This year, November is extra special for me in my annual recognition of National Diabetes Month and celebration of World Diabetes Day on November 14th. November 2018 marks my 50-year “Diaversary”—50 years since being diagnosed with type 1 diabetes. At the time of my diagnosis, my family and I were in shock and scared of the unknown. So, after 50 years of managing this chronic condition I feel there is a cause for celebration – a time to “stop and smell the roses.” What roses? I mean all the changes over the past five decades that have made controlling diabetes more effective and, nearly as important, easier. And to celebrate five decades, here are my choices for the top five advances in diabetes management since 1968.
The introduction of “carbohydrate counting” for blood sugar management has been an effective tool for people with diabetes. For the majority of my life with diabetes I followed a “Diabetes Exchange” meal planning strategy, where foods were divided into six food groups – starches, fruits, milk, meat and meat substitutes, fats and sweets plus a “free food” list. Diabetes is a family affair since lifestyle is a major component of management, and my family basically followed the same type of meal plan (although I don’t recall anyone else using the food scale to weigh portions). I’m glad I learned exchanges, but carbohydrate counting has added more flexibility in food choices and been a better tool for matching insulin doses to carbohydrate intake.
I can’t leave food choices without mentioning low calorie sweeteners like sucralose as an advancement in diabetes management. This advancement includes over 100 studies conducted over 20 years on safety of this sweetening ingredient. In a previous blog entitled, “Being More Normal – How Healthy Eating With Diabetes Has Evolved,” I discuss this in depth. But, having mentioned the Diabetes Exchange List earlier, I can illustrate my appreciation for sucralose, the no-calorie sweetening ingredient in SPLENDA® Brand Sweetener, by consulting the list and finding the “modest” portion sizes for banana nut bread as ½ ounce, lemonade as ¼ cup, and pumpkin pie as one-twelfth of a pie. Reducing the sugar and calories in these desserts and sweet drinks with low calorie sweeteners makes a significant difference in my enjoyment of sweets.
Insulin is essential for people with type 1 diabetes. Fortunately for me, insulin treatment for type 1 diabetes commenced in the mid-1920’s. In my fifty-year life with diabetes, it is not so much the discovery of insulin I have experienced, but rather the improvement of insulin. At my diagnosis, insulin was “animal derived” – isolated from the pancreas of pigs and cows. Animal derived insulin caused allergic reactions in some people, and for me tended to irritate injection sites. Now, synthetic human insulin is available, manufactured by bacteria or yeast that have had the genetic “assembly instructions” spliced into their DNA (recombinant DNA).
Insulin has also been modified over the years to create different formulations having different profiles in the strength and timing of their effectiveness in reducing blood sugar levels. “Rapid acting” insulin takes effect very quickly (5-15 minutes), profoundly increases insulin levels in the bloodstream, and its action dissipates within a few hours. The action of “long acting” insulins, on the other hand, are very modest (2-4 hours), but persist for 24 hours or longer. Long-acting insulin improved insulin therapy by acting as a “basal rate” similar to natural human metabolism. Overall, improvements in insulin therapy helped people with both type 1 and type 2 diabetes manage blood glucose levels.
I’ve always be unsure about calling insulin a “medication” since it is the same hormone I used to produce naturally. But, my long-term health with diabetes has likely benefited from medications effective in preventing heart disease (statins) and kidney disease/ eye complications (lisinopril), all conditions for which diabetes increases the risk substantially. And, people with type 2 diabetes have a range of oral and injectable non-insulin medications that help control blood sugar levels without the risk (in most cases) for hypoglycemia (low blood sugar levels) associated with insulin.
Just as technology was booming with electronic games, cell phones, the internet and improved digital TV’s, technology was also booming in the diabetes world. From my diagnosis until sometime in the 1980’s, I checked my blood glucose level by checking for excess sugar in urine, only detectable, by the way, when the level is too high. Now I work with patients whose blood glucose results are automatically uploaded to “the cloud” and will send me a text if the level is too low or too high. I now wear on my arm a “continuous glucose monitor” (CGM) the size of a quarter that can give me my level in 2 seconds. The ten-day active period for my CGM spares me as many as 100 finger sticks. I also wear an insulin pump that saves me 15 insulin injections over its three-day active span, and, more importantly, allows me to regulate my blood glucose levels much more accurately.
As the years have progressed, there has also been a huge increase in the availability of professional and peer support, and education. Certified Diabetes Educators (CDE), first credentialed in 1986, can train people to manage diabetes and help them with problem solving their diabetes. There are great resources available online, including peer support “communities.” The growth in diabetes support has allowed me not only to have a path to seek support myself, but also to provide support to others through my website, other media outlets, and as a CDE coach.
I know this may sound odd, but I’m thankful for all the challenges of living with diabetes. Those challenges have also brought opportunities to my life. Living with diabetes has taught me to be independent, a problem solver, a creative thinker and overall healthier by following a healthy eating plan and getting daily exercise starting early in life. And, it’s given me the opportunity to share what I’ve learned with others. Here’s to the next 50 years!
This blog post is sponsored by SPLENDA® Brand Sweetener. All thoughts and opinions are my own.
Cheryl Barthelman says
Toby, this is awesome! Happy Diaversary!