19 Yrs of Diabetes Care Advancements a Retrospect by Certified Diabetes Educator Jackie Jung, RN, CDE — Part 1 of 2
From the Editor: A BIG Thank You to Jackie Jung RN, CDE for this very interesting article, Part 2 will be published here on OntarioNewsNorth.com March 15th, 2013 be sure to watch for it! Scroll down below the article for a link to archives of Mrs. Jung’s Diabetes Health & Wellness articles which include information about prevention and diabetes screening as well as helpful information if you or someone you care about wants to enjoy an active and healthy life while living with Diabetes. If you, or someone close to you, is living with diabetes share your thoughts on how things have changed since you, or your loved one, was first diagnosed by clicking comment below.
We’ve Come a Long Way….
2013 is my 35th year Anniversary of becoming a Registered Nurse with 19 of those years spent working in the field of Diabetes. Recently I was asked by a High School student working on a project about what has changed in diabetes since Banting and Best’s discovery of insulin. That had me thinking of the changes I have seen since starting nursing and although those who have diabetes may feel frustrated and hopeless that a cure has not been found – we have come a long way.
I thought it might be enlightening to see how far we have come and how empowered the person with diabetes can be.
Until the 80’s the only way for people to know what their blood sugars were, was to do urine testing. A stick (strip) was dipped in urine and would turn a certain colour according to how much sugar was spilling into the urine from the kidney. The person would match this colour to the grid on the bottle. When the kidney is filtering all the blood through it, it detects that there is too much sugar in the urine and tries to help by making the person urinate more often (thus a sign of diabetes) in an attempt to get rid of the extra sugar. But, this is a very inaccurate way to know what blood sugars are as there was no exact blood sugar number, just a colour telling you that it was a small, moderate or large amount of sugar in your urine. Everyone has a different spilling rate, called a renal threshold so it was a very vague estimate of what was really happening.
Jackie Jung RN, CDE
In the 80’s blood sugar meters were used by Health Care Professionals – I remember working in VON and doing home visits where I would carry a huge machine (size of a Kleenex box) to a home. There was a complicated series of steps to finally arrive at a patient’s blood sugar for that very moment in time. We would have to get a large drop of blood from a finger poke with a thick needle, put it on a strip, wait for beeps and blot it on paper, more beeps and finally insert it in the meter probably 5 minutes later. Very few people could afford the hundreds of dollars they cost then. Nowadays, home meters are given away free at Diabetes Education Centres, are so small, take a very minute drop of blood, take 5 seconds for results, and hold thousands of results that can be accessed. The lancing device (that pricks your finger) is delicate and there are super fine needles that are even less painful. Meters can be downloaded onto the computer. The newest ones actually have a USB cord that either charges the small meter that looks like a cell phone, or downloads all the results onto a program. This information can be printed into many different formats – pie charts, log books etc., which can be emailed to their Doctor or Diabetes Educator. To date all meters that require a blood drop, except for a very expensive watch that takes a blood sugar without a finger poke. It is thousands of dollars and more for ongoing use and has proven too expensive for patients. I have many patients ask about the meters they see on TV that mislead and say you don’t have to poke your “fingers” to get a blood sugar. They fail to say that although you don’t have to poke your finger you still have to poke somewhere. It is called Alternate Site Testing – a new advance – which for certain times of day (not all times) you can check your blood sugars using your arm or different areas of the body.
In years past patients would go to the hospital lab once a month for a blood sugar test, that only told them what their blood sugar was at the exact moment. Now we have a HgbA1c test that is a great tool in diabetes management. It is an averaging number that doesn’t indicate the low blood sugars or very high blood sugars but gives us a picture of someone’s overall diabetes blood sugar control for the past 3 months. Used along with home testing this helps someone with diabetes and their Healthcare Professional team know if blood sugars are in guideline targets. We have a great system in Manitouwadge where people have what is called a Standing Order for diabetes bloodwork and have a blood requisition sheet that allows them to self-manage by getting their bloodwork done every 3 months. The required tests are from the Canadian Diabetes Association guidelines. If the person with diabetes has this bloodwork done before their appointment, the Doctor and Diabetes Educators have the results available for decision making during the visit.
Insulin has certainly changed in my diabetes career. In 1994, we had limited types of insulin to use that didn’t match the rise and fall of blood sugars when the body broke down food. It had to be timed and given 45 minutes before a meal so it could start to work and hopefully peak (at its strongest) when blood sugars were. Imagine trying to remember and know when exactly your supper was going to be ready to eat? Now we have a number of insulin types that do a much better job. They don’t have to be timed with food like they used to be to work effectively, but are given right before a meal for convenience. We give insulin more times a day now in recognition that this is how our own pancreas works. When we eat our pancreas scoots out the right amount of insulin, at the right time to match our meal. Why would giving insulin be any different?
How we give insulin has changed dramatically. Syringes used to be the norm but have now been replaced with an insulin pen that is much easier, less conspicuous and certainly more convenient. Needles for pens are very short now and less painful. I have patients that remember their grandmother boiling their metal and glass syringes to sterilize them and sharpening the needles! So times have certainly changed!
We now have insulin pumps that provide improved blood sugar control. In Ontario we also have financial help for Type 1’s (who are usually young people) for the pumps, and expensive supplies. Using a pump is not the easy answer to diabetes as it requires more blood sugar testing, skills such as being able to carbohydrate count and knowledge of how to adjust the amount of insulin to match blood sugars and meals. For most with diabetes it certainly provides much better results and blood sugar control. Technology continues to advance and there are now meters that work with the pump and will give blood sugars without having to do a finger poke. A pump works by a needle being inserted just under the skin in the abdomen area which is connected to tubing attached to a pump – which is like a big cell phone that is put on the belt or waistband. In the pump is insulin and this is adjusted throughout the day according to meals and blood sugar levels. The needle is changed every 3 or so days but it does save the 4 injections people will often do with insulin pens.
Keep reading OntarioNewsNorth.com for part two of We’ve Come A Long Way to be published March 15th, 2013…
Jackie Jung, RN, CDE
Manitouwadge Diabetes Health & Wellness Program
website: www.norwestchc.org
