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Feature Article

Type 1 diabetes – myths and misunderstandings about glycaemic management

Pat Phillips, Jessica Phillips

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Abstract

The myths about type 1 diabetes that have been passed down the generations may have been useful simplifications or shortcuts in the past but are misleading now, and may lead to inappropriate management. This article discusses some of the myths about glycaemic management.

Key Points

  • People with type 1 diabetes can use basal–bolus, fixed premixed or self-mixed insulin schedules for glycaemic control.
  • Insulin pumps are currently the best way to inject insulin.
  • Analogue insulins are usually better than traditional insulins but traditional basal insulins can give more flexible day/night glycaemic control and traditional bolus insulins better interprandial control.
  • Insulin is not the only effective hypoglycaemic medication for type 1 diabetes. Metformin and acarbose are of use for certain situations (off-label).
  • In type 1 diabetes, the most important blood glucose value to monitor and control is the fasting value.
  • The factor most predictive of severe hypoglycaemia in type 1 diabetes is a recent history of an episode.
  • On sick days, a person with type 1 diabetes should continue with his or her usual insulin schedule, monitor BGL frequently and take extra bolus insulin if BGL exceeds 15 mmol/L. Basal insulin should not be stopped.

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