Feature Article - Advances in the care of Tasmanians with diabetes, 1900-2000
Contributed by Maggie Lasdauskas, Diabetes Australia - Tasmania
During this century, the life expectancy and quality of life has improved greatly for Tasmanians with diabetes. In 1900, a child or adult who developed Type 1 diabetes (then known as ‘Juvenile Onset Diabetes’) had a short and miserable life. Treatment prolonged life through a severely restricted diet, but the disease was inevitably fatal. People with Type 2 diabetes lived longer, but their lives had little quality.
It was known that the pancreas (a gland situated near the stomach) was involved in allowing the body to use glucose. In 1910, fifty or more years before the first successful organ transplantation, Dr John Ramsay, at the Launceston General Hospital, undertook a pancreas transplant. His female patient had Type 2 diabetes (then known as ‘Mature Onset Diabetes’). For some days after transplantation, the woman’s urine was free of glucose, then the diabetes returned as her body rejected the pancreas. Today, Tasmanians benefit from the same operation, which tissue typing and immune system- suppressing medications make successful.
In 1922, insulin was discovered and became available in Australia. Insulin in 1922 was not the pure, easily measured medication we know today. Needles required constant sharpening and syringes were boiled. Painful abscesses caused by injections were common. As only short-acting insulin was available, injections were needed several times a day.
Until the 1940s when oral drugs were discovered, people with Type 2 diabetes also injected insulin. Around this time, research began into the effects of diet on diabetes.
A simple urine test was developed in 1956, enabling people to check their glucose levels.
By the 1960s, Tasmanians were able to check their blood glucose levels using ‘Dextrose Sticks’, a more accurate method of checking control. For parents of children with diabetes, this was an accurate way to see what was happening to their child, and relieve some of their fear and anxiety.
Throughout the 1970s, many scientific and medical advances were made. Insulin became highly purified, nutrition was recognised as a cornerstone of diabetes care, the first blood glucose meters appeared on the market, and blood testing strips became available on the National Health Scheme.
By the 1980s, the pace of change was increasing. More Tasmanians tested their blood glucose levels at home. ‘Human’ insulin improved the action and availability of insulin. Tablets to control Type 2 diabetes improved and there was a greater choice than before. By the middle of the decade, Diabetes Nurse Educators were appointed to all major Tasmanian hospitals. Diabetes Australia administered the ‘National Diabetics Supply Scheme’ for the Commonwealth Government to ensure costs of diabetes were kept to a minimum. In 1986, the Menzies Foundation set up the Register for Diabetes in Tasmania (which later expanded to become the National Register for Diabetes).
Throughout the 1990s, there has been a massive increase in knowledge about diabetes and its care. Improved technology has resulted in smaller, cheaper, more accurate meters; and easier injections due to smaller, sharper needles and disposable syringes. Pen injectors make insulin delivery more convenient. Insulin is now available in a variety of lengths of action. Research into nutrition and exercise has relieved dietary stress, a ‘sugar-free’ diet is no longer expected or desired in order to achieve good control. The 1993 United States ‘Diabetes Control and Complications Trial’ and 1998’s ‘United Kingdom Prospective Diabetes Study’ have provided doctors with information. This ensures they have proven guidelines to work with when helping people live well in the presence of this incurable, but treatable disease. Tasmanians with diabetes can now look forward to a life as long and fulfilling as the rest of the population.