In Which "Big Pharma" Is Not Keeping a Cure Under Wraps So They Can Make the Big Bucks

Until Sir Frederick Banting and his colleagues Charles Best and Dr. J.J.R. Macloed refined insulin from the pancreases of dogs and injected it into the first human patient in 1922, type 1 diabetes was universally fatal. This was less than 100 years ago. The first recorded incidence of diabetes occurred in Ancient Egypt in 2550, more than 3000 years ago.  Presumably it was present in the human population even earlier. I like to keep these things in perspective when people in the diabetes community lament the lack of a cure "after so much time."

To be fair, no one told us when Kittygirl was diagnosed that we were lucky because a cure was just 5-10 years away. Apparently many newly diagnosed diabetics have been hearing this since at least the 1970's. In fact, when Kittygirl was diagnosed I didn't even know there was promising cure research happening.

My hypothesis is that, with the technology we have available now and the research happening around the world, there will very likely be a cure and/or a revolutionary treatment that ends insulin dependence for type 1 diabetics within Kittygirl's lifetime. However, scientific research is slow and ponderous with a lot of stops and starts. I imagine it will be at least 10 years before anything resembling a cure is on the scene, possibly closer to 20 years or even longer.

In the meantime, I eagerly follow the advances in diabetes technology that are relatively quickly moving toward a true closed loop system with an insulin pump and a CGM. Such a system would not be a cure, but having normalized blood sugars with a small amount of work would be the next best thing as far as I'm concerned.

Just within the United States I know of several scientific teams that are experimenting with different types of pancreatic beta cell implantation. This has actually led to some human subjects achieving remission of their type 1 diabetes and becoming insulin independent. However, it comes at the cost of a lifetime of anti-rejection meds, which have their own potentially dire side effects. Partly for this reason, there are currently no pediatric trials of this procedure as far as I know.

There's a team of scientists at City of Hope in California who are looking for an immunological cure. According to an interview I heard with the director, their hypothesis is that the cure might look slightly different for everyone. They did achieve insulin independence for one subject. It only lasted a few years, but even a few years free of the burden of diabetes sounds pretty amazing.

At Faustman Lab in Massachusetts, Dr. Denise Faustman is pursuing a unique line of research, using a cheap and widely available tuberculosis vaccine in an attempt to rewire the immune system. So far, her research has resulted in her subjects being able to achieve a lower A1C with less work but it has not yet resulted in insulin independence. However, it is only in phase 2 of testing. If this research pans out, the treatment might be effective for many or even all autoimmune diseases, which would be a medical research coup to top all coups. No autoimmune disease has ever been cured.

About a year ago I read an article about a team of researchers in Indianapolis who were injecting beta cells under the skin of dogs with naturally occurring diabetes (this is noteworthy because in most animal research the animals are made diabetic) which has resulted in three months of insulin independence. I haven't seen any follow ups on this research so I don't know if it's gotten any further.

This is just research in the United States. I don't know much about it, but I know that there is cure research going on around the world. Sometimes people in the diabetes community look at all the research and ask themselves and others why none of it has yet resulted in a cure. They hypothesize that "big pharma" will never allow a cure to come to market because they're making too much money keeping people insulin dependent for life.

I think this attitude is flawed for several reasons. First of all, the fact is that the majority of industrialized nations around the world have government funded universal healthcare. It would be significantly cheaper in these countries for those who have diabetes now and those diagnosed in the future to be cured right away than to be treated for the rest of their lives. Even if a cure were discovered in the U.S. and there was pressure not to make it available here, I have faith that the scientists would get it on the market elsewhere and word would spread. In such a scenario I believe there would be such an outcry that it would eventually have to become available in the U.S. as well.

Secondly, this attitude ignores the fact that scientific research almost never moves in a straight line. Scientists had begun to understand that diabetes was a disorder of the pancreas in the mid 1800's. The islets of Langerhans, the part of the pancreas that produces insulin, were named for the scientist who discovered them in 1869. A variety of scientists had tried to isolate the pancreatic secretion that controlled blood sugar (with limited success) as early as the 1880's.

Dr. Banting, who was surprisingly ignorant given what a huge impact his work had on medical history, did not know about these previous studies when he proposed his own. It's a good thing he didn't, because he said later that, if he had, he would probably not have begun his ultimately successful work.

In the 21st century, it's nearly impossible for one scientist to be unaware of the work of another scientist in their field. It's quite possible that a cure will eventually come from a diverse interdisciplinary team of scientists working separately but in tandem around the world. It's possible that one of the projects currently underway will succeed and provide a cure for all or most diabetics.
It's also possible that all the current research will eventually fail, but will serve as inspiration for an up and coming gen Z scientist who discovers a cure in 20 years.

Even if it takes another 50 or even 500 years for a cure to be discovered, the span of time between the discovery of a lifesaving treatment for diabetes and a cure for diabetes will have been relatively short when looked at within the whole span of human history.

I hope and pray for a cure within Kittygirl's lifetime. I would love for her to be relieved of the burden of taking care of her diabetes for her entire adulthood. However, even if that doesn't happen, I'll remain grateful for the research toward that goal and for the technology that can hold us over until it is reached.

In Which I Review the Book I Wish Someone Could Have Handed Me 2 1/2 Years Ago

Disclaimer: I purchased this book with my own funds. The opinions are my own and I have not been reimbursed in any fashion for this review.

The world of Diabetes books has just gained a wonderful new addition. The World's Worst Diabetes Mom by Stacey Simms, host of the well-loved Diabetes Connections podcast, was released in October through her website and became available on Amazon this month. It is currently available in paperback and kindle editions, and an audiobook will be released in the future.

Stacey is the mother of Benny, who was diagnosed with type 1 diabetes at 23 months and is now almost 15. She has been living in the D-parent world for a long time, and she is ready to share many of her experiences, both good and bad, with us through her book.

I wish this book had already been written 33 months ago when my daughter was diagnosed and someone had handed me a copy. In addition to Think Like a Pancreas, which is still my favorite book for understanding what it means to have diabetes, this is going to be the go-to book that I recommend to parents whose children are recently diagnosed with diabetes. For parents who are afraid that they will never be able to live a normal, happy life again, this book can serve both as a comfort and as a breath of fresh air.

Stacey's mantra regarding her son's life with diabetes is, "not perfect, but safe and happy". She shares stories of her family's successes and failures, including the time they realized Benny's pump site was blocked by sand after going immediately from a day at the beach to dinner at a restaurant.

Beginning with the story of Benny's diagnosis, each chapter details an aspect of their family's life with diabetes and connects it to parenting any child with diabetes. Some examples are "Life Goes On", "School Skills", "Brothers and Sisters", "The Backup Plan", and "Summer Camp".

In case the honest, helpful text in each chapter isn't enough, every chapter also ends with a series of questions that you can ask your doctor to give you an even greater understanding of the topic at hand.

Stacey's writing style makes you feel like you're sitting down with her over a cup of coffee and chatting about raising a child with diabetes. Even though she has a wealth of experience to offer, she doesn't present herself as an expert, just as a mom who is a little further along in her journey and wants to bring others along with her.

When Kittygirl was diagnosed, we were blessed to already know a few D-parents who were raising healthy, happy kids as well as a few adults with T1D. This was a huge help to get us over the initial fear that our lives would be ruined and our kid would never be healthy and happy. However not everyone has those connections. In fact, I would venture to say that most people don't have those connections. In those situations, this book would be invaluable.

Whether your child was diagnosed 14 days ago or 14 years ago, I think this book has something for you. I'd venture to say even many adults with diabetes could relate to it and even learn a few things. I'm so glad Stacey decided to contribute to the wide world of diabetes books.

In Which It Is World Diabetes Day, and Diabetes Wants to Make Sure I Don't Forget It

Today is World Diabetes Day. The date was chosen to commemorate the birthday of Dr. Frederick Banting, a physician and scientist from Canada who led the team that discovered and refined insulin in 1921. Before that, type 1 diabetes was inevitably a death sentence. A few revolutionary doctors were keeping patients alive for months and sometimes even a few years on a near starvation diet. The only such patients who didn't eventually starve to death were those who were kept alive through this treatment long enough to benefit from the discovery of insulin.

Nearly three years into diabetes, it most often feels like a routine to us. There are days when we do everything right and Kittygirl's blood sugar stays in range all the time or only goes slightly out of range a handful of times.

However, there are still plenty of times when we really have no idea what we're doing and we make the same kinds of mistakes we made early on. One of those mistakes happened this morning.

Kittygirl and Mr. Engineer went to a fun event at her school last night that included a bake sale. They brought home some sugar cookies made by a mom who has her own cottage bakery and whose cookies are amazing. Due to me making another mistake yesterday afternoon in dosing a cookie for a birthday treat at Girl Scouts, Kittygirl's blood sugar had been high for most of the afternoon and was just coming back into range when the cookie was purchased. We told her she'd have to wait until today to eat it.

I'm not quite sure why I agreed to this, but Kittygirl somehow negotiated having the cookie with breakfast, instead of one of the two pieces of toast she most often has. She also always has fruit and sausage, in case you're aghast at that lack of balance in a breakfast consisting of two pieces of toast :).

I know exactly how to dose insulin for toast. If there are no other mitigating factors, I can keep Kittygirl's blood sugar in range with her typical breakfast. I thought I could do it with the cookie as well, but I was wrong.

By the time I dropped her off at school, Kittygirl's blood sugar was nearly 300. I gave her a little extra insulin, and she was back in range within an hour. It wasn't a disaster, but it was really annoying. I'm not a fan of these little reminders diabetes gives me that my skills are not equal to those of a pancreas, and in fact that often they're really pathetic in comparison.

We realized when we got to school that Kittygirl forgot the shoes she needed for Girls on the Run this afternoon, so I decided to come in for lunch and bring the shoes with me. I was glad I did, because, as she opened her container of goldfish crackers, Kittygirl managed to knock it off the table and spill all the crackers onto the floor.

Because she gets insulin for lunch beforehand, Kittygirl needed to replace the 20 carbs that the goldfish represented. If all else failed she could have done it with fast acting sugars from her supply bag, but that would be less than ideal. I scanned the lunch tray of the friend who was eating with us and calculated that her roll was about 20 carbs.

I took Kittygirl with me into the hot lunch line, explained the situation to the supervisor, and asked if we could have a roll. He graciously gave us one and the situation was saved. I'm not sure what Kittygirl would have done if I hadn't been there and she had spilled her goldfish. We need to have a conversation about how to problem solve in such a situation after she gets home.

I'm always aware of diabetes, of course. Even when everything is going well, diabetes is constant background noise in our lives. However, there are times, like the two situations today, when diabetes makes me extra aware.

In Which I Realize That Yesterday's Post Was Inconsistent

I received a little blowback about yesterday's post, in which I first stated that we shouldn't judge ourselves or others by an A1C and then proceeded to share generalities about how great my daughter's A1C is. Maybe it's because I wanted to finish the post quickly due to afternoon obligations and didn't spend much time rereading my post before publishing it, or maybe it's just because I'm a human being who makes mistakes, but it somehow did not occur to me that these two things were somewhat contradictory.

I still think the post, especially the first five paragraphs, has value, so I've left it up. However, I wanted to elaborate today on what I was really trying to say.

The A1C is a data point that gives a snapshot of your/your child's blood sugar control over the past 2-4 months. It can give you and your medical team an idea of what to do next. However, it has no bearing on your value as a person or as a parent.

Yes, there are actions you can take that increase the likelihood of a lower A1C. The dynamic management style subscribed in Sugar Surfing is one. Following a lower carb diet is another. However, no matter what methods you are using or are not using, managing diabetes is hard and there will always be a ton of factors affecting a person's blood sugar control, many of which are outside of your direct control.

If your child is starting puberty or going through a growth spurt, blood sugar can be particularly hard to control. There's no reason to beat yourself over the head if your child's A1C goes up in such a situation. It's simply a data point that shows you're still learning how to navigate within the new parameters.

Yes, it's true that many, many years of high blood sugar, indicated by high A1Cs, can lead to diabetes complications. Here's the thing, though. One high blood sugar, one high A1C, or even years of high A1Cs will not inevitably turn on the "diabetes complications" switch. There are a ton of factors, not all of which are well understood.

Both my father and my father in law have type 2 diabetes, and they've had it for similar lengths of time. My father in law is more careful about what he eats and has often had lower A1Cs. However, my father currently does not suffer from any complications and my father in law does. Diabetes doesn't play fair.

The good news is, there are treatments now available or being developed that can mitigate some of the complications of diabetes. Plus, there is data showing that good blood sugar control can halt and sometimes even reverse complications that have already started. All hope is not lost, even if years of high A1Cs and judgment for them have made you feel like a bad diabetic or a bad D-parent.

One of the reasons I left a Facebook group I used to belong to that advocated (with well-meaning intent) for tight blood sugar control, was the disregard so many members of the group had for the fact that diabetes is different for everyone and that the tight control they had on their child's blood sugar might be more difficult for someone else. I also got tired of reading statements like, "I keep such tight control because I want my daughter to keep her pretty little toes." The implication being that, if you don't consistently have tight control of your child's blood sugar, they will inevitably lose a limb in adulthood.

Here are some final thoughts on A1C and on sharing that data. In the beginning of our diabetes journey I shared a couple A1Cs on my Facebook feed. I decided later on that that was inappropriate in large part because it's not my data to share. While Kittygirl is fine at this point with me sharing about her diabetes, there's no good reason for me to create a digital cache of her private medical data.

This is different for adults with diabetes. If it's helpful to you to publicly share info about your A1C, either because you've been working hard and you want to brag, or because you've been struggling and you want to ask for help or just to get validation that you're not alone, share away. It's your own data, and it's your choice whether you want to share it.

Personally, I have chosen to only share actual data about Kittygirl's diabetes in personal conversation with a very limited number of people. If Kittygirl at some point in the future no longer gives me permission to do even that, I will stop.

I've read through this post a couple times now, and I'm pretty sure there are no contradictions, but I'd love to know what others think about this issue.

For your viewing pleasure, here's a pic of Kittygirl enjoying the snow we got yesterday - without a jacket and with her diabetes supply bag in view. She doesn't even know what her latest A1C was, and she doesn't care.

In Which My Daughter's A1C Is Not a Grade

Kittygirl had her quarterly visit at the endocrinologist office yesterday. She actually doesn't see a doctor, but rather a nurse practitioner within the practice with an endocrinology specialty. We had a personality clash with the doctor to whom we were initially assigned (purely because she was on call when Kittygirl was in the hospital), and a local friend recommended the nurse practitioner, whom we love.

Because I can't post a picture of Kittygirl, I'm sharing a picture of the book she was reading during the appointment. As you may remember from previous posts, I have been frustrated by the fact that, while she reads very well, she only chooses to read if a book catches her eye and most of those books are graphic novels. She picked up this little book at a Little Free Library box near her school (these are great, google them if you don't have them in your town) and literally refused to put it down from that point on. We had to pull it out of her hands so she could be weighed and talk to the nurses.

Anyway, based on my completely unscientific research consisting in the reading of blogs and Facebook posts, it seems as if a lot of adult T1Ds and parents of young T1Ds dread every endocrinologist visit. Many people feel judged by their endocrinologist if their blood sugar results aren't meeting the goals that their doctor has set.

This is a tragedy. Of course, it's best for a type 1 diabetic's A1C to be as low as possible without significant incidence of low blood sugar, and it's important for those using CGMs to continue to increase their time in range. However, it's never right for a medical practitioner to make patients or the parents of juvenile patients feel bad if they're not meeting these goals. The A1C and time and range are data points. If they're not where they should be, that's a call for the doctor and patient to work together to figure out how to change dosing, eating, activity, or whatever is necessary to move close to the goal.

The one case in which it might be permissible for the doctor to react negatively is the case of a patient who has stopped taking insulin regularly and is seriously putting their life at risk. In this case it could be permissible to attempt to "scare the patient straight." Even in this case, however, the subject should be approached with compassion and not with anger.

Despite consistently achieving an A1C that impresses our practitioner, I refuse to look at the A1C as a grade that says we're good diabetes students. The fact is, we started with a lot of advantages. We're able to afford the latest technology. We're intelligent and well-read and did a lot of our own research that has helped us manage Kittygirl's diabetes. We're not afraid to step out and make our own decisions about diabetes (with the blessing of our practitioner). Not everyone has had our experience.

Some people are struggling just to afford the basic insulin and blood sugar meter. They may  not even have a prescription that allows them to test their (or their child's) blood sugar often enough to understand blood sugar patterns and make adjustments. Or perhaps their doctor's protocol doesn't take into account the most recent research but it's the only doctor in their town and it's not within their resources to look elsewhere.

With the exception of people who are burnt out and truly not caring for themselves well, every adult with diabetes and every parent of a child with diabetes is doing their best with the resources they have. In this context, I believe that comparing A1Cs is counterproductive. Whether you're sharing your/your child's amazing low A1C to celebrate it or sharing your/your child's high A1C to commiserate, it doesn't actually do anyone any good.

Diabetes involves a lot of data. That data, including the A1C, is a useful tool to help us figure out our next steps. That might mean continue to do what you're doing, or it might mean you need to make some changes. Either way, sharing your/your child's A1C on Facebook isn't going to help you with that.

In Which I Review a Book That Changed the Way I Look At Diabetes Management

Disclaimer: I purchased this book myself. I have not been compensated in any way for this review, and all the opinions herein are my own.

A lot of people are given seemingly inconsistent information when they are diagnosed with type 1 diabetes. They are told that they can eat a normal diet as long as they cover the carbohydrates with insulin. However, they are also told that they should keep their blood sugars within range as much as possible.

Unfortunately, with the static diabetes management style that is still most often taught by well-meaning endocrinologists and diabetes educators, it is impossible to avoid a large spike in blood sugar after consuming a typical carbohydrate loaded meal. If the insulin ratios are correct your blood sugar will eventually come back down into range, but it will inevitably be high for at least a couple of hours.

A combination of a static management style and a desire to keep people from having frequent low blood sugars leads to the current A1C recommendations of 7.5 for children and 7.0 for adults. These are well above the A1C for a nondiabetic, and they aren't even achieved by about 80% of people with diabetes.

Some have chosen to address this crisis by eating low carbohydrate diets. That is absolutely a viable solution that works well, and I'll review two books later this month that speak to that option and have provided relief and renewed health to many people with diabetes.

However, the choice is not between a normal diet with roller coaster blood sugars and a low carb diet with mostly in range blood sugars. There's a third way, proposed and used by an endocrinologist who is a long time type 1 diabetic himself: Dr. Stephen Ponder. Dr. Ponder calls his dynamic diabetes management style Sugar Surfing, and it has allowed many people to have lower and sometimes even nondiabetic range A1Cs and mostly in range blood sugars while eating whatever they want to eat, within reason.

The one essential tool for sugar surfers is a continuous glucose monitor (CGM). Some people find an insulin pump a useful tool as well because sugar surfing often involves giving more doses of insulin than you would give on a standard static management plan. However, that is a personal choice. Many people, including Dr. Ponder himself, have successfully surfed their blood sugar waves using multiple daily injections.

Dr. Ponder challenges type 1 diabetics and their caregivers to use their CGM graph as a tool to understand how food, insulin, and activity affect their blood glucose trends and then to act on that knowledge.

His writing style is conversational and easy to understand, despite the fact that he uses some medical terms and introduces all new terms (such as delta wave and shelf) related to sugar surfing. It's easy to read this book over a day or two (I read it for the first time over two mornings while Kittygirl was at VBS the summer after she was diagnosed), but you'll want to keep coming back to it to gain a deeper understanding of sugar surfing as  you continue your journey with diabetes.

I won't give away all the secrets of sugar surfing in this review. Get yourself a copy of the book (a free e-book is available for new diagnosed type 1 diabetics at the sugar surfing website). However, I will say that Kittygirl would not have an A1C and time in range that consistently impress her endo and blow away her pediatrician if we had not found this book and applied its methods. Dr. Ponder also gives seminars all over the country in which he teaches the methods in his book. You can find upcoming dates on the website.

All that, and we're actually pretty mediocre sugar surfers. We don't apply all the techniques consistently and we almost never takes notes about either successes or failures. However, even if you're not ready to apply everything in this book, just changing one or two things could make a huge difference in your or your child's diabetes management.

Think Like a Pancreas, which I reviewed last week, is my #1 recommendation for people to understand what having diabetes means. Sugar Surfing is my #1 recommendation for people who want to take the next step and take control of their diabetes instead of letting it control them. Sugar surfing well is not easy, and you will inevitably fall off  your surfboard on occasion. However, the results are well worth learning the techniques and putting in the effort.

In Which I Reduce My Child to Tears Because She Didn't Do the Job Her Pancreas Should Have Done

Spoiler alert: I am not  a perfect parent, in the realm of diabetes or otherwise. My goal is to parent my children well and to address any problems or hiccups brought on by their challenges or just by being kids calmly and rationally. However, that is not in my nature, and all too often I crash and burn in that area. I experienced a crash yesterday that I'd like to share about.

Kittygirl is 8.5 years old, and closing in on 3 years with diabetes. Because she was diagnosed at a fairly young age (just weeks after her 6th birthday), in the beginning we kept a pretty tight rein when it came to managing her diabetes. We did everything for her for over a year, then we slowly started to introduce more independence. The summer before second grade she started testing her own blood sugar. The summer before 3rd grade she started using her insulin pump with adult supervision.

The ability to use her insulin pump with an adult looking on has opened up a lot of opportunities to Kittygirl this year. First of all, she no longer has to go to the nurse's office before lunch at school. Her teacher just quickly supervises her in the cafeteria before lunch. We've also given her more leeway to attend events with adults who have no real training in diabetes care. Two examples are an after school activity called Girls on the Run and a Parents Survival Night where she takes gymnastics. Both of these have had mixed results, diabetes-wise.

The Parent Survival Night includes dinner. Pizza is provided. We would allow Kittygirl to eat pizza if she wanted to, but she hates pizza (remember, she's extremely picky), so she brought her own packed dinner, including a sheet with a carb count for everything she packed. The only "training" the workers received was being told that they needed to doublecheck that Kittygirl entered the number on her sheet into the right place on her pump. They did that, but Kittygirl forgot to eat 10 carbs of her dinner and her blood sugar went a little low.

On the bright side, I reacted quite calmly when I found out what happened that time. I reminded her that it's important to eat everything she boluses for, even if she's at a fun activity. I told her that we'd give her another chance to do better, but that she could lose the privilege of going to such events if she repeatedly forgot to eat her whole dinner.

Yesterday's incident was worse - both in the degree of what Kittygirl forgot to do and in the degree of how I reacted to it. Twice a week after school, Kittygirl participates in Girls on the Run. This is a great program that teaches girls to be healthy and confident. Every lesson includes both some learning time and some running time, as well as a snack provided by the program. I met with one of the volunteer leaders before the first lesson and went over some basics of diabetes. I told her that she or another adult should doublecheck that Kittygirl entered the right number of carbs in her pump before eating the snack, and that she should text me with a picture of the snack if there was any question as to how many carbs it had. They've ended up bringing packaged snacks with an easy to find carb count, so I haven't needed to step in in that realm.

Up until yesterday, Kittygirl has been able to find the nutrition information on the packages easily and bolused the correct amount. For that reason, I had no idea that the coach had completely forgotten that she was supposed to be doublechecking the pump and Kittygirl had never reminded her but rather just gone ahead and bolused on her own. This fell apart yesterday, when she ate a snack and somehow completely forgot to bolus for it.

Usually, when I pick her up at 4pm, Kittygirl's blood sugar is in range or even low, because she spends the last 20-30 minutes of the lesson running. However, yesterday at pickup her blood sugar was 225. Our goal is to keep her blood sugar under 180 at this point, and we intend to lower that goal once we are consistent at reaching it close to 100% of the time. Normal blood sugar generally runs between 70-120, so even 180 is kind of high, and 225 is about twice as high as a nondiabetic's blood sugar is likely to be.

When I looked at Kittygirl's pump (she still prefers to have me bolus her when we're together) to see if she might need more insulin. I saw that there was no insulin on board. What this means is that she had not given herself any insulin through her pump in 3+ hours (this doesn't include her basal, which is constantly running). Well, that solved the mystery of why her blood sugar was high.

First I calmly asked her if she had eaten a snack. There was always a chance that she didn't bolus because she didn't eat a snack, and the high was caused by some other factor. She replied that she did eat a snack. I then asked her if she had bolused for the snack, and she replied, somewhat nervously, "I thought I did." I told her loudly that she, in fact, had not bolused for the snack, and that's when things started to fall apart.

She asked me what I had brought for her to eat on the way to dance class, and I told her that I had brought a banana and a granola bar, but that I was considering not giving them to her because her blood sugar was already high and I didn't want it to go higher. She started to cry, and, instead of taking that as my cue to calm down, I ramped up and told her that, if she couldn't remember to bolus or to eat all of her food (yes, I brought up an incident from nearly a month earlier) we would have to take away the freedoms we'd given her this year.

She continued to cry and said she just forgot this one time and really didn't want to lose her privileges. She said she'd do better. At this point, we'd arrived at the van and she climbed into her booster seat and curled up in a ball.

It should have hit me earlier, but it was then that I realized just how wrong my reaction had been. Yes, Kittygirl is a very responsible 8 year old, but she's still an 8 year old. None of her friends at gymnastics need to remember to eat all the carbs they bolused for. Their pancreases just makes insulin for however many bites or pieces of pizza they eat. Her friends at school don't need to remember to look up the carbs in the snack and bolus for them. Their bodies just make insulin for whatever they eat. It's not fair that Kittygirl has this responsibility, and it's not unusual that, at 8, she might forget about it occasionally.

I calmed myself down and apologized to Kittygirl. I told her that I got angry because I didn't want her to get hurt because she forgot to do something to take care of her diabetes, but that it was wrong of me to yell at her. I bolused her for the snack I'd brought and gave it to her (it didn't even raise her blood sugar, and she was back in range just a few minutes into dance class). She stopped crying, buckled herself into her seat, and asked me to start the audiobook we're listening to.

Thankfully, Kittygirl is very forgiving and recovers quickly when I apologize for yelling at her. However, as she gets older, this may not always remain true. We've been doing diabetes long enough now that I'm able to forget just how much responsibility it is to stand in for your own or your child's pancreas. It's just part of our lives. However, it's not a responsibility that the average 8 year old has, and I need to do better at keeping that a the forefront of my mind.