I find your comments especially interesting since my diagnosis date, January 1984, occurred within a year of yours. My progression from starting on once/day injection of NPH evolved more quickly than yours did. I went from once per day NPH in the morning to twice per day, adding a bedtime NPH.
I also used Regular (pork-derived) for meals. That meant I was technically on a basal/bolus regimen though I don’t remember that that term was ever mentioned. I don’t remember counting carbs at that time and I likely was injecting a fixed amount of Regular and eating to cover the insulin.
I moved from Idaho to San Francisco in early 1986 and saw my first endo who was in the UCSF orbit at the time. He suggested going on a pump but I resisted until mid-1987. When I did start on the pump, I began counting carbs and that was the start of the basal/bolus treatment for me.
I think my divergence from your treatment regimen was due to my private insurance status and my moving to the enlightened medical culture of the SF Bay Area. I think your HMO-constrained status delayed your escape from the NPH regimen that I left in 1987, even though you were living at ground zero of the diabetes treatment culture.
This brings up an important point even at this late date. Medical knowledge and awareness spreads at a snail’s pace from this patient’s point of view. Doctors are naturally skeptical of new developments and that is not inherently bad – to a point.
Dr. Bernstein was banging the basal/bolus drum for many years (late 1970’s, I believe) and the established medical culture resisted, belittled, and even mocked him. The DCCT in the '90’s finally proved that the basal/bolus regimen was the real deal and yet it took another 10 years for the mainstream practitioners to manage their skepticism and appreciate the good sense that it made.
It’s satisfying to me that Dr. Bernstein has lived long enough to see his prescient view of treating diabetes become the medical mainstream thinking. It would be even more statisying in the ADA’s, Joslin’s, and UCSF’s of the world would acknowledge that Bernstein was right all along and that they should have seen it sooner.
The glacial speed of mainstream medical thinking evolution is something that we diabetics need to factor into our view of current treatment practices. We only have one life and waiting for the mainstream medical culture to catch up is a luxury that many of us cannot afford.
As patients, our thinking and perception should not be easily dismissed by any medical practitioner. Our skin-in-the-game authority and deep experience gives us a rightful place at the table alongside our medical providers as well as the academic and scientific researchers. I definitely hold any doctor’s dismissal of the patient point of view as a negative and a mark against all of their advice.
