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 Scott E on -
Yes, it's progressed. Not in WHAT we treat with (it's still insulin in one form or another), but HOW we gauge and adjust that treatment.
Treatment was much easier back then. Two or three urine tests a day (no blood glucose tests yet), one injection (regular + NPH per day, an easy-to-understand exchange diet (dinner is 3 breads, 2 meats, 1 fruit, 1 milk exchange, if I recall). The Monoject insulin syringe (cheaper alternative to BD), had markings in 2-unit increments Of course, if I continued on that regimen, I'd probably not be doing so well now.
Thanks to DCCT, we now check our blood sugar a dozen times a day, deliver insulin in one-tenth unit increments constantly, and track carbohydrates with nauseating precision. But it helps us to live longer, happier lives (or so they say).
I suppose I am healthier with my pump, Novolog, and OneTouch; but on a day-to-day basis, things were a lot easier with Clinitest, Regular, and NPH.
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Permalink Reply by Brigitte on -
no progress? I don't think there's no progress. Yes I still make my shots and 4 shots per days (lantus,Apidra) but insulins of yesterday, and I speak about a very far away yesterday because my first shots where in 1967, are not the same that today's. 40 units per ml, now 100 units per ml... they work so much well. And what about the glucometers? I met my first in 1984... and before there was only the urinal tests.. when it was blue it was 0 and I eat. Well I'm still alive but for myself the progress is better insulins, better control (The Exceed from Abbott is only 3 seconds and my Freestyle is 5 seconds) and my last progress was with Tudiabetes : the carbs counting! In France doctors start to learn carbs counting, it's maybe hard to believe this for Americans type 1. And one more progress the doctors changed, they are more humans, they can accept we have a brain! And the news go faster than before . A diabetic from France could learn news from diabetes. And I forget the Frio. Of course there's no cure for us but I hope . There's progress for our life of everyday.
I'm not a pump user because I dream of a pump without tubes (there's one or maybe more in America) who analyses my blood sugar.
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Permalink Reply by Lara on
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Well, let's see, 34 years later I would say there's no huge difference from when I was a kid until now. The biggest advancement/change was the release of Humalog, which was significant and really affected my life in a positive way in terms of correction boluses. Beyond that, it's basically the same treatment protocol.
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Permalink Reply by Doretta Reily on -
Hi Scott,
I was diagnosed with Type 1 diabetes in 1968, long before insulin pumps, home blood glucose testing and CGM's. So I'm extremely pleased with the amount of technological progress that's been made over the years! For quite a long time, I can recall doing my absolute best to keep my diabetes "under control" and still ending up with an A1c of 11 or 12. But now, with the help of blood glucose testing and my insulin pump and CGM, my latest A1c was 5.1 and I don't have any signs of long-term complications. Yes, it takes a little more time to manage all the devices, but it's absolutely worth it!
Doretta
Fit4D Fitness Coach
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Permalink Reply by Mike Ratrie on -
Wow! You need to be an advocate for us on CNN!
Yes, I think there has been real progress. But there are a lot of facets to D, right? And "progress" to you has to be defined on your terms. C'mon let's face it, if you have T1 the only progress that matters is a cure. So without a cure all the other things that have occurred over the last 30+ years are only incremental. Just look at a partial list off the top of my head:
* Testing blood v. urine
* rDNA insulins v. beef/pork
* Pump or MDI v. 1 shot/day
* Meal time variety (hey, skip a meal if you want) v. Restricted meal times (Eat or call the paramedics)
* Food variety (you can now be a tamed Cookie Monster) v. Severely restricted foods (NO OJ!)
* CGMs and Glucometers that work quickly (yeah, they could be more accurate) v. the huge bricks that required a transfusion.
* Pre-diabetes testing!
* ID'ing that curing T1 is going to be a lot harder than just replacing beta cells. Will likely require a broader, multi-pronged effort.
Now, to your last point, does it totally suck? BIG TIME!
Could more be done to find a cure? No question!
In the meantime, I just keep putting one foot in front of the other so I can be here when it happens.
Fair Winds,
Mike
BTW, the report quoted is a simplistic political summary, designed to score political points somewhere.
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