50 Secrets of the Longest Living People with Diabetes

INTRODUCTION

FACING THE GHOSTS OF DIABETES PAST, PRESENT, AND FUTURE

Thank goodness that some things are in the past. For instance, one of us (Dr. Sheri Colberg) clearly remembers believing as a preteen that she was doomed to suffer a premature death from diabetic complications before finishing her high school years, at which point she would have already had type 1 diabetes for well over a decade (since the young age of 4). Now, over three decades later and a quarter century past her high school years, she is living well with diabetes, has given birth to three perfectly healthy sons, and has suffered only minor, treatable diabetes complications to date, despite living almost all of her life with the disease.

We consider ourselves the diabetic version of the ghosts of Christmas past, present, and future in Charles Dickens’s classic tale, A Christmas Carol. As was done for Ebenezer Scrooge, we and many other long-time diabetes survivors are going to help you understand your past, present, and possible future with diabetes—before it’s too late to change your personal story and choose a different, healthier ending.

PERSONAL GHOSTS OF DIABETES PAST

Luckily for Dr. Sheri, her early beliefs were no more than a Dickens-spawned ghost of diabetes past. Her false assumption of a predestined early demise had arisen from reading on her own about all of the “inevitable” consequences of diabetes, which were admittedly a more common reality before the availability of modern-day management tools, better medications, and a greater understanding of the actual causes of diabetes-related health problems. By finding her way to optimal diabetes control using whatever management tools were available to her at any given point in time, she prevented this possible bad ending from becoming her diabetes present or even a likely future.

“For me, the worst part of getting diabetes when I was 4 was being forced to give up eating Froot Loops!” Dr. Sheri recalls. “Back in 1968 when I was diagnosed with type 1 diabetes (just a month after I had the mumps), the standard diabetes diet required cutting out all sugar. I loved that cereal, and to this day—almost 40 years later—I still remember the cabinet in the kitchen where we used to store the box even though we moved the next year. Getting shots didn’t bother me nearly as much as losing my favorite cereal.

“Now, with modern-day insulin analogs and a blood glucose meter, I could eat Froot Loops if I really wanted to and still manage my blood sugars, but to tell you the truth, I tried them once a few years ago and thought they tasted horrible! I don’t let my kids eat them either, even though they don’t have diabetes, because I know that they make anyone’s blood sugar spike rapidly, and no one needs that.”

Dr. Steve Edelman’s past is a little different from Dr. Sheri’s. He didn’t develop diabetes until he was already 15 years old. “In junior high school, I would run to the restroom to urinate between classes, relieve my distended bladder, and then slurp up as much water as possible at the drinking fountain,” he recalls. “I could not quench my thirst, and all of the kids in line behind me yelled at me because I took so long. Then, halfway through my next class, I would have to urinate again and almost desperately seek out the nearest drinking fountain.” He had the classic symptoms of type 1 diabetes. When he finally realized something was really wrong with him, he asked his mother to take him to the doctor, where he was immediately diagnosed.

The ghosts of diabetes past have been more real for Dr. Steve because of his lack of good control in his early years of diabetes. “Every three months I would see my doctor, who would look at my urine and blood glucose results and say the same thing every time. ‘Steve, you are doing fine. I will see you next time.’ He said the same thing even after I’d had five doughnuts (two glazed, two chocolate cake, and one maple bar) one time before going in for my appointment when I knew my blood sugar was sky-high. In addition, I never went to a camp for diabetic kids or spent any time in support groups or classes for young people with diabetes. I was never educated on how to take an active role in my own diabetes care, and as a result, my control started to slip.” Since that time, though, he has sought out the best diabetes care and the knowledge he needs to both control the problems he has (some eye, kidney, and nerve problems) and prevent others from happening, and he regularly shares everything he knows with others.

In retrospect, even Dr. Sheri would agree that giving up eating her favorite sugary cereal, no matter how much it traumatized her at a young age, was well worth the better health she is likely experiencing now by going without eating it. By making other alterations in your diet and lifestyle that are just as simple to implement, you also have the power to change the course of your life and your experience with diabetes. You can control your blood glucose levels to prevent diabetes-related health complications from happening to you (or better control any you already have), and in the rest of this book, you’ll learn exactly how other long-time diabetes survivors have successfully done it and how you can, too.

IS THE GHOST OF DIABETES PAST IN THE PAST FOR EVERYONE?

Unfortunately, the diabetes past is still all too frequently a part of the present for many people. Poorly controlled diabetes can have a tremendously negative impact on your health. Almost everyone agrees that experiencing good health is truly the most important aspect of living well—with or without diabetes. In fact, without good health, a longer life is not really worth living. If you’re unsure, just ask someone with shooting neuropathy pains (due to nerve damage in the feet from diabetes) what he or she would wish for: a longer life or a pain-free one. While it’s perfectly understandable to wish for both a long and a healthy life (most of us desire both), if forced to make a choice between living long and living well, almost all of us would choose having good health for the rest of our lives, with living longer as our secondary goal.

When diabetes enters the picture, though, you could lose out on both counts. Diabetes has the potential to rob you, on average, of more than twelve years of your life. What’s more, it can also dramatically reduce your quality of life for more than twenty of those years by negatively impacting your health while you are still alive. Your quality of life can be reduced by many physical ailments, but diabetes often causes disability through partial limb amputations, chronic pain, loss of mobility, blindness, chronic dialysis, and/or heart disease. In fact, experts recently estimated that for the 38.5 percent of average females born in the year 2000 or later predicted to develop diabetes, the disease will shorten their lives by over 14 years (if diagnosed by the age of 40) and make their lives a lot less worth living during the last 22. As diabetes survivors ourselves, we can’t think of anything less desirable than living a shorter, disease-limited life.

Just by having diabetes, you already have twice the risk of dying young as someone who is diabetes-free. If you’re a younger type 2 diabetic person (between 25 and 44 years old), your risk is almost four times as high. Diabetes is the sixth leading cause of death, but it should actually have a higher ranking. For instance, if you die from a heart attack or stroke, your death certificate may not even mention diabetes as a cause or contributing factor, even though we now know that poor blood sugar control accelerates the blockage of arteries around your body. The World Health Organization recently estimated that diabetes kills more people worldwide than previously thought, causing well more than 3.2 million deaths per year, or at least six deaths from diabetes every minute of each and every day.

THE RAPIDLY GROWING DIABETES PRESENT

We’re not dwelling on the darker side of diabetes to upset you. Rather, our goal is to give you hope for a brighter future by increasing your awareness of what’s possible and how to prevent problems. Without better education and a concerted effort, all the diabetes management tools in the world aren’t going to make a difference or keep the diabetes past out of our collective present and future lives. The world is currently experiencing the fastest rise in cases of diabetes ever, resulting in an epidemic all around the globe. In fact, American children born in the new millennium have a one in three chance of developing diabetes in their lifetime, and for many minorities like Hispanics and African-Americans, the risk is closer to one in two. Likely more than 21 million people in the United States already have diabetes (7 percent of the entire population), although a third of them still have no idea that they do, and every twenty-one seconds someone is diagnosed with it. A recent conservative prediction of the number of diabetic Americans in the year 2030 is that there will be over 30 million, but with the way things are currently going, it’s likely to be much higher.

More than 90 percent of people are developing type 2 diabetes, which is largely due to an interaction of genetics and lifestyle habits that result in insulin resistance. In their bodies, the glucose-lowering hormone insulin is unable to effectively manage blood sugars, and they usually end up losing too many pancreatic beta cells to make enough insulin, so they will often have to take insulin injections to make up the difference. Another 5 to 10 percent have type 1 diabetes, which results from an abnormal immune system response (and possibly altered sensory nerves) that wipes out their bodies’ own beta cells, leaving them dependent on external insulin for the rest of their lives. Like type 2s, though, people with type 1 diabetes can also develop an insulin-resistant state as a result of lifestyle choices, which only makes their diabetes harder to control. So, when it comes right down to it, no matter what type of diabetes you have, the secrets to controlling it, living well, and preventing diabetes-related health complications are remarkably similar, as you are soon going to find out.

A SWIFTLY CHANGING GHOST OF DIABETES FUTURE?

Despite current remaining obstacles to diabetes prevention and control, the future of diabetes is still looking brighter and brighter all the time. The message we want to convey to you is that you can take control of your diabetes, even if you already have complications. It is never too late to feel in control, both mentally and physically. Reaching this future starts with learning from the lessons offered by survivors of past years with diabetes. Many long-time diabetic survivors have been officially identified and awarded by the Joslin Diabetes Center, Lilly Pharmaceuticals, and others. The Joslin facility was started as a private practice in 1898 by Elliott P. Joslin, MD, who believed that the key to managing diabetes is patient involvement, education, and empowerment. This philosophy closely parallels the one that Dr. Steve has adopted for his educational, not-for-profit organization, Taking Control of Your Diabetes (TCOYD), which puts on conferences and health fairs around the country as part of his mission (www.tcoyd.org).

Some time ago, researchers began to track long-living people with diabetes to find out their secrets of longevity. For example, in 1970, the Joslin Diabetes Center established the 50-Year Medal, an award given to anyone using insulin to treat diabetes for a half century (to correspond with 50 years of insulin availability starting in 1921), and they are also studying these individuals to find out their longevity secrets. As of 2005, more than 2,200 people worldwide had received this medal. On the seventy-fifth anniversary of the discovery of insulin in 1996, they also awarded the first medal for living 75 years with diabetes, and as of 2005, over sixteen people had been recognized for achieving this remarkable feat. Lilly Pharmaceuticals, the original manufacturer of insulin for diabetic use (but now just one of several companies that make it), also established 25-, 50, and 75-year awards (for insulin users) as part of its LillyforLife program in 1974, and since the program’s inception, this company has presented more than 1,500 of its own 50-Year Insulin Awards. While the majority of the recognized individuals have type 1 diabetes, anyone with type 2 diabetes who has been using insulin for at least a quarter of a century also qualifies for these awards.

What makes these long-living individuals’ accomplishments so remarkable is that blood glucose meters have only been widely available since the early 1980s, so these survivors have lived a large part of their diabetic lives without the benefit of knowing their exact blood glucose readings (or being able to fully control them). Furthermore, the average life span for most individuals, with diabetes or without, is only around 74 years for men and 78 years for women in the United States, so living for 75 years with the disease means that they have outlived many people living without it.