Outpatient Management of Type 1 Diabetes
Managing type 1 diabetes isn’t just about what happens in the hospital. Outpatient care is super important too! This is all the care and management that happens outside of the hospital, usually at home and during visits to your diabetes care team.
Regular Follow-Up Visits
After the initial education and diagnosis, people with diabetes should have regular follow-up visits every three months. These visits are important to make sure everything is on track.
- Insulin Adjustments: As children grow, they need more insulin. The doses might be adjusted during these visits. For example, the insulin dose usually increases about one-half unit for each pound of weight gained.
- Physical Exams: During the visit, the doctor will check thyroid size, eye changes, growth, and other signs of sugar control. If blood/CGM glucose values have been high, sugar can collect on the joint proteins, which might change how fingers look.
- HbA1c Testing: The HbA1c level, which shows the average blood sugar level over the past three months, should be checked every three months.
Screening for Complications
It’s important to screen for complications that can arise from diabetes.
- Eye and Kidney Exams: Initial screening for the eyes and kidneys should be done for people who have had type 1 diabetes for five or more years, starting at age 10 or at puberty, whichever comes first. The frequency of repeat screenings depends on how well the diabetes is controlled.
- For Type 2 Diabetes: Eye and kidney evaluations should be done at the time of diagnosis and then yearly.
Communication with Healthcare Providers
Staying in touch with your healthcare provider is key!
- Share Blood/CGM Glucose Values: Use fax, email, or cloud services to share glucose values with your healthcare provider. This helps them suggest any needed insulin dose changes.
- Telemedicine Visits: Some areas offer clinic visits via telemedicine. These can be alternated with regular visits so physical exam changes can be checked.
When to Contact Your Diabetes Team
Let your diabetes provider or team know if any of the following happens:
- Severe Low Blood Sugar: Any severe hypoglycemic reactions, especially with loss of consciousness or seizures.
- Frequent Mild Reactions: If you notice frequent mild low blood sugar reactions.
- High Ketones: Moderate or large urine ketones or blood ketones above 1.0 mmol/L.
- Surgery: Any planned surgery.
- Out of Range Glucose Values: If at least half of the blood/CGM glucose values are not in the desired range for age.
Support Groups and Continuing Education
Joining support groups and educational programs can be very helpful!
- Support Groups: There are age-related group clinics, special educational programs, and workshops (like Research Updates, Carb Counting Class, Pump or CGM classes, Grandparents Workshop, College-Bound Workshop, etc.) available in many areas.
- Special Events: Family workshops, bike trips, camps, and parties help children and families learn more about diabetes and connect with others who have similar experiences.
- Recommended Websites:
Standards of Care
The American Diabetes Association (ADA) publishes “Standards of Care” every January in the journal Diabetes Care. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines are published in Pediatric Diabetes. Your diabetes care team should be up to date on these standards, which can be found online.
By following these guidelines and staying connected with your diabetes care team, you can effectively manage diabetes and maintain a healthy and happy life!