Are we spoiled?
An interesting question has been poised this week, not really in that way, but that is the essence of the question. The real topic being explored is what has been accomplished? Like I said it is really a being posed as a dual edge discussion what has been accomplished and given all that has been accomplished are we spoiled?
So let’s look at the first part of that question. What has been accomplished? The answer is more than anyone could have reasonable predicted even in the 1990’s. Here are a few accomplishments:
1. Standard measure for units of insulin,
2. At home testing for blood sugar,
3. Almost universal availability of effective type 2 drugs,
4. A heavy emphasis on developing new type 2 drugs,
5. Insulin pumps,
6. Sterile syringes, and
7. The rise of Endocrinology and Certified Diabetic Educator as professions
The thing is every one of those accomplishments is in and of themselves revolutionary. Take for instance the standard measure of insulin units. Do we realize there was a day prior to 1950 that one unit of insulin depended on which insulin manufacture we used and which syringe we had? We hear the common complaint today that diabetes is really a math problem. I agree that diabetes is a math problem, especially for those who use a syringe for control. Today we first determine the amount of carb being consumed then they convert that too insulin units to administer. However, toss in calculations for the insulin being used and the syringe (as done in pre 1950) and you have something akin to a calculus problem at the dinner table. Without standardization we would not have carb based insulin dosing and likely no insulin pumps, or if we did we have to choose the pump based starkly on insulin availability, something that many of us know changes often.
How about the recent emphasis on type 2 drugs? Wow what a turn around. The new drugs being developed are remarkable both for their diversity of approach and the sheer number of new products. I entered the search term type 2 drugs. I got a list of over 100 drugs available for treating type 2 Diabetes. Several of these drugs are not commonly used, but many (about 15) are first line drugs. I cannot think of many chronic diseases with more options for treatment than are available for type 2 diabetes. This is a stark difference from the 1990’s when the main prescription for type 2 diabetics was to eat less. We have come a long way in a short time, That doesn’t mean we have done enough, but compared to where we were in the 1990’s we are so much better off.
How about sterile plastic syringes? We have several people in our community who will remember the problems with sterilizing syringes between uses. What a mess. The invention of plastic disposal syringes has led to the development of the pump, universal access to insulin and thin gauge smaller needles. Sterile single use disposable syringes were a technical revolution like few others for people with diabetes. It is a remarkable accomplishment we take for granted today. Yet in its day it completely revolutionized care of diabetes. If you take multiple daily injections, you do so because of sterile disposable syringes. Without sterile disposable syringes few could have that treatment option. Without multiple daily injections it is doubtful a pump would have ever been approved.
All this come to the unsaid point of the look back efforts. Are we spoiled? Well yes I would say we are. We are spoiled because we (me included) take these innovations for granted today. We want more innovation and we want it quicker. But, we often fail to remember how far we have come and the struggles we had getting here. It is a remarkable journey we have been on. So much ground has been covered, but it has taken a long time. Our innovations are small steps on a long road. We all want a big breakthrough and we all seem to define success differently. I can guarantee that in its day uniform insulin units seemed a far off goal. Today we hardly remember that was ever an issue.
Perhaps our lesson is that we need to celebrate our small successes. Each small success is like a brick being added to a path. Think of that path being the ultimate cure for diabetes. No one could have ever built the path all at once. Instead it will be built one brick at a time. So are we spoiled? I know I am. I often fail to give thanks for the things already accomplished. I just have to remind myself that the path to the cure will be built one brick at a time. It will take all the bricks, even the ones that ultimately lead nowhere, to build the path that will get us to the cure. We also have to remember the term cure is a moving target. My cure is likely your milestone and vice versa. It pays to remember the milestones while we push forward.