Amelia Lily, the 16-year-old Lady Gaga fan who performs on the British television talent show X-Factor, seems bound for stardom. She recently gave a performance of Janis Joplin’s Piece of My Heart which had one judge saying, “That was amazing. You blew up the stage.” The judge added, “People work their whole lives and take forever to get to the level that you are at now, you’ve come on that stage so much older than your years.” X Factor is a singing talent show created by Simon Cowell, who also created American Idol.

Few of her fans know, however, that Lily suffers from Type 1 diabetes and was diagnosed with the disease when she only three years old. Now 16, Lily gives herself insulin injections four times a day. Lily’s greatest fear is that her diabetes could affect her while she’s performing: “I have to monitor my blood constantly. It is hard and singing is tiring.” She’s determined not to let the disease affect her career, however: “But I’ve got it, so I’ve just got to deal with it.” She uses carbohydrate-rich foods to ensure that her blood glucose levels don’t drop too severely when she’s performing: “I make sure I have carbohydrates and bananas so my blood sugar is a bit higher than normal because singing uses a lot of energy.” Lily is from Middlesbrough, a large town of about 139,000 in North East England.

Type 1 diabetes is a chronic form of the disease, commonly diagnosed in early childhood or adolescence. In Type 1 diabetics, the immune system attacks the beta cells of the pancreas, which are responsible for producing insulin that transports glucose into cells to be used as energy. When the beta cells die and stop producing insulin, the glucose remains in the bloodstream and the body is unable to use it as energy; this causes the symptoms related to Type 1 diabetes, fatigue, including reduced vision, increased hunger and thirst, and increased urination frequency.

Those living with Type 1 diabetes must use supplementary insulin since their bodies do not produce it on their own, and insulin is necessary for sugar to leave the bloodstream and to be used for energy by cells. Most Type 1 diabetics give themselves insulin injections throughout the day while others use a pump that monitors blood glucose levels and continuously delivers insulin when it is needed. Most Type 1 diabetics take one to four insulin shots every day.

Additionally, people with diabetes must monitor their blood glucose levels to ensure that they do not enter dangerous territory. Blood glucose testing is usually done by pricking one’s finger with a needle called a lancet to produce a small amount of blood that is tested for glucose content. It typically takes less than a minute to receive the results of test. In addition to checking their blood sugar regularly, diabetics must take care when eating and exercising; those activities should be performed at about the same times every day to ensure that blood sugar does not rise or fall too significantly.

Living with diabetes can cause a wide range of complications, from loss of eyesight to cardiovascular disease to nerve damage and amputation of limbs. It is estimated that 5-10% of all diabetes cases are Type 1 diabetes, accounting for about 11 to 22 million people around the world. The rate of Type 1 diabetes has been increasing by about 3% per year.