Nov 14, 2006

Diabetes: Portrayal vs. Reality

Jan Chait

Welcome to American Diabetes Month, a time of free diabetes screening tests, specials on diabetes-related items, and a period in which diabetes gets a bit more media attention than usual.

But is the perception of diabetes being portrayed by today’s media a true picture of the condition in our times, or is it still relying on outdated methods and data?

Take The Iacocca Foundation, for example. In conjunction with Spike TV and 25/7 Productions, it's produced a public service announcement that includes "vivid images of the toll diabetes can take on individuals with the disease, especially children," according to a news release from the foundation. Its executive director, Dana Ball, talks about the "stark reality that children with diabetes and their families live with every day: needles, medications and dietary restrictions."

Surprisingly, my local newspaper had a decent piece about Type 2 diabetes (although it called it Type II). But a comic strip in Sunday's paper addressed the irony of selling candy to raise funds for diabetes. It's been more than a decade since the powers that be figured out that foods with sugar in them didn't affect blood glucose any differently than foods with, say, flour, and we didn't need to totally shun candy anymore.

Historically—and still today—the portrayal of diabetes has hinged on "painful shots," sad-eyed children standing outside a candy store with their noses pressed against the window, and dire warnings about "blind, bilateral amputees being wheeled off to dialysis three times a week." (That last is an approximation of a tongue-in-cheek quote in one of June Biermann and Barbara Toohey's books. Sorry, I can't find the book to tell you which one.)

More recently, a group of people with Type 1 diabetes was told they were unfit to climb mountains. Ignoring the "advice," they went on to climb Cerro Aconcagua in Argentina, the Western Hemisphere's highest peak, in January 2001. You can check out information about that climb and other expeditions taken since then at www.IDEA2000.org.

And how about Gary Hall, Jr., who was told at his diagnosis of Type 1 diabetes in 1999 that he would be unable to continue competitive swimming—and then went on to win six Olympic medals in the 2000 and 2004 games? (Before his diagnosis, he won four medals in the 1996 games. After his diagnosis, however, he lost his sponsors—afraid of that dastardly diabetes—and had to sell his car to make it to the trials for the 2000 Olympics.)

Am I saying that diabetes is a Sunday stroll in the park? Good grief, no! Am I saying that everybody with diabetes can climb mountains or compete in the Olympics? No way!

What I am saying is that today's diabetes isn't yesterday's diabetes. And yesterday's diabetes appears to be what the media often still focuses on.

Yesterday's diabetes featured larger-gauge needles that had to be boiled and hand-sharpened. I never used one, but friends who did said the needles got burrs and weren't altogether pleasant to use. Today's disposable syringes have short, small-gauge, silicon-coated needles that slide in—usually unfelt.

Yesterday's tests consisted of measuring the sugar in your urine—tests that could indicate when your blood glucose was high or when it was really low. Today, we have meters that are much more accurate and measure blood glucose levels in seconds. Continuous glucose monitors are beginning to hit the market, which will make it even easier to measure your blood glucose—and even show if it's on its way up or down.

Yesterday, you may have had your fasting blood glucose level measured at the lab or doctor's office once every three months. Your daily food intake and insulin dosing was based on that data.

Today's new oral diabetes medicines, rapid-acting insulin analogs, disposable syringes, and insulin pumps, combined with home blood glucose monitoring, mean that we can go inside the candy store (metaphorically speaking) and, matching insulin or drug dose to food intake, switching one food for another, or upping our exercise, eat what we want.

So, what do we need now? Education. Education for the media and education for all of us. If we're educated about diabetes, we can write or call the media and tell them when they're wrong and why. If we're educated about diabetes, we know if our doctors are up to date when it comes to diabetes care. If we're educated about diabetes, we have a better chance of maintaining better control of our blood glucose (and blood pressure and lipids and all the other things that go with taking care of our diabetes).

My dream is that the media will focus on what we can do to reduce our chances of diabetes complications. It seems to me that would be more helpful both to us and to our loved ones.

Not only do we have tools, insulin analogs, and oral diabetes medicines today that were unavailable yesterday, but we have studies that prove that good control can lessen the incidence of complications. While good control isn't a guarantee of a complication-free life, it certainly doesn't hurt.

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