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Shake a Leg!

Jan Chait

September 22, 2009

“I thought everybody had an uncle with one leg.”

There it sat, in a file in a folder of ideas and starts of blog ideas I keep on my computer. The blog post I was planning to write for this week fell through and I was looking for ideas.

Where did it come from? A book? An article? Somebody I had talked to at some point? The sentence has been in my file for so long, I no longer remember. I do know it was about diabetes. (I mean, it was in my Diabetes Self-Management folder. Duh!) And it had to be about losing a limb because of diabetes.

I surfed the ’net, trying to find it, but couldn’t. In the process, however, I came across this fun clip.

But back to the missing leg: I was talking to my friend Roger a couple of days ago. He’s had Type 1 diabetes for more than 60 years and still has all of his limbs. He was telling me about a wound dressing called TheraGauze. Seems he had scraped his leg up pretty badly and his doctor had him use the TheraGauze. “That was on Monday,” Roger said. “By Saturday, you couldn’t tell anything had happened.”

In the course of that conversation, he mentioned that he used to see lots of people with missing limbs when he went to the Joslin Diabetes Center to see his endocrinologist.

“I don’t see that any more,” he noted.

That, in turn, reminded me of something William Polonsky (author of Diabetes Burnout) has said, which is something along the lines of: “Diabetes is the cause of… nothing. Poorly controlled blood sugar is the cause of complications.” (I’m batting zero on finding things today.)

Yes, diabetes care has come a long way since the days of no (or substandard) blood glucose testing, one injection a day of intermediate-acting insulin, no oral diabetes medicines, and rigid diets that practically nobody followed.

I was diagnosed in the early days of home self-monitoring. In fact, when I finally did start checking my glucose, it was eight years after diagnosis. My first meter required me to give up a huge drop of blood, wait one minute, wipe the blood off the strip, put the strip in the meter and wait another minute for a result.

My current meters (one that I have to use with my continuous glucose monitor and one I use at other times) give me result in about five seconds. No huge drops of blood here: One takes a bit more than the other, but neither takes much more than a hint.

My friends tell me of the days when they used telephone poles to inject themselves with insulin and they had to sterilize and sharpen the poles by themselves. Well, maybe it wasn’t really telephone poles, but they may as well have been compared to today’s needles that are about the size of a human hair. Disposable syringes do away with dull needles, too.

Oral meds? As I recall, the first sulfonylurea — a type of medicine that stimulates the pancreas to release more insulin — was released in 1955. That was it for about 40 years, when first metformin (brand name Glucophage and others) was approved. Since then, there has been an explosion of oral medicines to treat Type 2 diabetes.

As for insulin itself, we’ve gone from animal-based insulin to those developed in a laboratory. I began with Regular and NPH. With Regular, you had to inject half an hour before you ate. I can’t tell you how much fun it was to go out to eat and figure out what time the food would come out. With insulin analogs, you can wait to inject when the food is in front of you.

I was the first Type 2 in my endocrinologist’s group to get an insulin pump. Today, they’re becoming common even among Type 2s and many people with Type 1 are getting a pump right after diagnosis.

Continuous glucose monitors appear to be on their way to becoming standard.

Food labels help us keep our glucose under better control by giving the carbohydrate counts. And, speaking of food, a “diabetic diet” is much easier to follow. (How long could a person put up with something like “2 meat exchanges, 2 vegetable exchanges, 1 fruit, and 2 fats” anyway? Not for long, I can tell ya!). Some restaurants even give you nutritional information.

Except in rare instances, your uncle shouldn’t be missing a leg anymore. Unless, like my uncle, he had the misfortune of serving in World War II.

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