How Has Diabetes Diagnoses And Treatment Changed Over The Years?
It started out as a very simple disease when I started out 22 years ago, we had two medications essentially to treat it insulin and sulphuranyareas, that was it. I started out in the VA so I was seeing older vets, and that was the scope. It was it was older, overweight men and women and we now have over 10 to 15 kinds of medications to treat diabetes in the last 22 years the scope is huge. You can't walk outside, you can't walk through an airport, you can't walk anywhere without chain probably one or two out of every four people I'm seeing have diabetes. It's quite a transformation. Type 2 Diabetes Continue reading >>
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- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
How My Experiences Working With Diabetics Has Changed Me
I am a Certified Diabetes Educator. How did I get here after 22 years in nursing, and why did I pick diabetes for my specialty? The answer to that starts way back in high school, 35 years ago. My experience with diabetes started when I met my best friend, Kelly, in high school. We were starting our junior year. We hit it off famously in assembly. She was one of the few people that I can ever say truly gets me. I started to go over to Kelly’s house in the afternoons and to spend the night some on weekends as teenage girls do. The first time I saw her give herself a shot, I was shocked. She said she had diabetes. Memories of why I am where I am today My father was a doctor, so I questioned him at home. “What is diabetes,” I asked. He said it was pretty bad, and that Kelly had it for a long time already. He said she has to give insulin shots or her blood sugar gets high. He said that if she is acting confused or sweaty when I’m with her, I should give her some juice. That was the extent of my knowledge of diabetes. Kelly missed first period many times during our junior and senior years in high school. Usually she missed on a Monday, after we had a weekend of parties where Kelly probably drank too much alcohol and didn’t eat anything. I wonder now how many low blood sugars she had as a result of those teenage nights out. Time went on. I didn’t really know anyone else with diabetes. I got my Bachelor of Arts in English at St. Andrews Presbyterian College, with a 1 year stint at the University of North Carolina at Wilmington in between to save some money on tuition. Following college, I worked for several years as a reporter for the Concord Tribune in Concord, NC. I moved to Florence, SC, to work for The News and Shopper there. That’s when I decided to return to Continue reading >>
How Has Diabetes Care In The U.s. Changed Over Time?
This collection of charts and a related brief explore trends in health outcomes, quality of care, and treatment costs for people with diabetes and related endocrine disorders. Endocrine diseases occur when any of the eight major glands in the endocrine system produce too little or too much of a particular hormone. In the U.S., diabetes is the most common endocrine disease. Diabetes is caused when the body is unable to create enough insulin to break down blood sugar. It is among the 10 leading causes of death in the U.S. and can cause serious health complications such as early mortality, blindness, kidney failure, lower-extremity amputations, and heart disease. There has been a reduction in complications due to diabetes and improvement in disease management, but diagnosis rates and spending continue to grow. Diabetes is among the 10 leading causes of death in the United States Diabetes is an endocrine system disease caused when the body is unable to create enough insulin to break down blood sugar. It is among the 10 leading causes of death in the U.S. and can cause serious health complications such as early mortality, blindness, kidney failure, lower-extremity amputations, and heart disease. There are three types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes, formerly called juvenile diabetes, is usually diagnosed in children and young adults when the body does not produce insulin. There is no way to prevent type 1 diabetes, and proper management includes daily injections of insulin and monitoring blood glucose levels. Gestational diabetes occurs when there is not enough insulin created to support the pregnancy and happens in about 9.2% of pregnancies according to an analysis by the Centers for Disease Control and Prevention. A diagnosis of gesta Continue reading >>
How Diabetes Changed My Life
At the age of 16, I was diagnosed with type 1 diabetes. It was the worst day of my life. I was devastated. At the time I was a competitive tennis player in Sweden and had represented my country on several occasions in the European and World championships. I was in the best physical shape of my life, and did not like losing. That made this diagnosis worse, since I could not accept or even understand how I could be punished like this. My lack of acceptance made everything more difficult. My two younger sisters, Anna and Lisa, who were 6 and 14 at the time, were supportive but in shock. I was their big sister who had always been strong, and now I was in the hospital. I would have to inject insulin multiple times daily, change my diet, and face the risks of short and long term complications from a disease we did not know much about. Upon diagnosis, I made the decision to dedicate my future to discovering a cure for diabetes. I would go to medical school as soon as I graduated from high school. I got accepted to the Karolinska Institute in Stockholm, Sweden where I graduated with both MD and PhD degrees after only six years. My research was, of course, in diabetes, but I kept a promise to myself not to let diabetes affect my behavior or require others to adjust to my needs. To do so I kept my diagnosis a secret from everyone except my family and doctors. Even my best friends in high school and my med school classmates had no idea that I suffered from the condition. When I stood before more than 100 people in the grand auditorium at the Karolinska Institute to defend my thesis, the only person outside of my family who knew that I was diabetic was my advisor, Professor Kerstin Brismar. This was because she also happened to be my medical doctor. After almost 20 years with diabe Continue reading >>
Diabetes Mellitus Testing Has Changed Over The Years
Testing for diabetes started a long, long time ago. The word “diabetes” comes from ancient Greek and literally means “pass through," intended to mean excessive passing of urine. This characteristic of “too much urine” was first described 3500 years ago on an Egyptian papyrus. About 1900 years ago, Roman physician Galen called it “diarrhea of the urine.” The reason for so much passing of urine with diabetes mellitus is because high levels of sugar in the blood overwhelm the kidneys' ability to keep sugar out of the urine. Like a dam on a river, sugar spills over the dam into the urine when sugar gets too high in the blood. Then, with concentrated sugar in the urine, fluid is pulled out of blood into the urine, resulting in dehydration of the diabetic. Indeed, the name “diarrhea of the urine” seems appropriate. About 2500 years ago, someone noted flies were attracted to the urine of diabetics. Tasting urine for sweetness may seem disgusting today, but it was how they diagnosed diabetes all the way through the Middle Ages. It was English physician John Rolle who in the 1700's added “mellitus” to the term diabetes to reflect the age-old understanding of the sweet taste of the urine in diabetic patients. The word mellitus comes from Latin meaning “sweetened with honey.” Starting in the 1950's, patients roughly estimated the level of sugar in their blood by testing their urine with a chemical test they could do at home. By determining how much sugar spilled into the urine, people with diabetes mellitus were better able to adjust their insulin dose. Home URINE glucose testing was an improvement for patients with diabetes, but home BLOOD glucose testing, developed in the '80's, took it to the next level. Patients could finally know when sugars were too Continue reading >>
Type 1 Diabetes
Tweet Type 1 diabetes is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels. Type 1 diabetes may sometimes be referred to as juvenile diabetes, however, this term is generally regarded as outdated as, whilst it is commonly diagnosed in children, the condition can develop at any age. Insulin dependent diabetes is another term that may sometimes be used to describe type 1 diabetes. Because type 1 diabetes causes the loss of insulin production, it therefore requires regular insulin administration either by injection or by insulin pump. Type 1 diabetes symptoms Type 1 diabetes symptoms should be acted upon immediately, as without treatment this type of diabetes can be deadly. Symptoms include: Type 1 diabetes tends to develop more slowly in adults than it does in children and in some cases type 1 diabetes in adults may be misdiagnosed as type 2 diabetes. Type 1 diabetes in adults over 35 years old will sometimes be referred to as Latent Autoimmune Diabetes of Adulthood (LADA). See more information on recognising the signs of type 1 diabetes Type 1 causes Type 1 diabetes is caused by a fault in the body’s immune response in which the immune system mistakenly targets and kills beta cells, the cells in the pancreas responsible for producing insulin. As more insulin producing cells in the pancreas are killed off, the body can no longer control its blood glucose levels and the symptoms of diabetes begin to appear. What causes the initial fault in the immune system is yet to be discovered, however, research suggests that the condition results from a combination of genetic predisposition with an environmental trigger. What tri Continue reading >>
The Past 200 Years In Diabetes
Diabetes was first recognized around 1500 B.C.E. by the ancient Egyptians, who considered it a rare condition in which a person urinated excessively and lost weight. The term diabetes mellitus, reflecting the fact that the urine of those affected had a sweet taste, was first used by the Greek physician Aretaeus, who lived from about 80 to 138 C.E. It was not until 1776, however, that Matthew Dobson actually measured the concentration of glucose in the urine of such patients and found it to be increased.1 Diabetes was a recognized clinical entity when the New England Journal of Medicine and Surgery was founded in 1812. Its prevalence at the time was not documented, and essentially nothing was known about the mechanisms responsible for the disease. No effective treatment was available, and diabetes was uniformly fatal within weeks to months after its diagnosis owing to insulin deficiency. In the intervening 200 years, major fundamental advances have been made in our understanding of the underlying causes of diabetes and the approach to its prevention and treatment (see timeline, available with the full text of this article at NEJM.org). Although diabetes is still associated with a reduced life expectancy, the outlook for patients with this disease has improved dramatically, and patients usually lead active and productive lives for many decades after the diagnosis has been made. Many effective therapies are available for treating hyperglycemia and its complications. The study of diabetes and related aspects of glucose metabolism has been such fertile ground for scientific inquiry that 10 scientists have received the Nobel Prize for diabetes-related investigations since 1923 (Table 1). Thus, as a result of the efforts of the past 200 years, there is much good news to report Continue reading >>
Misdiagnosis By Design - The Story Behind The Ada Diagnostic Criteria
This is the little known story of how--and why--the American Diabetes Association keeps doctors from diagnosing Type 2 diabetes early. If you wait for your doctor to give you a diabetes diagnosis, the chances are good that by the time you are diagnosed you'll already have one or more serious diabetic complications. These include retinal damage, nerve damage, and early kidney damage. It is now known that these diabetic complications only develop after years of chronic exposure to high blood sugars. But, tragically, the way that today's doctors are forced to diagnose diabetes ensures that you will get no warning that you are experiencing those chronically high blood sugars until they have reached a level so high they have already done irreversible damage. This is not an accident. Years ago a committee of medical experts whose task was to decide how diabetes should be diagnosed decided it was better to avoid diagnosing patients with diabetes than to give them early warning that they were suffering from elevated blood sugars. As a result, these medical experts intentionally set the standards for diagnosing diabetes artificially high, so that most patients do not get diagnosed until their blood sugar has reached a level where they may soon develop the diabetic eye disease that leads to blindness. Their reasons for doing this this made sense in the late 1970s when these diagnostic criteria were originally crafted. At that time there was no treatment that could help people with early diabetes, while delivering a diabetes diagnosis could make it impossible for their patients to get health or life insurance. These circumstances led the experts to conclude that an early diagnosis of diabetes was more likely to harm than help their patients. So they defined diagnostic criteria tha Continue reading >>
History Of Insulin
The modern age has been full of amazing technological advances -- high-speed travel, the Internet, blue M&M's... However, if you have type 1 diabetes, you are no doubt a big fan of one particular 20th century innovation: insulin therapy. Before there was insulin therapy, people whose bodies stopped producing the hormone didn't hang around for long; there wasn't much doctors could do for them. In the 19th century, after researchers figured out that the body needs this critical hormone to burn glucose as energy, doctors tried different ways to restart production of insulin in people with type 1 diabetes. Some physicians even tried feeding fresh pancreas to patients. The experiment failed (and probably left more than a few patients begging for a palate-cleansing sorbet), as did the other attempts to replace missing insulin. Finally, in 1922 a former divinity student named Dr. Frederick Banting figured out how to extract insulin from a dog's pancreas. Skeptical colleagues said the stuff looked like "thick brown muck." Banting injected the insulin into the keister of a 14-year-old boy named Leonard Thompson, whose body was so ravaged by diabetes that he weighed only 65 pounds. Little Leonard developed abscesses on his bottom and still felt lousy, though his blood sugar improved slightly. Encouraged, Banting refined the formula for insulin and tried again six weeks later. This time Leonard's condition improved rapidly. His blood sugar dropped from 520 mg/dl to a more manageable 120 mg/dl. He gained weight, and his strength returned. (Poor Lenny -- although his diabetes remained in control for years, he died of pneumonia when he was just 27.) Banting and a colleague, Dr. John Macleod, won the Nobel Prize for their work. Commercial production of insulin for treating diabetes be Continue reading >>
Treatment
Treatment for diabetes aims to keep your blood glucose levels as normal as possible and control your symptoms to prevent health problems developing later in life. If you've been diagnosed with type 2 diabetes, your GP will be able to explain your condition in detail and help you understand your treatment. They'll also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team. Making lifestyle changes If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life. This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment. After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle and make any necessary changes. Three major areas that you'll need to look closely at are: You may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment. Lifestyle changes Diet Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should: increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil choose skimmed and semi-skimmed milk, and low-fat yoghurts eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers grill, bake, poach or steam food instead of frying Continue reading >>
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How Our Daughter’s Type 1 Diabetes Diagnosis Changed Her Life—and Ours
I suspect that every parent has something they’re particularly worried about, something they work especially hard to protect their children from. For my husband, who spent his summers during high school and college restoring old houses, that something was lead paint. For me, that something was melanoma, after my father died of the disease. You control what you can control—you make your kids take off their shoes when they enter the house, to keep the lead dust outside; you slather them with sunscreen to protect them from the midday sun. But then something comes along, a bolt from the blue, that makes you realize you have no control at all. This happened to us at the end of August, 2012, when our six-year-old daughter, Bisi, was diagnosed with type 1 diabetes. I first felt the chill of unease that something was wrong at a summer picnic with friends. Twice Bisi had to race behind a tree to pee, with an urgency that reminded me of when she was first wearing underwear rather than diapers. But she was at summer camp, and swimming two or three times a day. Probably, we told ourselves, she was just drinking too much chlorinated pool water. We left at the end of the week for our annual vacation on Block Island. So often as a parent, your mind jumps to the worst possibility, and it turns out you’re just being silly. But there’s the other side of the coin, too, when the symptoms are right in front of you, and you work to believe that nothing’s wrong. Over the weekend, we started to worry more and more. Bisi’s energy level—never very high—was even lower than usual, and it was clear she’d lost weight (something we’d noticed but again blamed on summer camp). We started obsessively searching her symptoms on the Internet after Bisi and her older brother went to bed, Continue reading >>
Why Treating Diabetes Keeps Getting More Expensive
Laura Marston is one of the 1.25 million Americans who suffer from Type 1 diabetes, an autoimmune disorder in which a person's pancreas can't make insulin. She hoards vials of the life-saving medicine in her refrigerator to protect herself from the drug's rising prices. (Jorge Ribas/The Washington Post) At first, the researchers who discovered insulin agonized about whether to patent the drug at all. It was 1921, and the team of biochemists and physicians based in Toronto was troubled by the idea of profiting from a medicine that had such widespread human value, one that could transform diabetes from a death sentence into a manageable disease. Ultimately, they decided to file for a patent — and promptly sold it to the University of Toronto for $3, or $1 for each person listed. It was the best way, they believed, to ensure that no company would have a monopoly and patients would have affordable access to a safe, effective drug. “Above all, these were discoverers who were trying to do a great humanitarian thing,” said historian Michael Bliss, “and they hoped their discovery was a kind of gift to humanity.” But the drug also has become a gift to the pharmaceutical industry. A version of insulin that carried a list price of $17 a vial in 1997 is priced at $138 today. Another that launched two decades ago with a sticker price of $21 a vial has been increased to $255. [This 90-year-old fight over insulin royalties reveals just how much has changed in medicine] Seventy-five years after the original insulin patent expired — a point at which drug prices usually decline — three companies have made incremental improvements to insulin that generate new patents and profits, creating a family of modern insulins worth billions of dollars. The history of insulin captures Continue reading >>
Diabetes Technology During The Past 30 Years: A Lot Of Changes And Mostly For The Better
I finished my pediatric endocrinology fellowship just over 30 years ago. I can truly say I have participated in the revolution in diabetes management. In 1977, insulin consisted of animal-sourced, relatively impure regular insulin and NPH (neutral protamine Hagedorn), Lente, or PZI (protamine zinc insulin), names many younger readers will not even recognize. Insulin treatment was considered advanced if more than one injection was used for type 1. Glucose monitoring was with urine, mostly Clinitest tablets that boiled urine, along with some glucose monitoring tapes. Ketones were measured with tablets that changed colors. Dipsticks for urine were just being introduced. That said, right at the end of my fellowship at the University of Minnesota, Dr. Don Etzwiler sent me to Wyoming with a dozen teens to hike above the tree line. My mantra then was, “Keep it a trace of glucose.” I have no idea about the true glucose values, but I expect, if measured, the hemoglobin A1c (A1C) values would have been > 9%. We all came home; the greatest danger was the raging thunderstorm in South Dakota on the way back. Those were simple times, even though we thought we were practicing “state-of-the-art” diabetes management. Technology was really nonexistent when compared to 2008. In fact, compared to the past 30 years, the 30 years from 1947 to 1977 really didn't bring any major changes in management. Urine monitoring and a fixed dose of insulin usually one or two times a day was the norm. What, then, did we have to do in 1977, and how is it different in 2008? What are the true costs and the true benefits of 30 years of diabetes management and the changes experienced? Perhaps the best way to look at the true cost of technology is through the lives of real patients. Their experiences ma Continue reading >>
The Changing Classification And Diagnosis Of Diabetes
At its annual meeting in June 1997 the American Diabetes Association announced the conclusions of an expert committee, which recommended changes to the way that diabetes is classified and to the choice of diagnostic method and cut off value that should be used to define the disease.1 A provisional report from a World Health Organisation consultation group, with some overlap in members with the American committee, has recently been published.2 These recommendations could have important epidemiological implications, but they will also affect individual patients. The previous classification of diabetes was based on the extent to which a patient was dependent on insulin.3 Although this was a logical distinction that separated the two main forms of diabetes, it gave rise to clumsy and sometimes confusing subcategories. Both the reports of the American Diabetes Association and the WHO recommend altering the classification to define four main subtypes of diabetes. Type 1 includes immune mediated and idiopathic forms of β cell dysfunction which lead to absolute insulin deficiency. Type 2 diabetes is disease of adult onset, which may originate from insulin resistance and relative insulin deficiency or from a secretory defect. Type 3 disease covers a wide range of specific types of diabetes including the various genetic defects of β cell function, genetic defects in insulin action, and diseases of the exocrine pancreas. Type 4 disease is gestational diabetes. The move to a classification that allows for subgrouping by pathogenesis is an explicit recognition of the heterogeneity of processes that lead to diabetes. It is forward looking as it creates a framework that can accommodate the increasing number of specific causes for diabetes which are likely to be discovered.4 The hope Continue reading >>
- The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern
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Treating Diabetes: 1921 To The Present Day
The lives of people with diabetes has changed considerably in 50 years. They now have specific tools and easier access to information than ever before. The healthcare professionals who treat them also know more about the complexity of the disease, and which treatments work best. Pending the next medical revolution, Diabetes Québec is demanding the implementation of a national strategy to fight diabetes – a strategy founded on education, prevention, support and treatment. The last 60 years have clearly demonstrated that people with diabetes who are well informed, properly supported and treated appropriately live longer lives in better health. The discovery of insulin and glycemic control Insulin, discovered in 1921 by the legendary Banting, Best and MacLeod collaboration, is nothing short of a miracle. Worldwide, it has saved thousands of patients from certain death. Before the discovery of insulin, diabetics were doomed. Even on a strict diet, they could last no more than three or four years. However, despite the many types of insulin and the first oral hypoglycemic agents that came to market around 1957 in Canada, glycemia control – the control of blood glucose (sugar) levels – still remains an imprecise science. In the 1950s, the method a person used to control his blood glucose levels was to drop a reagent tablet into a small test tube containing a few drops of urine mixed with water. The resulting colour – from dark blue to orange – indicated the amount of sugar in the urine. Even when they monitored their patients closely, doctors realized that blood glucose levels had to be much better controlled in order to delay the major complications significantly affecting their patients’ lives: blindness, kidney disease, gangrene, heart attack and stroke. A disc Continue reading >>
