World Diabetes Day: How diabetes care changed over decades

"Upon my type one diabetes diagnosis, the nurses began administering me insulin injections before every meal. There weren't any disposable syringes back in those days. We would use Glassvan's syringe and a steel-made needle," wrote Manjeet Kaur, in her 1977 memoir titled Diabetes — An Art of Living A Healthy Life.

Glassvan syringes would cost Rs 25, a significant amount at the time. Every time before a patient administered the injection, they would have to sterilise the needle.

Checking sugar levels — the most important practice for a healthy sugars — was even more challenging. Sugar checking devices like Glucometers were either not available, except in a select few cities, or were too costly to maintain. Manjeet said, "Usually, we'd go to the lab for blood tests. At home, we'd check urine sugar (ketone bodies in urine) by putting a few drops of urine in the benedict solution in a glass bottle. We'd then heat the bottle and depending on the colour of the urine, we'd know if ketone bodies were present."

It's been 41 years since Manjeet's diagnosis. "I cannot imagine, and neither can my parents, to live with such a rigorous process of diabetes management. Not that it's easy now, but with the insulin pump that I am on, things are more in my control," says Nupur Lalvani, living with Type-1 diabetes for 23 years.

Insulin Pump is an advanced insulin administering technology which allows patients with diabetes to configure the device and the dose, along with the timing of the dose, based on their individual requirement. The needle pricks are also reduced to nearly once in four days as compared to MDI's or multiple daily injections.

Interestingly, glucometers entered the Indian market only around the 2000s, that too at exorbitant cost of the test strips. This may be one of the reasons why many patients living with diabetes do not have a glucometer today, even as research in making sugar monitoring painless and convenient is on full swing.

Mumbai-based diabetologist Dr Dakshata Padhye says fear of technology among patients is one of the reasons behind the resistance. Delhi-based Apoorva Gomber, a doctor and a type one diabetic herself, says, "Basic education about what diabetes is, is the need of the hour. And this applies not only to patients but to doctors just as much."

Nonetheless, patients like Angad Chandhok found their way through trial and error followed by doctor support. "Endocronologists play a major role in equipping us with the information we need to manage our condition, but after some time we become so much educated about it ourselves," he says.

The existing technology is merely the beginning in diabetes management; a lot is yet to come. The question that remains is, is the medical fraternity, including patients, equipped to utilise it?

THE GLOBAL  BATTLE AGAINST DIABETES

As per a new study by the international Diabetes federation, 4 in 5 parents have trouble recognising warning signs of diabetes

425 mn – Diabetes cases reported worldwide

72.9 mn – Cases reported  in India in 2017

THE GOOD

79.5% had regular blood sugar check up

71.5% had a regular foot examination

71% never missed an antidiabetic drug dose

62% underwent regular kidney and eye check up

63.5% knew that polyphagia (excessive eating or appetite) was a sign of diabetes

THE BAD

18% respondents thought diabetes is a communicable disease

74.5% believed it could be totally cured 

67% believed it could be cured by bitter food

48% respondents thought their disease affects only sugar and not lipids.

60.5% believed diabetes can be solely controlled by antidiabetic diet

73% believed self-care in diabetes is difficult

My family played a pivotal role in my 23 years of journey with diabetes. It has been just as much a learning for them as it has been for me and there’s still way to go.
Nupur Lalvani, Pune-based type one diabetic