When a child is diagnosed with juvenile diabetes, also known as Type 1 diabetes, the most serious form of the disease, routines and priorities change.
"From that moment on," said Ellen Gould, "it's part of every day." Gould, the mother of three children with juvenile diabetes, and her husband, Dave, said they were stunned when their first child was diagnosed with the disease.
"When Patrick was diagnosed, there was a real grieving period, a mourning period for us," said Dave Gould. "No child should ever have to live with this disease. It's an awful disease."
But the Goulds are past mourning now. The challenges are too real, and the need to keep up with all the tests, measurements and injections just too important to worry about feeling sorry about it, they said.
Patrick is 15. His brother Sam is 12. Their sister Sarah is 8. Every day, they each roll out the tiny packs they carry with them everywhere: needle sticks, blood sugar meters and injectable insulin. Their other siblings, who don't have diabetes, know the routine well and help their siblings prepare the shots and squeeze the blood and read the levels.
"What arm do you want to do?" Andrew asked his brother Sam.
Sam can't decide. They laugh. Finally, it's the left arm. They both count "Five seconds, one, two, three" as the insulin was delivered. Andrew spun around to play with his little sister, and Sam packed up his insulin needle.
To the outsider, it's not obvious that this is a family dealing with a life-threatening illness. The children play school sports, go on outings with friends, do chores and horseplay with the easy banter of siblings. And the family expresses hope.
"Great hope," said Ellen, looking toward her husband.
"Oh, yeah," he said. "I'm thoroughly convinced they will not have to live with this for the rest of their lives."
Medical science is moving so quickly and research advancing so rapidly, that Dave Gould believes there is strong reason to hope.
The Goulds are particularly optimistic about a groundbreaking national research study now under way that's focused on trying to stop Type 1 diabetes from developing in children. Children under the age of 5 are the group developing the disease the most rapidly.
"Every year, 13,000 new cases are diagnosed in the pediatric age group," said Dr. William Russell, director of pediatric endocrinology at Vanderbilt University. Russell and his staff are working with fellow researchers around the country on the project, which is known as the oral insulin study.
"We're using orally administered insulin to try to prevent the onset of diabetes in someone who is at high risk," Russell explained.
What they have found, through previous studies in mice, is that -- for reasons that have yet to be fully understood -- insulin taken in by the digestive tract seems to send out signals to the body that insulin is OK.
In a healthy body, that's not a concern, because insulin-producing cells are an important part of the mix, working in synch to regulate sugar in the blood.
But in a body with Type 1 diabetes, the immune system goes haywire, treating insulin-producing cells as invaders, attacking and destroying them. Without those insulin producers, the body has no way to keep sugar in the blood at a healthy level. It can become life-threatening.