Sunday, August 7, 2011

Diabetes history

I was diagnosed with juvenile diabetes in 1973. I was five years old. There were no blood glucose meters. There was no A1C test. There were urine tests before every meal, and there was a fasting blood sugar done at the hospital every few months. Injections were done with a syringe, once a day, using Toronto insulin and Lente insulin. (I think I switched to two injections a day when I was 16.) The word "carbohydrate" was never mentioned; instead, we had food exchanges. Half a banana was one fruit exchange. (Half of what size of banana? Well, that was guesswork.) Half a cup of milk was a milk exchange. A certain amount of cereal -- not a lot of choice there, either -- was a starch exchange. The exact measurement was found in a book with some original title like "The Diabetic Diet." It had a blue and yellow cover and was spiral-bound.

There was some "diet" food available. I could drink Tab, Fresca or Bubble Up. There were a few sugarless candies available. That was until the Canadian government decided to ban saccharin. Suddenly there was no diet pop, no sugarless gum, no sugarless candy. I drank Kool-Aid prepared with Sugar Twin, which was cyclamate. There was no Equal or aspartame, no Splenda or sucralose.

I went to summer camp four times, sponsored by the Canadian Diabetes Association. There were three or four other diabetic kids my age in my hometown, and we all had the same doctor, who made an effort to get us together every so often, and we all travelled to camp together. Diabetes camp was really just like any other summer camp, with the exception that we all had diabetes and the counsellors had to carry emergency sugar supplies with them. We went swimming and boating, hiking and camping, made arts and crafts and had dances.

When I was 13, which would have been in 1981, I saw a blood glucose meter for the first time. It was about the size of a hardcover book, took a large amount of blood from your finger, and had a pointer on a dial that showed approximately what range your blood sugar was in. At that point we were still all doing urine tests, and four times a day there would be two campers assigned to do the tests for each group. Take two drops of urine, add ten drops of water, drop in a Clinitest tablet and watch the chemical reaction take place.

By my third time at camp, when I was 15, we were all using blood glucose meters -- Glucoscan or Glucometer. These were sophisticated machines for their time! They were now about the size of a paperback book instead of a hardcover. The lancing device was a nasty little thing called an Autolet. (See a picture of it here.) The drop of blood was still pretty big, and you had to wait 60 seconds (the machine would sound a buzzer) and rinse off the strip with a special bottle of water before putting it in the machine. It then gave you a digital readout. This was a big improvement over urine tests. Aspartame became available around this time too, and we now had sugar-free pop again, including Diet Coke. For the first few years, though, products made with aspartame were more expensive than their sugar-containing counterparts.

When I was in my teens I had to spend some time in the hospital. I got my tonsils out, was admitted for nausea and vomiting because I couldn't keep my blood sugar under control when I couldn't eat, and had dental surgery. Each time I was admitted, I wound up teaching the nursing staff how to use the blood glucose monitor and how to mix two types of insulin in one syringe so that I didn't have to take extra needles.

By the time I was in university I was taking two shots a day -- still Lente and Toronto -- and the blood glucose monitor was now the Glucoscan II (image) and no longer required rinsing. Now it used a slightly smaller drop of blood. It still required a countdown, but now you had to blot the blood on a special pad before inserting into the machine. It was still about as big as a paperback book.

When I finished university in the early 1990s my insulin changed from beef-pork insulin to synthetic "human" insulin, or Humulin. I now took Humulin R and Humulin L, and a newer blood test machine that now read in mmol/l instead of mg/dl and required neither rinsing nor blotting of the strips. (Sadly, I can't remember the name.) Unfortunately, it was around this time that I became unemployed and had to go on welfare. Due to a poorly informed case worker and my being so shy and timid that I didn't dare speak up for myself or contest what I was told, I was left with the impression that my diabetes supplies would not be paid for by the welfare program, and I wound up reusing my syringes, taking as little insulin as I could get away with, and never testing my blood sugar. To make things worse, the company making my blood glucose meter discontinued it, and the strips were soon impossible to find.

Fortunately, in the mid-90s I discovered the diabetes clinic at the Royal Jubilee Hospital, and I also got a better caseworker for the welfare benefits. The diabetes clinic supplied me with my first One Touch blood glucose meter (image), and the caseworker got my medical supplies paid for.

One day around 1995 or so, I went to the pharmacy to pick up my prescriptions as usual, and the pharmacist asked me if I would like to try an insulin pen made by the Novolin company. I was intrigued by this new device. Sadly, there wasn't one for Lente insulin, but I started using it for my Toronto insulin. In 1997 I went on disability, which guaranteed that my medical benefits would stay in place.

It was in 1999 that I changed insulin for the first time since 1973. I switched from Lente to NPH insulin. Now I could use an insulin pen for that insulin too. A few years after that, in the early 21st century, I changed from using Toronto (Regular) insulin to NovoRapid. A few years after that, I went on Lantus insulin. My cat was also diagnosed with diabetes, of the feline variety, and now we both take Lantus -- me once a day, and my cat twice a day. I also went through a few more glucose meters, all from Lifescan -- the Fast Take, the Ultra and the Ultra Smart.

Today I am no longer on welfare or disability. I have a job now. I still use insulin pens, and now I use a One Touch Ultra Smart for my glucose meter, alternating with an Ultra Mini that I carry in my purse for convenience. I've tried almost every diabetes gadget under the sun except for the insulin pump and the continuous glucose monitor, both of which are out of my price range and neither of which is covered by public medical insurance and the medical benefits I get from my job only go up to $500 a year.