emotional health

People with diabetes: their capacity for achievement today

A view from Germany

For a long time, people with diabetes were seen as ill and impaired. Before the year 1922, when insulin was given to the first person suffering from diabetes type 1, the 14 year-old Canadian boy Leonard Thompson, people with diabetes were in fact condemned to death. They were rescued when insulin was introduced. Their glycemia could be normalized by the regular application of insulin. There was, however, as yet no knowledge as to what to allow or forbid people to keep them healthy. Thus many, partly unneccessary restrictions were developed, particularly with respect to eating, which continue to have an effect on recommendations today.

For a long time, people with diabetes in Germany were sent to hospitals every 1-2 years for several weeks to have their diabetes adjusted. Their therapy demanded strict compliance to a daily schedule of food and regular pauses for snacks. At the same time, it was not yet possible to normalize blood sugar sufficiently, so that it was only a question of time before the so called "late complications" of diabetes occurred. People with diabetes were therefore impaired in many ways, and were rated as seriously disabled. They were indeed less capable of work, they had a special status at work, and they had to retire earlier because of their late complications. Nevertheless, people with diabetes produced great accomplishments at this time, which did not always become widely known.

People with diabetes were seen as people who had to be cared for continuously and carefully in order to give them a fairly normal way of life. From lack of experience, people with diabetes were not thought capable of taking care of their daily therapy themselves. It was believed that every change in their insulin therapy had to be decided by the physician, who was held responsible for those decisions. Thus, people with diabetes consulted their physicians more often than other people and were very dependent on them.

Today this picture has changed dramatically: Diabetes education programmes teach people how they can handle their therapy themselves. People need about 20 minutes a day for their therapy. The majority of the necessary blood sugar controls can be done in their leisure time. People with diabetes virtually become their own doctors and consult their own doctor as a "senior doctor" only when they meet with special problems. They are often able to prevent a hospital stay themselves. When people with diabetes today need hospital care, this is often not because of the diabetes. When they do go, there is widespread staff acceptance of the insulin therapy that the person has learned. The health status of people with diabetes has improved dramatically: As they are able to control difficult situations by themselves they cease to be sick more often than others. As they pay special attention to themselves, people with diabetes are often very reliable and enthusiastic. There are far fewer late complications today because of the better level of glycemia. Due to modern diabetes treatment, people with diabetes are no longer "handicapped persons".

A person educated in diabetes therapy today can take up almost every profession. He or she accomplishes as much as people without diabetes, is not more often sick, and works until retirement like other people. This has been witnessed with many well-known persons with a long duration of diabetes like (Miles Davis, Liz Taylor, gold medal swimmer Mark Spitz). In every profession you can find people with diabetes working: actors, cooks, physicians or athletes. There are only restrictions for driving public transport vehicles like buses, trains or aeroplanes. There are many people with outstandig careers whose diabetes is not known to the public.

The new developments in the treatment and education of diabetes are not widely known to the public in spite of many well-written and easily understandable reports in the mass media. Many people still believe earlier restrictions to be valid today. People with diabetes can live a fairly normal life today: have a happy childhood, learn like others, take up nearly all professions, take part in competitive sports, eat and drink like other people, and have healthy children. As a result, changes are now also being seen in how the capacity of people with diabetes is being evaluated at a social level.

People with diabetes are employed in the public service, become civil servants, have responsible tasks in economics and politics. In individual cases responsible individuals may even take up professions where they need to carry firearms or where they may experience dangerous situations. People with diabetes who apply for disablement status and benefits, are today given this status only when they also suffer from other serious diseases as well.

It is not necessary to mention the diabetes when applying for a job unless they have disablement status. Questions about diabetes as part of a job interview are no longer permitted. Similar questions are to be banned from driving license applications in the near future, because diabetes is no longer seen as a special risk for driving, if the person treats his diabetes well. There are even discussions about whether, in individual cases, persons could be allowed to drive trucks or transport people. Forms of sporting activities which used to be barred to people with diabetes until today, e.g. scuba diving or alpine climbing, are now open to them, given that they obtain special instruction. In most of the marathons in great cities like New York there is a group of people with diabetes attending under the same conditions as other participants.

It is a matter for the individual to decide how much he or she is willing to make use of all the possibilities self therapy offers. There is a growing number of people who can and want to normalize their life by getting diabetes education. They justifiably resist discrimination because of lack of information or prejudice. They win cases against employers who want to withhold their rights. There is hope that these changes in the treatment of diabetes will be known to an ever growing segment of the public, particularly with regard to its consequences for the increased capacity of people with diabetes for achievement. This will also result from more and more people with diabetes admitting to their diabetes in public.

Dr. Axel Hirsch, Prof. Dr. Manfred Dreyer
Dr. Hans-Ulrich Clever, Dr. Falk Kunigk
Hospital Bethanien - Dept. Diabetes metabolic diseases

Translated by Susan Wood-Büggein
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