It seems to me that proper insulin injections and proper eating, along with regular exercise, will prevent complications, yet the leading cause of blindness, amputations and number six on the leading cause of death scale is people who aren’t doing things correctly. How can companies who manufacture insulin sell it for decades without concern? NPH and Regular are inconsistent, Humalog has finally given a realistic time frame for molecular breakdown, and Lantus offers long term effectiveness without highs and lows. It seems that the answer is always “consult your doctor”. Why are the insulin manufacturers allowing people to use these outdated drugs? Why are they not accountable?

You ask some tough philosophical questions. The “job” of pharmaceutical companies is not to force people to take better care of themselves. I would say the job of Lilly, Novo Nordisk, Aventis and other pharmaceutical companies is to produce new products that work better than old products. These companies actually do a fantastic job not only making new insulins but making them in pure form and investigating new types of products at the same time. They also have a fantastic amount of educational material available, usually free of charge, for patients. In addition, they donate large amounts of money for local, national and international diabetes scientific meetings as well as camping programs. So I wouldn’t be so hard on the insulin manufacturers.

Also, you know that making decisions about life with diabetes is difficult and needs to be continued every day. Some folks don’t know that it is important to learn about these choices and then make the best ones for themselves. Some physicians and nurses also do not know this. When someone gets a serious, chronic illness like diabetes, they should first become educated about this illness. Then they should decide what they need to learn and how to apply current information. Diabetes treatment is very individualized and very difficult. Even when following all the “rules” about diabetes, some times food and insulin do not work so consistently. Many abstract factors must be balance and sometimes guessing is the best that can be accomplished. If I had my wish as a long-time diabetologist who lectures about diabetes care around the world, it would be as follows:

Education available and updated for everyone with diabetes.
Support for family members of those who have diabetes to be educated as well.
Psychosocial support for the person with diabetes
Modern insulin available with either syringes, pens or pumps.
Blood glucose testing supplies and instructions on how this should be applied, used for making food and insulin adjustments etc.
Appropriate hemoglobin A1c testing at least every three months, more frequently if problems occur.
Appropriate monitoring for blood pressure, eye, thyroid, celiac disease, blood lipid problems, and kidney problems.
diabetes specialty teams including physicians, nurses, dietitians, exercise specialists and mental health professionals who work together to update information about modern diabetes treatment

Even when all of this is available, it is still up to the patient and his or her family to use this information and keep themselves updated.

SB