Honestly, Has Treatment Advanced All That Much Since Your Diagnosis?
In 1997, the Congressionally-appointed "Diabetes Working Group" released its report, which was entitled "Conquering Diabetes: A Strategic Plan for the 21st Century" (see here for the full report), and in its assessment of type 1 diabetes treatment, the authors wrote:
"Genetic engineering of the insulin molecule and new methods of delivery have improved insulin therapy, but in essence, the treatment for Type 1 diabetes has changed little since insulin was discovered. Moreover, while treatment with insulin has prevented death from acute metabolic complications of the disease, it has not halted the devastating secondary complications of diabetes, such as blindness, kidney disease, heart disease, stroke, amputations, nerve damage, and premature death." (see page 27 of the report)
That was a shocking admission, namely that while the nation's top researchers credit themselves for improving insulin therapy slightly, they also admit that treatment has fundamentally not changed very much since the discovery of insulin. While some people cite home glucose testing, insulin pumps and some even insulin analogues as improvements, thinking about it honestly, has your life with diabetes improved dramatically in terms of the amount of time you're required to manage the disease? Has a $6,500 insulin pump completely eliminated all the imperfections of using subcutaneously injected insulin? Just remember, today, instead of blaming diabetes for most health ailments, today the patient is routinely blamed for improperly caring for his/her diabetes -- even if their health ailment has nothing to with diabetes.
Answer me honestly, is this really progress? I have to admit, if it is, progress sucks.
"Genetic engineering of the insulin molecule and new methods of delivery have improved insulin therapy, but in essence, the treatment for Type 1 diabetes has changed little since insulin was discovered. Moreover, while treatment with insulin has prevented death from acute metabolic complications of the disease, it has not halted the devastating secondary complications of diabetes, such as blindness, kidney disease, heart disease, stroke, amputations, nerve damage, and premature death." (see page 27 of the report)
That was a shocking admission, namely that while the nation's top researchers credit themselves for improving insulin therapy slightly, they also admit that treatment has fundamentally not changed very much since the discovery of insulin. While some people cite home glucose testing, insulin pumps and some even insulin analogues as improvements, thinking about it honestly, has your life with diabetes improved dramatically in terms of the amount of time you're required to manage the disease? Has a $6,500 insulin pump completely eliminated all the imperfections of using subcutaneously injected insulin? Just remember, today, instead of blaming diabetes for most health ailments, today the patient is routinely blamed for improperly caring for his/her diabetes -- even if their health ailment has nothing to with diabetes.
Answer me honestly, is this really progress? I have to admit, if it is, progress sucks.
Replies to This Discussion
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Permalink Reply by Andy Stanton on -
We've taken some baby steps along the way. My diabetes specialist is someone with diabetes himself and we were talking about the changes we've seen along the way. He started on a pump when he was in med school in the early 1980's (one of the first ones available). We were talking about how big the first glucometers were and how long they took to read your blood sample.
The treatment of diabetes is essentially the same (diet, exercise, insulin and new oral meds) but the way the treatment is delivered is drastically changing. Having a OneTouch Ultra Mini with a 5-second reading from a glucometer that is the same size of a magic marker is an improvement in my life. My insulin pump that has a 500 food/carb database that communicates to my computer wirelessly is an improvement.
When I was first diagnosed in 1985 we thought in 20 years there might be a cure. Here we are 23 years later and there is no cure in sight (besides a kidney/pancreas transplant) but I think that it is much better than it was many years ago!
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Permalink Reply by Doris Ann Dickerson on -
Honestly the discovery of insulin kept us alive to keep waging the war! The discovery of a bs machine may have just given us a little more freedom but really that's all I can think of. Oh one more thing with me pumping my insulin I can eat WHEN I WANT TO!!!!!!
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Permalink Reply by JDavid on -
In a word YES-NO...........
As a diabetic on insulin for over 26 years, a lot has changed When I first started insulin it was great jsut to feel better. Then another eyar or so things went wierd and had to go to 2 shots a day with a mix of R & N instead of one poke of NPH. It was a WILD roller coaster.I did get my insulin dose down to one mixed R+N for much of the time but had to take a second one when it zoomed up. Last year, after not doctoring or watching my BS properly I fell and tore my shoulder rotor cuff, and fir the first time in maybe a couple decades DKA...
I pulled myself out (again) but was forced to return to doctoring, walking into a new docs office barely able to walk I was so weak from the DKA. He worked on my inusulin routine and had to go to insulin shots morning noon and night, but it was a LOT better, but still on the olde spike and dive roller coaster (I hate that).
Skipping a few details surgeries etc, I went for an insulin change, yep olde stuck in ye olde ways got BOLD!
The local diabetes center did a change over to Lantus and Humalog, I wanted the humalog change after doing my own study and as long as I was getting that I went along with the Lantu, thinking oh well I had already gnoe to a seperate NOH dose later at night to level myself out a bit. No big deal...so I thought then I found out the Lantus would be 2 doses as well, half AM and half PM.........now its FIVE shots a day (or more). The endo started my Lantus dose way too high and humalog too low (carb ratio too high).
I learned from a PUMPER how to properly test and adjust BASAL and BOLUS insulin doses PROPERLY and man-o-man is it so much better.......For the FIRST TIME in nearly 30 years iI feel NORMAL BS wise........... Not more shots, still at 5+/day, but PROPER doseage FOR ME! That's the key! No more fars everytime I am a few minutes late for a meal will I go bananas or out cold.
From MY personal experience the number one problem for me was EDUCATION that doctors just do not bother teaching. They don't ahve the time, maybe not the patience or do many even REALLY KNOW what the heck they are doing, in other words do THEY understand how to balance insulin doses themselves?
Doctors tend to take the easy way out, tell you to take so many units of what and when, then you NEED to eat accordingly. Now I eat what I want (sort of, other complications limit my options) and jsut shoot up afterwards when I finish my meal. I can go 5 hrs between meals w/o taking an unexpected dive, seldom have lows and lovin it!
For the firtst time I KNOW and UNDERSTAND my insulin doses, and how to figure everything when and if I need to. I got my lantus BASAL down to a fixed 17 units AM and 17u PM, my carb ratio is 1:10 or 1u of Humalog per 10grams of carb and if I calc ti right I will be right back BS wise before my next meal, not much above or below. I also figured my correction factor at 1:25 or 1 unit of humalog lowers my BS level 25 points (almost and w/safety factor). So I can easily get back on track if I get off a bit in my questimate or have a sick day.
From THAT standpoint, there has been great progress not to leave out carb counting instead of calories that never worked. We are TOLD to check our feet and doctors are supposed to check them EVERY time we go, BUT DO THEY? The VA checked my feet ONCE in over a decade, the local diabetes center checked them ONCE in the 4 or 5 times I have bene there.....My pcp who WAS managing my diabetes never did except ONCE when I complained and he was not thrilled about doing that.
The always tell US to do thing, but the docs I ahve had seldom bother to what THEY should...........
WHY was I not tauht PROPERLY about my insuin routine, I ahh to seek the info on my own, then the DC endo says I am on the GOLD STANDARD now................(thanks after decades of roller coaster BS and several complications that no amount of PROPER control now will undo?)
(*&(* GOMER
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Permalink Reply by Ken on -
Hi Everyone, I'm new to this site but would like to respond to this question. I've been a diabetic for 29 years (April 2009 will be 30 years) and honestly, yes, I do believe we have made some progress. I agree all Type 1s have to take insulin one way or another but my parents were told that even with insulin, I would probably not see my 45th birthday. Like most people, I had ups and downs over the years and woke up in the ER a couple of times but I just turned 45 and had a huge celebration. My parents of course never told me this until about a year ago. I was lucky to have such great parents who gave up a lot in order for me to have my first pump, a MM504, back in the mid 80s.
I remember testing my urine with what seemed like a small chemistry kit. I would put urine in a small test tube and then drop a pill in it which would bubble up and then change colors. The change in colors would then tell how much sugar was in my urine. Now I can prick my finger and know within 5 secs where my blood sugar is, not how much sugar has spilled into my urine over a period of time. Also, carb counting has made life much easier than the exchange system.
For me, the small steps has allowed me to still be around and be very healthy.
Thanks
Ken
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Permalink Reply by Kelly on -
When I was diagnosed IDDM around 1980, there were pork and beef insulins. Lucky girl that I am I used to have bad reactions at the injection sites, [redness, swelling, etc.] So I am gloriously happy about the human synthetic's we have now,
But aside from that, the ONLY advancements and or improvements I've noticed in the past 27-28 years have been,
Testers: which are faster, smaller, easier to use, etc.
and
Needles have gotten thinner.
[Don't get me wrong, I am thankful for ANY advancements made that positively impact diabetics, but consider this; back then the cutting edge video game was Pong. Then look at how far videogames, graphics and gaming has come in that time span.
Suddenly the image of my first Lifescan tester along side my current fast-take tester isn't so impressive.
Is that really all they've come up with in nearly 30 years?....What about actual medical discovery's? Advancements? Breakthroughs?
SOMETHING?
ANYTHING?
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Permalink Reply by JDavid on
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REACTOINS................I became ALERGIC to boof-pork NPH. I thought I ahd steped into red ants, my leg I used for the morning shot was full of big welts, and I was feelin funny very funny. I worked in the basement (computers) at a hospital back then. Stupid me decided to drive to work, its where I belonged either way. I made it but still not quite right. I was told it was an alergic reaction was LUCKY i was not worse. (like lucky I made it to the hospital). There was no rDNA insulins back then and changed to beef NPH and pork regular and stayed with that combo w/o any more problems, and of course switched to rDNA versions after they came out.
Here a funny, living in coastal SC I needed a Rx for syringes, but for the insulin jsut for insurance.....then they started giveing out FREE syringes to drug addicts while I had to PAY for mine even when I lost my job and lived out of cars. (w/ 1 wife, 3 kids and 2 cars)
TODAY the VA is so backwards its pathetic, unless your a1c is 8.2 or above NO MDI............and if you do get the newer long & rapid insulins, if your a1c drops below 8.2 for more than ONE test, they can take it away and its back to the old spike & dive roller coaster..........go figure?
(*&(* GOMER
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Permalink Reply by Phil on -
I agree totally with Kelly. I have had this dang disease since 1972 and I have always heard a cure is just around the corner. Well after 36 years I am convinced it is a mighty big corner. Give me a break with the technologies that are coming out daily no one can do better than a pump? No way to do auto blood checks with out costly strips? It's all about the money and profit. I know I sound synical but I'd say it is more realistic.
What are we waiting for?
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Permalink Reply by Stuart on -
It is NOT progress....
The approach to this little connect the dots routine many pretend to be "control" has done ZERO to improve the quality of my life. The ~knowledge~ has made my peers and juniors hyper viligant and candidly paranoid as hell....
The end result, no tangible improvement.
Stuart (a branded "skeptic")
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Permalink Reply by Phil on
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Great post. As a Vet with 36 years experience with type 1 I'd say "WAKE UP WE NEED ACURE NOW"! I am convinced of a conspiricy for profit by the BS monitor and pump and med companies. Give me a reak I have heard a cure is almost here since being diagnosed in 1972. I m no scientist but I know many who are and wait for the 60 minuets exposure progarm as there IS a cover up for profit going on - I am convinced.
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Permalink Reply by Doris Ann Dickerson on
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I have to more than agree with that Phil! Like I said before I got diagnosed in 73 and am STILL waiting for that mirca cure! Hasn't happened yet but am hoping it will in my daughter's lifetime now she's a type 1 too!!
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Permalink Reply by Lee on -
Hi there,
Just to add my 2 cents worth.....as someone else pointed while the treatment hasn't changed, the delivery has. I am glad we have insulin pens now rather than having to draw the insulin out of the vials like we used to. I can be so much more discreet in injecting in public. That is nice I reckon.
Like many of you, I have long held the view that to come up with a 'cure' would lose the pharma industry too much money!!! Yeh, I am just feeling a tad cynical!! Take care everyone!
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