Life With Diabetes – Then and Now!
By Usha Dhiman 

The other day I was grumbling about the many times I have to prick my fingers to check blood sugars, when I recalled what a trying time I had had trying to manage diabetes for the past 44 years.  In fact I realized that I should not be complaining but be grateful for the so many new gadgets, which have made now monitoring and managing diabetes so much easier, and as a result have made our lives much more comfortable, than it was, say about two decades ago!

I went back into the era when there were no meters for checking blood sugars, no disposable syringes or sticks for checking urine sugars and ketones and no sugarless foodstuff to gorge!   I remember the tedious time my mother and I had just checking the sugar in my urine.  I had a small spirit lamp and would mix 8 drops of urine in 5 ml of benedict solution in a test tube and keep it on flame for about 2 minutes and check the colour change.  If it was blue it was very good, green was good and yellow was bad and orange and brick red were really bad (that is the sugar was very high).  Now the limitation was that though blue was very good, it could mean it was lower than about 180 but one could not tell whether it was say 140 or 40 and red could mean 300 or even 500. Now we have sticks for testing sugars - just a dip in the sample of urine and a few seconds wait, and one has the result.

Usha Dhiman

And as for the blood tests - I would go to the laboratory lugging my insulin and breakfast along, give a fasting sample (which was drawn intravenously and was therefore painful) and then wait for two hours to give the post-prandial blood sugar sample. And all this would give me the profile only for the fasting blood sugar and the one after breakfast, so I was clueless as to what my sugars were for the rest of the day!  I recall the mornings when I would not get up and my mother would scold me, both of us not realizing that I was actually having a hypo at that time.  The numerous hypos I had at the work place and outside, which could have been averted had I known which way my sugars were going, and also the many hospital stays (because of high sugars and ketones) which could have been avoided.  When one was ill and had high ketone levels, there was no quick way of knowing except from the lab tests.  Now you just dip a strip in the urine sample and know whether you have ketones or not and if so, you can take remedial action.

Now we are also lucky to have disposable syringes (which can be discarded after use) with very fine needles, therefore much less painful.  These can be carried easily during travel, as there is no sterilization needed.  About twenty years ago, we had glass syringes, which along with the needles had to be sterilized in boiling water after each use.  I cannot imagine now sterilizing the syringes four times a day. This process was quite cumbersome during travel and during hectic schedules or exams or when a shot had to be taken at the work place, and quite painful too as the needles were thick and more painful compared to the fine needles of syringes and insulin pens these days.  And of course we had to be careful that we do not break the fragile syringes!   Now we also have insulin pens, which are even less painful than the disposable syringes and are very convenient to carry, during travel, meetings etc. 

Now with the advent of a meter, life is so much easier and predictable.  We need not go to the laboratories nor make wild guesses whether our sugar is 40 or 120 and most importantly, we know our blood sugar profile for the whole day. Whenever in doubt, we just prick a finger with the lancet and know exactly where we stand!  And when we are sick and sugars are very high, we have the option to check the urine for ketones, thanks to the sticks, which are available now and this helps avert so many hospital stays as we can increase our rapid acting insulin dose and bring the sugars under control. This has helped me prevent so many hospitalization stays, as earlier whenever the sugars were out of control, I was admitted for stabilization, and it was quite often that I landed with high sugar and ketones levels!  Now I also have the liberty to have variation in my food timings and quantity with the sugar results at hand.  And the meter has helped me immensely in detecting night hypos.  When in doubt, just check the sugar and take remedial action, it is so easy. 

Then we have glucagon injections, which can be kept at home and given by non-medicos like family members/friends in case of severe hypos.  Prior to this, one had to be rushed to the hospital whenever unconscious with a severe hypo!  We are also lucky to have material on diabetes on the net and various diabetes associations’ magazines to update our knowledge, which helps keep abreast of news on diabetes and helps to control it better.  There are various diabetes groups/associations, which also have meetings, picnics and camps for diabetics, so that they can exchange views with fellow diabetics and learn from each other, besides mutually providing support to each other.

And now with the various new human insulins in the market, the control is so much better and predictable.  Like Humalog insulin, this has very rapid action so there is no need to wait for half an hour after injecting insulin to have a meal, which was done with the previous insulin.  One can even eat after a meal, if need be.  When one is in a hurry to leave for office, this half hour really is a real boon and it really saves time if you need to inject in the work place.  Then there is the latest, Lantus the longest acting insulin, which acts for 20 to 24 hours and does not have any peak action and therefore averts nocturnal hypos.  Now I can take a lantus shot and sleep peacefully without the fear of hypos and the bother of getting up in the middle of the night to monitor sugars. 

Then we have so many new tests to help us, like the microalbumineria test, which helps detect kidney problem at a very early stage, so treatment can be started earlier. We have the GDX test to detect glaucoma at a very early stage and thus protect our eyesight.  And now with the advent of insulin pen, carrying and traveling with insulin has become so much more convenient. Then, for those who can afford it, there is the insulin pump.  The pump makes your life injection free and the control is much better with the continuous supply of insulin and it gives you much more freedom in your lifestyle.  The only intimidating factor is the high cost.

We also have sugarless chocolates, ice creams, jellies, jams, chewing gum, sweets and even “mithai” in the market, so we do not feel deprived of sweets.   One can even have diet pepsi /cola drinks and sweet halwa, kheer etc made with various artificial sweeteners available in the market today

In the near future we have new discoveries in the pipeline, which would make life much easier - like nasal spray instead of injections, new insulin pumps which would also reflect blood sugars, transplants of islet cells, new painless methods of testing sugars without pricking fingers etc.

So thinking of all the above made me reflect with a smile that life is not very difficult after all and definitely not what it used to be.

About Usha Dhiman: I got diabetes at the age of 7 years and have been on insulin injections
ever since.  This year I will complete 45 years with diabetes. It has not
been easy coping with diabetes but by God's grace and support of family and
my perseverance and discipline I have come this far. At age 6, I was loosing
weight drastically and feeling very hungry and thirsty, but since we were in
a small town in Kenya (Nanyuki) diabetes got detected only when I went into
a coma.  Now I am 51 years of age, single and fortunately do not have any
major complication. Cataract surgery was done in the right eye, blood
pressure is normal and eyes and vision are fine too and so are the heart and
kidneys, so far!

I did my primary schooling from Kenya (Nanyuki) and then school and college
from Mumbai.  After that I did a secretarial course from New Delhi and have
been working as a secretary since 1981 in New Delhi.  For the past one year
I am working at the American Embassy as Secretary to the General Services
Officer.  I take four shots of insulin a day (3 of humalog before meals and
1 of lantus at bedtime).   Pumps have come in the Indian market but they are
very expensive and we do not have any medi cover here, therefore I have not
yet gone on the pump though I feel it would help since my sugars fluctuate
quite a bit.  I keep quite active and go for daily walks in the evening
after office.  I keep abreast of the latest developments in diabetes by
going through the various diabetes web sites and reading any diabetes
magazine I come across.  I would love to interact with other diabetics and
help them in any way I can.

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