Synopsis
Deliver safe lifelong insulin replacement, technology-supported self-management and complication prevention while recognising hypoglycaemia, ketosis and changing insulin needs early.
- Type 1 diabetes is autoimmune beta-cell failure requiring insulin replacement; clinical suspicion and metabolic safety take precedence over awaiting classification tests.
- Offer diabetes-specific autoantibodies near diagnosis; use paired non-fasting C-peptide later when uncertainty persists because its discrimination improves with time from diagnosis.
- A basal-bolus regimen with rapid-acting mealtime insulin and long-acting basal insulin is usual first-line adult therapy, integrated with carbohydrate estimation and dose adjustment.
- Structured education, continuous glucose monitoring and equitable access to pump or hybrid closed-loop technology are therapeutic interventions, not optional accessories.
- Sick-day rules require extra monitoring, hydration, ketone-directed action and continued basal insulin; vomiting or persistent ketones should trigger early clinical contact.
- Hypoglycaemia treatment must be followed by rechecking and prevention review, including insulin timing, exercise, alcohol, renal function and awareness impairment.
- Annual review includes HbA1c, blood pressure, lipids, renal function and albuminuria, retinal screening, foot surveillance and assessment for associated autoimmune disease.
- Driving, work, exercise, travel, contraception and pregnancy planning need individual anticipatory advice based on current UK rules and the person's insulin system.
Investigation priorities
Support autoimmune classification near presentation using the locally available antibody panel.
Management branches
Type 1 diabetes is newly diagnosed or strongly suspected without established DKA.
- Involve the specialist diabetes team promptly, begin an individualised basal-bolus insulin regimen and teach injection, storage and glucose-monitoring safety.
- Provide structured carbohydrate-counting and dose-adjustment education, hypoglycaemia treatment, ketone testing and written sick-day rules from the outset.
- Agree glucose and HbA1c goals, offer suitable CGM, assess psychological and social barriers, and ensure early review while insulin requirements evolve.
Key medicines
Rapid-acting insulin analogueCalculate each subcutaneous mealtime and correction dose from the person's specialist-agreed insulin-to-carbohydrate ratio, glucose target, sensitivity factor, active insulin and planned activity; pump settings require equivalent individualisation.Dose stacking, delayed meals, alcohol and exercise can cause hypoglycaemia. Pump interruption can cause rapid insulin deficiency; ensure backup pens, needles and an emergency dosing plan.
Long-acting basal insulin analogueGive the individually titrated subcutaneous daily or twice-daily regimen at consistent times according to preparation and specialist plan; continue during fasting and illness unless explicitly adjusted by the team.Omission risks DKA, while excess causes fasting or nocturnal hypoglycaemia. Different basal products are not unit-for-unit interchangeable without deliberate clinical review.