As part of its 200th anniversary celebration, today’s New England Journal of Medicine carries an article called “The Past 200 Years in Diabetes.” It describes some of the advances made in understanding and treating this disease, like the discovery of insulin and the development of personal blood-sugar monitors.
The article, by Dr. Kevin S. Polonsky of the University of Chicago, provides a good overview of the diabetes story (you can see a timeline here). But it doesn’t tell much about how living with diabetes has changed. As someone newly diagnosed with an adult-onset type 1 diabetes, I wanted to know more about that, especially for those of us who need to use insulin.
To me, living with this condition seems relatively easy. I can check my blood sugar with a quick finger prick, and almost painlessly give myself some insulin from a pen-like device. My life expectancy is pretty good (as long as I’m pretty good about taking care of myself). Fifty years ago, checking blood sugar and administering insulin were much bigger ordeals, and people with diabetes weren’t expected to live more than a few years after their diagnoses.
For a peek at how life with diabetes has changed, I spoke with Dr. M. Donna Younger, who has worked at the Joslin Clinic (now the Joslin Diabetes Center) for more than 50 years.
“When I started in 1959, we had no way to quickly determine if someone was in a diabetic coma because their blood sugar was too high or too low,” said Dr. Younger, who is also an assistant clinical professor of medicine at Harvard Medical School. “On a good day, the lab could give us a blood sugar measurement in two hours.” That information is essential for treatment. A person with high blood sugar (hyperglycemia) needs insulin, while someone with low blood sugar (hypoglycemia) needs glucose, and needs it fast.
Checking your own blood sugars in those days was not an option. The only way to get some idea about blood sugar control was by testing urine. And that required boiling a few drops of urine with a dye called Benedict’s solution, letting the mixture cool, then looking at the color, which could range from blue (little or no sugar) through brick red (a lot of sugar). Next came paper strips that changed color based on sugar concentration in the urine—a very crude stand-in for blood sugar levels.
Administering insulin was no walk in the park either. It had to be given via a reusable syringe and good-sized needle. Between uses, the syringe had to be boiled and the needle soaked in alcohol, to keep them as germ-free as possible. Because needles dull with use, people often spent hours sharpening theirs on a whetstone. What’s more, it was difficult to calibrate the daily insulin dose.
As a result, many people with diabetes had a difficult time controlling their blood sugar. And that led to diabetes-related complications like blindness, and problems with blood vessels and nerves. “I was saddened by how many people with diabetes were missing feet or legs, or using seeing-eye dogs,” Dr. Younger recalled.
The advent of devices that can instantly measure blood sugar and the development of different types of insulin have made it possible to control blood sugar much more carefully. At the same time, advances in protecting and treating the heart, eyes, kidneys, and limbs have helped reduce complications from diabetes.
Several of Dr. Younger’s patients have lived more than 50 years after having been diagnosed with diabetes. Many other long-term survivors are part of a study aimed at unlocking the mysteries of type 1 diabetes.
A long way to go
One thing that surprises Dr. Younger is that researchers haven’t yet figured out how the islet cells in the pancreas instantly respond to food, stress, and other factors that affect blood sugar. “I thought by now we would have an artificial way to mimic what those amazing cells do,” said Dr. Younger. Meters that continually monitor blood sugar coupled with pumps that can automatically deliver insulin are a step forward, but they are sluggish in comparison with what the body does. “There’s no way they can keep up with pie and ice cream.”
Another surprise is the rapid increase in type 2 diabetes. As Dr. Polonsky writes in the anniversary article in the New England Journal of Medicine, “we are arguably worse off than we were in 1812.” In 1960, under 2 million Americans had diabetes. Since then, there has been an explosion in the number of people with type 2 diabetes. If current trends continue, the Centers for Disease control and Prevention estimate that 1 in 3 American adults will have diabetes (95% of them with type 2 diabetes) by 2050.
For the Journal’s 300th anniversary, I hope that a reviewer will be able to look back and applaud how doctors, researchers, public health specialists, and the rest of us helped halt this looming epidemic and further improved daily life for people with diabetes.