How to treat type 1 diabetes: the new ICMR guidelines in 10 points

The Indian Council of Medical Research (ICMR) has released new guidelines on type 1 diabetes. Here are the 10 key points from the research document.

Balanced diet

To manage type 1 diabetes, the ICMR recommends following a nutritious diet. Carbohydrates should make up 50-55% of total calories. Fat should represent up to 30% of the total calories consumed daily. Protein should make up 15-20% of total calorie consumption. Salt intake should be reduced to 2.5g per day for children 1-3 years old, 3g per day for children 4-8 years old, 3.8g per day for children and adolescents 9 years old and over and 6 g per day for adults. Processed foods are high in salt, so they should be eaten in moderation.


Regular physical activity improves general well-being, prevents obesity and reduces cardiovascular risk in patients with type 1 diabetes. Insulin sensitivity increases during and immediately after exercise and then decreases 7 to 11 hours later. Glycemic regulation can be improved by aerobic capacity. During anaerobic activity, however, catecholamine levels increase significantly and the pancreas in patients with type 1 diabetes is unable to stimulate insulin secretion to counter the effects of catecholamines. Typically, children engage in short bursts of intense activity followed by intervals of relaxation. However, additional physical activity may require occasional insulin changes.

Side effects of insulin therapy

Hypoglycemia is the most common side effect of insulin therapy and a major obstacle to maintaining tight blood sugar control. Better glycemic control can lead to weight gain. Injection of insulin into the same site and frequent use of a blunt needle cause lipohypertrophy. The physician and patient should regularly inspect injection sites, especially if there is unexplained variability in blood glucose levels. One of the negative effects is insulin site infection.

Blood glucose monitoring

In people with type 1 diabetes, blood glucose monitoring is an important predictor of glycemic control. In young children, especially those with poorly controlled blood sugar, the frequency of daily self-monitoring of blood glucose (SBGM) can vary from four to six times a day. In young people with improved glycemic control, a more liberal ASBG two to three times a day may be recommended. For some people, even monitoring 1-2 blood sugar levels can be difficult due to financial constraints. Testing could be limited to sick days and hypoglycaemic episodes, with a “basic minimum” of two to four times a day for two to three consecutive days a month.

Diabetic ketoacidosis

Nausea and vomiting, abdominal pain, acidotic breathing with a characteristic fruity odor, and indicators of dehydration appear as diabetic ketoacidosis (DKA) develops. Although commas are rare, the patient is frequently drowsy at the time of presentation. Better access to medical treatment, adequate patient education, and effective communication with a healthcare provider during intercurrent illness can all help prevent DKA.

Vision loss

Diabetic retinopathy is a leading cause of blindness in adults and one of the most common microvascular complications of type 1 diabetes. It is a degenerative disease which, if left untreated, can lead to significant vision loss. Patients with type 1 diabetes are more likely to develop cataracts, glaucoma, retinal vein occlusion, and cranial nerve palsies, among other eye problems. Additionally, cataract surgery can have a long recovery time and is linked to poor visual outcomes in these patients.

kidney disease

Diabetic Nephropathy (DKD) is the leading cause of Chronic Kidney Disease (CKD) in India and across the world. It is characterized by albuminuria, decreased glomerular filtration rate (GFR) and hypertension, as well as a high risk of cardiovascular disease. In recent decades, early diagnosis combined with effective glycemic control and blood pressure management has improved the prognosis of these patients.


In people with type 1 diabetes, neuropathy is a common microvascular consequence. It is linked to a high rate of morbidity and mortality. It is the most important determining factor in the development of foot ulcers and lower limb amputations. There is, however, little information on the frequency of microvascular problems in Indian patients with T1D.

Increased risk of death

Compared to the non-diabetic population, patients with type 1 diabetes have a higher risk of morbidity and mortality from cardiovascular disease. Examples include coronary heart disease, stroke, and peripheral arterial disease. Cardiovascular events occur earlier in type 1 diabetic patients than in the general population.

More children affected in India

In India, type 1 diabetes is now being diagnosed in an increasing number of children. This could be because the actual frequency of the disorder is increasing in the country. It could also represent increased awareness and, therefore, better diagnosis of type 1 diabetes. It is also possible that children are surviving longer due to earlier diagnosis and treatment.

Read the full document HERE.

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