Meanness in the Management of Diabetics


During that first week of instruction we had at the Joslin Clinic I remember a nurse writing on the blackboard in giant letters, ‘DIE,’ and saying, “Always remember that if you don’t follow the regimen of Diet, Insulin, and Exercise, this is what is going to happen to you.”


With many things, I choose to retain the more prevalent better experiences and not dwell on the infrequent less pleasant experiences.


I also remember a triangle drawing connecting diet, exercise, and insulin when I received diabetes education back in the R and NPH days. It’s interesting to me that nowadays the diet and exercise parts have been dropped in favour of focusing on insulin alone. In my opinion, as crappy as the older insulins were, there are some merits to looking at all three of these aspects as important and as crucial parts of diabetes management, rather than just focusing on one and ignoring the other two.


That is a great point. In fact, we are seeing moderate exercise is having significantly greater impact as compared to dietary variability.

We were clearly always aware that exercise had an impact but the degree of the impact is surprising.


I’ve been type 1 for 37 years. Over many hospital visits in which my non-internal medicines doctors literally destroyed the control I know the most about, and I had to get it back under control Un-beknowst to them, I finally concluded that I would never allow another doctor to take control of my BG away from me. One nurse who understood the average diabetic, read my blood sugar at 230, an hour later fed me breakfast, an hour after that came in to test my blood sugar before giving me a dose of insulin & did not understand why my BG was 450… doesn’t happen to my other diabetic patients. Not her fault, except that I know what needs done & when it needs done, & the doctors should never have wrested control from me. At about the same time I said never more, the hospital policy became, insulin pump users would maintain their own control.