Table of Contents
Managing Type 1 diabetes is a complex, lifelong journey that demands unwavering attention, consistent self-care practices, and a comprehensive understanding of how various factors influence blood glucose levels. For the millions of individuals living with this autoimmune condition, each day presents unique challenges that can significantly impact both physical health and emotional well-being. Diabetes is a complex, chronic condition requiring continuous care with comprehensive risk-reduction strategies beyond glycemic management, and ongoing diabetes self-management education and support are critical to empowering people, preventing acute complications, and reducing the risk of long-term complications. Understanding these common obstacles and developing effective strategies to overcome them is essential for achieving optimal diabetes management and maintaining quality of life.
The Evolving Landscape of Type 1 Diabetes Care
Type 1 diabetes is the most common metabolic disorder in children, and this disease is associated with a range of potential complications, including developmental and endocrine abnormalities, acute events such as diabetic ketoacidosis, as well as long-term microvascular and macrovascular complications. The management of this condition has evolved dramatically over recent decades, with technological advances and improved understanding of diabetes pathophysiology transforming treatment approaches. However, despite these advances, individuals with Type 1 diabetes continue to face numerous barriers that can interfere with optimal self-care.
The ADA Standards of Care in Diabetes–2026 are pushing past traditional insulin therapy and glucose-only management by embracing a fuller, more modern approach to life with type 1 diabetes, with new updates standing out with early CGM usage, easier access to automated insulin-delivery systems, and a broader emphasis on mental health and equity for all. This holistic approach recognizes that successful diabetes management extends far beyond simply monitoring blood sugar and administering insulin—it encompasses psychological support, nutritional guidance, technological literacy, and access to comprehensive healthcare resources.
Blood Glucose Monitoring: Challenges and Modern Solutions
Traditional Monitoring Obstacles
Regular blood glucose monitoring remains the cornerstone of Type 1 diabetes management, providing essential data that informs treatment decisions throughout the day. However, maintaining consistent testing schedules presents significant challenges for many individuals. Traditional fingerstick blood glucose monitoring can be painful, inconvenient, and disruptive to daily activities. The need for frequent testing—often six to ten times daily for individuals with Type 1 diabetes—can lead to testing fatigue, where individuals gradually reduce the frequency of checks due to physical discomfort or psychological burden.
Device discomfort is a common complaint, particularly among children and adolescents who may resist the repeated finger pricks required for conventional monitoring. Forgetfulness also plays a significant role, especially during busy periods or when routines are disrupted by travel, illness, or changes in daily schedules. Without accurate and timely readings, individuals cannot make informed decisions about insulin dosing, carbohydrate intake, or physical activity adjustments, potentially leading to dangerous blood glucose excursions.
The Revolution of Continuous Glucose Monitoring
Continuous glucose monitoring (CGM) technology has emerged as a transformative tool in diabetes management, offering real-time glucose data without the need for constant fingerstick testing. Advances in CGM technology have made lives easier for people with diabetes, as insulin administration and blood glucose monitoring have transformed from multiple finger pricks in a day to a few swipes on a cell phone, and with a CGM, one can see in real time if they’re trending high or low and take preventative measures against hypoglycemia and hyperglycemia.
Never before have CGMs been so popular with all types of diabetes, and the 2026 Standards recommend CGM use at diagnosis and continued wear for anyone who could benefit from this life-changing health benefit. These devices use small sensors placed under the skin to continuously measure glucose levels in interstitial fluid, transmitting data to a receiver or smartphone app. This provides users with a comprehensive view of glucose trends, patterns, and fluctuations throughout the day and night.
The benefits of CGM extend beyond convenience. CGM shows a more accurate picture of glucose levels through the day and overnight, shows current glucose level and predicts direction that glucose is heading and rate of change, allows patient to assess glycemic patterns and glycemic variability, can potentially prevent hypoglycemia and hyperglycemia, provides alerts when glucose level is too low or too high, shows how lifestyle choices and other factors affect glucose, and provides ability to share glucose levels with a family member and healthcare team.
Barriers to CGM Adoption and Use
Despite the clear advantages of CGM technology, significant barriers prevent many individuals from accessing or consistently using these devices. Despite its proven effectiveness, several barriers to CGM adoption remain, preventing many patients from achieving optimal diabetes control and limiting its full potential to transform diabetes care.
Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors, and additionally, patients report difficulties in interpreting the large volumes of data generated by CGM systems, as well as discomfort or fear related to sensor insertion. The financial burden is particularly significant, as CGM sensors must be replaced regularly—typically every 7 to 14 days—creating ongoing expenses that may not be fully covered by insurance.
Use of CGM is increasing, however not all who could benefit from the technology have access, and studies show that poorer, older Black and Brown Americans and Americans on Medicaid have less access to CGMs than their counterparts. This disparity in access creates significant health equity concerns, as those who might benefit most from improved glucose monitoring may face the greatest barriers to obtaining the technology.
Physical challenges also present obstacles to CGM use. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM. Skin irritation from adhesives, sensor insertion pain, and the visibility of devices can all contribute to discontinuation of CGM use, particularly among children and adolescents who may be self-conscious about wearing visible medical devices.
Psychological Impact of Continuous Monitoring
While CGM provides valuable data, the constant stream of information can also create psychological challenges. The constant monitoring and stream of data associated with CGMs can exacerbate diabetes-related stress and cause anxiety and decision paralysis, increasing the emotional burden for people with diabetes. Some individuals report feeling compelled to maintain perfect glucose values, leading to obsessive monitoring behaviors and increased stress.
Participants described feeling compelled to maintain values within the target range with DHT use, making them fixated on achieving the perfect “time in range” values and overly trusting DHTs above bodily symptoms, and participants felt that this led to stress and a sense of self-competition, particularly during the initial phase of technology use. This phenomenon, sometimes called “CGM burnout,” can paradoxically lead individuals to discontinue use of a technology designed to improve their quality of life.
Alert fatigue represents another significant challenge. Frequent alarms for high or low glucose levels, particularly during nighttime hours, can disrupt sleep and create anxiety for both individuals with diabetes and their caregivers. An article evaluating the sleep quality of parents of children with type 1 diabetes using CGM showed similar perceived sleep quality before and after CGM use, however, sleep diaries indicated more frequent nighttime awakenings when using CGM, as well as an increase in total wake time, and although subjective sleep quality did not change, it has been demonstrated that CGM may negatively affect sleep continuity.
Training and Education Requirements
In some settings, CGM training can be done by users themselves with company-provided training materials, although for underresourced, younger, and older individuals, more repetition and time spent reviewing concepts is often indicated, and additionally, regular monitoring and review of the data obtained from CGM devices is needed to inform and optimize clinical care. Adequate education is essential for maximizing the benefits of CGM technology.
For healthcare professionals, CGM data can be complex to understand and use effectively, requiring specialised knowledge and training in glucose data analysis, and furthermore, integrating CGM data analysis into routine patient consultations can be time-consuming, impacting the overall efficiency of healthcare delivery. This creates challenges not only for patients learning to interpret their data but also for healthcare providers who must stay current with rapidly evolving technology while managing time constraints in clinical practice.
Insulin Management: Precision and Complexity
The Critical Nature of Insulin Therapy
Insulin is an essential life-preserving therapy for people with type 1 diabetes, and to avoid DKA, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals. For individuals with Type 1 diabetes, insulin is not optional—it is a life-sustaining medication that must be carefully calculated and administered multiple times daily. The complexity of insulin management cannot be overstated, as it requires constant attention to numerous variables including carbohydrate intake, physical activity, stress levels, illness, and hormonal fluctuations.
Calculating accurate insulin doses represents one of the most challenging aspects of diabetes self-care. Individuals must consider their current blood glucose level, the carbohydrate content of meals, their insulin-to-carbohydrate ratio, insulin sensitivity factor, and any active insulin remaining from previous doses. Errors in any of these calculations can result in dangerous hypoglycemia or prolonged hyperglycemia, both of which carry significant health risks.
Insulin Delivery Methods and Associated Challenges
Insulin may be delivered through injection, with an AID system, or with an insulin pump alone depending on individual preference, capability, and circumstances. Each delivery method presents unique challenges and considerations. Traditional multiple daily injections require individuals to carry insulin pens or syringes, plan injection sites to avoid lipohypertrophy, and manage the logistics of administering insulin in various settings—at work, school, restaurants, or social gatherings.
Insulin pumps offer more precise dosing and greater flexibility but introduce their own set of challenges. Users must learn to manage pump settings, troubleshoot technical issues, change infusion sets regularly, and monitor for pump malfunctions that could result in insulin under-delivery. Infusion site problems, including infections, scarring, and absorption issues, can compromise insulin delivery and glucose control. The visibility of pump devices and tubing can also create self-consciousness, particularly among adolescents and young adults.
Automated Insulin Delivery Systems
Diabetes technology now includes automated insulin delivery (AID) systems that use CGM-informed algorithms to modulate insulin delivery, and diabetes technology, coupled with education, follow-up, pharmacotherapy as needed, and support, can improve the lives and health of people with diabetes; however, the complexity and rapid evolution of the diabetes technology landscape can also be a barrier to implementation. These advanced systems, sometimes called “closed-loop” or “artificial pancreas” systems, represent a significant advancement in diabetes care.
Insulin pumps and AID systems generally require training and education for safe use, and there are studies where youth with type 1 diabetes have been able to self-initiate tubeless AID systems, but for most, training with a certified or trained diabetes educator and education specialist is necessary for full understanding and safe use of the technology. The learning curve for these systems can be steep, requiring users to understand not only basic pump operation but also how algorithms make insulin delivery decisions and when manual intervention may be necessary.
Real-world data showed that AID systems provide the same glycemic benefits to Medicare and Medicaid beneficiaries with type 1 and type 2 diabetes, emphasizing that access to this technology should be made available regardless of A1C levels and should be based on the individual’s needs. However, access to these advanced systems remains limited by cost, insurance coverage restrictions, and availability of trained healthcare providers who can prescribe and support their use.
Injection Site Management
Proper injection site rotation is essential for maintaining insulin absorption and preventing lipohypertrophy—the development of fatty lumps under the skin that can interfere with insulin uptake. Many individuals struggle with consistent site rotation, either due to habit, preference for certain sites, or lack of awareness about the importance of this practice. Lipohypertrophy can lead to unpredictable insulin absorption, making glucose control more difficult and increasing the risk of both hypoglycemia and hyperglycemia.
For pump users, infusion site management presents similar challenges. Sites must be changed every two to three days to prevent infections and maintain proper insulin absorption. Adhesive allergies, skin irritation, and the physical burden of wearing devices on small body surface areas—particularly in children—can make consistent site management difficult.
Hypoglycemia and Hyperglycemia Management
Improper insulin management can lead to episodes of both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), each carrying significant health risks. Hypoglycemia can cause symptoms ranging from shakiness and confusion to loss of consciousness and seizures. Severe hypoglycemia represents a medical emergency requiring immediate treatment. The fear of hypoglycemia can lead some individuals to intentionally run their blood glucose levels higher than recommended, increasing the risk of long-term complications.
Hyperglycemia, while less immediately dangerous than severe hypoglycemia, contributes to long-term complications including cardiovascular disease, kidney damage, nerve damage, and vision problems. Persistent high blood glucose levels can also cause acute symptoms such as fatigue, increased thirst, frequent urination, and difficulty concentrating, all of which impact quality of life and daily functioning.
Diet and Nutrition: Balancing Act of Carbohydrates and Health
The Complexity of Carbohydrate Counting
Balancing carbohydrate intake with insulin doses represents one of the most challenging aspects of Type 1 diabetes management. Carbohydrate counting requires individuals to estimate the carbohydrate content of all foods consumed, a skill that demands extensive nutritional knowledge, mathematical ability, and constant vigilance. Restaurant meals, processed foods with unclear labeling, and homemade dishes with multiple ingredients all present challenges for accurate carbohydrate estimation.
Errors in carbohydrate counting directly impact insulin dosing decisions, potentially leading to glucose excursions. Underestimating carbohydrates results in insufficient insulin and high blood glucose, while overestimating leads to excessive insulin and hypoglycemia. The margin for error is often small, particularly for individuals with high insulin sensitivity or those using rapid-acting insulin analogs.
Meal Planning and Preparation Challenges
Many individuals with Type 1 diabetes struggle with meal planning and preparation. The need to consider carbohydrate content, timing of meals relative to insulin administration, and the impact of protein and fat on glucose levels adds complexity to what should be a simple daily activity. Busy schedules, limited cooking skills, and financial constraints can all interfere with the ability to plan and prepare diabetes-friendly meals.
The reasons for the increased risk of hyperglycemia can include the consumption of inexpensive carbohydrate-rich processed foods, binge eating, financial constraints to filling diabetes medication prescriptions, anxiety and depression, and poor sleep, all contributing to hyperglycemia and poor diabetes self-care behaviors. Food insecurity represents a particularly significant barrier, as individuals may not have consistent access to appropriate foods for diabetes management.
Portion Control and Dietary Consistency
Maintaining appropriate portion sizes requires constant attention and often conflicts with social norms around eating. Restaurant portions are typically much larger than recommended serving sizes, making it difficult to accurately estimate carbohydrate content and determine appropriate insulin doses. Social situations involving food—parties, family gatherings, business meals—can create pressure to eat foods or quantities that don’t align with diabetes management goals.
Dietary consistency, while beneficial for glucose control, can feel restrictive and monotonous. The need to carefully consider every food choice can lead to decision fatigue and feelings of deprivation. Some individuals develop disordered eating patterns, either restricting food intake excessively to avoid the complexity of insulin dosing or engaging in binge eating followed by guilt and anxiety about glucose control.
Managing Cravings and Food Relationships
The psychological relationship with food becomes complicated when every eating decision must be calculated and medicated. Cravings for high-carbohydrate foods can feel particularly challenging, as satisfying these cravings requires careful insulin dosing and may result in glucose fluctuations. Some individuals report feeling that diabetes has taken away the spontaneity and pleasure of eating, transforming meals from enjoyable experiences into medical calculations.
The concept of “forbidden foods” can be particularly problematic. While no foods are truly off-limits for individuals with Type 1 diabetes who properly dose insulin, the complexity of managing certain foods—particularly those high in both carbohydrates and fat, which can cause delayed glucose rises—may lead individuals to avoid them entirely. This restriction can contribute to feelings of deprivation and may paradoxically increase cravings and the likelihood of unplanned eating episodes.
Nutritional Education and Support
Recommendation 5.4 was revised to recommend using behavioral strategies to support diabetes self-management education and support (DSMES) and engagement in positive health behaviors, and Recommendation 5.5 was modified to state that DSMES should be culturally and socially appropriate based on personal preferences and needs. Access to registered dietitians with expertise in diabetes management is essential but not always available, particularly in rural or underserved areas.
Comprehensive nutrition education should address not only carbohydrate counting but also the impact of protein and fat on glucose levels, strategies for managing restaurant meals and special occasions, techniques for estimating portion sizes, and approaches to developing a healthy relationship with food. Successful diabetes care requires a systematic approach to supporting the behavior change efforts of people with diabetes, and high-quality DSMES has been shown to improve a person’s self-management, satisfaction, and glycemic outcomes.
Emotional and Psychological Challenges: The Hidden Burden
Diabetes Distress and Burnout
Living with Type 1 diabetes creates a constant psychological burden that extends far beyond the physical demands of disease management. Diabetes distress—the emotional response to the relentless demands of diabetes self-care—affects a significant proportion of individuals with Type 1 diabetes. This distress manifests as feelings of being overwhelmed, frustrated, angry, or defeated by the constant requirements of diabetes management.
Diabetes burnout represents a more severe form of distress, characterized by complete exhaustion with diabetes management tasks and a desire to ignore or abandon self-care activities. Individuals experiencing burnout may skip blood glucose checks, miscalculate or skip insulin doses, or disregard dietary recommendations. This can lead to dangerous glucose excursions and increased risk of both acute and long-term complications.
The need for support and navigating the burden of psychosocial challenges led to feelings of exasperation, and the exasperating experiences hindered participants from experiencing a full sense of empowerment with DHT use. The constant vigilance required for diabetes management can feel exhausting, particularly when glucose levels remain difficult to control despite best efforts.
Anxiety and Depression
Individuals with Type 1 diabetes experience higher rates of anxiety and depression compared to the general population. Anxiety may focus on fear of hypoglycemia, worry about long-term complications, concerns about diabetes management in social situations, or general stress about maintaining adequate glucose control. Some individuals develop specific phobias related to diabetes management, such as fear of needles or fear of hypoglycemia that leads to intentionally maintaining high blood glucose levels.
Depression can significantly interfere with diabetes self-care, as the motivation and energy required for consistent management may be lacking. The relationship between depression and diabetes is bidirectional—poor glucose control can contribute to depressive symptoms, while depression makes it more difficult to maintain the consistent self-care behaviors necessary for good glucose control. This creates a challenging cycle that can be difficult to break without appropriate mental health support.
Guidance on behavioral health screening and referral for concerns such as diabetes distress and anxiety has been incorporated into current diabetes care standards, recognizing the critical importance of addressing psychological aspects of diabetes management.
Social and Relationship Challenges
Type 1 diabetes can significantly impact social relationships and interactions. Individuals may feel self-conscious about checking blood glucose, administering insulin, or eating differently from others in social situations. The visibility of diabetes devices—insulin pumps, CGM sensors, or glucose meters—can attract unwanted attention or questions. Some individuals report feeling stigmatized or judged by others who don’t understand Type 1 diabetes, particularly when they encounter misconceptions about the disease.
Dating and intimate relationships present unique challenges, as individuals must decide when and how to disclose their diabetes diagnosis. Concerns about being perceived as “damaged” or “high-maintenance” can create anxiety around new relationships. Within established relationships, diabetes management can create tension, particularly if partners have different perspectives on appropriate management strategies or if the burden of diabetes care falls disproportionately on one partner.
For parents of children with Type 1 diabetes, the psychological burden can be particularly intense. Parents described benefits of CGM use, including decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. However, the constant vigilance required to keep a child safe can lead to parental burnout, anxiety, and sleep deprivation.
The Importance of Psychological Support
Support from healthcare providers, family members, and peer groups plays a crucial role in managing the psychological challenges of Type 1 diabetes. Mental health professionals with expertise in chronic disease management can help individuals develop coping strategies, address anxiety and depression, and work through diabetes-related distress. Cognitive-behavioral therapy has shown particular promise in helping individuals manage diabetes-related anxiety and develop more adaptive thought patterns around diabetes management.
Peer support groups, whether in-person or online, provide opportunities to connect with others who understand the unique challenges of living with Type 1 diabetes. These connections can reduce feelings of isolation, provide practical management tips, and offer emotional validation. Many individuals report that connecting with others who have Type 1 diabetes helps them feel less alone and more capable of managing their condition.
Given the pluralistic needs of people with diabetes and the challenges they experience (complex insulin treatment plans, new technologies, changes in capacity for self-management, etc.) that vary over the course of disease management and life span, engagement of an interprofessional team with complementary expertise is essential. This team approach should include mental health professionals as integral members of the diabetes care team.
Access to Care and Health Equity Concerns
Financial Barriers to Optimal Care
The financial burden of Type 1 diabetes management is substantial and represents a significant barrier to optimal care for many individuals. Insulin costs have risen dramatically in recent years, creating situations where some individuals must ration insulin or skip doses due to inability to afford their prescriptions. This practice is extremely dangerous and can lead to diabetic ketoacidosis, a life-threatening complication.
Beyond insulin, the costs of test strips, CGM sensors, pump supplies, and other diabetes management tools can be overwhelming. Insurance coverage varies widely, with some plans covering advanced technologies like CGM and insulin pumps while others provide only basic supplies. High deductibles and copayments can make even covered supplies unaffordable for some families.
Insurance coverage can lag behind device availability, people’s interest in devices and willingness for adoption can vary, and health care teams may have challenges in keeping up with newly released technology. This creates situations where individuals may be aware of technologies that could improve their diabetes management but unable to access them due to insurance restrictions or cost.
Healthcare Access and Provider Expertise
Access to specialized diabetes care varies significantly based on geographic location, insurance status, and socioeconomic factors. Individuals living in rural areas may need to travel long distances to see endocrinologists or certified diabetes educators. This can result in infrequent appointments and limited access to the ongoing support necessary for optimal diabetes management.
Older adults with diabetes should be assessed for disease treatment and self-management knowledge, health literacy, and mathematical literacy (numeracy) at the onset and throughout treatment, and limited time for medical visits, and competing priorities such as acute problems or change in living situation or social support, can make implementation of these recommendations challenging. These challenges affect not only older adults but individuals of all ages who face barriers to comprehensive diabetes care.
Although CGMs have revolutionised diabetes management and diabetes self-management, barriers exist to accessing this technology, particularly in low- and middle-income countries, and in higher-income settings, insurance coverage can limit access to CGMs and related supplies, leading to financial barriers for people with diabetes and healthcare facilities, and in LMICs, the affordability of devices and healthcare infrastructure challenges limit access to CGM technology.
Health Literacy and Education
Health literacy—the ability to understand and use health information to make informed decisions—significantly impacts diabetes self-management. Individuals with limited health literacy may struggle to understand complex diabetes education materials, interpret glucose data, calculate insulin doses, or navigate the healthcare system to access needed services.
Language barriers can compound these challenges for individuals whose primary language differs from that of their healthcare providers. Cultural factors may also influence diabetes management approaches, dietary patterns, and willingness to use certain technologies or medications. Behavioral strategies should be used to support diabetes self-management education and support (DSMES) and engagement in positive health behaviors, and DSMES should be culturally and socially appropriate based on personal preferences and needs.
Addressing Disparities in Diabetes Care
Digital self-management tools or coaches should be considered as appropriate to provide support for people with diabetes, and community health workers play an important role in supporting the management of kidney disease risk factors, in addition to diabetes and cardiovascular disease risk factors, in underserved communities and health care systems. These approaches can help bridge gaps in access to traditional diabetes care services.
Efforts to improve health equity in diabetes care must address multiple levels—from policy changes that improve insurance coverage and reduce medication costs, to healthcare system changes that increase access to specialized care, to community-based interventions that provide education and support in culturally appropriate ways. Partnerships with people with diabetes, health care professionals, advocacy groups, and policy makers are needed to address CGM access for those who use Medicaid, advocating for CGM coverage and working to get rid of barriers to necessary diabetes technology so people can better manage their diabetes and experience fewer poor health outcomes and premature deaths.
Special Populations and Unique Challenges
Children and Adolescents
Effective self-management is considered the cornerstone in controlling this chronic condition, and the responsibility for self-care may be assigned to adolescents who have not yet fully accepted their diagnosis, which can negatively impact their adherence to self-care practices. Young people with Type 1 diabetes face unique developmental challenges as they navigate the transition from parental management to independent self-care.
Adolescence brings particular challenges, as the desire for independence and peer acceptance may conflict with diabetes management requirements. Teenagers may skip blood glucose checks or insulin doses to avoid appearing different from peers, or they may engage in risky behaviors like alcohol consumption without adequate precautions. Hormonal changes during puberty can also make glucose control more difficult, requiring frequent adjustments to insulin regimens.
Section 14 was reorganized to clearly differentiate guidance for type 1 versus type 2 diabetes in children and adolescents while merging sections that applied to both types of diabetes, and narrative discussions of developmental considerations and the impact of obesity and psychosocial factors were expanded, and language was strengthened to emphasize child and family-centered care, ongoing reassessment of self-care transfer, and training of daycare and school personnel.
Older Adults
Many of the recommendations regarding comprehensive geriatric assessment and personalization of goals and treatments are directly applicable to older adults with type 1 diabetes; however, this population has unique challenges and requires distinct treatment considerations. Older adults may face challenges related to cognitive decline, physical limitations, vision problems, or reduced dexterity that can interfere with diabetes management tasks.
Older adults with diabetes have higher rates of functional disability, accelerated muscle loss, mobility impairment, frailty, and coexisting illnesses, such as hypertension, chronic kidney disease, coronary heart disease, stroke, and premature death than those without diabetes, and they also have higher rates of common geriatric syndromes such as cognitive impairment, depression, urinary incontinence, falls, persistent pain, frailty, and polypharmacy, and these conditions may affect older adults’ diabetes self-management abilities and quality of life.
Hypoglycemia presents particular risks for older adults, who may have reduced awareness of low blood glucose symptoms and face greater risks of falls, fractures, and cardiovascular events during hypoglycemic episodes. In the “Hypoglycemia” section, recommendations now include use of CGM for older adults with type 1 diabetes or type 2 diabetes on insulin to improve safety and glucose management.
Pregnancy and Preconception Planning
Women with Type 1 diabetes face unique challenges during pregnancy, as maintaining tight glucose control is essential for maternal and fetal health. The use of AID systems in diabetes and pregnancy presents particular challenges, as the current FDA-approved AID systems (except for one that has been FDA approved but is not yet commercially available) have glucose goals that are not pregnancy specific and do not have algorithms designed to achieve pregnancy-specific glucose goals, and initiating or continuing AID systems during pregnancy needs to be assessed carefully.
Pregnancy requires more frequent blood glucose monitoring, stricter glucose targets, and often significant adjustments to insulin regimens. Morning sickness can make carbohydrate intake unpredictable, while hormonal changes throughout pregnancy affect insulin sensitivity. The stress of managing diabetes while pregnant, combined with concerns about fetal health, can create significant psychological burden.
Strategies for Overcoming Self-Care Challenges
Building a Comprehensive Care Team
Engagement of an interprofessional team with complementary expertise is essential, and findings from a systematic review and meta-analysis of 35 team-based care interventions with adults with type 1 or type 2 diabetes showed significant improvements in A1C, systolic blood pressure, diastolic blood pressure, and LDL cholesterol. A comprehensive diabetes care team should include endocrinologists, certified diabetes educators, registered dietitians, mental health professionals, and primary care providers working collaboratively to address all aspects of diabetes management.
Table 1.1 was enhanced to specify additional care team members whose expertise may be beneficial for older adults with diabetes. This recognition of the need for diverse expertise applies to individuals of all ages, as different life stages and circumstances may require input from various specialists.
Leveraging Technology Effectively
Technology is rapidly changing, and there is no one-size-fits-all approach to technology use in people with diabetes, and insurance coverage can lag behind device availability, people’s interest in devices and willingness for adoption can vary, and health care teams may have challenges in keeping up with newly released technology. Despite these challenges, diabetes technology offers tremendous potential to improve glucose control and quality of life when used appropriately.
In general, no device used in diabetes management works optimally without education, training, and ongoing support, and there are multiple resources, including online tutorials and training videos as well as written material, on the use of devices. Taking advantage of these educational resources and working closely with healthcare providers to optimize technology settings can help individuals maximize the benefits of diabetes devices.
The exasperating experiences may widen the digital health inequities and therefore are important to address, and improving technological literacy and ongoing support from health care or device manufacturers may help users to address exasperating experiences. Adequate support during the initial learning phase and ongoing troubleshooting assistance can help prevent technology abandonment.
Developing Sustainable Self-Care Routines
Creating sustainable diabetes management routines requires finding a balance between optimal glucose control and quality of life. Perfectionism in diabetes management can lead to burnout, while overly relaxed approaches can result in poor glucose control and increased complication risk. Working with healthcare providers to establish realistic goals and flexible management strategies can help individuals maintain consistent self-care without feeling overwhelmed.
Habit formation strategies can make diabetes management tasks feel less burdensome over time. Linking diabetes care activities to existing routines—checking blood glucose before meals, administering insulin at consistent times, or reviewing CGM data during a morning coffee routine—can help integrate these tasks into daily life more seamlessly.
Prioritizing Mental Health
Recognizing that psychological well-being is as important as physical health in diabetes management is essential. Regular screening for diabetes distress, anxiety, and depression should be part of routine diabetes care, with prompt referral to mental health professionals when concerns are identified. Developing healthy coping strategies, maintaining social connections, and engaging in stress-reduction activities can all support better mental health and, consequently, better diabetes management.
Self-compassion—treating oneself with kindness and understanding when diabetes management doesn’t go as planned—can help reduce the psychological burden of living with Type 1 diabetes. Recognizing that perfect glucose control is impossible and that occasional setbacks are normal can help individuals maintain motivation for ongoing self-care without becoming discouraged by inevitable challenges.
Advocating for Better Access and Support
Individual and collective advocacy efforts can help address systemic barriers to optimal diabetes care. This includes advocating for better insurance coverage of diabetes technologies and supplies, supporting policies that reduce medication costs, and working to increase access to specialized diabetes care in underserved areas. Connecting with diabetes advocacy organizations can amplify individual voices and contribute to broader efforts to improve diabetes care for all.
Patient advocacy also includes self-advocacy within the healthcare system—asking questions, expressing concerns, requesting referrals to specialists, and insisting on comprehensive care that addresses both physical and psychological aspects of diabetes management. Individuals who feel empowered to advocate for their own needs are more likely to receive care that meets their specific requirements and preferences.
Looking Forward: The Future of Type 1 Diabetes Care
The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge, and the American Diabetes Association has long been a leader in producing guidelines that capture the most current state of the field. Continued advances in diabetes technology, including improvements in CGM accuracy, development of more sophisticated automated insulin delivery systems, and integration of artificial intelligence to predict glucose trends and recommend management adjustments, hold promise for reducing the burden of diabetes self-care.
Research into biological therapies, including beta cell replacement and immunotherapy approaches to prevent or reverse Type 1 diabetes, offers hope for future treatments that may reduce or eliminate the need for exogenous insulin. In the meantime, ongoing efforts to improve access to existing therapies, reduce costs, and provide comprehensive support for all aspects of diabetes management remain critical priorities.
The recent 2026 updates show important changes in how type 1 diabetes is screened and managed, both personally and professionally, and beyond basic insulin therapy and A1c testing, today’s technology, mental health, and complication prevention are at the forefront of treatment, and a more patient-centric approach, across many ages and life circumstances, improves health outcomes and advances diabetes care management for the entire T1D community.
Conclusion
Managing Type 1 diabetes presents numerous challenges that extend far beyond simply monitoring blood glucose and administering insulin. From the technical complexities of using diabetes technology to the psychological burden of constant disease management, from nutritional challenges to barriers in accessing comprehensive care, individuals with Type 1 diabetes navigate a complex landscape of obstacles daily.
Understanding these challenges is the first step toward addressing them effectively. By recognizing the multifaceted nature of diabetes self-care barriers—including physical, psychological, social, and systemic factors—healthcare providers, family members, and individuals with diabetes themselves can work together to develop comprehensive strategies that support optimal management while maintaining quality of life.
Success in Type 1 diabetes management requires more than just medical knowledge and technical skills. It demands ongoing education and support, access to appropriate technologies and healthcare services, attention to mental health and emotional well-being, and a healthcare system that recognizes and addresses the diverse needs of all individuals with diabetes. By addressing these common challenges through comprehensive, patient-centered approaches, we can help individuals with Type 1 diabetes not just survive but thrive.
For additional information and resources on Type 1 diabetes management, visit the American Diabetes Association, the JDRF (formerly Juvenile Diabetes Research Foundation), the Centers for Disease Control and Prevention Diabetes Program, International Diabetes Federation, and Association of Diabetes Care & Education Specialists. These organizations provide evidence-based information, support resources, and advocacy opportunities for individuals living with Type 1 diabetes and their families.