This week marks 43yrs since my Dx as a T-1.  Everything works, even my eyes though I have had some eyeball struggles over the past few years. I just started having issues with retinopathy about 3yrs ago.  I learned something. Though my control has been very good nearly the entire duration of my T-1 career. I have always attempted to manage to non diabetic BG levels. This has resulted in a tendency to have relatively frequent hypoglycemic episodes.  Which results in correction. The swings are what is the major contributor to retinal hemorrhaging.  

I went on a next gen pump and CGM two years ago and I have had nearly zero hypo episodes (unless my CGM supplier screws up the delivery and I have to manually correct).   My guess is that the greater stability has improved my bleeding issue.

I empathize with the T-1s in your area. To avoid the nightmare consequences of the disease it has to be lived nearly 24/7. There really is no break.  

When I was Dx'd my engineer dad made a BG tracking and plotting spreadsheet (manual) that I used for many years to test, log, and track (graph).  I learned the management of countless variables in this disease.

The lynchpin to managing BG effectively was the advent of low carb nutrician breakthroughs.  My first retinologist recommended it to me. I had a blood clot in my L eye. His wife was completing her PhD in Nutrician and used the book as one of her research references in her Discertation.

Dr. Bernstein's Diabetes Solution, low carbohydrate diet, control blood sugars (diabetes-book.com)

I do not have any skin in the game on this book, but it is my go to for BG management, diabetes overview, and low carb life as a diabetic.   I have purchased nearly 100 copies over the years and I give them to people I meet who are newly Dx'd, or have a newly Dx'd kid, etc, etc, etc....  In a low income area there may be a charitable channel for getting copies.  I know you are in a low literacy area but having a number of copies on hand as a reference or to teach some community education sessions.

The biggest challenge, in my experience, is the changes that occur metabolically. Correction factors are not static. It takes near constant monitoriing of BG and a clear understanding of what foods impact BG. While the basics are commonly the same for everyone, the details are different for each diabetic.

For the fist time ever, I have an Endo who is a T-1.  This lady is a true Endo rockstar.

Anyway, I am fortunate in how my disease has worked out.  

Though not a low literacy area, I was Dx'd in the Middle East.  Pre personal BG tester days. I used a 10drop method urine glucose test kit with reagent tabs, etc....   When DW and I moved their for work 33-ish years later.... I ended in tehe hospital for  a spider bite that turned into cellulitis. A young Saudi female Endo came to my room to give me a diabetes management talk. She was shocked that I was 50+ had all my toes, my eyes were retinopathy free (this was nearly 10yrs ago), and that I had the level of knowledge I had. I was in the hospital for a week on IV antibiotics. She brought her young Interns in every day that entire week for Q&A on my management techniques, my history, etc... That I was Dx'd and spent my entire Christmas break from school in a hospital less than 5miles from the beautiful brand new state of the art facility I was in for the cellulitis kept my stay very busy.  

This disease is incessent.  As treatments and medical technology improves and more and more diabetics have children, we will see a higher frequency of the disease will just contiue to increase.

Tragically.

Though it was not a conscious decision for me until I was in my mid  to late d30s, I chose to not have kids in part so as to not pass this one to my kids.  My DW nearly lost her life while pregnant with SS-31 (toxemia/pre-eclampsia) and her lady bits Docs were adament that she not have more children.  We ended up not having any ours babies.  I was not willing to jeopardize her well being for a Rags spawn even before I chose to not risk propegating my disease to children.  Though she did upon occassion express interest in having more kids.

That makes sense to my engineeric brain. They are the ones with experience starting much nearer to day one of their memories. than is a person Dx'd at a much older age.  

T-2s or later onset age T-1s already have their eating habbits ingrained are extremely unlikely to do the right thing. Even those with the mental ability to know what the right thing is regarding their version of the disease.

Want and right are rarely the same thin in diabetic life.

T-1s Dx'd as children learn the disease as they learn life and everything else. When they eat a whole huge candy pile, etc...and end up with their head in a bucket they learn that when they eat carb they feel like crap.  When they easily see how great they feel when compliant to low carb Vs how they feel when they go to a friend's B-day and there is nothing to eat but pizza, cake, and standard soft drinks.

That your DIL has young onset T-1s who are engaged in their own health and actively managing their disease Vs suffering it is great.  I am glad that she has good experiences in her diabetes related patient group.  For many health care professionals focused on diabetes care of endocrinology that is a notably rarity.  

Because I am unusually knowledgeable and highly active in managing my disease and partnering with my Endo and care team my appointments always seem to be far longer than most where the Endo/etc deals with an unengaged and underknowledgeable patient or parent to a young patient.

Thank your DIL for me. 

Unmanaged the disease can be a nightmare, amputations of the extremeties, blindness, strokes, heart disease, ED (that even the little blue poll won't help), sexual complications with both men and women, extreme mood swings associated with precipitous BG swings,  significant increased risks of some cancers, extremely painful nerve degradation/neuropathy, and more...

The main cause is consistently elevated BG. Though evolving research is indicating that precipitous BG swings are nearly as causal of some issues as are consistently elevated BG.

When I see idiot parents shoveling crap foods down their kids throats (sweek breakfast cerials, pizza, fries, piles of pasta, pastries, and any vairant of the big 4 (Sugar (of any source), rice, corn, potatoes, wheat based products....) it is infuriating to me.  I also have a specific aversion to diabetic adults who scarf down coutless loads of high carb crap and play the "I just take more insulin" or "I see my GP and get a blood test once a quarter and my sugars are always fine".

Women with uncontroled diabetes  have nearly all of the same riskes that men with uncontroled diabetes and are also at massively increased risk of pregnancy related deat, complications for themselves and their unborn child, having extremely large babies at birth, etc........ 

I have mentioned Dr. Bernstein's Diabetes Solution which is my go to guide and management resource for the disease and for Low Carb and why and how it all relates.

Dr. B is an engineer. He started his career in engineering, became a medical device company executive and quit his career to go to med school when he was 42.

He was Dx'd as a T-1 at 12yrs old.  He had many of the characteristics of a T-1 diagnosed in the very early years of insulin availability.  Stunted growth, etc....   He had followed the ADA dietary guidelines  (60% of caloric intake from carbs) to a T and had degraded nerve performance, retinopathy,etc...  As an adult he got frustrated with his BG instability so he went engineer on the problem. When the first "portable" BG testers came out (the size of a briefcase) he obtained one (his wife is a Doc and had to order it for him) and started a years long engineering study on his own BG. He would test, eat, test and document the response of his BG to foods. Carbs drove rapid and extreme elevation of BG. Protein and fat, did not.  

He attempted to publish his findings. He got no interest because he was not an MD or PhD.  So, he quit his job, went home, told his DW that he started med school in a few weeks.  Throughout med school he continued his self study of BG response to foods, insulin dosing regiments, assessed tBG testing frequency to determine effective data levels for managing his disease, etc....

The day he graduated he submitted his study too NEJoM, JAMA, etc...and poof. Published and lauded as the greatest breakthrough in diabetes treatment/management since the synthisizing of insulin in the 1920s.

He is now in his mid-ish 80's and has outlived just about anyone Dx'd as a T-1 in the late 40s/early 50s.

His entire practice has been Diabetes management.

I am a strong follower of his model. As an engineer, it makes sense and I have proved it on myself.  For 43 years.... this week.

Again, please give your DIL my thanks for her work.

I hope your brother has his head in the right place in managing his disease. 

I suggest you buy him a copy of the book for Christmas.  

Dr. Bernstein's Diabetes Solution, low carbohydrate diet, control blood sugars (diabetes-book.com)

It is a treasure for understanding and managing this never ending disease.

Still Hallmarking this evening. I turn it on when DW gets home and we generally watch while eating dinner, tonight was an omelet dinner, and until we go to bed. We just started the third movie of the evening. 

What is this "secretly likes" hallmark movies? I know not of what you speak.