U.S. Diabetes Care May Be Improving Dramatically

[Richard157]

U.S. diabetes care may be improving "dramatically" (http://www.topix.net/content/reuters/2008/01/u-s-diabetes-care-may-be-improving-dramatically)

[notme]

I think a lot of this has to do with just knowledge. When I was diagnosed in 1986, there were not a lot of tools in place for tight control. I was given NPH and REG, a high carb/low fat diet and a meter. Frustration set in quickly as I could never get control with those tools. Today we have carb counting, pumps, fast acting insulin and A1c's to tell us how we are doing. This knowledge has increased my control dramatically.

[JediSurfer]

Didnt you have AC1 testing or carb counting in 1986?

[notme]

No carb counting Jedi..... Most of us were put on high carb diets and told to watch our fat intake. Don't ask me why? As far as the A1c, I don't think so. I didn't have one until the mid 90's.

[JediSurfer]

Wow, I have always carb counted since diagnosis in 1979. My Mum was given a little blue book which gave carb values for most foods. And have always had an AC1 test. I remember being terrified aged about 4 years old by a doc with a huge needle, a massive beard and a turban. First turban I had ever seen.

Rich

[JediSkipdogg]

I never carb counted till pumping in 2002. I will say though I did something similar (or was suppose to) to carb counting. I broke food down into fats and starches and other items. Carb counting truely wasn't around till the mid to late 90s.

As for A1Cs, I've always had those since my diagnosis in 2002, however, over time they have lowered the standard. I remember when a 10.0% A1C was considered good control and we should stay under that. Of course, I never cound and when I finally did, they lowered the number more.

Education has come a long way, now it's just a problem of making sure those that need it get it.

[JediSurfer]

Looks like there is a vast difference over years between the USA and England. But I also had my Father to point me in the right direction. I owe him a **** of a lot.

[Dewey]

As Nancy had said, I was given basically a similar regime. I had to take NPH & REG and was on somewhat of a sliding scale. I was never able to gain control that way (it's a wonder I'm not in bad shape now!) until I got on pump therapy 14 years after diagnosis in 1996.

Carb counting truely wasn't around till the mid to late 90s.

Education has come a long way, now it's just a problem of making sure those that need it get it.
I totally agree here, Jedi. When I first got on pump therapy in '96, I was not carb counting. I was on a sliding scale, but it was working a heck of a lot better than the MDIs I was taking. I didn't start carb counting till around 1999 or 2000 or so (maybe even later).

Education has indeed come a long way...but I'm just glad many of us made it through the times before we had all these fancy new gadgets and ways to maintain our health. :thumbsup:

[JediSurfer]

I forgot to mention that the carb counting was for an entire day at that point and was match to insulin. Quite different from todays methods. But there are a few of us who started this modern day carb counting and insulin ratios but had to hide the fact from our docs because at that time it wasnt an accepterd way of doing things. Eventually the wonderful world of science caught up.

[Alice]

I also think it's the slow educational movement (why it's slow, I don't know!) away from a "no sweets" mentality to a "count all carbs" mentality.

While we weren't all counting carbs back "in the early days" we were still doing a prehistoric version ...exchange diets. But, they weren't looking at how fruit & bread exchanges raised blood sugars...just "avoid" sweets. Made no sense.

The insulins are better. Most people are no longer taking Lente/NPH and Regular mixes which were very difficult to handle and eat normally. (Severe lows and no coverage at times)

Also, blood glucose equipment is much more convenient and portable now.

For me, it's 3 main things: carb counting, newer insulins and easier glucose testing...that have improved.

[JediSkipdogg]

As Nancy had said, I was given basically a similar regime. I had to take NPH & REG and was on somewhat of a sliding scale. I was never able to gain control that way (it's a wonder I'm not in bad shape now!) until I got on pump therapy 14 years after diagnosis in 1996.

That's one reason I look at people and wonder why they go berzerk when they hit a 300 or drop in the 40s. I survived 20 years of that and those 20 years are a person's most crucial to not having any maturity complications. I also see people in their 50s and 60s today diagnosed in the 50s and they lived through that and are complication free.

Basically what I'm saying is the methods weren't perfect then, but they also obviously weren't that bad. Now it seems like education has gone that if you hit 400, get to the ER. I remember on NPH and R hitting 50, eating to bring it up, hitting 400, then going back down. Alot more of a rollercoaster than today as back then it would be a weeklong rollercoaster. And so far, I'm complication free.

[Dewey]

Alice, you are very right about all you have said. In terms of education, I also don't know why new information or developments seems to gain momentum so slowly.

I also remember having swings due to the old insulins I'd use (just as you stated, severe lows & no coverage at times = Not fun :(). Today's insulins offer the ability to attain better control & more flexibility, etc.

As for meters, pumps, etc...well, the first meter I had took over 2 minutes to read the sugar level & I had to wipe the blood off the strip. The first pump I had was a MM 506 and all it did was deliver insulin & allowed me to input a couple of different basals - no square or dual wave boluses, & certainly no fancy features.

Fast forwarding to now: Some meters today can read levels in less than 5 seconds, not to mention CGMS systems are now becoming part of the norm. And with pumps, many now offer an abundance of features - from different bolusing options to customized carb databases and more. The advancements have been incredible, so though some of the education can be slow (carb counting vs. exchanges), at least it hasn't hindered the ability to gain new technology and the like. With the 'Net & other sources, people can stay much more "in the know" than ever before. :)

[Dewey]

Though I Hate to double-post, I just read your comment, Jedi:

That's one reason I look at people and wonder why they go berzerk when they hit a 300 or drop in the 40s. I survived 20 years of that and those 20 years are a person's most crucial to not having any maturity complications. I also see people in their 50s and 60s today diagnosed in the 50s and they lived through that and are complication free.

Basically what I'm saying is the methods weren't perfect then, but they also obviously weren't that bad. Now it seems like education has gone that if you hit 400, get to the ER. I remember on NPH and R hitting 50, eating to bring it up, hitting 400, then going back down. Alot more of a rollercoaster than today as back then it would be a weeklong rollercoaster. And so far, I'm complication free.

Jedi, you make very good points here as well. I have noticed that as advancements have been made (and things have changed), even I have become guilty of "freaking out" over a high (& sometimes cause myself to go low if I over correct). And just like you, I've dealt with A LOT of that over my last 25 years of having Diabetes, yet made it to today a-ok. :) I do wonder though, if some of the reason we're 'a-ok' is because of our genetic makeup along with other factors, as opposed to those who have been raised similarly (but who have endured issues).

Thanks for saying this, because it has made me view things from another perspective. Maybe next time, I won't get so upset when my BG jumps up & I fix it. ;) Thanks!

[Alice]

It's true...we are able to make corrections "within the hour" instead of "between doctors appointments" now.

I think we do spend more time on our disease than in years past, but I have a hard time judging that since I was growing up with it...seems like I do remember hating the "bathroom time" when testing urine...that was super slow!

In regards to the snail-pace on education...it almost seems to me that the technology is improving and hitting the market faster than the medical "establishment" can handle. For instance, I hear about the pod on this forum...ask my endo...and she didn't know what it was...this is more typical now than ever.

[Carwy]

You know I see all the people on here who have had diabetes for a very long time and it seems as though you all say the same thing. In the 90's and before if you had a high or a low the first thing you would do is treat at home and if that did not work then you would go to the hospital. If the high or low was not bad enough to throw you into DKA from a high or shock from a low then many of you did not go to the hospital.
Now it seams as though they tell you if it's high or low then you should seek medical help.
It seams to me all of you are alive and still kicking with no problems. This leads me to think that the medical community found out that by you treating these problems at home they were loosing millions of dollars a year. So they changed the game plan to get you back into the hospital and to get that money back. This is just my thoughts so please don't get mad.

[notme]

As for meters, pumps, etc...well, the first meter I had took over 2 minutes to read the sugar level & I had to wipe the blood off the strip. The first pump I had was a MM 506 and all it did was deliver insulin & allowed me to input a couple of different basals - no square or dual wave boluses, & certainly no fancy features.

Fast forwarding to now: Some meters today can read levels in less than 5 seconds, not to mention CGMS systems are now becoming part of the norm. And with pumps, many now offer an abundance of features - from different bolusing options to customized carb databases and more. The advancements have been incredible, so though some of the education can be slow (carb counting vs. exchanges), at least it hasn't hindered the ability to gain new technology and the like. With the 'Net & other sources, people can stay much more "in the know" than ever before. :)

You said a mouthful Dewey. My first meter took over a minute to read my blood sugar and I also had the little bloody tissues or cotton balls from wiping the test strips. I was a busy young Mother back in those days and it was a pain in the butt and I didn't do it nearly as often as I should have. Quite honestly, the results would have not made me do things much differently. If I tried to do a correction with REG, my NPH would peak about the same time the correction did and I would go low. I was a constant 300 girl for years. I avoided the doctor because I would get told that I was not doing well. Who wants to hear that for 14 years?

After all of the years of training and the diet advice, my endo finally sent me to a nutritionist who first told me about carb counting. I remember driving home from her office in tears wondering what the heck I was supposed to eat. Low carb, no fat, no sugar. I look back in wonder now at how uninformed I was.

The internet was the biggest help to me. I first heard about the pump from a guy who I chatted with on yahoo. I was terrified when he told me that it was installed right at his kitchen table. (I thought they were surgically implanted). Over the course of a few months he explained it to me and it started to make sense. I joined a few boards and finally got on the bandwagon.

I can never thank people like Tony and the people that frequent this site enough. Without a DF, we may all still be living in the dark ages.

[Alice]

Persnally, I wouldn't even consider going to the hospital/doctor over a single number...not counting a severe low needing medical attention (Thank god, never happened)...but I work very hard at preventing it from happening as well.

Hitting 400? Doesn't happen often, but I can hit it easily if I "forget" to take a dose after a large meal. Heck, I hit 350 the other day after eating a salad (raspberry dressing was pretty sweet stuff...)for lunch...I just got caught in a flurry of errands and waited too long to bolus...but regardless, I was back in normal range very shortly...

I would seek medical attention if my boluses weren't making sense and getting no results. But heading to the ER? Guess I just can't identify with that...but I'm sure some do.

I was tickled watching Grey's Anatomy the first season. They had someone in the ER that was suffering from "diabetic shock" at a "glucose level of 64"...they actually shouted out the number...The guy was sitting up and complaining he felt funny. The writers could have at least made it a little more convincing...

[Dewey]

It's true...we are able to make corrections "within the hour" instead of "between doctors appointments" now.

I think we do spend more time on our disease than in years past, but I have a hard time judging that since I was growing up with it...seems like I do remember hating the "bathroom time" when testing urine...that was super slow!

In regards to the snail-pace on education...it almost seems to me that the technology is improving and hitting the market faster than the medical "establishment" can handle. For instance, I hear about the pod on this forum...ask my endo...and she didn't know what it was...this is more typical now than ever.
LOL - Yes, I remember urine testing also! I used to use Keto-Diastix (& some had tablets they had to use :s:). Did you have to use the tablets? I now keep some Ketostix on hand in the event of a high or sick days (to ensure I'm not spilling ketones).

I also agree that new & better technology is hitting the market way faster than the medical community can keep up with it. I can guarantee many of us here have heard endos/doctors say statements like... "Haven't heard of that...what is it?" (or something along similar lines). There have been many new things I learned about on the forums.

[Alice]

Yes, in second grade...my mom and I would drop the tablet into the tiny test tube (in a grey container...I can see it today!) and we would "cheer" when the color turned blue for Negative. Ok, the irony today is...how "negative" was I? I'd go out and play and that was it...did the same thing when I was "orange" or "4+"...what the heck did that mean?

Then there were the vile colors inbetween...a sort of grey/pukey color...of course, I like the dark blue best!

Then it seems like some kind of yellow tape came out...which I hated to use...

I must have been some kind of miracle child...never was hospitalized for lows or highs...I did know when to snack...and learned to drink Cokes when low and ignore the "old wives"...still ignore them today!

I have to say...even with the early meters, the numbers didn't mean much to me. I really never had an endo/internist sit down and explain the ranges to me...I maybe gradually read info in some Eli Lilly brochures picked up at the doctor.

I didn't hear about carb counting from a doctor either...learned that by attending a grocery store tour for diabetics (I was the only Type 1) led by a nutritionist. That was when it all "clicked"...and really, that was in 1998 or so...it's like the doc's knew this stuff...but kept if for themselves...the internet has changed all that!

[Richard157]

I was diagnosed in 1945 so I spent about 50 years not knowing about carb counting and running high BGL's almost all the time. I experienced only a few minor complications in that time period. Carb counting and record keeping turned me around. The second year that A1c's were done I had an A1c less than 6.0. My doc would smile and say "nondiabetic" in his heavy Thailand accent. There are still diabetics who have not been told to count carbs and they don't know what an A1c is. Correct me if I'm wrong but I have read that there are about 23 million diagnosed diabetics in the USA and at least that many more who are not diagnosed. If that is true then it is no surprise that diabetes is still one of the leading causes of death. Then there are so many who know they have diabetes and they get frustrated and give up, or never even try to get good control. I have tried helping people like that but have rarely succeeded. <sigh>

Richard

[Lizzy]

In the 90's and before if you had a high or a low the first thing you would do is treat at home and if that did not work then you would go to the hospital. If the high or low was not bad enough to throw you into DKA from a high or shock from a low then many of you did not go to the hospital.


Carwy I agree, I have not been in the hospital because of a high since 1970 and have never been for a low. Treating at home always seems to work for me. After 44 years I have no major complications. I believe I owe that to good genetic makeup. God knows, I was never in good control (I should be blind and legless) LOL, and I am still fighting to gain good control.

[Alice]

I think about the only reason you would be hospitalized now would be if paramedics brought you in...unresponsive.

In the "old days" before HMO's...your doctor might check you in for 1 or 2 weeks for "diabetes education"...which usually meant you watched TV, ate off partitioned trays and attended food exchange classes. Learned to check your feet. It was big business in the 70's and 80's for a hospital to have an entire wing for "diabetes care".

That profit center disappeared with HMO's.

[JediSkipdogg]

I think about the only reason you would be hospitalized now would be if paramedics brought you in...unresponsive.

In the "old days" before HMO's...your doctor might check you in for 1 or 2 weeks for "diabetes education"...which usually meant you watched TV, ate off partitioned trays and attended food exchange classes. Learned to check your feet. It was big business in the 70's and 80's for a hospital to have an entire wing for "diabetes care".

That profit center disappeared with HMO's.

It really hasn't disappeared. Childrens Hospital Cincinnati is building an entire center dedicated to diabetes. I have no idea what they plan on having in it but the place is huge, about half the size of a hospital.

You'd actually be amazed at the number of life squad calls I get for a diabetic emergency. I'd say at least 10 a week and our city is only 7.7 square miles in size. Probably about half of those are transported to the hospital. I never find out why they were called, but we get alot of "diabetic emergencies."

[Bunkins]

I was in the hospital last week for 3 days, because of a "diabetic emergency".. I was very sick for a few days, on the day I decided to go to the ER I hadnt corrected my BG.. It was 480, but I know it was only like that for a few hrs. I was scared to take insulin because I was throwing up so often, because if I went low the only thing that would pull me out of it was a Glucagon shot. Once I realized this wasnt just a little bug, I did was I was supposed to do, go to the ER.. They started to treat me for not being able to breath ( hurt my ribs from throwing up ) and the stomach flu.. Once they saw the high BG, the tables turned and they treated me for DKA, thinking the reason I was sick was because I wasnt taking care of myself, they wouldnt listen to a word I said about it not being DKA... I was even told that the only reason I was stuck in the hospital for 3 days was because my BG was so high.... Yeah it was high, but for the few hrs it was, it's not going to hurt me.. In my days of horible control seeing a number like that wasnt rare... I'm still going round and round with the hospital dirrector about the whole deal.. They still wont tell me what my ketone levels were at the time ( because they DIDNT KNOW, they NEVER checked it, they checked my urine output and flushed it down the toilet )..

So from that experience I figured out that it doesnt matter why your in there, if they see a high number you might as well forget about being treated for the reason you came in. You'll have better luck talking to a wall. And that I dont care if someday I'm as sick, or sicker than I was, I WILL NOT go in to the ER without my BG being under 200, because chances are I wont be treated for the illness..

[caswellhb]

My father was t1 and goodness, the things I saw.I should have been scared to death.
However, all it did was taught me.
You know what? Keep control, don't let it get control of you, live and laugh.

Heather

[Jill-O]

I bet a big part of the improvement is the ease of getting information thanks to the internet, and discussion groups like this one -- where people share ideas and encourage each other.

http://www.getsmile.com/emoticons/funny-smileys-68129/thumbs-up2.gif

[ant hill]

I think a lot of this has to do with just knowledge. When I was diagnosed in 1986, there were not a lot of tools in place for tight control.

Indeed Nancy!!, As we learn to understand our bodies on control we get better at what the industry is trying to tell us. or do we? :rolleyes:

Education has come a long way, now it's just a problem of making sure those that need it get it.

Yes Kev!! Me has a lot to learn. :confused:

I totally agree here, Jedi. When I first got on pump therapy in '96, I was not carb counting. I was on a sliding scale, but it was working a heck of a lot better than the MDIs I was taking. I didn't start carb counting till around 1999 or 2000 or so (maybe even later).

Hey hi Dewey :), I was diagnosed in '71 and I was introduced to the pork purified insulin and was Carb Counting then also there was the forbidden list!!! and you can guess what those are. :eek: Since that the animal insulins are for animal design and so have to simulate the amount you eat until the 1980's and BG meters were around then too. WOW the U100 synthesized insulins as arrived and the whole carb counting flew out the widow so the I can have honey LOL.
Now we have to think again and look at carb counting again.

As for meters, pumps, etc...well, the first meter I had took over 2 minutes to read the sugar level & I had to wipe the blood off the strip.
Fast forwarding to now: Some meters today can read levels in less than 5 seconds, not to mention CGMS systems are now becoming part of the norm. :)

Yes Dewey, I had those 2 minute meters and they were bulky to take around plus the amount of blood you have to get on the strip. Today far much better. :D

In the "old days" before HMO's...your doctor might check you in for 1 or 2 weeks for "diabetes education"...which usually meant you watched TV, ate off partitioned trays and attended food exchange classes. Learned to check your feet. It was big business in the 70's and 80's for a hospital to have an entire wing for "diabetes care".

Yeah I was in one of those ward's in the 70's. :(

My father was t1 and goodness, the things I saw.I should have been scared to death.
However, all it did was taught me.
You know what? Keep control, don't let it get control of you, live and laugh.

Heather
Yes I agree Heather, With the onset of diagnosis I had a lot to learn and after 36 come march 37 years later I am still learning.
As we get the sudden diagnosis you go in a spin over what you must know and the relentless teachings of control!!!

[deansreef]

i was taking 42 units per day of humulin 70/30 and my a1C came in at between 5.5 and 6.0 every time tested. I am on a pump now mostly due to some many low blood sugars. Out of 200 tests 80+ were below 50.

Dean

[Bunkins]

i was taking 42 units per day of humulin 70/30 and my a1C came in at between 5.5 and 6.0 every time tested. I am on a pump now mostly due to some many low blood sugars. Out of 200 tests 80+ were below 50.

Dean


Wow thats a lot of lows :eek:

[Injecto]

That's one reason I look at people and wonder why they go berzerk when they hit a 300 or drop in the 40s. I survived 20 years of that and those 20 years are a person's most crucial to not having any maturity complications.

I often wonder why so many "vets" seem to have a complete lack of understanding when noobies go berzerk when they hit 300 (16) or drop in the 40s (2.2). Seems experience has made "them" forget what it was like to be diagnosed, the fear, the over teaching that high BGs will eventually take away some of your organs and health. Gee...

Thanks for understanding.

PS: 'twas not directed at all "vets"....

[JediSkipdogg]

I often wonder why so many "vets" seem to have a complete lack of understanding when noobies go berzerk when they hit 300 (16) or drop in the 40s (2.2). Seems experience has made "them" forget what it was like to be diagnosed, the fear, the over teaching that high BGs will eventually take away some of your organs and health. Gee...

Thanks for understanding.

PS: 'twas not directed at all "vets"....

I see experienced people going nuts over hitting highs and extreme lows. I won't mention names, but I can think of at least a dozen active members on here now that if they hit a high of a low they freak out.

[Alice]

I don't see it as a "lack of understanding". Anyone who's experienced a high or low knows the frustration...and the fright of coming out of a really bad low.

In my case, I had doctors that always reassured me that hitting an "off number" isn't that big of a deal. It's more of a concern if those numbers are frequent or extended and insulin is not working.

When I was growing up, there were a few kids in my school that were Type 1. It was interesting to see how the different parents reacted to life with diabetes. Some were "helicopter" parents and showed up every day at school in the morning and afternoon to "check on their diabetic child"...others, such as my mom, taught me to ask for juice when needed. I can't remember asking much...I did on a school hike.

Maybe it's because the veterans didn't grow up relying on meters like we are today. (Not complaining, I just don't take them for granted)...

I practice tight control. But not manic or micro-managed control. But due to stressful and busy jobs, I can't go "berzerk" over high or low numbers. I just have to fix it and move on...I have "other" important things to do. Notice I didn't say "more important"...just additional things I have to do in my life. (A few months ago I ate glucose tabs while running to catch a train in Chicago...no time to stop and test for a "number"...I just knew I'd better start inhaling glucose tabs to get me to that train...no time for "berzerk" or ER...I was a perfect 110 or so when I sat down 1/2 hour later. Small example, but sometimes we just have to deal with it and move on...

I also think you can make your life "medical" or you can make your life normal...with the medical balanced in...

[notme]

We all seem to handle things differently and we all seem to find our way eventually.

We all have heard the stories and we all know what the consequences are to high blood sugar or low blood sugar. We just react differently.

I think the internet is a great place for information and we all know that it is also a great place for misinformation. Take the advice you recieve and file it away for reference later. I doubt most people take what they read on the internet as gospel.

[Dewey]

I see experienced people going nuts over hitting highs and extreme lows. I won't mention names, but I can think of at least a dozen active members on here now that if they hit a high of a low they freak out.
Well, I already admitted that I sometimes do that (get "freaked" about 300s, etc.)....don't know if you meant me, but I do indeed do that sometimes.
We all seem to handle things differently and we all seem to find our way eventually.

We all have heard the stories and we all know what the consequences are to high blood sugar or low blood sugar. We just react differently.

I think the internet is a great place for information and we all know that it is also a great place for misinformation. Take the advice you recieve and file it away for reference later. I doubt most people take what they read on the internet as gospel.
Nancy, I totally agree on both counts, especially the part I made bold. I really don't think it's fair for ANYONE to compare ANYONE to each other (i.e. vets to vets or newbies to vets (or even fellow newbies, for that matter), as it goes against the statement I always make..."what works for one, may or may not work for others" (though...heck, I may even be guilty of comparing sometimes myself). :o

I just feel like it's comparing apples to oranges. As stated time and again, "what may work for one, may or may not work for others." This statement applies to EVERYONE (ALL humans, in ALL situations).