It's a good thing Ellie Shelton likes math, because to eat a meal or snack she has to figure out ratios and then add and divide quickly in her head.
The Herndon fourth-grader was diagnosed with Type 1 diabetes two years ago at age 7. Having this disease means her body can't make insulin properly. Insulin is a hormone that controls the amount of sugar in the blood, which is what gives a person energy.
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It's not known for certain what causes diabetes. To treat it, diabetics such as Ellie get insulin shots every day and must be careful to get their blood sugar level just right. Too high, and over time they could get heart or kidney problems or go blind. Too low, and they could be cranky or pass out.
Ellie gives herself five shots most days, each time doing the math to get the amount of insulin right: What's her blood sugar level right now? Will she be having pizza? Better add more insulin. Is there swim practice? Then she might need less.
After all that, sticking a quarter-inch-long needle into her skin is a breeze. "It doesn't really hurt. I'm just used to it," she says.
Ellie's mother, Lani, says Ellie "cried and said she hated diabetes" at first. But now, much like practicing the violin, she accepts diabetes as part of life.
Fern Shen spent a day with Ellie to see how she does it.
6:50 a.m. -- Still in her PJs, Ellie tests her blood by sticking her finger into a small glucose meter. (Glucose is the main kind of sugar in food.) A needle pricks a drop of blood, which Ellie smears on a strip of paper for the meter to read. The number 175 -- Ellie's current blood sugar level -- pops up. Normal for her is 80 to 150.
Now she must figure out how much insulin to take, using a ratio that changes with each meal. Her breakfast ratio is 1:12 (one unit of insulin for every 12 grams of sugar-rich carbohydrates she eats). Her standard breakfast -- a cup of cereal and milk -- has 60 grams of carbs, which requires five units of insulin (60 divided by 12). But since Ellie's blood sugar level is high this morning, she needs extra insulin -- 5 1/2 units, she figures. Using what looks like a fat plastic pen, she plunges the needle into her right upper arm.
"You should have done a belly shot!" her dad says, teasing yet serious. If Ellie always gave herself shots in the same spot, she might damage muscles.
"I hate belly shots," Ellie says, grinning. "They always hurt."
She eats and heads for the bus.
11:55 a.m. -- Before lunch, Ellie always stops at the nurse's office. Today her blood sugar level is low (69) so she grabs a juice box. (She always keeps candy and fruit juice handy.)
More math: Her lunch ratio is 1:7 (one unit of insulin per seven grams of carbs). Her standard lunch has 60 grams of carbs. Since her blood sugar is low, she takes less insulin, shooting seven units into her right hip. Then it's off to the cafeteria.
1:30 p.m. -- School is out early, and Ellie wants a cookie (15 grams of carbs). Her blood sugar level is 203, but she eats the cookie anyway and gives herself a shot.
"People always think you can't have candy or sweet stuff if you have diabetes, but you can if you do it right," she says. Ellie knows the carb count for lots of treats: a cupcake is 45, a Dairy Queen Blizzard with Oreos is 83.
Still, having to give herself an extra shot makes her think before snacking. Before diabetes, "I was into junk" food, she says; now a safe snack is string cheese or lunchmeat.
5 p.m. -- At Girl Scouts, Ellie and the others drink sparkling cider and snack on low-carb cheese cubes and popcorn.
6 p.m. -- Swim practice. Ellie is delighted with her 500-meter freestyle time. "I did 3:32, Mom! I improved by seven seconds!"
7:30 p.m. -- Ellie's blood sugar level is low, so her pre-dinner insulin is also low.
9 p.m. -- Right before bed, Ellie tests one last time today, then gives herself an injection of special insulin. It will last through the night.