To have Type 1 Diabetes

I saw Andy the other day- he was a new referral for hyperglycemia. Lean, with no family history. His glucose was found to be 455 mg/dL at his primary physician's earlier that day, with a hemoglobin A1c of 14%, so they rushed him in for a visit with the endocrinologist.

I hate being the one to break it to patients; invariably, most patients are initially quite upset by the diagnosis of type 1. To be told that their islets no longer have the capacity to secrete insulin, and to have this disorder for life. To be told that from this moment on, they will need to be on insulin to survive, and to be aware of dietary carbohydrate intake, blood sugars, and all that stuff.

I don't blame anyone for being upset. And I don't blame them too for not quite believing the optimism I show at these visits. I tell them, diabetes does not mean the end of junkfood, or candy, or fun stuff, or exercise. It's just that one has to make some changes to one's lifestyle, and obviously educational empowerment of the patient is key. A lot of learning. But the truth is, with good teaching, and commitment by the patient and health provider, a vast majority of patients have excellent prognosis. They do well.

But the look on their faces tell it all:

"Patients do well?? How can that be? I'll need to check my sugars and take a shot 4 times a day! For the rest of my life??!"

I can understand the patients' scepticism. But, from the other end of the fence, speaking as a doctor, I am humbled as well by the advances we have made in the field of type 1 diabetes. After all, before the discovery of insulin by Drs. Banting and Best in 1921, type 1 diabetes had 100% mortality when it became fullblown. ALL patients died, most never seeing adulthood. In probably the fastest drug developmental program, the first human subject testing occurred in 1922, and insulin came on the market only a year later! Dr. Banting eventually received the Nobel prize in 1923. And now, the situation has completely reversed- with insulin, we expect all our patients to not only live, but live meaningful lives albeit with numerous adjustments to lifestyle.

Imagine if we can someday say this for cancer.

And so, when I do try to be optimistic with these new patients, I do really mean it though I realize we may be looking from different angles.

And I agree with the battlecry of many of my patients still looking out at the horizon for new developments in treatment: Insulin is not a cure.

Someday hopefully we get there. But in the meantime, this is the best we have.