Is it risky if my cousin with T1D skips insulin shots?

Question

Hello doctor,

My 16-year-old cousin was recently diagnosed with type 1 diabetes. He is always feeling tired despite eating, and his mother is concerned that his blood sugar levels are not being properly managed. He does not like taking insulin injections daily and sometimes skips them. Could this be dangerous for him? We are also unsure how to balance his diet to manage his condition. We are worried since it is a chronic issue. Can type 1 diabetes lead to heart or eye problems later on? He gets very upset when we insist he take insulin. Are there any other options? Please help.

Thank you in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

In type 1 diabetes, the pancreas (an organ near your stomach) either does not make insulin or makes very little insulin. Insulin is a hormone that helps move blood sugar (glucose) from the blood into cells, where it is used for energy. Without insulin, blood sugar cannot enter the cells and builds up in the blood, which can damage the body.

Type 1 diabetes is also known as insulin-dependent diabetes or juvenile diabetes because it often develops in children or young adults, but it can occur at any age. It is less common than type 2 diabetes, affecting about five to 10 percent of people with diabetes. While there is no known way to prevent it, it can be managed successfully.

Symptoms of type 1 diabetes:

Excessive urination: Needing to urinate a lot.
Excessive thirst: Feeling very thirsty all the time.
Excessive eating: Constant hunger.

Complications of Type 1 Diabetes: If diabetes is not managed properly, it can lead to other health problems, such as:
1. Diabetic ketoacidosis: A serious condition where the body produces high levels of blood acids called ketones, which can be dangerous.
2. Diabetic retinopathy: Damage to the eyes due to high blood sugar.
3. Diabetic nephropathy: Kidney damage caused by high blood sugar.
4. Diabetic neuropathy: Nerve damage caused by high blood sugar.
5. Heart disease: Increased risk of heart-related problems.
6. Infections: Higher risk of infections.
7. Anxiety: Stress and worry related to the condition.
8. Skin conditions: Skin problems that can arise from high blood sugar.
9. Low blood sugar (hypoglycemia): A dangerous drop in blood sugar levels.
  
  How to manage type 1 diabetes:
  
  You should work with a multidisciplinary team, including:
  1. An endocrinologist: A doctor who specializes in diabetes and hormones.
  2. A dietitian: A nutrition expert who can help with food planning.
    
    Blood sugar levels: Your HbA1c (glycated hemoglobin) is a test that shows the average blood sugar levels over the past two to three months. The goal is to keep it at 6.4 percent (48 mmol/mol) or lower. If it is higher than 10 percent (86 mmol/mol), it means the blood sugar is not well controlled.
    
    You should check your blood sugar levels several times a day:
    1. Fasting blood sugar: Measure blood sugar before eating breakfast.
    2. Post-breakfast: Measure blood sugar one hour after breakfast.
    3. Pre-dinner: Measure blood sugar before dinner.
    4. Post-dinner: Measure blood sugar one to two hours after dinner.
    5. Bedtime: Measure before going to bed.
      
      Here are the target levels to aim for:
      1. Fasting blood sugar: 5.6 mmol/L (95 mg/dL).
      2. 1 hour after a meal: 7.8 mmol/L (140 mg/dL or less).
      3. 2 hours after a meal: 6.4 mmol/L (115 mg/dL or less).
        
        Adjust your insulin dose based on these levels, and work with a dietitian to make sure you are eating the right foods. It is also important to consult a nephrologist (kidney doctor) and ophthalmologist (eye doctor) for check-ups. A fundoscopy is an eye test to check for any damage caused by diabetes, may also be required.
        
        I hope this helps.
        
        Kindly revert so I can assist you further.
        
        Thank you.