Diabetes Treatment

How has the treatment of diabetes changed over the years?

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How has the treatment of diabetes changed over the years?
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How would a closed loop insulin delivery system help in diabetes treatment?
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How much does treatment for diabetes cost?
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I was diagnosed in 1971, and things have changed even since then. Back then, there was no home blood glucose testing. Instead, you checked your urine - a useless waste of time. If it showed as high, that didn't mean it was high right then. There was no such thing as A1C testing either. White potatos were considered to be better for diabetics than sweet potatos. Now the opposite is true. And before my time, diabetics had to boil syringes on the stove to sterilize them. At one point, diets high in fat were recommended for diabetics. I wonder what will change between today and 50 years from now.
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This one could fill a book. The most important part of managing diabetes and preventing the long term complications of the disease process is control. The traditional system of check sugars before meals and before bed and additionally as needed and treat the sugar accordingly is somewhat similar to swatting a mosquito with a sledgehammer. It's effective, but clumsy. The human body does not respond to blood sugar in this way. The body makes very small changes in response to very small alterations in blood sugar. The closed loop system is an attempt to more closely mimic the body's natural response to rising blood sugars. Pros: automatic blood sugar reading (many people don't treat high sugars because they don't want to use the tester), smaller correction doses of insulin given throughout the day (instead of a few large doses), and less chance of hypoglycemic episodes because the pump reads your sugar and turns off as soon as you hit target. While high sugars will damage your body over time, low sugar can be just as dangerous, and far more quickly. Cons: It will be expensive, people will still have to change their lifestyles, we still have a ways to go before one is perfected, and of course, technology can always malfunction. Hope this helped.
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The good news is that there have never been as many good treatment options for diabetes. The bad news is that nearly all are punishingly expensive. Type 1 diabetics must use inuslin and modern analog insulins - basal plus bolus insulin - may run $350 to $450 per month. Type 2 diabetics may require insulin but most start off on oral medications. The most typical progression is metformin hydrochloride (on the so-called $4 drug lists), pioglitazone (Actos), and sitagliptin phosphate (Januvia). The latter two drugs would also likely cost $350 to $450 per month. There are obviously many more diabetic medications from which to choose but most are expensive as noted above. I am very displeased with American medicine. As a physician I find our current state embarrassing. The US presently ranks 29th in the world in health care outcomes yet American medicine is the most expensive by far. We pay the most and receive the least for our money. It is my belief that 'medicine for profit' and 'greed' and the primary reason. It is not compatible with medical ethics that a physician should be allowed to profit off the misfortunes and miseries of their patients. This is a capitalist country but when it comes to something like healthcare - the commonwealth of its citizens - I believe that the government has an obligation to cap physician incomes and prevent pharmaceutical companies from making obsene profits. Exxon-Mobil is the most profitable company in the history of human civilization. You have the option to buy a more fuel effecient car or to find an alternative mode of transportation. If you have diabetes you have no option. Medications are a life and death decision. And too many patients cannot afford their medications. Yes pharmaceutical companies have public relation programs where they will provide medications for free to those below the poverty level. This is nice but the average middle class American is not able to afford medications as expensive as those listed above. We need real change not some politically motivated healthcare bill. That having been said I hope that this is a homework question and that neither you nor a loved one has diabetes. I wish you the very best of health and may God bless.
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