Conquer Your Diabetes: Prevention • Control • Remission

By Martin Abrahamson, Sanjiv Chopra and Deepak Chopra

"If you want your wellness to include mastery over diabetes, this book is a must-read."

-Deepak Chopra, MD

Managing diabetes often feels daunting and challenging. Conquer Your Diabetes comprehensively covers the best approaches to prevention, control and remission of this condition, and provides

• Language: English
• Publisher: Abrahamson Chopra Publishing
• Release date: Jan 25, 2022
• ISBN: 9798985423709

Martin Abrahamson

Martin Abrahamson is an Associate Professor of Medicine at Harvard Medical School and previous Chief Medical Officer at Joslin Diabetes Center. He has been cited as one of Boston's "Top Doctors" on many occasions, lectures widely on diabetes nationally and internationally, and has spearheaded educational initiatives on diabetes for physicians around the world. He is the recipient of the Samuel Eichold II Memorial Award for contributions to diabetes from the American College of Physicians. He and Sanjiv co-direct the Division of Continuing Medical Education at Boston's Beth Israel Deaconess Medical Center and have been conducting numerous CME meetings for more than 25 years.

Book preview

1: HOW PATIENTS MASTER THEIR DIABETES

Attitude is a little thing that makes a big difference.

—Winston Churchill

Winners never quit, and quitters never win.

—Vince Lombardi

I, Martin Abrahamson, have had the privilege of helping people manage their diabetes for many years, initially in South Africa where I trained and then practiced for some years, and subsequently in Boston, USA. I have developed long-lasting relationships with many of my patients, getting to know them, their spouses or significant others and their children and grandchildren, to become a friend with special knowledge, rather than solely their doctor.

Diabetes is a condition that has no social, economic, or political boundaries. It affects people from all ethnic groups, although there is a higher prevalence in Asian Americans, Pacific Islanders, Native Americans and Hispanic people compared to others. It affects the rich, the poor, people with doctorates, and the illiterate. It affects successful entrepreneurs, academics, blue-collar workers, manual laborers, people who live in rural areas, and people who live in cities. Each person with diabetes has his or her unique challenges with which they must live every day.

Universal Disease, Individual Treatment

Clinicians who take care of people with diabetes need to understand everyone’s unique circumstances, and that he or she is living with a chronic condition 24 hours a day, 7 days a week, 365 days a year. This applies to people with both type 1 diabetes and type 2 diabetes.

Because of each patient's unique circumstances, I, like many of my peers have recognized that treatment needs to be individualized, something which we have articulated throughout this book. At the same time, I have also realized that, despite all the efforts made to help some people manage their diabetes, the responses to recommendations, motivation to improve or maintain good glucose control and the degree of engagement varies enormously from person to person and is not related to social or economic circumstances. It also varies at different times of years (holidays being a common example) and with changes in life circumstances (loss of job, illness of family members, etc.).

I have seen the illiterate rural laborer with type 1 diabetes who has no access to electricity take superb care of himself and maintain excellent glucose control; and I have also seen a highly intelligent and wealthy entrepreneur, unable to adhere to a treatment regimen of primarily diet and exercise interventions, unfortunately go on to develop multiple serious complications.

The challenges that people face are demanding. Some patients’ stories are truly remarkable! I have learned an enormous amount from people with diabetes whom I have cared for and have been able to use this invaluable knowledge to help many others. Many of my patients are incredible teachers and amazing sources of inspiration. We have aimed to imbue in this book as much of this knowledge and inspiration as we could. But, below, I am going to share two stories that we hope will particularly encourage you to meet the challenges that you face day-to-day, month-to-month and year-to-year.

KH: Living Life to the Fullest

I first met KH when she was 73 years of age. She had already had type 1 diabetes for 65 years having been diagnosed at the age of eight in 1937. I was privileged to take care of her in the latter part of her life, until she passed away six months after her 90th birthday, having lived with type 1 diabetes for 82 years.

At the time of her diagnosis, she was living in a small town called Paris, 60 miles from Toronto, Ontario. She was hospitalized for ten days at the Sick Children’s Hospital in Toronto and started on insulin – this was only 15 years after insulin had become available. At that time there was only 1 kind of insulin – regular porcine insulin. It had to be injected with reusable syringes and needles. The needles were much larger and longer than the ones we use today and certainly caused more discomfort. Additionally, the needles and syringes had to be boiled to sterilize them after each use, and the insulin needles needed to be sharpened regularly using a sharpening stone! As the insulin then was less concentrated, the volume injected was much higher than modern preparations. Not only this, but it also contained many impurities which caused local skin reactions.

KH was homeschooled after being diagnosed. She described her mother as being highly protective. Her mother weighed all her food and carefully monitored her intake. She injected her insulin four times a day and tested her urine for glucose multiple times a day. This was done by adding a special solution called Benedict’s solution to the urine and then boiling the mixture on a gas flame in the kitchen. The color change that ensued reflected the amount of glucose in the urine. Home blood glucose monitoring did not exist at that time (it became available in the 1970s), nor were there HbA1c measurements (which also became available in the 1970s).

KH often reminded me how her mother would massage her hips with cocoa butter prior to injecting the insulin. Initially, her life was socially isolated, and she was not able to go to sleepovers or birthday parties. She was not allowed any sweets and she said, my life was that of a protected, pampered invalid. She described how this lack of freedom affected her feelings of self-worth and how she had to fight to regain confidence in later years. However, she also commented that her mother had taught her self-discipline that would stand her in good stead for the rest of her life.

When she started college, she was not allowed to leave home. She commuted by bus every day to Waterloo College, 30 miles from home. Ultimately, she transferred to the University of Western Ontario and lived in the dorms there.

She recounted how doctors would tell her that she could expect to live a much shorter life span than many others, and that some doctors advised her to marry a man with children because the chances of having your own (baby) are nil. She married in 1953. She had a devoted husband who was incredibly supportive and who helped her resolve her feelings of isolation. She described her first pregnancy and how she was told how risky it would be and how unlikely it was that she would deliver a live infant. The baby was born prematurely at Toronto General Hospital and required intensive nursing but thankfully survived. She subsequently had two more children after leaving Canada and relocating to the United States.

Diabetes did not stop her from enjoying an active life – she took up aerobics, and exercised frequently, and in later years she took up curling and represented the United States in an international curling event. She lived to see many advances in diabetes management and embraced them all – she started using disposable syringes and testing blood glucoses at home in the 1970s, started using human insulin and then insulin analogues in the 1980s and 1990s. She embraced the use of insulin pen devices when these became available and started using continuous glucose monitoring when this became available a few years before she passed away.

She suffered numerous setbacks and complications, but this did not deter her from leading an active life and traveling with her husband throughout the USA and to all corners of the world. She broke multiple bones and required treatment for osteoporosis. She developed celiac disease, a disease with a higher incidence in those with type 1 diabetes, in her late 40s, and had to maintain a gluten-free diet. She described vividly how her symptoms of celiac disease flummoxed doctors for many months. I had chronic diarrhea, gas and allergic lesions under my arms, she told us, and then added, My weight was dropping, I had broken capillaries on my legs, inflamed gums and aching teeth. She also described frequent episodes of nocturnal diarrhea that doctors thought was a complication of her diabetes. Finally, she said, her diabetologist at the time referred her to a gastroenterologist who did a biopsy that confirmed the diagnosis of celiac disease. My villi were flat against the lining of my intestines! she commented.

Her diabetes led to retinopathy (retinal disease of the eye) that required laser photocoagulation. She was treated for osteoporosis and had numerous falls leading to several broken bones over the years, including her clavicle and leg. She developed coronary artery disease and had several heart attacks, but she remained active physically and mentally and lived life to the