by Emily Gaines Buchler
In 1912, my grandmother's aunt, Grace Goforth, died on a small farm in the
foothills of North Carolina. What did this have to do with me? Diabetes.
Grace had grown up like any other kid on a farm. She rose early to milk cows
and cultivate seeds, delivered bread four miles on foot to the nearest neighbor,
and played rounds of Kick the Can and Ante Over for fun. At age 18, she fell
in love with George, a young man who traveled to town by horse and buggy to
sell the tobacco, milk, chicken, and eggs produced by the Goforth farm and other
establishments in the area.
Soon after, Grace started accompanying George from the country to town, and
it was during this 30-mile stretch she first felt the pangs of diabetes. She
complained of thirst, stopped frequently to urinate, and slept the whole trip
back, despite bumps and holes in the winding dirt road. Within one year, Grace
dropped from a robust 130 pounds to just below 100, and when she finally saw
a doctor, on the eve of her twentieth birthday, her condition was grave. On
May 16, 1912, Grace slipped into a coma and died.
My grandmother first mentioned Grace a few years after my own diagnosis of type
1 diabetes in 1983. She started her story by stressing my luck in developing
diabetes in the late twentieth century and not earlier. "My aunt Grace,"
my grandmother would say, "lived before insulin was even available. Can
you imagine your own life without insulin?"
As a nine-year-old, happy-go-lucky kid who loved to showcase her ability to
inject insulin without crying, thoughts of dying from diabetes never crossed
my mind. I viewed Grace as a mystery and wondered if she really had diabetes,
or if some sort of cancer or heart failure had in fact claimed her life.
Reaching the 20-year milestone of my life with diabetes, I realize the deadly
consequences of the disease. At the same time, I feel fortunate to live in the
era of insulin and blood glucose monitoring systems. Had Grace held out for
another ten years, she might have lengthened her life with injections of insulin,
the wonder drug invented in 1921 by Banting and Best and mass-produced the next
year by Eli Lilly and Company.
The invention of insulin transformed diabetes from a deadly disease to a chronic
illness. Prior to 1922, a diagnosis of diabetes meant death. Pre-insulin era
patients were put on "starvation diets" of lettuce, cabbage, broccoli,
cucumbers, and other low-carbohydrate foods. Subsisting on less than 900 calories
a day, most of these patients wasted away within a year from starvation and
acidosis.
By the 1940s, the average life-span approached the non-diabetic "normal,"
due to the development of longer-acting and purer forms of insulin. Yet diabetes
treatment was not as we know it today. There was no home blood glucose monitoring
equipment, and assessing the level of sugar in the body could only be done through
urine tests, or through a (very slow) hospital pathology lab.
By the time sugar showed up in the urine, it had long since entered the bloodstream,
making the result far less "immediate" than those results read by
meters today. Nevertheless, as the only means of regularly assessing sugar,
home urine tests were administered every morning, afternoon, evening, and night.
Obtaining the result required more than peeing on a strip and watching it turn
color. It required a rigmarole of steps that took close to ten minutes. The
most widely used urine test was the Benedict test, which included a test tube,
dropper, and a bottle of Benedict solution.
After collecting a urine sample, patients used the dropper to transfer eight
to ten drops of urine to a test tube containing a teaspoon of the Benedict solution.
The mixture was then heated to a boil for three minutes, after which it cooled
and turned color. Blue indicated no sugar, while green indicated a trace, and
orange and red revealed an excess.
Phil Johnson, a native of Charlotte, North Carolina, diagnosed with diabetes
50 years ago, remembers a variation of the Benedict test: "All the mixing
of solutions and dropping of urine from one test tube to another really took
a lot of time. But the worst part of the whole experience was waiting for that
dreaded orange color. If the color turned out blue, I rewarded myself and felt
proud, but if the color turned out orange or red, I felt like I'd been bad."
Along with the lengthy urine testing, preparing syringes for injecting took
much longer back then, too. Phil recalls getting up early before school to boil
a pot of water to sterilize the glass barrel and steel piston of the syringe,
along with the steel needle. "The old steel needles weren't like the sharp
little needles we have today," Phil says. "The old needles were thick,
and they felt like ice picks!"
After injecting the insulin, Phil remembers rinsing the needle and syringe in
cold water, while a burning sensation lingered for several minutes beneath the
surface of his skin.
A cartoon produced in the late 1920s by Guy Rainsford, a traveling salesman
from Maine, and patient of the renowned diabetes doctor, Elliott Joslin, depicts
this kind of early diabetes treatment. Test tubes, droppers, and bottles of
Benedict solution line the table, transforming an ordinary home into a scientific
laboratory. A larger-than-life syringe and needle pierce the top of Rainsford's
knee, while a caption reads: "Here goes, folks."
Despite the hassle of preparing the treatment and the painful poke of the needle,
the patient maintains a hearty sense of humor. In the lower center of the page,
he informs his audience that his slippers came from Japan, and cost only 19
cents, and he bids onlookers a friendly "cheerio."
Sharper needles, disposable syringes, and home glucose monitoring systems are
not the only major changes in treatment over the years. The emergence of diabetes
specialists represents another major advancement. As Phil Johnson recalls: "When
I was little, there was no such thing as a diabetes educator, and there were
certainly no diabetes camps or support groups. I saw a family doctor, and he
just didn't have the kind of handle on diabetes that many specialists have today.
I'll never forget that first week in the hospital when he told me I'd never
eat a candy bar or piece of birthday cake again. As a kid, that really killed
me, and it and made me that much more tempted to sneak."
My own week in the hospital, during my initial diagnosis of diabetes, left me
envisioning, like Phil, a life without sweets. "I can't eat sugar,"
I told my best friend, Barry. "I can eat sugar-free cake and ice cream,
and my mom makes sugar-free pudding, but I can't have any other sweets."
In the 20-plus years since my diagnosis, faster-acting insulin and carbohydrate
counting have given diabetics more opportunity to incorporate desserts into
their diet.
Aaron Corns, a recently diagnosed 14-year-old from Tomah, Wisconsin, confessed
to worrying more about not eating sugar than the box of 100 syringes placed
on his bedside table the first week of treatment. "My grandmother has type
2 diabetes, and I always associated the disease with not eating sugar. I was
pleasantly surprised when my doctor finally told me that diabetes doesn't mean
I can't have sugar. It just means I can't have it all the time."
Given the recent rise in popularity among the Atkins diet and other low-carbohydrate
plans, a wide range of low sugar-desserts now line most grocery store shelves,
making it that much easier to satisfy cravings without taking in an excess of
carbs. Growing up in the seventies and eighties, my dessert options included
Jell-O pudding, Sweet'n Low ice cream, and a few Estee brand products -- all
of which contained large doses of sickeningly sweet saccharin.
The "diabetic food exchange" adorned the side labels of these products.
Eating a piece of sugar-free cake meant giving up a piece of bread for dinner,
while indulging in chocolate pudding meant going without a helping of potatoes.
In this pre-carbohydrate counting era, diabetics exercised much less control
over what, and when, they ate. Their medication determined both schedule and
amount. As a child and teenager, I ate when my Regular and NPH insulin peaked:
breakfast at seven, a mid-morning snack, lunch at noon, a mid-afternoon snack,
dinner at six-thirty, and a bedtime snack around nine. My daytime snacks consisted
of apples and crackers with cheese, while my bedtime snacks included a cup of
sugar-free hot chocolate and ginger snaps with peanut butter. I ate this same
series of snacks for ten years, with little-to-no variation.
Although today's doctors advise people with diabetes to follow regular eating
routines, the development of Humalog insulin made mealtime planning a lot more
flexible. Approved by the FDA in 1996, Humalog takes an average of 15 minutes
to take effect, compared to the 45-minute lag with Regular insulin.
Mandy Hunter, a part-time pharmaceutical consultant and mother of a six-month-old
daughter, designated Humalog the greatest advancement in diabetes treatment
since her diagnosis in the mid 1980s: "My body never responded well to
Regular insulin, which peaked three hours after my meals," Mandy recalls.
"As a kid, I remember going low almost every day, on my way to the school
cafeteria for lunch. Taking Humalog really changed that. It lets me eat when
I'm hungry, instead of when my insulin peaks."
Warren Prickett, a 29-year-old type 1 diabetic diagnosed in 1991, sees little
room for improvement in daily diabetes management. " We're almost at a
peak," Warren says. "Daily management is almost maxed-out. Needles
are as small and sharp as they can get, the pump delivers doses in one-tenth
of a unit, and glucose monitors give results in five seconds. The way I see
it, there's just one way to go, and that's for people with diabetes not to have
diabetes."
Although Warren anticipates a cure, he also welcomes the development of a way
to gauge blood sugar without stopping to draw blood. "Knowing my blood
sugar level at all times would make a huge difference in my treatment,"
Warren says. "If I was sitting in a business meeting and noticed my blood
sugar climbing, I could give a little dose of insulin before it climbed too
high. I could prevent highs and lows, and maintain readings in the normal range,
like people without diabetes."
Frequent or continuous glucose monitoring, multiple injections throughout the
day, and the widespread use of insulin pumps characterize the new wave of diabetes
treatment. Tighter control is now possible, improving the quality of life and
preventing complications.
Although tighter control leads to a longer, healthier life, it does require
work; but when I weigh the alternatives, diabetes management is worth every
ounce of hard work. As the renowned diabetes doctor, Elliott Joslin, wrote in
his DIABETIC MANUAL of 1959, "Work shortens the day, but lengthens the
life." In an era of constant monitoring and tight control, his words ring
true in many ways.
Dealing with diabetes is not a walk in the park, and it's easy to get discouraged
from the day-to-day roller-coaster of the disease. As we continue to hope for
a cure, either through islet transplant or some other means, we should feel
fortunate to live with the many advancements in diabetes management that have
occurred over the years. We do not boil water to sterilize syringes in the morning;
we do not sharpen needles on a whetstone; and we do not rely on urine tests
to determine our insulin and dietary needs. Grace Goforth, along with the many
other people diagnosed with diabetes in the pre-insulin era, literally wasted
away from the disease. Thanks to medical science, grassroots efforts, and other
invaluable measures, we continue to go forth in our quest for better control
and healthier lives.