While sorting through some of my accumulated diabetes literature, I was reminded of the vast improvements for diabetes care over the years. Among my many diabetes texts, the one that gives me flashbacks is titled "Instructions for the Diabetic Patient" and was republished in 1978. In reading this book, the three areas that have seen dramatic changes are the methods of glucose testing, types of medications and nutrition management. So let's take a short stroll down memory lane to remind ourselves how much easier it is to manage diabetes in 2008 than it was in 1978.
The technology for present blood glucose testing was only a dream 30 years ago. When I was in nursing school in the 1970s, we tested for glucose by mixing five drops of urine and 10 drops of water in a test tube then adding a Clinitest tablet. The color after the chemical reaction finished was an indicator of the amount of glucose in the urine sample and regular insulin was given based on that glucose reading. Complications were expected and commonly seen; treatment was geared to the amount of glucose that was excreted in the urine so microvascular damage already was quite extensive.
Palm-sized home blood glucose monitors now allow you to conveniently track the impact of food and activity on your blood glucose level in just five seconds; definitely a giant leap forward!
New oral medications and types of insulin now help individuals to better control diabetes. In the 1970s there was one oral medication that acted on the pancreas to stimulate insulin production, but now there are numerous medications that each have a different physiological action on the body. Insulin was discovered in 1921 and made rapid strides to help those patients who were not able to produce any insulin. Now with insulin action times ranging from 15 minutes to 24 hours, it is much easier to personalize good glucose control. I can remember watching my grandmother boil syringes and carefully sharpen her needles to make the injections less painful. The development of disposable syringes has greatly simplified insulin injection. For some individuals, the development of an insulin pump for continuous insulin infusion has provided glucose control and freedom that they had only hoped was possible. Inhaled insulin was marketed for a short period of time but it is no longer available.
Nutrition management also has gone through many transitions in the past 30 years. In "Instructions for the Diabetic Patient," elaborate methods for food selections are listed to analyze caloric requirements. The consumption of any form of sugar was not allowed. In the 1970s, there was a "diabetic diet" that described a slice of dry turkey breast, a scoop of instant mashed potatoes, overcooked green beans and a small cup of sugar-free jello. Fortunately, improvements have been made and now carbohydrate counting gives you freedom to consume nutritionally balanced meals that provide the building blocks for good health. So on those days that you are discouraged about living with diabetes, think about and be thankful for the improvements for glucose testing, medications and nutrition of the past 30 years that help control diabetes and enhance our quality of life.
Susan Sorensen is a registered nurse who does diabetes education in the community and can be reached at firstname.lastname@example.org.
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