I’ve been thinking lately about the unique challenges of type 1 in a very young child. I like lists, so I made one:

1. When your child weighs 20 pounds (weight of Hazel at dx), there’s really no such thing as a free snack. For bigger people living with T1D, they can eat a few grams of carbs without much consequence. When you are tiny every gram matters.

2. Toddlers fall asleep at inopportune times—like after you dose them for the ice cream they wanted but before they eat it.

3. Potty training brings all sorts of hazards. Once Hazel fell in a toilet in an Airbnb. Her pump was in a belt around her waist and got soaked. Luckily it was fine (and so was Hazel), but none of the books I read prepared me for how to clean toilet water off of a pump. (We used a lot of alcohol swabs.)

4. Growth hormones pop up all the time out of the blue and wreak havoc on blood glucose levels.

5. Toddlers generally can’t count. Hazel has been able to recite numbers in order for a long time, but she doesn’t have the ability to count items yet. So when I found her with a package of candy delightfully eating it, she couldn’t tell me how many she had eaten. She did tell me multiple times how delicious it was.

6. Breastfeeding. Hazel was still nursing when she was diagnosed. It is very difficult to carb count breast milk. We figured it out, but it was a challenge.

7. Everything is made for bigger people. The devices are huge on tiny bodies. The belts to hold the devices are huge.

8. Hazel uses diluted insulin. This means we get the insulin and the diluent from the pharmacy and we mix it ourselves. Small size means small insulin needs.

9. Everything has a name and a personality. Sometimes it’s hard to keep all their genders and personalities straight. There’s Pumpy, Dexy, Dexy Phone, and Riley. Their genders change regularly and Hazel gets annoyed when I don’t get it right (“No! Pumpy’s a girl!”)

10. Alarms can scare small people. When we first got Dexy, the loud jolting alarm startled her more than once. Finally I told her that the alarm was Dexy’s way of telling her she needed a snack (we only had low alarms set at the time). Now Dexy snacks are just part of her life.