25 years with diabetes, and my hopes for future breakthroughs…

I marked my twenty-fifth anniversary with diabetes earlier this month. I wish I could say that I observed this milestone in some noteworthy way, but I didn’t. I had to fly to Frankfurt, Germany for work. I landed at about 8 a.m. and went straight to an all-day meeting, though not before checking my blood sugar – 126 mg/dl. I'll take it. There was a time in the history of this disease when reaching your twenty-fifth year was a very big deal. In 1948, Dr. Elliott Joslin began giving out “Victory Medals” to patients who’d been taking insulin for 25 years. In that era, in the aftermath of insulin’s discovery, 25 years was a huge victory. The Joslin Clinic now gives out medals to patients who’ve been on insulin for 50 years or even 75 years – but not 25 years anymore. It’s the ultimate sign of progress that the quarter-century plateau is no longer seen as exceptional.

And yet . . . I’d be lying if I said 25 years didn’t mean a great deal to me. Three years ago I went so far as to call my alma mater, Amherst College, where I was diagnosed in my freshman year, to find out the exact date of my diagnosis. (And they knew! October 16.) So I may not have received any medals, but I do see my two-and-a-half decades as a sign of something.

The milestone comes with mixed feelings. Do I celebrate? Do I breathe a sigh of relief? Do I feel a sense that I'm on a journey that never ends? Or do I just check my blood sugar to make sure I’m doing okay? This jumble of emotions reflects my ever-conflicted feelings about the disease to which I have devoted my professional life. I talk constantly about how this is the luckiest time in human history to be diagnosed with diabetes, but when anyone asks me if any of my children have diabetes, I get a lump in my throat, and I don’t mention what a lucky time this is to be diagnosed.

But I’m nothing if not an optimist, and at 25 years, I’ve seen enough improvement – from incremental gains to startling breakthroughs – to give me hope for the next quarter century. But let’s take things one decade at a time, so here is my diabetes wish list for the next 10 years:

1) A hybrid artificial pancreas
2) Significant progress toward glycemic-dependent insulin
3) GLP-1 approved for type 1 diabetes
4) Incretins approved for pre-diabetes
5) Better ways to deliver insulin
6) Recognition by Medicare and payers that we will have to invest more in diabetes before we can pay less
7) A tax on the soda and foods that are clearly contributing to the obesity epidemic, and subsidies for fruits and vegetables
8) A “patient credential” to indicate that some patients have enough education to help others
9) Better reimbursement for doctors and nurses who are helping people with diabetes figure out how to manage their condition better
10) More incentives for patients to do better in managing their diabetes

Granted, that’s an ambitious wish list, but after 25 years, a girl can dream, can’t she?

My dreams are big because my worries about the future are significant. I live in fear of my ophthalmologist – Dr. De Juan always says, with a smile, that I’m doing well, but will that always be the case? I wonder how close I am to heart disease. I still don’t take a statin or a baby aspirin. I don’t exercise enough (I don’t even find the time for a daily walk), and some days I feel certain that my doctor is going to fire me for not being sufficiently compliant (“Kelly, I’ve reviewed your charts, I found one too many glycemic spikes, you’re fired. Next?”).

But through all these 25 years, I feel gratitude more than anything else. I am grateful that I have no diagnosed complications and that I have a busy and fulfilling career doing what I love to do. I’m grateful to my healthcare providers who’ve given me so much guidance (even if I haven’t taken it all); to my amazing family who made me realize 25 years ago that all this could be okay; to my friends and colleagues over the years for their unwavering support; to our incredible diaTribe/Close Concerns/dQ&A team; to my three beautiful children who fill my heart; and to Johnny, who makes every day happen.

Diabetes for 25 years is a long and difficult road, but if you’re traveling with the right people, it’s worth the trip.

Very best,

Kelly L. Close