Diabetes: steps forward, falling behind


Former Executive Editor, Harvard Health

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.

Difficult times

“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.


  1. Ilmu Kimia

    Diabetes is one of dangerous disease in my country, Indonesia. Indonesia is the 5th country with largest number of diabetes.

    Ilmu Kimia

  2. Scoliosis treatment

    I really excited to know ! what peoples thinks about Diabetes. They need to know more about this. Great post. Please post some more about Scoliosis treatment.

  3. Kimm

    Helpful health information for us. I think diabetes is hard category.

    Thanks and good luck,

  4. Chris Gaza

    Wish it could be that easy for diabetes patients in africa

  5. kangdamar

    thanks for info. my father have diabetes. i need this info

  6. Dr Kevin

    Very very good post about Diabetes. Is there information about Scoliosis treatment??

  7. Adam Williams

    This is great information, I have diabetes!

  8. miftah

    Diabetes is horrible. For patients with diabetes, keep the spirit, do not stress and eating healthy foods

  9. Thomas Hardaway

    I Love your site. it is very informational and education. i love the various links. i am a former diabetic and love related topics.

  10. gungho

    thank you for the wonderful info about how to prevent diabetes

  11. BD Dale

    My doctor said I am a pre-diabetic – is there such a thing? Was he just being nice?

  12. Mary44

    Thanks, Skerrett. I am a history buff. I have accessed the article and have bought 24 hour access to it and the accompanying slides. I like to use the historical perspective for certain groups of individuals, I like to use a historical perspective approach as a means of encouragement for people with diabetes and the nurses who care for them…to show how far we have come with diagnosis, therapies and tools to assist in self management.

  13. Greg

    Living with Diabetes is surely not as “easy” for the guy who writes the articles at http://losethelovehandles.net

  14. Wendy

    My husband was diagnosed with type 1 diabetes when he was 6. He’s now 64, and has seen all the changes in testing, etc. and loves them. The biggest improvement in our lives came with the diabetes pump which allows us to eat meals on a flexible schedule and a blood sugar meter which allows the meter to nag him that his blood sugar is out of whack, rather than me.

    As you can imagine, there have been spectactular disasters, but nothing ending in death or permanent injury, other than perhaps to the marriage.

    Best wishes to all you with type 1 diabetes (and 2, also) and to their significant others.

    • henny81

      Marriage will not be destroyed because of diabetes. My Parents-in-law have diabetes, and their marriage was not swayed by the diabetes. But with diabetes, they are getting much closer to each other and together do a therapy and treatment for diabetes. Be Strong in Love and faith.

  15. smithmarlon95

    You will find a diabetic person in every second house. Even my mother is also a type 2 diabetic for the past 10 years and now using insulin. It is quite difficult to live with the disease but if you maintain a healthy lifestyle then you can easily control the disease. Have a diet plan, do exercise and have regular check up but the most important is be happy and remain stress free.

  16. Maddy

    I would just like to say that I have absolutely no problem with your comment about Type 1 being “easy,” despite what everyone else seems to be arguing. All these people who have disagreed with you seem to have neglected to notice that you described it as RELATIVELY easy, for YOU. Not for ALL diabetics. And I think that personal accounts of chronic illnesses hold a lot of weight, especially if they’re not ones that make the disease seem more extreme than it is.
    It also looks like those who say you’re being “relative” are the same people who say, “diabetes is hard” – is that not just as relative? In my opinion, the acceptance of one’s condition as being manageable (especially when compared to the hundreds of diseases that aren’t) shows more strength than does giving a personal account of just how hard diabetes is, because it demonstrates the ability to look at the situation at hand with an all-encompassing perspective rather than a purely individual one.
    I am 18 years old and have had Type 1 since age five, and personally, I believe that we should all be able to express our own experience with diabetes without being back-stabbed by others who share the disease but who don’t share the same opinion about its difficulty. In fact, why is there the need to categorize its difficulty at all? It’s not going to make it any easier, and it surely doesn’t help others understand our plight because everything is relative.
    When I read that a fellow diabetic has learned to control his condition with ease, it makes me overjoyed, not angry. It’s a reminder of how far we have come, and the fact that we’re alive today and able to afford the medicine that keeps us that way.
    Thank you for your article, and I hope you remain successful in your diabetes control!
    Best wishes,

    Maddy K.

  17. Nancy

    Easy? I extend an invitation to vist for a few days with my family which includes a 13yo type one diabetic dealing daily with growth hormones and puberty. We live a daily struggle. There is nothing easy about type 1. The emotional, physical and financial toll is very high. If you were trying to make the point that blood glucose testing and insulin delivery technologies have improved since 1959 I would have to agree. But that in no way makes life with diabetes easy; it simply makes testing a bit more convenient. Poorly done.

  18. dagosearch

    thank you, it is great information for health education.

  19. Natalie ._c-

    If you are newly diagnosed as an adult, I’m not surprised that it is relatively easy for you. Adult onset (which is what I have) often means a far slower deterioration of the beta cells, and gives you a longer “honeymoon” period. In the beginning, it IS fairly easy, but just wait. See what happens 5 or 10 years from now, when it will become NOT so easy. I could almost say downright hard.

    And I do understand the objections of the parents of diabetic children and those of grown-ups diagnosed as children. For them, it has NEVER been easy. They probably feel VERY invalidated by your remark, even though you might not have intended it to be so.

    Meanwhile, enjoy the honeymoon, because it WON’T last! 🙂

  20. Candace

    Type 1 diabetes is far from easy. You were diagnosed as an adult male (as was my husband) which means your hormone levels are rather stable. My husband was diagnosed at the age of 25 and made it almost 9 months with very minimal insulin. Then his c-peptide dropped to below detectable levels. Once your pancreas gives up, you will understand. Our 7 year old daughter is also a type 1 and she is MUCH more difficult to regulate. Most parents know their child is growing when their jeans become to short. I know when her blood sugars suddenly spike up to 400 and I feel like I’m drowning her in insulin with no change. Her last A1C was 6.8% and I worked my butt off for it. I am the mother of two other children as well (boys, ages 5 and 20 months) and I rarely sleep more than 2-3 hours at a time, because our daughter requires being checked every 2-3 hours both day AND night. The closest thing I can compare it to is having a newborn for YEARS: currently 2 years and counting. I’m very sleep deprived, but she is worth every bit of it. We spend well over 20% of our income on medical expenses and that is despite having great insurance. My husband and I also haven’t had a date in almost 6 months. But the worst part, is putting her through all the needles. I don’t know if you have kids, but when she was first diagnosed (at age 4), it was 6+ finger pokes and 4+ shots a day. Now she has a pump and although the finger pokes still occur, we’re down to 3 infusion sets a week (28 gage needle) and 3 CGM sensors a week (22 gage needle – large enough that it requires numbing cream). If you have kids, you should try simply telling one of them you’re going to give them even 1 shot a day. See what they say. My little girl cries every single time she gets a CGM sensor. Every. Single. Time. It absolutely tears me apart inside. But I have to put her through it all just to keep her alive. It’s a very cruel joke. What’s her biggest fear? That one of her little brothers will be diagnosed and have to go through what she does. See, as a father, your kids have approximently a 10% chance of getting type 1 diabetes as well. Their odds are acutally lower if their mom (instead of their dad) is the diabetic. So yeah, compared to 50 years ago, we’ve come a long way. But that doesn’t mean it’s easy. Please don’t dismiss what we go through because you just don’t understand. I doubt you’d think it was such a walk in the park if it was your kid.

  21. Michelle


  22. Michelle

    I am absolutely livid that this person has published such a painfully inaccurate representation of this all-encompassing and most DIFFICULT disease. Perhaps it is because he’s newly diagnosed…. I’d like to see what he has to say in a few years.

  23. Michelle

    “Easy”? Come talk to us in another five years.

  24. Lori

    Only because you are newly diagnosed do I forgive you for this article and saying that having Type 1 is relatively easy. Your ignorance is only excused by being new to this.

  25. Mary Collins

    To the author: The fact you’re newly dx’d as an adult w/T1 excuses your comment. Yes, compared to decades ago, there are better management tools. But give it a few years and revisit how ‘easy’ it is.

  26. elizabeth

    Not by Choice. The Hard Way.
    Diabetes is easy? Or do patients make the difficulty seem easy with confidence and moxie? Popping an aspirin for a headache is easy. Diabetes is not easy – it’s solidly in the hard category.

  27. Willem

    I have been looking for some information like this for some time, thank you for your informative website.

  28. antiaging

    thank you for all of this great information. I realized then how important prepardness and planning are. Think about it.

  29. Matt

    Hi PJ-

    I also agree with Elizabeth’s comments above. I am glad that you as a newly diagnosed Type 1 are finding your diabetes easy to control. However, I was diagnosed over 30 years ago, and while technology improvements have made diabetes easier to control, it is still time consuming, frustrating and stressful. I am disappointed that your article suggests that diabetes is easy to live with; it’s not.

  30. Elizabeth

    Hi PJ, I was diagnosed with T1 38 years ago (I am 47) and complication free although with a large dose of discipline and hard work/sacrifice. Your comment “living with this condition seems fairly easy” is fairly inaccurate. As a type 1 diagnosed as adult, you do realize there is a pretty good chance your pancreas still produces insulin – right? That’s a real game changer, you know. I think my point is this… there is such a huge range in the category of DIABETES with different patient profiles and outcomes that it is unwise (and a disservice to the need for research and better care) to make blanket statements that diabetes is merely an inconvenience. While T1 diabetes is fairly easy for you, T1 diabetes may not be easy for millions of patients diagnosed much earlier in their life than you. And we’re not even discussing Type 2 which is an entirely different condition with even more risks for suffering/early death.
    Best regards Elizabeth

  31. bobbybeasley

    Thanks a lot for sharing this information with us all, it has really helped me that’s for sure…..

  32. Larry Covington

    I was diagnosed with diabetes in 2001. But it wasn’t until I was told by my VA doctor that amputation of my swelling feet was ‘just something I had to expect’ that I finally started to fight. With a list of supplements I got from a self help publication I removed the swelling from my feet and reduced the amount of insulin I use daily, by half.
    I know you all are experts, but you don’t know or refuse to help people. I recorded my results on my blog, easistever.com
    I didn’t cure as I had hoped but I did remove the blocks on cell wall receptors and reduced my intake of Lantus by 45% and my Novolog intake is now less than 20% of what it was before I began this fight. My eye sight as well as skin and feet are all returning to full health.
    I continue to search, Larry Covington

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