My name is Chester Lynn Wickwire (I go by my middle name) and have lived with type 1 diabetes for 68 years, diagnosed in October 1944, at four and a half at the Yale New Haven Hospital. I am now 72, married, with a son and a daughter and two granddaughters, none of whom have diabetes. My mother, 100% Norwegian, was diagnosed as type 2 in her sixties and lived with it for over thirty years. Three of her siblings also were diagnosed later in life with type 2.
My comments and reflections relate to my life with type 1 diabetes as treatment has evolved and improved over the years, while the basic equation (tight control through diet, exercise, and insulin) promulgated by Dr. Elliott P. Joslin has remained the basic tenet of all type 1s.
I met Dr. Joslin at his camp, Camp Joslin in Charlton, MA, in 1947–48 and returned for many summers. When I became a senior counselor, my cabin, with 8–10 boys and a junior counselor, was the first totally “diabetic” cabin, something that was treated in some quarters with considerable trepidation. At camp, I realized that there were hundreds of children with diabetes and that living a “normal” life was possible. When asked now to describe what “good control” was in those days, my conclusion was that I implicitly defined it by having at least one low blood sugar a day.
My recollections of growing up with diabetes include having blood drawn from an ear lobe into a glass pipette that was then centrifuged to obtain a blood glucose reading. This only happened when I went to camp. Benedict’s solution was used for the testing of urine and collection of all urine for a 24-hour period was obtained periodically for analysis. We also learned to despise the color orange since that is the result when 5 drops of urine and 10 drops of water were combined with a Clinitest tablet indicating a high blood sugar. Blue or green were the “good” colors. One requirement of camp was that everyone had to learn to give their own insulin since we all were taught that we had to become our own “docs.”
At camp we also learned to count calories with a scale being used to measure every gram of food that anyone would ingest and exercise was an important component each day. This allowed me to realize that I could accomplish anything in life—and live a healthy life with the good control that is vital with diabetes.
Until the ’60s, I used a glass insulin syringe and two steel needles, all of which were used over and over again. The needles would become dull over time and had to be sharpened on a stone like you sharpen a knife since they also would develop burrs. The photo below shows that we had to use wires that were pushed through the needles to make sure they were clear.
I can remember times when the needle would bounce off the skin since it was so dull and I would have to use almost brute force to get the insulin under the skin. Additionally, the bottom of the glass syringe would become permanently cloudy over time because the particles in the protamine zinc and NPH insulin would begin to adhere to the side of the syringe. Periodically, I would boil the syringe and needles to keep them clean and relatively sterile.
I now use an insulin pump with Novolog and a continuous blood glucose monitor (CGM) 24/7 and as a result have an A1C that is excellent. The CGM is invaluable, since it provides trending information and warning signals, which is important since I have had hypoglycemic unawareness for about ten years, allowing me to take corrective action when indicated. This is especially important when driving and in the middle of the night. My wife has not had to use glucagon with me since I started with the CGM, some 5–6 years ago.
One important facet of my early life with diabetes was the relative freedom and encouragement provided by my parents as I was growing so that I could learn about how best to incorporate diabetes in living, even though I distinctly remember going to birthday parties and not being allowed to have any cake while everyone else was partaking and I had some fruit.
Today’s understanding of carbohydrates and high and low glycemic foods have made control easier and more enjoyable. Also, being able to take an extra bolus with a simple button push from a pump or a pen rather than going to the bathroom with the syringe and insulin to take a shot makes a world of difference.
Exercise has been an important part of my life and help in the control of my diabetes. I have run a marathon, the Mount Washington Road race and countless other races. I continue to exercise at least four times a week which produces positive blood sugar results lasting 12–18 hours post-exercise.
Today’s technology with the super fine coated needles, disposable syringes, insulin pens, blood glucose meters, and fast and long acting insulin make for a much easier life with much better control. New technological advances in treatment and in search for a cure are quite remarkable. For years I was very skeptical about the success of a search for a cure but am optimistic that it might actually occur even though I still have difficulty, intellectually and psychologically, grasping the thought.
The Joslin Diabetes Center has a 50- and a 75-year medal that it awards people who have reached these milestones. The last meeting of the medalists included each awardee making comments about their life with the disease. What was fascinating to me was that virtually every person noted that they had been told by their doctors when diagnosed that they probably would have serious complications by the time they were young adults. The ongoing 50-Year Medalists study shows that 48% of the participants have not had any complications!
While there are challenges of living with diabetes, the diet, exercise and insulin equation, instilled in me and others by Dr. Elliott Joslin, has enabled me to continue to live a vibrant fulfilling life.
By Lynn Wickwire
Joslin Diabetes Center