If forced to attempt to analyse the psychological effects of the disease on my behaviour, I arrive at an uncomfortable conclusion: I was ashamed of being a diabetic, as if it betrayed some moral as well as physical weakness. This, perhaps more than anything else, led me sadly astray.
I conclude this account with one piece of advice, particularly aimed at the carers of young diabetics: convince the kid that despite all the advances in knowledge and treatment, the cause of diabetes mellitus is still a mystery, like life itself, and that having the bloody disease is a nuisance and a challenge, but nothing to be ashamed of.
REFERENCES
1 Such as Understanding Diabetes: Managing your life with diabetes, The Diabetes Centre, St Vincent's Hospital, Sydney: Simon & Schuster, 1997.
2 As an example, medical opinion about the complications associated with diabetes was not exactly optimistic. The Methuen Concise Encyclopaedia of Science and Technology, published in 1978, states: 'eye complications should be recognised early, especially in juvenile onset cases, as early intervention may prevent or delay blindness.' p166
3 Jean and I were both married when we met in 1972. We lived together for 11 years without marrying and then separated. By then we were both divorced. Jean married again and I entered a relationship with another woman. Jean's husband died and my relationship ended. We got back together again in 1990 and married in 1991.
4 Sunday Mail Magazine, 16 November 1997
5 London: Alison & Busby, 1988
6 New York, 1989
7 Darkness Visible, New York, 1990
AFTERWORD
I have been asked to add a few words about this book, concerning the interface between the social and scientific aspects of diabetes, and the advances in science and technology which have occurred since Peter Corris was diagnosed as a diabetic 42 years ago. Having had Type-1 (insulin dependent) diabetes myself for 40 years, since I was a medical student, I can easily identify with the problems Peter has faced, such as coping with hypoglycaemia during university exams, sport, loss of self-confidence, and having doubts about the ability to succeed in my chosen profession. Like Peter, I have also tried to conceal hypoglycaemia due to embarrassment and, like Peter, have found that one's saviour from severe hypoglycaemia is usually a woman (men usually think you are drunk, or are too embarrassed to say anything!).
Improvements in our understanding of diabetes, and in technology, have made it a lot easier to live with in recent years. The greatest single advance in patient management was the introduction of home blood glucose monitoring in 1978, arguably the most significant step forward since the discovery of insulin in 1921. Prior to this, diabetics relied on urine glucose tests which were at best unhelpful, and often frankly misleading. The early glucometers were bulky desktop devices, but modern monitors are small enough to be carried in a coat pocket or small handbag, and are more accurate and reliable. Attempts are being made to develop a continuous blood glucose monitoring device which can be worn like a wrist watch (and this would be of immense benefit) but the models currently available are too inaccurate and too expensive to operate for most patients.
The glycosylated haemoglobin (HBA1c) assay, also introduced in the late 1970s, gives valuable and reliable information about overall blood glucose control over the preceding two to three months. It is particularly useful in identifying patients who falsify their blood glucose record in an effort to mislead their parents and doctors into believing they are compliant with treatment strategies.
It has been possible to measure plasma insulin levels by radioimmunoassay since the 1960s; understanding the fluctuations which occur in insulin levels during the day has led to the development of insulin regimens which more closely mimic the insulin levels in the non-diabetic, such as the basal-bolus regimen of four injections per day – these have made it much easier to achieve satisfactory diabetic control. Rapid acting insulin analogues are now available, eg. LisPro (Humalog) and Insulin Aspart (NovoRapid), which provide better control of blood glucose after meals than conventional insulins; long-acting insulin analogues are currently in clinical trial.
Injector pens were introduced in 1985 to cope with the basal-bolus insulin regimen, and have largely replaced syringes except where long acting insulins or mixtures are required. Continuous insulin infusion devices for home use were first described more than 20 years ago, but their usefulness is limited by considerations of cost and inconvenience.
We can now measure circulating antibodies in children of insulin dependent diabetics, and predict with considerable accuracy which children are at risk of developing diabetes. Strategies to delay or prevent overt diabetes from developing are being trialed. In 2000 the 'cure' is still elusive, but advances in DNA technology should soon lead to the production of artificial Beta cells which can be implanted, and which will release insulin when the blood glucose rises above normal. We live in exciting times.
Peter Corris' account of the life and experiences of an insulin-dependent diabetic is fascinating and easy to read. His description of the 'denial' of diabetes and the risk of complications ('it won't happen to me') will be immensely valuable to young people or those with newly diagnosed diabetes who are having difficulty coping with injections, fingerpricks and the need for a regulated lifestyle. Parents of young diabetics will also learn a lot about the tortured thought processes of their children as they struggle to come to terms with their diabetes – and make no mistake, it is a struggle!
Diabetes nurse educators are generally much better than doctors at teaching patients how to live with diabetes, and if there is any deficiency in this book, it is that the importance of diabetes educators is not given enough prominence.
One final comment: There is a distressing tendency to use political correctness (aka political idiocy) and refer to the diabetic as a Person with Diabetes or PWD. Personally I believe the use of the term PWD is one form of denial of diabetes, and am delighted that the straight talking and disarmingly honest Peter Corris calls himself a diabetic. Long may he flourish!
Dr Alan E Stocks A.M.
MB., BS(London) MRCS.,
LRCP., MRACP., FRACP., FRCP.
Emeritus Consultant Physician, Princess Alexandra
Hospital, Brisbane
Clinical Associate Professor, University of Queensland
President, Australian Diabetes Society 1980-82
Patron, Diabetic Association of Qld 1972-87
Governor, Kellion Diabetes Foundation
May, 2000
GLOSSARY
Beta cells:
the insulin producing cells of the pancreas
Cardiovascular:
pertaining to the heart and blood vessels
Cataract:
an opacity in the lens of the eye
Coma:
loss of consciousness from any cause. In diabetes from very high or very low blood glucose levels
disease in which the body cannot produce insulin or use insulin properly. Characterised by high blood glucose levels
Erectile dysfunction:
See Impotence
Glucometer:
blood glucose monitoring unit
Glucose:
the form of sugar found in the human body
Glycosylated haemoglobin reading:
test that gives accurate reading of overall blood glucose control over last 2-3 months
Haemoglobin:
the red coloured iron protein that carries oxygen in red cells
Hyperglycaemia:
blood glucose higher than normal
Hypoglycaemia:
blood glucose level lower than normal
Impotence:
the inability in males to start, sustain or complete the act of sexual intercourse
Insulin:
a hormone produced by the pancreas that lowers blood glucose
Insulin Dependent Diabetes:
See Type-1 diabetes
Juvenile Onset Diabetes:
See Typ
e-1 diabetes
Ketones:
chemical substances from the breakdown of fat which can be dangerous in large amounts
Maturity Onset Diabetes: (late)
See Type-2 diabetes
Non-Insulin Dependent Diabetes:
See Type-2 diabetes
Pancreas:
a gland lying towards the back of the abdomen half-way between the navel and line joining the nipples
Plasma:
the liquid portion of blood
Type-1 Diabetes:
where little or no insulin is made, usually occurring under the age of 30 and requiring insulin injections for life. Also known as insulin dependent and juvenile onset diabetes
Type-2 Diabetes:
Insulin is present but doesn't work adequately. Usually occurs over the age of 30 and is controlled by diet and medication or diet and insulin. Also known as non-insulin dependent and maturity onset diabetes.
RESOURCES LIST - DIABETES AUSTRALIA
Australian Capital Territory
Diabetes Australia - ACT
The Grant Cameron
Community Centre
Mulley Street
HOLDER ACT 2611
PO Box 3727
WESTON CREEK ACT
2611
Ph: 02 6288 9830
Fax: 02 6288 9874
New South Wales
Diabetes Australia - NSW
26 Arundel Street
GLEBE NSW 2037
GPO Box 9824
SYDNEY NSW 2001
Ph: 02 9960 3200
Fax: 02 9566 4235
Email:
dansw@talent.com.au
South Australia
Diabetes Australia - SA
Unit 4, 159 Burbridge Road
HILTON SA 5033
GPO Box 1930
ADELAIDE SA 5001
Ph: 08 8234 1977
Fax: 08 8234 2013
Email: dasa@da-sa.com.au
Western Australia
Diabetes Australia -WA
48 Wickham Street
PERTH WA 6004
Ph: 08 9325 7699
Fax: 08 9221 1183
Victoria
Diabetes Australia - VIC
3rd Floor, 100 Collins Street
(PO Box 9824)
MELBOURNE VIC 3000
Ph: 03 9654 8777
Fax: 03 9650 1917
Email: dav@peg.apc.org
Queensland
Diabetes Australia - QLD
Cnr Ernest & Merivale
Street
SOUTH BRISBANE QLD
4101
PO Box 3814
SOUTH BRISBANE MAC
QLD 4101
Ph: 07 3239 5666
Fax: 07 3846 4642
Email: ea@daq.org.au
Tasmania
Diabetes Australia - TAS
57E Brisbane Street
HOBART TAS 7000
Ph: 03 6234 5223
Fax: 02 6234 5828
Email: DATAS@bigpond.com.au
Northern Territory
Diabetes Australia - NT
2 Tiwi Place
TIWI NT 0810
GPO Box 40113
CASUARINA NT 0811
Ph: 08 8297 8488/
08 8927 8482
Fax: 08 8927 8515