Sara was a happy, active 12-year-old. Suddenly she started losing weight, feeling tired and drinking lots and lots of water. She was getting weaker and started vomiting. Her parents took her to the emergency room where she was diagnosed with type 1 diabetes. Her parents were shocked. There was no family history.
Diabetes lessons started in the hospital after she was transferred from the intensive care unit. She and her parents were reassured she could live a “normal life” and enjoy all the things she wanted to do. She could play an instrument in the band, ice skate, downhill ski, go to college, choose any profession – plumber, accountant, doctor, lawyer – anything she wanted to be.
Then the diabetes instruction began with learning how to count carbohydrates for every meal, and every snack. In addition to adding up all her carbohydrates, she would need to give a life-saving drug called insulin and – oh, by the way – it needs to be injected with a needle. No easy pill to solve this problem.
She will need to check her blood glucose, or BG, before every meal and before bed, and sometimes in between. It’s “easy.” Just take a lancet device that has a needle, poke a finger, take that little bit of blood and put it on a glucose strip inserted into a small computer to learn the BG level. If the BG is high, she’ll need more insulin. If it is low, she will have to learn how to adjust the dose to give her a bit less and eat some carbohydrates to raise her BG.
Then when she decides to turn out for track, the doses may be a bit different, so she will have to do a little trial and error. She has to make sure she has enough insulin so she does not get too tired and not too much insulin so she stumbles, falls and collapses on the track.
How “normal” does this seem, really? One out of 350-400 individuals living in Montana deal with this every day of their lives.
This diagnosis is incredibly life-changing – not only for the individual with diabetes, but the entire family. It is a disease that can be managed. But it takes 5-6 finger sticks per day (that’s a minimum of 1,825 figure sticks per year); 4 shots per day (unless she chooses to use an insulin pump) – that’s 1,460 shots per year). Individuals need to count the carbohydrates in the food they eat, 24 hours a day, 365 days per year. The amount of insulin to take must be calculated multiple times a day to not only feel better each day (more energetic, sharper physically and mentally) but also to prevent the serious long-term consequences of chronically high blood sugars.
It is like being Sherlock Holmes every day, all day. Type 1 diabetes is manageable, but it is non-stop. It is a balancing act like no other.
There are programs, apps, websites and technology to help with diabetes management. Every summer the American Diabetes Association hosts a camp for children with diabetes in Montana. More than 90 children come together to be just one of many, rather than alone with this tedious disease.
An all-day educational seminar and activities for children with type 1 diabetes, their families, school nurses, caregivers and anyone interested in this disease is scheduled from 8 a.m. to 3:30 p.m. Saturday, April 23, in the Broadway Building Conference Center at 500 W. Broadway in Missoula. Admission is free. Come learn more about his disease, how to treat it, and advances in care. You are not alone.
This Nurse's Notes column was written by Carla Cox, PhD, RD, CDE, of Providence Endocrinology, Diabetes and Nutrition Center.