Exactly 50 years ago, I was diagnosed with Type 1 diabetes. My “diaversary” doesn’t trigger self-pity; rather, it fills me with gratitude. That’s because we’ve come a very long way in how diabetes is managed…
Exactly 50 years ago, I was diagnosed with Type 1 diabetes. My “diaversary” doesn’t trigger self-pity; rather, it fills me with gratitude. That’s because we’ve come a very long way in how diabetes is managed since the day I was diagnosed, and an even longer way since the 50 years before that, when World War I stalled diabetes research at a crucial juncture.
Back then, 100 years ago, scientists knew that diabetes was related to the metabolism of “sugar,” but even the best “treatments” (starvation diets) only extended life for a few months. Fast-forward to today, and advances in understanding, treating and managing diabetes have not only made diabetes a survivable illness, but also one my patients, followers and I have learned to live with happily and healthfully. Here are 10 milestones in diabetes research and management I’ll be celebrating this National Diabetes Month:
1. Insulin Treatment
Insulin is what makes diabetes survivable. Between 1920 and 1922, researchers at the University of Toronto isolated the hormone insulin and developed methods to purify it from cattle pancreatic extracts. They then tested the injection on themselves, treated their first patient with “spectacular” success and essentially transferred the manufacturing technology to Eli Lilly and Company. By 1923, insulin was, by and large, available in sufficient quantities to treat people with Type 1 diabetes.
Over the years, drug manufacturers have steadily improved insulin. Initially, they focused on improving the quality of insulin isolated from animal sources, but eventually they modified the hormone’s strength and peak activity time frame so that long-acting insulin formulations (or those that act over periods of 24 hours or more) more closely mimicked natural background levels of insulin in people without diabetes. In 1982, the Food and Drug Administration approved the first synthetic human insulin derived from genetically altered bacteria. Known as Humulin, the substance reduced allergic reactions and other side effects of insulin derived from cattle and pigs.
3. Meal Planning
Eating with diabetes used to be riddled with restrictions and lists of what not to eat. Today, however, the food options for people with diabetes only continue to expand, and books and programs on how to manage diabetes through meal planning abound. I love the American Diabetes Association and U.S. Public Health Service’s exchange system for its solid foundation in eating a variety of healthy foods, as well as carbohydrate counting for its accessibility as a diabetes meal planning tool.
Speaking of expanding food choices with fewer restrictions, low-calorie sweeteners (sometimes called artificial sweeteners or sugar substitutes) have allowed me and others with diabetes to enjoy “normal” portions of sweet foods and drinks (and even baked goods!) without rising blood sugar levels. Managing diabetes effectively is demanding and intrusive in nearly every aspect of your life — anything that brings normalcy without compromising health is important and enthusiastically welcomed.
5. Foundational Research Trials
The Diabetes Control and Complications Trial, which was conducted from 1982 to 1993, and the Diabetes Prevention Program, which is ongoing, are long-term, well-designed clinical trials that revealed, respectively, that blood glucose control can reduce the risk of complications from Type 1 diabetes and lifestyle choices (diet and exercise) can delay the development and progression of Type 2 diabetes. The results from both trials defined a path for long-term health in spite of diabetes.
6.Access to Fitness
The most serious complications of diabetes are related to an increased risk for heart disease. Regular physical activity not only reduces risks for heart disease, but also improves blood sugar control. Having spent the great majority of my 50 years with diabetes in the Chicago area, my treadmill has allowed me to get regular aerobic activity in the most convenient way possible without freezing. Other people with (and without!) diabetes are benefiting from fitness apps, YouTube channels and other programs that can help keep them in shape, even without a gym membership.
For me, the development of medications like statins (which control cholesterol and triglycerides) and ACE inhibitors (which control blood pressure) have provided a margin of safety against diabetes eye, heart and kidney complications. I simply take a small dose of each for prevention, in addition to my diet and exercise habits. For my patients with Type 2 diabetes, non-insulin medications have helped control blood glucose levels in a variety of different ways.
8. Blood Glucose Meters
Prior to sometime in the early 1980s, it was not possible for me to get an accurate blood glucose level at home, or in “real time” for that matter. It was only possible to know if blood glucose levels were so high you were shedding sugar in urine. Now, blood glucose meters make it possible to know blood glucose levels accurately in a few seconds at home (or anywhere), and with very little discomfort. Blood glucose meters made it possible to know how to treat high blood sugar with insulin or low blood sugar with food. And, meters make it possible to match insulin with food.
Insulin pumps not only make diabetes management easier, but also more effective. In the 1990s, I typically took five insulin injections each day — now I have one puncture every three days when I change the location of my insulin pump infusion set. More importantly, like people without diabetes, I receive a constant rate of insulin, which is called a basal rate, and I can respond to high blood glucose levels or a between-meal snack with the push of a button.
10.Continuous Glucose Monitors
Some years ago, continuous glucose monitors allowed doctors to download a graph of patients’ blood glucose fluctuations, measured every few minutes, over the course of several days. Today, I wear a CGM the size of a quarter which can display my blood glucose level via a Bluetooth connection anytime I ask for it over a 10-day period. Applying a 10-day CGM with a little poke on the back of my arm replaces as many as 100 finger sticks I used to do with a typical blood glucose meter. Already products are coordinating CGMs with insulin pumps, adjusting basal rates automatically.
I suppose I would prefer not having diabetes, but I have benefited greatly from the experience. I’ve learned to be self-sufficient, and to solve problems. It’s possible that without diabetes, which either inspires or frightens me into good habits, I would be less healthy than I am now. I’m proud to have helped countless patients as a registered dietitian nutritionist and certified diabetes educator, and to have helped even more I’ve never met with a book, website and pieces like this. Happy “diaversary” to me, and cheers to 100 more years of advancements in diabetes management.