I thought it would be fun to have a discussion completely dedicated to the changes in diabetes management over the years. Be sure to include the year that you were diagnosed as well!
Without a doubt, the biggest for me was home blood testing which replaced urine testing. I am still using that technology, even after the advent of CGM. It’s funny to think that as old as the home BG tester is, we still use it to calibrate our CGM.
For you youngsters, we used to have to test our pee, which only told us basically high, medium, or low BG, and what it was a few hours ago!
“Tell us more, grandpa!”
Home meters and disposable syringes were already common when I was dx, so I never had to cope with the older technologies. Pumps were still pretty new, and pretty simple by today’s standards. Probably the biggest change (and it was gradual) is the explosion in medicinal options – DPP-4 inhibitors, GLP-1 agonists, more and better insulins. Oh yeah, and CGMs. That’s a biggie.
I was diagnosed T1D in 1984. Here’s a list of my most effective treatment tools since then:
- Blood glucose meters
- Basal/Bolus therapy using multiple daily injections and counting carbs
- Insulin pump
- Rapid and long acting analog insulins
- Continuous glucose monitor
- Low carb, high fat way of eating
- Loop - the experimental open source hybrid artificial pancreas system
I rate the Loop as the most dramatic and promising treatment in my 33 years with diabetes. It’s hard to compare across so many years. Some things were very important to me early on because we had so few effective tools to work with. The home blood glucose meters were a big deal back in the '80’s but now seem small when compared to a CGM.
The low carb, high fat way of eating was/is a revolutionary method for me to control blood glucose. I don’t think my Loop experience would be as successful and promising if I reverted to my pre-diabetes way of high carb eating. For that matter, the CGM plays a critical role in the function of the Loop. I couldn’t enjoy the benefits of the Loop without my Dexcom CGM.
I still think the Loop is the biggest/best change in my diabetes treatments over the years with carb-limited eating and the CGM very close behind.
Diagnosed in 1983 after about 15 years of “pre-D” testing. The A1c! Before graduating to the miracle of a CGM, this was the first indicator that my control might not be as perfect as I wanted–and I couldn’t “cheat” by starving myself before pre-doctor visit blood tests!
Rather than repeat Terry’s list, I would just add that the availability of information from OUTSIDE the medical community was very significant.
Having access to books, conferences, online communities, etc to support/educate and enable/empower us to take more control ourselves, and adapt our care to what’s best for each unique person with diabetes.
diagnosed in 1965. Without the medical/technical advancements, I’d likely be blind, on kidney dialysis, or dead today.
I was only diagnosed earlier this year as Type 2, and then re-diagnosed as LADA very recently. However, I feel like something has definitely changed even in that short amount of time. When I had my first meeting with my CDE, she told me “eat a minimum 50% of your calories from carbohydrates.” When I had my last meeting with my CDE, since 50% of calories was more than I was eating before diagnosis, she said “some people have good experience with very low-carb diets, but I can’t suggest them due to my certification. You could look them up…” wink wink.
Honestly, there is a lot of recent research that LCHF or LC diets in general can work really well for diabetics of all types, although it is still somewhat controversial (due to entropy in the dietary-guidelines world). I know it hasn’t actually changed since my diagnosis, but it feels like it has. Doctors aid “eat carbs.” CDE said “eat carbs.” ADA said “eat carbs.” Then I find out from the DOC, “don’t eat carbs.” Duh. And now my BG is fantastic, for now…
Everything! Diagnosed in 1970. I was told I could lead a perfectly normal life and I at the age of 8 said, “what normal person plays with their urine 4 times a day?” Wow I hated testing my urine with that stuff chemistry set up in each bathroom. Also it was one shot of Lente insulin. Very, very scary times. Short of insulin, I think home blood testing meters is the greatest invention but think the CGM is the greatest tool we have now. But still need my blood testing meter as I am not as close as many are on readings.
Other big change was diet. How many of us got that paper with the exchange list and thought, this is all I can eat? For me all those great Italian dishes my Mom made were not on the list. Spinach, beets, cauliflower etc not fun times for me or my brother and sister.
So glad we are to the point where I can eat whatever I want, whenever I want as long as I cover it and bolus correctly for it.
Also love my pump vs the five shots a day I was on before starting on my first pump 26 years ago.
While there is no great time to have diabetes, now isn’t so bad!
Cure just around the corner?
The pace of change in the traditional wisdom is painfully slow. Glacial, in fact. Low carb eating has been recommended for blood sugar control since the mid 90s, but you’d never know it from talking to the average mainstream health care professional. People are coming around, but OH so slowly . . .
Which is the confusing part to me… why do the people who are supposed to understand diabetes the most thoroughly (doctors, cde, ada, nutritionists etc) make totally unmanageable recommendations such as eat 50% of calories from carbs?
What are they thinking? Do they know something we don’t? Are they just collectively brainwashed (and if so how did that come to be)? In the more educated circles do the other benefits of eating carbohydrates outweigh the negative effect they have on bg management? are we the stupid ones egging each other on over the internet into eating a way that modern medicine nearly universally rejects?
Before all the slew of diabetes medications we now have, the ONLY treatment was extreme LC… then for some reason the medical world has taken the position that you’re better off to eat a ton of carbs and medicate for them than to just avoid the problem entirely… I can’t help but wonder if they know something we don’t but are terrible at communicating it…
I really don’t get it…
@Terry4’s list covers it for me from a technical standpoint. No surprise, since I was dx’d in 1983, not long before he was. The one thing I would add, and it’s pretty huge: the DOC. It was 20 years after my dx before I ever met another person with T1, and just that one meeting was crucial in informing me about a treatment none of my caregivers had ever suggested, namely carb-counting MDI (I was still on R/NPH). Now there are hundreds of other people w/T1 who will share their knowledge and experience with me at the click of a mouse.
Well, I’m not taking a position on this, pro or con, but one longtime member here claims that the ADA’s real motto (as opposed to their publicly stated mantra) is, “The ADA – Keeping blood sugars high to support our corporate sponsors.”
Draw what conclusions appeal to you. Further deponent sayeth not.
My personal experience is that it’s not an intentional conspiracy, but that they are indeed, and collectively, brainwashed. To put this into perspective, consider what happened when, believing I was a weird Type 2, I started paying out of pocket for a real M.D. who happens to be a board-certified metabolic specialist (i.e., not an endo, but a doctor-level dietitian who specializes in treating Type 2, dyslipidemia, and Metabolic Syndrome). First thing she suggested was simple:
Cut out all carb-heavy foods from your diet, with the exception of green veggies (broccoli, cauliflower, brussel sprouts, green beans, greens, etc.) and eat those sparingly at first til your BG stabilizes.
Add eggs, fatty meat, fatty fish and fish oil, aged cheeses, coconut oil, olive oil, and butter (preferably grass-fed) into your diet in large quantities. Reduce soy products to minimal or non-existent levels.
Keep exercising at high volume and intensity.
See what happens.
What happened was my borderline genetic dyslipidemia got better (triglycerides down, HDL up, overall cholesterol down), blood pressure remained stable (and good), and I started (unintentionally) losing weight. My weight loss and low-insulin levels after my next set of labs (5.1 a1c down from 7.8) were why she got me tested for antibodies (the second set of which came back low but positive) to confirm Type 1.
So it’s not all doctors, but it certainly does seem to be most if not all dietitians in the US. Funny thing is, the keto diet (or other variations of Low Carb) are basically the old Diabetic Diet repackaged for people wanting to lose weight or increase ultra-marathoning performance. Why they don’t get suggested automatically for actual diabetics I have no idea. I can understand why they could be very dicey for many Type 1s (because of the issues with low-circulating insulin, DKA, and having to carefully manage hypoglycemia). But if you’re Type 2, or a Type 1 like me with significant endogenous insulin production, it makes perfect sense to minimize the demands on your beta cells by reducing the amount of carbs you take.
Only thing I’ll add is something I again got from my metabolic doc (who I’m still seeing because she’s also an certified exercise physiologist, which I’m all about…), which is to make good use of supplements and electrolytes while on low-carb diets. Stripping glycogen out of your system (liver and muscles) is great, but it makes it hard to stay hydrated and hold on to certain kinds of absolutely-necessary ions (sodium, calcium, potassium, magnesium, and chlorides). So I eat an unconscionable amount of salt, and I take several supplements daily (ALA, multivitamin sans iron, chelated magnesium, potassium chloride, high-Omega 3 fish oil).
Honestly, I don’t think it’s a matter of “they know something and can’t communicate it.” From what I’ve seen, newer/younger doctors are getting on board with the LC diets, and dietitians are far behind the times. I don’t know what’s up with the ADA, but a lot of their guidelines seem more than a bit outdated, from their suggested BG ranges to suggested treatment/testing regimens (like “don’t test too much, it’s depressing”). I honestly think their entire schtick is built on a 70s and 80s model of aging Type 2s without long to live who are inevitably on insulin because they can’t or won’t adopt better diet and exercise regimes. So why bother with tight control if you’re going to die anyways? And why bother with LC if you’re already injecting insulin?
Dietitians get shoddy education compared to doctors, and they certainly get the “orthodoxy.” The orthodoxy on dieting is changing (compare twenty years of dietary advice on margarine vs. butter or eggs and cholesterol), but certification exams are clearly lagging behind the times.
Diagnosed in 1983: short answer is Dr. Bernstein and Dexcom G4.
Just FYI, there is a common belief that low carb diets for the purpose of weight loss were first popularized by Atkins and people like him beginning in the 1960s or thereabouts. Not so. They were first popularized in the 1860s. That’s how far back the awareness goes. That’s how slowly the general body of accepted belief evolves in the certified professions.
But the question remains how did the opposition who still doggedly advocates eating high carb ever come to exist? What information, logic, or theories were they basing it on? Clearly there must have been some sort of rationale in order to convince the vast majority of “experts” in the world for the past century…
It’s easy to see how low carb came to be considered… because when heavy people ate low carb they lost weight, and if they had blood sugar problems they were less severe— it sells itself.
But what ever sold all these educated people and institutions on high carb eating?
So, I can only point you in two directions, neither one of which I’m going to say are “proven,” although there is some evidence for each.
There is some evidence, including that presented in major newspapers, that there was a concerted post-WWII push towards seeing high-carbohydrate diets as “healthy” based on faulty science (originally from the US Military) and then backed up by the food industry. There have been articles in Time, the New York Times, the Washington Post, etc. over the last year outlining the bad research, bad conclusions, and the efforts in the last decade to reshape the orthodoxy on high carb diets. Google is your friend, even though it all sounds more than a bit like a conspiracy.
Since WWII, what is undoubted is that cereal crops in the US and Europe have been “fortified” along with milk. Vitamins and minerals have been added in very large amounts to almost all pre-packaged foods, and many Western-diet folks have come to rely on breakfast cereals, 2% milk, and packaged bread for everything from calcium to iron to Vitamin D. Since such micronutrients are undoubtedly necessary to living healthy, and since you have to supplement a LC diet heavily to get sufficient quantities of vitamins and other micronutrients, I suspect there is a strong push towards “carbs are healthy” because the food industry has made them healthy, at least on the micronutrient front. This one doesn’t require conspiracies, just a bit of basic research walking down the aisle at your nearest grocery store and reading labels. It’s hard to get iron and magnesium for most people, especially if you’re trying to eat low-fat and low-carb (which many people do).
I was diagnosed in 1991, by which time glucose meters were in common use. I think for me the biggest changes have been the basal-bolus method (whether with MDI or pump) and the use of CGMs. Both of these were life-changing as far as my diabetes management was concerned and allowed me tighter control with more flexibility.
I just learned that have to get taught how talk and how to eat all over again,had several stroke’s.
God bless you and many hugs to you!