A day in the life of a type 1 toddler
Diabetes is an invisible disability, as such its daily impact and routine management can be something of a mystery to anyone lucky enough not to have encountered this disorder as a sufferer or a carer. I certainly had no idea what daily life with type 1 diabetes looked like before our diagnosis, so I thought I’d try and give an insight into daily life, managing type 1 diabetes.
What is Type 1 Diabetes
Type 1 diabetes is an autoimmune disorder. The immune system has been triggered to attack the Beta cells in the Pancreas and this stops them from producing insulin. Insulin is a hormone that makes your body cells absorb glucose, this is important because you need glucose for all your life processes (not least respiration). If you cannot absorb glucose out of your blood stream and into your cells, you cannot survive for very long. Type 1 diabetes is life threatening and the only treatment is to inject insulin that your body cannot make itself.
Treating Type 1
The only treatment for type 1 diabetes is to inject insulin so the body cells absorb glucose, which you get from the food you eat. This means Type 1 diabetics must inject before each meal, and inject a background insulin dose that works slowly over 24 hours.
The average day
If anyone knows what an average day looks like, please let me know! We’re still waiting for one.
Every day revolves around numbers, graphs and ratios. Specifically the amount of glucose in the blood (7-4 mmol/L is normal range for non diabetics) and units of insulin that needs to be injected and the ratio of carbs to insulin.
Each day is a challenge to try and keep blood glucose levels within normal range. Most diabetics aim to keep within a range of 10-4 mmol/L. 24 hours within this range is affectionately known as a unicorn and we spend every day chasing them! A full day between 10 and 4 is about as common as unicorn poo, we’re still working to capture our first unicorn.
Constant Glucose Monitoring
Monitoring of blood sugar levels has been made significantly easier with constant glucose monitoring technology (CGM). This is a sensor permanently attached to a person’s skin, with a tiny needle under the skin monitoring glucose levels in tissue. I honestly don’t know how anyone successfully managed this condition without it. It alerts when sugars are low or high throughout the day or night. We check this data several times every hour and use it to make decisions about treatment, insulin dose and meal timings. CGM technology has made unicorn chasing easier. They are not quite as elusive as they once were.
Injections and meals
Early in the morning a lot of diabetics experience blood sugar levels beginning to rise, without having eaten any food. This is known as the dawn effect. A combination of hormones, circadian rhythm and your body’s natural response to get you ready to have enough energy in the morning before you refuel with breakfast. Most people are more insulin resistant in the morning so have to inject more insulin for breakfast than for other meals.
Breakfast
The day begins with an injection of slow acting insulin, (some people inject this in the evening) followed by careful thought into preparing breakfast. Huge blood sugar spikes are common in the morning and these can take hours to bring back down into range. Eating fat, protein and fibre before carbs can help slow down the blood glucose spike. We start breakfast with a scrambled egg, before a short break then a slice of seeded toast with butter and Nutella. Trial and error are the only way to find out what food works for each person. This means lot of highs and whole days out of range.
Lunch
We time lunch and choose food based on blood sugar levels and what we feel confident the tyrant toddler will eat. The insulin dose is calculated based on the number of carbs in the meal and his blood sugar level. We inject shortly before starting lunch, then watch the CGM closely to check we have given the right dose.
Dinner
We repeat the same steps for dinner and aim to have him fall asleep with a blood sugar level around 8 to allow him to slowly tick down over night.
And that’s it, that’s all it takes to navigate an ideal day with type 1 diabetes. Simple really.
Reality
Except, it never really happens like that and unicorns don’t exist. There are countless variables that affect how much insulin your pancreas really need to release. Exercise, stress, type of food, excitement, amount of sleep, hydration level and wind direction to name a few. A healthy pancreas is a masterpiece of monitoring equipment, releasing tiny amounts of insulin every few seconds to keep blood sugar nicely balanced and its completely impossible to recreate that immense fine tuning with 4 injections a day. So an average day more often goes like this…
1) Low sugar at 2am- treated with a sugary drink. But it was a bit too sugary
2) High sugar at 7am because you over treated the 2am low so you treat with extra insulin.
3) It was just a tiny bit too much insulin so type 1 toddler starts going low at 9am
4) You prevent a low by feeding him a biscuit at 9am and blood sugar ticks down quite nicely to lunch.
5) You inject for lunch but picky toddler doesn’t eat the whole sandwich so you give him a bit of banana to top up the carbs
6) You miscounted the carbs in the banana and you get a rapid rise alert, too late, his blood sugar goes over 15mmol/L. Its going to take hours to get back down
7) You treat the high with extra insulin but it only works quite slowly and he’s still high at dinner time
8) You make a low carb dinner in an attempt to bring the blood sugar back down. He goes to bed at 6mmol/l. Perfect
9) Not perfect, He goes low at midnight and we treat with a sugary drink. It wasn’t quite sugary enough
10) He goes low at 4am and you treat the hypo again. It stays low for 40 minutes so you finally get back to bed at 4:50 am. The morning alarm goes off at 5:45am.
No bloody unicorns here, not even a hoof print.
