diabetes care over the years: what’s changed and what's remained over seven decades

type 1 diabetes care has come a long way and robert gawley has seen it all happen. he remembers his diagnosis well, right down to the exact date: june 30, 1962, the day before doctors went on strike at his nearest hospital.

robert was lucky, though, because his physician, dr. paul schwan, got him in after diagnosing him through a glucose tolerance test. while patients were being taken out of the hospital because of the strike, he was being admitted. he spent two weeks in the hospital during the strike, where “they took good care of” him.

“they, first of all, wanted to get me regulated. in those days, it was one shot a day, one shot of insulin a day, so it took time,” he said. “they taught me how to take insulin. that was a fairly long procedure. i first had to try with water and inject it into an orange and then they had me do insulin where i could inject it into myself.”

hands-on beginnings

the insulin shots of robert’s time were far less advanced than they are today and when he was diagnosed, his medication came with glass syringes and a needle that he had to sharpen on his own using emery paper, a coated abrasive made of the mineral corundum.

he was travelling at the time and found that the process of keeping his diabetes under control by taking his insulin was “very hard.”

“i got a number of glass syringes, and i got the little stainless steel holders, syringe holders, like the doctors used to use. fill those with alcohol and off i went,” he said. “it burned every time i inserted the needle [because of the alcohol].”

the introductory experience of sharpening needles and having injection sites burn with alcohol was later replaced by an easier method using a busher injector he was given from his mother-in-law.

“it was spring-loaded and bang … it was a much quicker in and out, so i used that,” he said, noting that around that time he was also able to change his needles to disposable ones he got from a friend who was a traveller for a medical company.

“that kept the cost down and it was much easier to use that needle than to use the old one i had to sharpen,” he said.

the care itself wasn’t just different — the way he monitored his blood sugar levels was as well.

“i used litmus paper, that was paper to test my urine and that’s the way i lived with travelling.”

over the following decades, robert saw home blood glucose testing metres and test strips evolve into continuous glucose monitors and now automated insulin delivery systems.

robert’s grandson, nate, was diagnosed with type 1 diabetes at around nine years old. while he didn’t experience the same extent of changes throughout diabetes care, his has changed pretty drastically as well. he first started on something called n insulin, which would be given once in the morning and was long-acting. he then needed to get on r insulin, which was more short-acting. within a few years, he was taking multiple shots per day.

“they [treatments] stayed relatively the same until, i want to say maybe five, 10 years ago when the blood glucose sensors have come out,” he said.

both robert and nate have seen how diabetes care has changed throughout the years, showing just how far innovation has truly come.

innovations changed the game

today, both nate and robert have taken advantage of some of the more innovative technologies developed for people living with diabetes. for example, nate now wears an insulin pump and a blood sugar sensor. insulin pumps continuously deliver insulin to keep blood sugar levels stable, which nate describes as being “pretty darn close to almost being its own little pancreas,” while the sensor provides real-time data by measuring blood glucose every few minutes.

“it helps out a lot with just my everyday life,” said nate. “i’ve got a six-year-old and a four-year-old boy that are very active now, but also, i’m an elementary phys. ed teacher. so, the new things, like the sensor and my insulin pump, make life a lot easier to manage. i don’t have to, like, completely and totally shut down what i’m doing in the moment to take care of myself.”

he notes that at the beginning, it became kind of overwhelming having that real-time access, but over time, his routine that he’d developed using older styles of diabetes care updated with the times.

“when i was on a blood glucose meter, when we woke up in the morning, the first thing i would have to go and do is lay my stuff out and test. but now, i just roll over, look at my phone and see what my blood sugar is.”

the newest technologies also alert nate to his blood sugar dropping, by shooting off an alarm “like a police siren” so he knows that it’s time to act.

“it’s really fun when that happens in the middle of the night when my wife is beside me,” he jokes. “i’ve also had times where i’ve got my phone hooked up to a bluetooth speaker at school and we’re out in the middle of the football field and i’m running around with the kids and all of a sudden the music cuts out and there’s a siren that’s going off through the speaker and the kids just like completely lose it. some of them have figured out now, it’s like ‘oh, gawley needs some sugar.’”

while robert is on the blood glucose monitor to keep a read on how his blood sugar changes throughout the day and to let him know if it’s getting too low and it’s time to eat, he hasn’t yet signed on for the insulin pump.

“i just haven’t thought it necessary. i get along fine with my little metre and the sensor,” said robert.

he still uses needles, one long-acting one at bedtime and short-acting with meals.

support has always been important

while diabetes care has advanced significantly throughout the years, from the old days of sharpening needles to wearable devices that can deliver insulin when the body needs it, some things remain the same.

“with a good team looking after you and you listening to them, you can live with diabetes,” said robert.

he later continued, “listen to the diabetes educators and the dietitians and of course, the endocrinologist. they’re part of your team and if you listen to them and follow their advice and make sure that your partner is with you.”

robert leaned on diabetes canada, which at the time was called the canadian diabetes association, along with family and friends. over the years, he has given back to the diabetes community because he knows how important support truly is. he was branch chairman on the saskatchewan division board of the canadian diabetes association, when it was called that and before it went national. the divisions are no longer around, but that doesn’t stop robert from getting involved in the new advocacy and fundraising work diabetes canada does across the country.

both he and nate have worked with the organization, more recently with pump couture, a national fundraising fashion show that celebrates people living with diabetes by showcasing insulin pumps and continuous glucose monitors on the runway. the main goal of the fashion show is to raise money to send children to diabetes camps (d-camps), shatter stigma and build community amongst those living with the condition.

“it is an absolute blast,” he says of being part of the show, noting that when he’s out in the world, he’s not afraid to ask someone he sees with a monitor if they’re interested in getting involved.

nate’s level of care and advocacy stems from him having an “incredible support system” because he had experience with people living with diabetes in his family, including robert, which allowed him to see what it was like before being diagnosed himself.

“my grandfather [robert] has it, my father has it and then the second that i was diagnosed, my mom … got her diabetes education,” he said. “i’ve got a twin brother. he got the good pancreas … but as we grew up, we’re still very close with all of our friends that we grew up with and played sports and anytime that i was over a friend’s house, all of their parents were incredibly understanding and helpful to a point where they knew that i was responsible for myself, but they still were there if i needed something.”

he continued, “it’s probably the reason why i haven’t experience as much challenges as well as he [robert] did, but also as other people, it’s just that i was born into this little diabetes community and not a lot of people have that.”

for both robert and nate, living with type 1 diabetes has its ups and down, but seeing the progress made for the next generation of those living with diabetes has helped them become vocal advocates for the condition while creating community.

“i’m proof that you can live a long life with diabetes,” said robert. “you just have to make sure that you make up your mind, you’re going to live with it.”