A guide for children and teens living with Type 1 diabetes

By:

Tara Marshall

2011

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A Special Thanks To:

Dr. Richard Mauseth Dr. Michiels Dr. Troutman Mr. Wilson

The nurses who took care of me at St. Joseph’s Hospital My 7th grade teachers at Shuksan Middle School

Mr. Porteous for his encouragement and visit in the hospital Mrs. Foster for editing my book

My family and friends

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Table Of Contents

Forward ..................................................................................................... 7

It all started with an ear ache .................................................................... 9

Back to life, back to reality ..................................................................... 15

Back to school blues ............................................................................... 27

Fast forward: This is me now .................................................................. 31

Helpful hints and tips .............................................................................. 37

Low carb food and snacks ....................................................................... 39

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Forward:

Hello, my name is Tara Marshall. You have probably just picked

up this book because you know someone, or are related to someone, with

Type 1 Diabetes, or better yet if you’re like me you have Type 1

Diabetes. I have been living with Type 1 Diabetes since I was 12 years

old. During my senior year in high school all the seniors had to do a

culminating project that would benefit the community in some way. I

decided to write a booklet about my experience living with diabetes to

help young children and teenagers that are newly diagnosed with

Juvenile Diabetes, relate to someone and feel like everything is going to

be okay. Because the truth is everything will be okay, and I hope by

reading this book you can tell your daughter, son, sister, brother,

grandchild, niece, nephew or even yourself that living with diabetes is

just another bump in the road.

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It All Started With An Ear Ache

May 5, 2006. Some call it Cinco De Mayo. I call it the first time

I ever went into the hospital scared, was the first time I saw my dad cry,

and it was the first time I heard the term Type 1 diabetes. I was unaware

that there were different types. It sounded like I got an ice cream flavor

instead of a disease. I felt dazed and confused. I went in for an ear

infection and came out with a one way ticket to the hospital. In a way I

was somewhat relieved going into the hospital, as my appearance had

been starting to frighten me. I was starting to scare myself for a while.

For the past year I had been a walking skeleton, weighing only a

frightening 89 pounds going into eighth grade. I had a long lasting case

of every type of cold you can get, I was always tired, had extreme hunger

and thirst 24/7 and my skin was so dry no lotion could stand up to it. I

couldn’t believe it, for an entire year I was misdiagnosed. The doctor

would say, “She’s just growing,” I went in for everything, nausea, fevers,

headaches, persistent colds, I was prescribed every kind of medication

but nothing worked. The doctor was just oblivious, I guess.

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Until, my mom took me in for an ear infection one morning that

changed my life. I was called in to the doctor’s office; my regular doctor

was not there at the time. I had a female physician named Dr. Michiels,

visiting from Children’s Hospital. I truly believe she saved my life. My

mom began to tell her all the symptoms and problems I had been having

and with in five minutes of talking to my mom she decided to give me a

urine test. I was confused but too tired to care.

She returned to the room and informed my mom that I have Type

1 diabetes. Mom started crying uncontrollably, and I was thinking to

myself what the heck is Type 1 diabetes?

I started to cry. It seemed like I was going to die, something

awful was happening to me. Something awful had happened to me.

After about five minutes of tears I stopped. Crying was not going to

change my diagnosis.

My entire life had to change.

The coffee aroma penetrated my nose as I was wheeled in

through the big sliding glass doors that opened and closed as if they were

going to eat me. The building was quiet, but buzzing with doctors and

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patients. I have always said it, ever since I was young, hospitals smell

like coffee and hand sanitizer. The nurses wheeled me to my room in this

oversized wheel chair. Well, I guess it was just oversized to me because

at the time I was so skinny I considered myself half a person. I was too

tired and thirsty to care about anything that was happening, all I could

think about was how dry my mouth was and I was getting thirstier by the

minute. Once in my room, the nurses had me lay down in my new

“home.” The walls were bright neon green with this tacky circus animal

trimming around the entire room. As if they thought this is going to make

me feel better! Well it kind of did, but only for a moment. I spaced out

for just a second and before I knew it the doctors and nurses had an IV in

my arm and hand which are both hooked up to this metal thing that

looked like a coat rack with bags of water hanging off of it. I noticed my

whole family was in the room with me by now and I was the only one

not crying. I remember thinking, Pull it together people I’m alive aren’t

I? Sure they had a right to be sad and sensitive but I was the one with

diabetes and I still had no clue what diabetes was…but I was sure to find

out soon.

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After just a few days in the hospital I felt as if I had learned more

in three days than seven years of school. I learned I wasn’t going to die, I

learned useful math (how to count carbohydrates and carbohydrate to

insulin ratios), how to take my blood sugar and most importantly, I

learned to give myself an insulin injection. One of the male nurses,

Aaron, came into my room with a few syringes and vial. He sat down

next to my bed and carefully showed me how to take a shot in my

stomach. He showed me the needle and explained how to pinch the skin

on my lower stomach where I was going to take my shot. Then he stuck

the needle into his own stomach waited for five seconds after releasing

the saline medication and took the needle out. Now it was my turn. At

first I was a little skeptical before sticking this sharp needle inside my

stomach, but when the doctor showed me the size of the needle I realized

how tiny it was! So I sucked in the right amount of insulin, flicked it a

few times and boom it was done. I have to admit it didn’t feel great but it

was ten times better than I expected.

My days in the hospital went by awfully slow; all I could do was

lie in my bed and hope for my well-being and return to a healthy state so

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that I could finally go home. Some days I was lucky enough to have a

friend visit me from school but most of the time it was just my mom and

I. I did a lot of thinking when I was just lying in my bed. I thought about

how my life was going to change when I got home, I thought about how

my friends at school were going to react to my disease and I thought

about the girl in the room next to mine. I had walked by her room a few

times and noticed there were constantly people at her bed side crying.

My mom eventually asked what was wrong with her, the doctor told us

that she was very ill and had to be flown to Children’s Hospital right

away. I remember thinking to myself right then that my life could be a

lot worse and if having diabetes is the worst thing that is going to happen

to me in my life then I am okay with that.

I was released from the hospital on May 15 after being there for

ten days. Leaving my obnoxious green room was exciting but somewhat

scary. In a way I wanted to stay there with all the doctors and nurses as

they all took such good care of me and I didn’t know if I was capable of

keeping myself healthy. I was worried that once I got home I would

forget everything that I had learned in the hospital and go back to where I

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started: unhealthy and miserable. I had missed a lot of school and I was

really nervous to go back. I didn’t want anybody to treat me different just

because I was diabetic. I had already come to the conclusion that I was

going to get a lot of questions about my new disease and I had decided to

just be patient and go with it. I had gained about 10 pounds from being in

the hospital and I was actually experiencing the feeling of being full

rather than being constantly hungry. But the number one thing that I was

most nervous about was taking a shot in front of my classmates at lunch.

I figured for the first couple weeks I would take my shot in the office or

the bathroom, but I knew the day would finally come that everyone

would see me take a shot.

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Back To Life, Back To Reality

Going home was one of the strangest feelings of my life. I

walked into my house feeling like it wasn’t my home anymore. I was so

happy to see my dog and rest in my own bed but it was weird not have a

nurse or doctor by my side constantly. After a few days spent unpacking

all my flowers, presents and balloons I finally settled down and felt

comfortable in my own home again.

I was out of the hospital for four days and at that time my

classmates were on a train headed to Seattle for the 7th grade science trip.

I was so unbelievably disappointed that I wouldn’t be attending. I had

been awaiting this trip since last year and I wasn’t going. My mom did

give me the option of going, she would come along of course, but to say

the least I was rather scared and uneasy of the thought of going on a day

trip when I had just gotten out of the hospital and had yet to take a shot

in public. So I completely psyched myself out of going and stayed home.

I really missed all my friends and classmates and I wanted badly to go

back to school. I had missed a little over two weeks and I felt like I was

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missing out on everything. My mom and I decided that I would go back

to school the following week but first we had to set up a meeting with the

school nurse. I didn’t really understand why, I thought I could just take

my shot in the bathroom or the office on my own; after all I had been

getting good at checking my blood sugar and taking a shot. But I guess

my doctor thought I was still an amateur and needed someone to make

sure I didn’t screw up.

My mom and I pulled up to school ready to meet with the nurse.

Class was in session which made me relieved because I wasn’t sure if I

really wanted to see anybody at the moment. I was nervous walking into

the school, I felt as if I hadn’t set foot through those doors in years. Once

inside we made our way to the nurses’ office where Denise, the school

nurse, sweetly welcomed us. We sat down and started talking about my

lunch plan. Denise said that I would meet her in the office, where I

would test my blood sugar, show her the number and then she would

make sure that I was taking the right amount of insulin. We also talked

about my IHP which is my very own Individual Health Plan. My IHP

allowed me to leave class whenever I needed to, have an unlimited

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amount of bathroom passes and if my blood sugar was ever too high or

low I could be excused from taking a test.

My talk with the nurse made me even more excited to come back

to school especially because I didn’t have to worry about taking my shot

in front of anybody. I was glad to have someone monitoring my blood

sugar in case I ever made a mistake and took the wrong amount of

insulin. However, there was one thing the nurse told me that I wasn’t so

ecstatic about. I had to test my blood sugar in my morning class and call

the nurse to tell her what it was. This was because I needed to be

monitoring my blood sugar every couple of hours because I was no

longer having a doctor do it for me. I really didn’t want to test my blood

sugar in front of my class mates but I guess it was one step closer to

giving a shot in front of everyone.

The night before I went back to school I was nervous but really

excited to see all my friends. My mom and I had gone out and bought me

a cute tote bag to put all my needles, testing kit and a juice since there

was no way that it could all fit in my backpack. All I could think about

was seeing everyone and how they would react. I was hoping for the best

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but expecting the worst. I didn’t want anything to be awkward going

back to school I just wanted everything to be normal the second I stepped

in those doors, like nothing ever happened. I knew that was very

unlikely.

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April 5, 2005. Sarah and I in my room, this was the start of

all my symptoms and when I was just beginning to lose weight.

Here, I am in 7th grade with Sarah, this is when all of my

symptoms were occurring at their worst.

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March 2006. Chauntee, Julie, Caitlin and I pose for a picture after our volleyball banquet. Even though I was sick I still chose to play sports. My coloring and eyes show how sick I am. I had not yet been diagnosed.

March 3, 2006. Britney, Jessica, me, Kelsey and Julie during our talent show in 7th grade, everyone could tell something was wrong due to all

the weight I had lost. My arms and legs had become so thin.

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May 6, 2006. The day after I was admitted to the hospital it was my brother’s senior prom. My brother, Wes and his prom date, Katie visit me in the hospital. I was diagnosed and admitted to St. Joseph hospital in Bellingham. There were 2 IV’s hooked up to me. My AIC test was at 17. I was lucky Dr. Michaels admitted me into the hospital after a year of being misdiagnosed.

May 28, 2006. I had been out of the hospital for a little over two

weeks.

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June 1, 2006. Three weeks after getting out of the hospital I had a dance performance at Mt. Baker Theater. I was weak but had practiced all year for the performance. My friend Jessica is in the picture.

My nurse, Tricia from St. Joseph Hosptial was at the dance recital too, she had let me tap around in her tap shoes while I was in the hospital.

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April 15, 2007. Staying healthy

and playing catch with Katie, my

brother and dog Ali.

May 3, 2007. Sarah and I at our dance recital, almost one year

after I was in the hospital.

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June 20, 2007. My mom and I at my 8th Grade Tea

February 8, 2008. A close friend (whom I trust) Andrew gives me a shot for the first time. Another friend Taylor watches.

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October 27, 2010. Here I am setting and serving the ball during a volleyball match. I have played

volleyball since the 7th grade.

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March 14, 2011 Cheering for wrestling at Squalicum High School.

I have been a varsity cheerleader for 4 years.

February 19, 2011. Sammy and I are cheering at the state

tournament for wrestling.

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Back To School Blues

My mom and I pulled up to the school ready to walk in together.

All my life my mom has worked for the school district and she has

always managed to work in the school I went to. I never really

appreciated her working in the same school that I went to; in fact I

thought it was rather annoying. When I walked in with my mom that day

I felt a sense of security and I was glad she was with me.

My friends rushed over to greet me with hugs. Right then all my

nerves went away and I knew that this day wouldn’t be so hard to get

through. Everyone kept telling my how healthy I looked and how much I

was missed. Of course as I suspected there were a lot of questions that

were being asked and I briefly told everyone what happened to me from

going into the hospital until now. I decided to try and not hide anything

and showed my friends my testing kit and insulin pen in my new bag.

They told me that my teachers had told most of my classmates that I had

diabetes but didn’t give much of an explanation as to what exactly

diabetes was. Meaning, it was my job to tell them. I did my best trying to

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explain that I had to test my blood sugar and give myself a shot before I

eat anything. Most everyone seemed to understand even though I wasn’t

even sure that I fully understood diabetes yet.

I walked into my first class and my teacher, Mrs. Everhart,

welcomed me back, and pulled me over to her desk to talk. She said that

she and all my other teachers are aware that if I need to leave the class at

any time I am permitted to go. She also told me that most of my work

would be excused and I would only have to make up a few small

assignments in all of my classes. After we talked I sat down at my desk

relieved and ready to start and try to get used to the rest of one of many

days with diabetes. But then I remembered that I had to test my blood

sugar at 9:30 and call the nurse. I was dreading this but knew I had to do

it. Mrs. Everhart already knew that I had to as well. I was hoping that the

class wouldn’t notice the loud annoying beep of my meter, but I figured

that eventually everyone would see me test my blood sugar and I might

as well get the first one over with.

I walked over to Mrs. Everharts desk, sat down and got out my

meter. I put the strip in the meter which made a loud beep. I anxiously

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looked around the room with my face feeling hot, I got a few glances but

nobody thought anything of it. I called the nurse to tell her what my

blood sugar was and then I walked over to my desk and sat back down. I

took a breath and realized that’s all I had to do; it was as easy as that.

The remainder of my morning went by pretty fast and I couldn’t

stop thinking to myself how glad I was to be back in school and seeing

all my friends. It was a strange thought for me because I disliked school

very much. I went to the rest of my classes including P.E. The nurse had

specifically instructed me to test my blood sugar before doing any

physical activity and to take a snack if it was under 200. If my blood

sugar was low meaning under 90 I couldn’t participate at all.

The school day came to a surprisingly fast end and before I knew

it, it was time to go home. I couldn’t believe how relatively easy my day

was. I thought to myself that I was finally feeling back to my normal

self, but when I started to think about the future I got scared, especially

when I thought about going to high school where I most likely wouldn’t

have a nurse to help me, or what about when I started to drive? What if I

was to go low and pass out at the wheel? I started thinking about sports

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and I wondered if I would get to keep dancing and playing volleyball?

When I started thinking about my future everything looked pretty unsure

and full of questions, but I had to tell myself that only time will tell.

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Fast Forward: This Is Me Now

It has been five years since I was wheeled through those big

sliding glass doors and that Doctor Michaels from Children’s Hospital

told me I was diabetic. Since then I have been through so many good

and… not so good experiences. After I was diagnosed I wasn’t so sure

what my future held, but I came to find that my diabetes wasn’t going to

hold me back--especially when it came to playing sports.

I started jazz at Wendy Setter Dance Studio when I was in sixth

grade. After I got diagnosed I was very unsure if I could still dance, and

even if I could, I didn’t really know if I would want to continue. I was

almost embarrassed to go back, worried I would have to test my blood

sugar in front of everyone or stop periodically for juice and snack breaks

if I became low. But after visiting my new diabetic specialist, Doctor

Mauseth, I learned that one of the best ways to manage my blood sugar

would be to get daily exercise. That’s when I knew even if I was too

embarrassed to go back, if it meant staying healthy, I was going to keep

on dancing. Thankfully even after two years of dance with diabetes, I’ve

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never had an incident where I went extremely low to the point where I

had to stop. However, playing high school volleyball was a completely

different story.

Dance class was just an hour long and only one day a week, but

playing high school volleyball three hours a day six days a week can

make a girl go low. Even now I still make sure I test and have a snack

before practicing. I also make sure I have at least three extra juices in my

bag in case I go low, which does happen to me and will most likely

happen to you too, so make sure you are prepared. It is very important to

let your coaches and even your teammates know what diabetes is and

what you have to do if you go low. There have been many times where I

have had to sit out, drink a juice and wait until my blood sugar is back up

which can take up to 20 minutes. I remember one time I had to sit out

because my blood sugar was 58 and my coach kept asking me if I was

ready to go back in after only 10 minutes, and the truth was my blood

sugar had barely gone up at all. Some people just don’t quite understand

how crappy I feel and why I need to sit and let my blood sugar go back

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up. And that is why it is extremely important to let coaches, teammates

and even teachers know what needs to happen if you’re low.

Besides having low blood sugar, having high blood sugar can be

dangerous to your health too. There have been times where my blood

sugar has been 300 before a practice. When my blood sugar is this high I

have troubles catching my breath and sometimes I just end up confused

and tired. Exercise however, is the best way that I can keep my blood

sugar at a normal level even if it means having a hard time at practice.

The worst thing you could do to make your blood sugar go down

is to take a shot without eating anything. This will make your blood

sugar go really low especially if you exercise without eating.

High school, all together, was a completely different experience

than middle school, as it is for everyone. Being back at the bottom of

the food chain and trying to find your way around a new school that is

twice the size as your old school while dealing with diabetes was hard!

When I got to high school I ditched the purse that carried my testing kit,

insulin and snacks. Mainly because Squalicum High School doesn’t have

lockers, so I knew that I would have to make room in my backpack

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which had lots of pockets to put juice in. On my very first day of ninth

grade I did meet with the school nurse. During eighth grade I became

independent and did not need to test my blood sugar in front of the nurse

anymore nor did I need to call her in the morning. But when I got to high

school I met with the school nurse just to know who she was and to get

familiar with each other if I ever had an emergency. While I was meeting

with her she told me there were two other diabetics at Squalicum and I

got to meet with one of them. It was nice to know that I wasn’t the only

one in my school who was diabetic. I was glad that I could relate to other

people and have someone to talk to.

During lunch time I am completely comfortable with taking my

blood sugar and injecting insulin whether it’s in my arm or my leg.

About two or so years ago I stopped taking shots in my stomach due to

the development of really bad scar tissue from taking my shots in almost

the same spot every time. Taking shots in my arm is much more

convenient most of the time because if I’m wearing jeans I’ll have to go

to the bathroom to take them off, and then give my self a shot. And I will

be honest; sometimes I feel lazy and don’t want to go through the trouble

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of going all the way to the bathroom to take a shot. However, taking it in

my thigh gives me a lot more space to move my shot injection around so

I don’t end up with scar tissue like I have in my stomach.

Even today I still get annoying questions like “does that hurt?”

or my all time favorite: “Can I give you your shot today?” I feel really

uncomfortable when someone who I don’t know that well asks me that,

as I’m not some toy that you can just start poking at! However, it is very

important that your family and close friends know how to give you a shot

incase of an emergency. I have let a few of my friends’ give me shots

and which makes me feel comfortable that I can count on them to know

what to do in case of an emergency. And that’s why it is so important not

to hide your disease from anyone.

I have had diabetes for almost five years now, and to be honest, I

don’t wish my life was different. I feel this is how my life is supposed to

be. I can’t imagine not having to take four shots a day or checking my

blood sugar every time I eat.

I am perfectly fine knowing my pancreas has no purpose. But

instead of hiding my non working organ, I let my friends give me shots. I

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let my family check their blood sugar, and if anyone needs to know how

many carbohydrate they’re eating, I am the first to tell them. If I could

get anything out of living with diabetes, it wouldn’t be for people to pity

me, but rather for people to know its okay to be who you are.

I am Tara Ashlee Marshall. I am funny. I am weird. And I am

kind.

I am who I am. I am a diabetic, and I am proud of it.

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Helpful Hints And Tips:

• Don’t try and hide your disease. The first step is feeling comfortable with your diabetes.

• Research Type 1 diabetes online to learn more about it.

• Always have your testing kit and insulin on you at all times. You never know when you might have an emergency.

• Test your blood sugar before you do any physical activity.

• Always have either juice, granola bars, candy or something sugary with you to bring your blood sugar back up if you go low.

• Educate your friends about your diabetes so they know what do to in case of an emergency.

• Know that you can still be active. Exercise is a great way to manage your diabetes.

• Never take a shot in the same place. Try and move around whether you’re shooting in your arm, thighs or stomach. This will avoid scar tissue from building up.

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Low Carb Food And Snacks

• Cheese

• Eggs

• Meat: fish, chicken, turkey, ham, steak

• Sugar free Jell-o

• Sugar free pudding

• Sugar free hot chocolate

• Ginger snaps

• Peanuts

• Walnuts

• Macadamia nuts

• Avocado

• ! cup of blueberries, blackberries, boysenberries (10 Cb)

• Small mandarin

• Small orange

• Tomatoes

• Asparagus

• Broccoli

• Cucumber

• Eggplant

• Peppers

• Salads (always count for dressing)

• Teas (bags, herbal) * Always check for the nutrition facts on the back of foods for the serving size and how many carbs are in one serving size.

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