Living long and well with diabetes--Lessons for the rest of us
Living Long and Well with Diabetes
A short tale of two long (diabetes) lives
Few people so far have managed as well or as long as the Cleveland brothers of Syracuse, New York, who had over 160 years of living with diabetes between them. Robert "Bob" Cleveland, who reached his 90th birthday before passing away in 2010, had lived longer with diabetes than anyone else so far--84 years--from the age of 5. And he was not the sole member of his family who has survived a remarkably long time with diabetes! His older brother, Gerald, who lived to be 93 years old, also had type 1 diabetes only slightly less long at 78 years, from the age of 16. Experts say that they know of no other person who lived to be as old as Gerald after having had type 1 diabetes most of his life.
While inheriting a good set of family genes undoubtedly has something to do with the extended longevity of these brothers, there is far more to it than just that. Scientists tracking the brothers and other long-living diabetes survivors say that while these remarkable individuals almost certainly have some genetic advantages, what helped them just as much was their underlying behaviors in controlling their disease: vigilance, hard work, self-sacrifice, and determination. Both brothers meticulously kept track of their blood glucose readings, insulin doses, diet, and exercise on a daily basis for most of their diabetic years.
In their early lives with diabetes, times were quite different, and all they could really do at that time was to be vigilant and hope for the best. The Clevelands actually lived most of their lives in what we often refer to as the "dark ages" of diabetes care. Before the early 1980s, almost no one had access to the modern tools of diabetes care, like home blood glucose monitors and synthetic human insulins, to help optimize control of blood sugars. The expected outcomes of diabetes back then included amputations, blindness, kidney failure, and heart disease, not to mention a severely shortened life span.
The Cleveland brothers were lucky to develop diabetes just late enough to have insulin commercially available and be able to survive those early years and many, many more. At the time they were born (1916 and 1920), type 1 diabetes was still a death sentence within weeks or months in most cases (even on a "starvation" diet with limited carbohydrate and food intake) because insulin was not discovered until 1921, and it was not widely available commercially until 1922 to 1923, mostly in the larger suburban areas. Likewise, although type 2 diabetes could often be controlled with diet and exercise, it also usually led to years of debilitating illness and a shortened life expectancy.
Just a few years after the brothers' arrival into the world, however, scientists at the University of Toronto isolated insulin in a form that was effective and safe enough for human use (although far from optimal), and then Eli Lilly & Company began to mass-produce it for the first time by 1922. Although insulin's discovery kept the 5-year-old Bob from dying soon after his diagnosis in 1925, it didn't change the fact that he had a difficult road with diabetes ahead of him. Admittedly, controlling diabetes was hard and painful work back in the early decades of insulin therapy, and the good control of today was simply not possible to achieve.
In the early years, insulin was made from pancreases of pigs and cows and was so impure that the doses needed were many times larger than typical ones today. What's more, the insulin's strength was often inconsistent. Even when the product became purer and more predictable, some people suffered serious adverse reactions to it. The insulins were also only short-acting ones that had to be given frequently to cover both meals and basal insulin needs. Moreover, people using these insulins did not have any way to measure their actual blood glucose levels, and as a result, they often suffered from a roller-coaster ride of damaging blood sugar highs and dangerous lows. Until the development in 1936 of a longer-acting insulin (PZI) that stabilized insulin levels throughout the day and night, doctors advised patients to interrupt their sleep to inject themselves rather than let their sugar levels climb through the night from lack of insulin. Human synthetic insulins were not available until Lilly got FDA approval for the first one (Humulin) in 1982.
Even up until about twenty-five years ago (almost six decades into Bob Cleveland's time with diabetes), the only tool people had to use at home to get some feedback on their blood sugar levels was an antiquated method of testing urine for glucose, which was notoriously inaccurate. For decades, the Clevelands and millions of other people with diabetes (including Dr. Sheri Colberg) caught their urine in cups and then added a chemical reactant to a certain amount of urine diluted with water that turned it various colors depending on the amount of sugar in it, running the gamut from dark blue (indicating sugar-free urine) to bright orange for the highest concentration of sugar that could be measured.
Of course, this method was still a more accurate technique for determining blood sugar levels than was available in even earlier times. In the second century AD, during Greek times, the name "diabetes," meaning "siphon," was adopted to describe patients with great thirst and excessive urination, and in the seventeenth century, the term "mellitus" (meaning "like honey") was added to describe the sweet smell of their sugar-filled urine. Reportedly, physicians back in those days tasted urine for sugar content to diagnose the disease, but we're sure that it wasn't an accurate way to measure the actual quantity present!
Being aggressive about controlling diabetes back in the Cleveland brothers' early years meant running a serious risk of taking too much insulin, which could easily have resulted in a hypoglycemic coma and early death. The alternative, though, was to let their blood glucose levels stay higher than normal, which over many years could lead to damage and the potential for many diabetic complications. Against these immense odds, both of the Cleveland brothers had successful careers, long marriages, children, grandchildren, and great-grandchildren-with truly a minimum of diabetes-related health problems. In fact, Gerald believed that he lived as long as he did to help inspire others with the disease. "My main reason to stay alive is to prove to young people there's a way to live with diabetes, to live well," he said at the age of 91.
Now, as diabetes poses a rapidly rising threat to the health of so many Americans and others worldwide, the remarkable lives of these brothers offer the ultimate diabetic success story, giving all of us hope that living a long and healthy life with diabetes is a real possibility for everyone. Thankfully, long gone are the days when diabetic complications and a shortened life span were a foregone conclusion, a sentence that was handed down along with the diagnosis. The Clevelands lived long and generally healthy lives in part through extraordinary discipline in diet, exercise, and monitoring of their diabetes, along with a very positive outlook on life.
The discipline involved in living well for so long was not always easy. As Bob admitted, "I never had any sweets as a child-never."
Both brothers always recognized the importance of their diet and daily exercise in living well. Even to the day he died (in 2009), his older brother Gerald kept meticulous logs of his insulin doses and blood sugar readings, tested his sugars seven or more times a day, avoided desserts and rapidly absorbed starches, exercised, and stayed thin. Gerald was a compulsive reader of food ingredient labels, so he knew exactly what was going into his body and how much insulin it was going to take. At 87, Bob was still an avid cyclist, often biking twenty or more miles outdoors, while Gerald regularly attended exercise classes and did daily exercises with five-pound weights well into his 90s. Largely due to their extraordinary diligence, the brothers' lives were even longer than the average life span for most people and remarkably free of any serious diabetic complications.
Throughout their later lives, the brothers continued to make a point of meeting with younger people with diabetes, giving them hope and encouragement. "It hasn't been easy," Gerald said a couple years before his passing, "but I've had a terrific life."
Will you be able to say the same?
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