Diabetes Mellitus Type 1: Therapy

General measures

Aim for normal weight!Determine BMI (body mass index, body mass index) or body composition using electrical impedance analysis and participate in a medically supervised weight loss program.
Nicotine restriction (abstaining from tobacco use) – smokers showed significantly worse glycemic control than nonsmokers (HbA1c 8.5% vs. 7.9%); lipid profile also worse than nonsmokers (triglycerides: 1.62 vs. 1.35 mmol/l; LDL cholesterol: 2.78 vs. 2.67 mmol/l)
Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can lead to hypoglycemia (low blood sugar).
Regular examinations of the feet and footwear (foot care).
Review of permanent medication due topossible effect on the existing disease or secondary diseases:
- No use of nonsteroidal anti-inflammatory drugs (drugs that suppress inflammation and are not glucocorticoids (steroid hormones)): Nonsteroidal anti-inflammatory drugs should not be used regularly in patients with hypertension or chronic kidney disease (CKD; chronic renal failure) of any etiology, including diabetes mellitus.
Avoidance of psychosocial conflict situations:
- Bullying
- Mental conflicts
- Stress
Avoidance of environmental stress:
- Nitrosamines (carcinogenic substances).
Regular physical activity (↑ glucose uptake into the muscles).
Before starting a trip participation in a travel medical consultation.
On the subject of “diabetes and road traffic” see below the guideline of the same name.

The following vaccinations are advised, as infection can often lead to worsening of the present disease:

Pneumococcal vaccination
- The 13-valent polysaccharide vaccine (PCV13) covers fewer serotypes than the 23-valent polysaccharide vaccine (PPSV23), but has a better protective effect in immunosuppression
- PPSV23 should be given no earlier than 2 months after PCV13; an interval of 6-12 months appears to be more immunologically favorable.
Influenza vaccination
Herpes zoster vaccination

Recommended interval of follow-up examinations depending on the stage of retinopathy.

	Stage I	Stage II	Stage III	Stage IV
Screening	4 years	3 years	6 months	3 months

5 Retinopathy grades: none, mild, moderate, and severe non-proliferative, and proliferative or macular edema.

Nowadays, the diet for a person with diabetes is not as strict as it was a few years ago. Foods containing sugar may also be eaten.

Nutritional counseling based on a nutritional analysis.
Observance of the following nutritional medical recommendations:
- Meals of diabetics should contain 10-20% protein (protein), <30% fats and 45-60% carbohydrates.
- Avoidance or reduction of monosaccharides (single sugars) and disaccharides (double sugars).
- Diet rich in fruits and vegetables and marine fish (due toOmega-3 fatty acids).
Note: Although intensified insulin therapy allows patients with type 1 diabetes great dietary freedom, an extremely low-carbohydrate diet (very-low-carb diet) with an average of only 36 grams of carbohydrate per day (≅ 5% carbohydrate) is associated with a much better HbA1c (long-term blood glucose) of 5.67% on average compared with people with type 1 diabetes and a “normal” diet, who usually achieve an HbA1c of only 8.2%. It would be desirable if these results were verified by a clinical trial.
See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Endurance training (cardio training; ↑ glucose uptake into muscles) and strength training (muscle training).
Exercise lowers blood glucose levels and improves insulin sensitivity. However, diabetics may experience blood glucose fluctuations during and after exercise, so blood glucose monitoring before and after exercise is important.
Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
Detailed information on sports medicine you will receive from us.

Stress management, if necessary
Detailed information on psychosomatics (including stress management) can be obtained from us.

In a diabetic training, the affected persons are primarily shown the correct use of insulin, the importance of blood glucose self-monitoring, hypoglycemia awareness (hypoglycemia) and adapted diet. Furthermore, in such groups, a mutual exchange of experience can take place.