Type 1 Diabetes Management - Warfighter Wellness

T1D Management

Type 1 diabetes is far more than dosing insulin for the food you eat. The goal is to keep blood glucose between 70-180mg/dL, which requires continuous checking either through finger sticks (e.g., glucometer) or digitally with a continuous glucose monitor (CGM). It’s recommended to stay within this range at least 70% of the time, though each individual may have a different ‘optimal’ daily goal. Individuals with T1D receive their insulin either from manual daily injections (MDI/shots) or insulin pump. No matter the delivery method or glucose check, T1D requires constant attention.

Insulin

T1D requires continuous insulin delivery since your body no longer produces the hormone.

Basal insulin is the baseline insulin your body needs to keep it functioning at a basic level. On MDI, this is often taken in one long-acting dose per day. On insulin pumps, basal insulin is automatically delivered continuously all day based on either your input settings or an automated algorithm.

Bolus insulin (or short-acting) is all other insulin delivery. Bolusing covers food intake, certain types of activity and hormone fluctuations such as stress and menstrual cycles.

Insulin sensitivity means you need less insulin to reach your desired outcome. Many factors impact sensitivity including weight, hormone fluctuations, time of day, activity, stress, illness and certain medications.

Insulin resistance means you need more insulin to reach your desired outcome. All the factors impacting insulin sensitivity also impact insulin resistance.

Nutrition

There are no ‘good’ or ‘bad’ foods for people with T1D, but there are foods that are more challenging to dose for. Talk to your care team about dosing strategies for carbohydrates, protein and fat. Experiences spikes after meals does not mean you need to avoid or restrict food—it means the current strategy isn’t effective and a different approach would be better. Dose amount and timing are important for dosing.

Quick Fuel

Carbohydrates are the fastest fuel source and usually impact blood glucose levels for 1-3 hours.

Delayed fuel

Protein takes longer to break down and a portion of it converts to glucose, so you may notice blood glucose spikes a couple hours after eating as glucose enters your blood stream. Protein is an essential fuel source for people living with T1D, especially around exercise.

Sustained Fuel

Higher fat foods often lead to “sticky” highs that take hours to bring back down into range. Fat slows down carb absorption and increases insulin resistance around 2+ hours after eating. Consuming healthy fats may also help sustain blood glucose in a healthy range when dosed for properly.

Activity

Not every activity has the same impact on blood glucose. Aerobic (i.e., cardio) can lead to low glucose without proper fueling, whereas anaerobic (e.g., strength training, HIIT) can lead to blood glucose spikes. When you place a high demand on your muscles in a short period of time, it can lead to a release of glucose from the liver.

Factors to Consider When Preparing for Activity

Active insulin on board (IOB)/insulin in your system
Type of activity
Length and intensity of activity
Time of day
Environment (e.g., heat, cold, elevation)
Fuel strategy before, during and after activity

Consistent activity, such as a weekly routine that incorporates daily movement, increases insulin sensitivity. Research has found that strength training can drop hemoglobin A1c by 0.5-1%. A routine with both strength training and cardio shows even further A1c reduction.

Hormones

Hormone regulation occurs during sleep. Since insulin is a hormone, sleep is an essential part of its effectiveness. Other hormones also play a role on blood glucose. Cortisol (e.g., the “stress hormone”) is highest in the morning and increases insulin resistance. As cortisol decreases throughout the day, you may notice more insulin sensitivity in the afternoon and evening. Just as there is a daily hormonal shift, there is a monthly hormonal shift for those with a menstrual cycle. You may notice more insulin sensitivity at the beginning of your cycle and more resistance towards the end of your cycle. High stress moments, such as travel, public speaking, illness and trying something new also increase glucose levels.

T1D and the Military

Though living with T1D is an automatic disqualification for joining military service, it is not an automatic medical separation if diagnosis occurs during service. With technological advancements and increased education, some Warfighters are able to continue their military service on a case-by-case basis. To stay active duty, Warfighters are referred to a Medical Evaluation Board (MEB), must pass their branch’s physical requirements and successfully complete other unit-related activities. Warfighters that are retained may not be fit for deployment, though a T1D diagnosis does not automatically make someone non-deployable.

Type 1 diabetes is a condition with a lot of aspects to consider for healthy management. Its constant demand leads to 180+ decisions per day, increased stressors, risk of burnout and decision fatigue. It’s not just managing blood glucose and dosing insulin – it also takes a lot of mental and emotional effort. Though it’s a demanding condition, people with T1D live full lives with the right tools and support. If you or someone you love lives with T1D, ask your care team and search for ways to connect with others for additional support!