There are so many times over the past few decades when I get the opportunity to feel like, “boy that was a close one.” Glucose levels can be scary high or even more frighteningly low with changes in personality, agitation, confusion, and even fighting when glucose is trying to be given. (The importance of having a glucagon emergency pen at all times becomes crystal clear).   How unfair that patients with type 1 and their families and friends have to walk a tightrope that is almost impossible to do, despite everyone’s greatest efforts.

A very well educated patient of mine with type 1 for more than 30 years became hypoglycemic after a trip abroad, likely due to having to change insulin dosages to account for the time zone differences.   Despite everyone in the family knowing about diabetes, she roamed around her home with a swollen ankle. It took quite a while before someone realized that her sugars were low and she had fallen and actually broken her ankle, later requiring surgery.

I breathed a sigh of relief when she contacted me that she was now alert and oriented and in the emergency room. It’s so easy to take for granted that I have a normal pancreas even when I see patients with type 1 every day.   Then, I get back into the reality of seeing that even doing the best that I can, along with patients and their families following everything they have been taught and learned about this disease, and that simply isn’t enough when it comes to type 1 diabetes.

I am grateful for the opportunity to learn so much from patients and their families who literally live on the type 1 tightrope every day. Oftentimes, onlookers, such as teachers, friends, even physicians have no clue of how hard it is to live with the uncertainty of whether or not the glucose levels will cooperate with the insulin one calculates to take. A mom recently told me of how everyone told her how great her 13 year-old son did on their class fieldtrip. Behind the scenes, she had texted her son over a dozen times during the day’s fieldtrip.

This is Diabetes Awareness Month. My awareness is raised for how tough it is to live with this disease and how despite insulin being the difference between life and death for patients with type 1 diabetes, that life with type 1 varies from person to person, day to day, minute to minute.

I congratulate all of you with type 1 diabetes and your families for taking on one of the most challenging diseases I have ever come across. There are so many variables that can throw your glucose balance off, activity, food, stress, sleep, hormones, illness, etc.; it takes constant adjustments and readjustments, without overcompensation.

I believe even attempting to walk the type 1 tightrope deserves a standing ovation. This month, Diabetes Awareness Month, I congratulate all of you, those with diabetes, families and friends for walking this tightrope. No one knows better how to walk the type 1 tightrope than you.