No one succeeds without effort....Those who succeed owe their success to perseverance. Ramana Maharshi
It is now October which means that Atlanta's JDRF Walk to Cure Diabetes is just weeks away ... on October 19th to be exact. We are reaching out to you once again for your support of Team Tallman in our fundraising efforts to help find a cure for Type 1 Diabetes … which two of our children, John and Caroline, suffer from. Sitting down to compose this annual letter tends to be one of my most challenging tasks. I have been mulling it over for weeks now and have gone through many options that my un-tech savvy self was not able to put down on paper. I have decided to try to explain to you what Caroline and John rely on and deal with on a daily basis … and mind you, this is a normal day … not a sick or out of the ordinary blood sugar day … just their everyday life.
First, let me tell you in very basic terms about Type 1 Diabetes. It is an auto-immune disease in which the pancreas stops making insulin. Insulin is needed for sugar in food (carbohydrates) to get into the cells to be used for energy. If the sugar cannot get into the cells, it remains in the blood causing a very serious condition called diabetic ketoacidosis (or DKA), which if gone untreated or unmonitored can lead to death. When someone has Type 1 Diabetes, they have to monitor their blood sugar throughout the day and give themselves insulin when they eat carbohydrates and try to maintain a target blood sugar range. To do this, they rely on several tools … a glucometer (blood sugar meter) and test strips, insulin (both slow-acting and fast-acting), syringes or an insulin pump, carbohydrate ratios and ways to help determine carbohydrate amounts in food, ketone strips, fast-acting sugar sources should they have lows, snacks with some carb/some protein to keep level blood sugars, glucagon should they go extremely low and several other tools that are pictured below. These are items that need to be available to them at all times.
The kids check their blood sugar with their meters and determine their blood sugar about 8 to 10 times per day. If the blood sugar is lower than their target range, they have to treat with a fast acting sugar (a juice box or sugary drink, fruit snacks, glucose tablets), wait 10 minutes and then check again. If still low, repeat the steps. If they are back in the normal range, they need to eat a snack with some carbs and protein (peanut butter crackers, etc.). If the initial check showed a high blood sugar, they would need to administer some fast-acting insulin (through the pump or by giving a shot) based on a calculation formula to bring their blood sugar back into the target range within the next 2 hours. If it is mealtime or they are planning to eat a snack or have a drink with carbs, they have to determine the amount of carbohydrates in their meal/snack and administer fast-acting insulin (via the pump or a shot) based on an insulin to carbohydrate ratio (in our case, Caroline gets 1 unit of insulin for every 12 carbs that she eats; John gets 1 unit for every 18 carbs). In addition to this, they each have basal insulin that gets injected each day … an amount of slow-acting insulin that keeps a little insulin in their system all day long. On a normal day, they each get 4 to 5 injections/boluses … sometimes more.
If their blood sugar is high, you have to consider … did they not enough insulin for what they ate, did they forget to give insulin when they ate something, are they stressed or irritated, did they exercise excessively, are they growing, did they check too soon, are hormones affecting their blood sugar, are they anxious about a test or something going on in their lives, … and the list goes on. If their blood sugar is low, you have to ask … did they miss a meal or snack, did they exercise too much, did they take too much insulin, did they take a shower too soon after insulin, are they sick, did they forget to make sure their sugar was back in normal range after a low, etc. And for each of these, you have to think through the scenario for treating the high or the low blood sugar.
Both high and low blood sugars have specific physical symptoms that accompany them that make them feel crummy … weak and tired, faint or dizzy, shaky, the inability to concentrate, confused, muscle cramps, irritability, cranky, headaches, blurred vision, thirsty and/or hungry, stomach pain, and more. Any of these interfere with whatever they have going on … whether it be homework or studying, getting ready to take a test, have practice or a game, want to hang out with their friends or just living their daily lives … and it takes time to feel normal again after being treated.
People ask us all of the time about the kids and if everything has “regulated” or become “routine” in their lives. It is easiest to explain that they have grown to manage their diabetes as best they can … it is difficult to explain the constancy of it in their lives and the fact that each day is different and although some of the steps are routine, how they handle or analyze what to do is influenced by so many other factors. And as they mature and their bodies grow, things change … ratios and basal insulin amounts change and they may even have different ratios at different times of the day. There is no standard routine, like taking one shot or a pill 2 times a day. It is an ever-changing constant in their lives that they deal with on top of normal everyday living.
While insulin does keep people with Type 1 diabetes alive, it is NOT a cure. Aside from the daily challenges of living with Type 1 diabetes where mismanaged blood sugars can cause sleep loss, trouble concentrating, confusion, irritability and just plain feeling bad, there are many severe, often fatal, complications caused by the disease such as heart and kidney disease, blindness, numbness which can lead to amputation and early death. We will do anything within our power to make sure John and Caroline do not have to experience any of these complications. We're writing to ask for your support in the perseverance of our efforts in fighting for a cure for Type 1 diabetes for John and Caroline in one of the following ways:
We are so very grateful for your support and for persevering with us as we continue to work towards making a cure for Type 1 Diabetes a reality!
Matthew and Mary Tallman
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