Active Engines
⚠ Autoimmune beta cell destruction
GAD65 + IA-2 + ZnT8 autoantibodies — T-cell attack on islets
⚠ Absolute insulin deficiency
No endogenous insulin produced — requires exogenous replacement FOREVER
⚠ DKA risk — the crash engine
Missed insulin + illness = ketoacidosis. Medical emergency. pH <7.3.
✓ Glucose oscillation (CGM wave)
HbA1c = average of thousands of micro-waves. Target <7%.
✓ Hypoglycaemia counterwave
Too much insulin = brain glucose crash. The other cliff.
✓ Genetic predisposition (HLA)
HLA-DR3/DR4 = loaded gun. Environmental trigger fires it.
⚠ Drug Interactions
HIGH · insulin + any illness/infection
Illness increases insulin resistance + ketone production. INCREASE insulin during illness — never stop.
HIGH · insulin + alcohol
Alcohol blocks hepatic glucose release = delayed hypoglycaemia 4-8h later. Eat before drinking.
MEDIUM · insulin + exercise
Aerobic = drops glucose. Anaerobic = raises glucose. Adjust bolus accordingly.
Protocol
Basal insulin (Lantus/Tresiba/Basaglar)
0.2 U/kg/day starting, titrate · Lifelong
Covers background insulin need 24h. Flat release curve. Given at same time daily.
Bolus insulin (NovoRapid/Humalog/Fiasp)
Insulin:carb ratio (start 1U:10g) · Lifelong — with every meal
Covers post-meal glucose spike. Timing is critical — 10-15min before eating.
CGM (Dexcom G7 / Libre 3)
Worn 24/7 · Lifelong
The oscilloscope for this engine. Without it you are flying blind. Game-changer for T1D management.
Closed-loop insulin pump (optional)
Auto-adjusts basal every 5min · Lifelong if chosen
Tandem Control-IQ / Omnipod 5. Algorithm adjusts insulin based on CGM trend. Best outcomes.
Glucagon kit / Baqsimi nasal spray
1mg IM or 3mg nasal · Always on hand
Hypoglycaemic rescue. Every T1D must carry this. People around them must know how to use it.
DKA Prevention Protocol
N/A · Ongoing education
Sick day rules: NEVER stop insulin during illness. Test ketones. >1.5 mmol/L = hospital.