection. If you develop nerve damage, you should check your feet every day and report any changes to your doctor, nurse or podiatrist. Look out for sores and cuts that dont heal, puffiness or swelling, and skin that feels hot to the touch. You should also have a foot examination at least once a year. Sexual dysfunction In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication. Women with diabetes may experience: a reduced sex drive (loss of libido) reduced pleasure from sex vaginal dryness a reduced ability to orgasm pain during sex If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel. Miscarriage and stillbirth Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood glucose level isnt carefully controlled immediately before and during early pregnancy, theres also an increased risk of the baby developing a serious birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetes clinic. This allows doctors to keep a close eye on their blood glucose levels and control their insulin dosage more easily. Read more about diabetes and pregnancy: Diabetes UK My Diabetes My Way Living with type 1 diabetes Look after your feet Having diabetes means that youre more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is because blood glucose can damage the nerves in your feet. To prevent problems with your feet, keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly and see a podiatrist or chiropodist (a foot care specialist) regularly so that any problems are detected early. Regularly check your feet for cuts, blistersor grazes because you may not be able to feel them if the nerves in your feet are damaged. See your GP if you have a minor foot injury that doesnt start to heal within a few days. The Diabetes UK website has more information and advice about taking care of your feet . Regular eye tests If you have type 1 diabetes, you should be invited to have your your eyes screened at once a year to check for diabetic retinopathy. Retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long time (hyperglycaemia). If it isnt treated, retinopathy can eventually cause sight loss. Read more about diabetic eye screening Diabetes sick day rules If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when youre ill  known as your sick day rules. Contact your diabetes care team or GP for advice if you havent received these. The advice youre given will be specific to you, but some general measures that your sick day rules may include could be to: keep taking your insulin  its very important not to stop treatment when youre ill; your treatment plan may state whether you need to temporarily increase your dose test your blood glucose level more often than usual  most people are advised to check the level at least four times a day keep yourself well hydrated  make sure you drink plenty of sugar-free drinks keep eating  eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier check your ketone levels if your blood glucose level is high Seek advice from your diabetes care team or GP if your blood glucose or ketone level remains high after taking insulin, if: youre not sure whether to make any changes to your treatment you develop symptoms of diabetic ketoacidosis you have any other concerns Pregnancy If you have diabetes and youre thinking about having a baby, its a good idea to discuss this with your diabetes care team. A planned pregnancy enables you to make sure your blood glucose levels are as well controlled as possible before you get pregnant.Most women with diabetes have a healthy baby. Youll need to keep your blood glucose under tight control, particularly before becoming pregnant and during the first eight weeks of pregnancy, to reduce the risk of the baby developing serious birth defects. You should also take a higher dose of folic acidtablets. Folic acid helps prevent your baby developing spinal cord problems. Doctors now recommend that all women planning to have a baby take folic acid. Women with diabetes are advised to take 5mg a day until theyre 12 weeks pregnant (only available on prescription). Folic acid should be taken alongside pregnancy multivitamins that include vitamin D . Insulin and metformin are safe to take during pregnancy. Its important to review any other medications you take to ensure these are safe to take during pregnancy. You should also have your eyes checked. Retinopathy (see above) affects the blood vessels in the eyes and is a risk for all people with diabetes. Pregnancy can place extra pressure on the small vessels in your eyes, so its important to treat retinopathy before you become pregnant. Your GP or diabetes care team can give you further advice. Diabetes UK and JDRF also provide more useful information about pregnancy and diabetes to help you get your pregnancy off to a healthy start. Education Youll be best equipped to manage your diabetes if youre given information and education when youre diagnosed, and then on an ongoing basis. The National Institute for Health and Care Excellence (NICE) strongly recommends that all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves. This gives people the best chance of developing the skills they need to effectively treat their condition, maintain their glucose levels at a normal level and help prevent long-term complications. It also reduces the risk of developing hypoglycaemia (low blood glucose levels). Structured patient education Structured patient education means theres a planned course that: covers all aspects of diabetes is flexible in content is relevant to a persons clinical and psychological needs is adaptable to a persons educational and cultural background There are also several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide. Diabetes and your child For a parent whose child is diagnosed with a life-long condition, the job of parenting becomes even tougher. Although being diagnosed with type 1 diabetes will involve coming to terms with the diagnosis, getting used to treatment and makingchanges toeveryday life, your child can still lead a normal and healthy life. The Diabetes UK website has information and advice about your child and diabetes . Help and support Many people find it helpful to talk to others in a similar position, and you may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others whove been