Our Journey with Type 1 Diabetes for over a Half Century: A Dialogue between Patient Spouse and Her Physician Caregiver

A personal perspective and a narration by a patient and her Physician spouse caregiver regarding coping with evolution in therapeutic modalities including ongoing changing insulin formulations and insulin administration devices. Narration also encompasses and establishes the utility of the improving glycemic monitoring tools in assisting in attaining desirable glycemic goals.

Journal of Diabetes Mellitus young age and that she would likely be unable to have children. Also the prospect of kidney failure and blindness were discussed. Fortunately then as now she was determined to take good care of herself even before we understood that good control could minimize and eliminate many complications of diabetes. Linda At the time I was diagnosed the only available insulins were NPH and regular. For the first few years I was controlled nicely by taking 12 to 14 units of NPH insulin each morning along with following a diabetic diet. In retrospect I had a "honeymoon phase" and was likely still making some of my own insulin during that time period. Several things that we now take for granted such as home glucose testing, continuous glucose monitoring, long-acting insulin, insulin pumps, were not available. Monitoring consisted of seeing my family physician (there was no endocrinologist in the city where I lived) monthly for fasting and postprandial blood glucose done by venipuncture. Home testing consisted of urinary test tape to look for evidence of glycosuria and if acutely ill to look for evidence of ketones in my urine.
Eventually a single shot of NPH did not adequately control my sugars and I started taking a combination of NPH and regular in the morning and evening. Adjustments were difficult in the absence of careful blood sugar monitoring but I seemed to get along quite well. As Larry progressed in his medical career he was paying close attention to current literature regarding the care for diabetics. In 1982 the DCCT (Diabetes Control and Complications Trial) was begun [1]. It is hard to believe but before this study many medical experts did not feel there was a relationship between control and prevention of complications [2]. In essence they were saying that this disease will be running its course and there is not much you can do about it [2]. This was not particularly good feeling for a young and otherwise healthy diabetic like myself. Larry The DCCT trial was a large multi-center randomized controlled trial that looked for and compared complications in diabetics that were put on a strict regimen to control their blood glucose levels versus routine standard care [1]. The trial was terminated early because of the profound decrease in complications for those patients who were under good control. Over the next several years the concept of intensive conventional therapy was developed. Long acting insulins became available and Mayo Clinic was promoting more intensive therapy. Linda and I discussed this type of treatment and she subsequently went to Mayo Clinic where she was started on an intensive conventional therapy of long-acting insulin plus regular before each meal. Also this was around the time when home glucose testing became available and hemoglobin A1c testing became available for routine clinical practice. All of these advances made management of Linda's diabetes much easier and much more effective. Linda   To preserve my islets I was treated with several immunosuppressive drugs,

Larry
Where are we now?
As was likely to occur Linda's diabetes returned 4 years after her transplants.
Fortunately she did not have as much difficulty with hypoglycemic unawareness.
She continues to do extremely well and remains very active and to this day has been blessed not to have any retinopathy or renal disease.
Three years ago after attending a play we were walking to our car on a cold winter night. When we got in the car Linda told me that she had some vague discomfort in her chest which was relieved after sitting in the warm car. Rather than go home we went to the hospital and she subsequently had a coronary angiogram which revealed an isolated lesion and she underwent a coronary stent without complications. This is not an unexpected thing to occur in a longtime diabetic but again thanks to advancements in health care this problem was quickly managed.
Linda and I recently celebrated our 48th wedding anniversary. We feel very blessed to have shared this journey together. We had two beautiful children and currently have 2 wonderful granddaughters. We hope that our story gives hope to other diabetics that this disease can be managed and that you can lead a full and fulfilling life while you manage your diabetes. We are also hopeful that with continued research more and better options will become available to manage and hopefully cure diabetes mellitus type 1. It is also our hope that our healthcare system evolves to the point where it can provide the latest treatments for all