The Changing Face of Diabetes
Acknowledging twenty years with type one diabetes.
September 2006 — Type one diabetes is a chronic condition. What makes it "chronic" is that it doesn't go away. It's a "forever" kind of arrangement, sustained by maintenance drugs and constant monitoring. There is no medical cure at the moment that can cause my islet cells to produce insulin again. I provide my body with the hormone it refuses to make and my life continues.
This fact does not change.
But the face of my diabetes changes every day.
When I was diagnosed, twenty years ago this past September 11th, I was a seven-year-old child. I played soccer and wrote poems about the fat cat that lived in our neighborhood. I went to the beach with my family and loved going to school with my friends. With this new condition to deal with, my family and I were introduced to blood glucose meters that took 120 seconds to count to a result, a test tube set to check my urine for protein, and long, disposable needles to inject pork insulin into my arms. I wore a clunky, metal medic alert necklace at my soccer games. A meal plan governed my meals and my parents were responsible for the majority of my diabetes management. The goal for my A1c was 8% or lower, according to my physician at Joslin. I met other girls with diabetes at Clara Barton Camp, but there wasn't anyone I knew in my hometown.
The face of my diabetes was that of a happy little girl with a long ponytail and a big smile.
As a teenager, I was involved in the school newspaper and I was a class officer. I had my first kiss when I was 13 years old and I went to my first school dance the same year. My blood glucose meter took only 60 seconds to give me a result, ketone strips replaced the test tubes, and my A1c goal was set at 7.5%. I rebelled against the so-called diabetic diet and I snuck snacks and lied to my parents about why my blood sugar was so high. My mother and I fought about 385 mg/dl (21.39 mmol/l) and boys calling, all in one breath. I kept in touch with the girls from CBC, but those letters tapered off and stopped altogether, leaving me feeling alone with my disease. I had a diabetes bracelet but I kept it in my dresser drawer. I was trying to gain independence with my disease and from it at the same time.
The face of my diabetes was a frustrated teenager who battled her parents, her disease, and her world, but she smiled freely and wasn't afraid to still love herself.
College brought on challenges that I wasn't prepared to face: living outside of my parents' house, balancing work, school, and diabetes all on my own, and the startling divorce of my mother and father. The emotional struggle of the events in my life and the integration of diabetes weighed heavily on me. I engrossed myself deeply in school and my seven college roommates. My meter gave me results in five seconds, I was taking new short-acting and basal-like insulin with skinny, short needles, and my A1c goal was under 7%. Granted, I did not achieve that goal throughout college. Not even close. But the parameters of the diabetes world became tighter and tighter, urging for vigilantly good control to stave off complications. Everything was changing and I wasn't sure if I could keep up. I tried to smile but it was tough sometimes, in those most trying moments of my life. I was scared sometimes.
The face of my diabetes was confused, trying to find her footing as a young adult.
Now I sit here, twenty years from the date of my diagnosis with type one diabetes, looking at the new face of my diabetes. I have had the same disease for twenty years, but it doesn't feel like the same disease anymore. I treat it differently, with an insulin pump, remarkably fast-acting insulin, a bevy of capable doctors, and a desire to maintain a healthy body. Carbohydrate counting, insulin to carb ratios, and glycemic indexes made achieving an A1c of 7% or under a realistic goal. Technological advances such as the continuous glucose monitoring systems and inhaled insulin are happening now.
And I feel differently about it. I'm not afraid to have diabetes or to tell people I am a diabetic. I have the luxury of a loving family, supportive friends, and a partner who inspires me. Feeling alone with diabetes is a thing of the past, thanks to companies like dLife and the community of diabetes bloggers. I even wear a beautiful beaded medic alert bracelet instead of hiding it in a box. I am not afraid.
The disease itself hasn't changed, but I have. As I reflect on the past twenty years, the face of my diabetes is smiling; confident and ready for what the next twenty years will bring.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from