Marilyn Hagerty: Learning about how diabetes treatment has changed over time
“It’s a metabolic disorder. Not a disease.”
That was the description of diabetes by the late Dr. Edgar A. Haunz of Grand Forks, who was chosen in 1975 as the Outstanding Diabetes Clinician in the United States.
In fact, diabetes is a metabolic disorder and a disease, says Dr. Casey Ryan, one of the physicians here who has followed the late Dr. Haunz in caring for diabetics.
Other diabetes physicians who followed Dr. Haunz over the years have included Dr. Robert Warner, Dr. James Brosseau, Dr. William Zaks and Dr. Eric Johnson. Dr. Lori Sondreal manages pediatric diabetes. The physicians have had the help of nurse educators and dietitians in the Altru Diabetes Center started by Dr. Brosseau.
Diabetes treatment has advanced tremendously since the days of Dr. Haunz, according to local doctors. Finger stick testing began in the late 1970s. Now devices can monitor sugars without the need for stick testing. Insulin pumps began in the 1990s, and now pumps can measure blood sugar and deliver insulin.
Dr. Haunz was unique in caring for diabetes when he came to Grand Forks in 1947, according to Dr. Ryan. “It was difficult to manage Type 1 diabetes patients taking five shots of insulin daily – one with each meal, one at bed time as well as at 3 a.m. There were no blood tests, other than in a hospital or clinic,” he said. “Patients could do primitive tests at home to assess urine sugar. And in essence, Dr. Haunz was using an insulin pump type treatment.
“The rest of the world did not catch up to Dr. Haunz until the late 1970’s or early 1980’s,” Dr. Ryan said. “Because of his excellent care, there are many individuals who lived with Type 1 diabetes for more than 50 years.
“And this,” Dr. Ryan said recently, “is considered amazing and a tribute to Dr. Haunz.’’
Weight loss, thirst
Type 1 diabetes can occur at any age, but the most common onset is between 8 and 15 years of age, according to Dr. Ryan.
Usual symptoms are weight loss, thirst and frequent urination, he said. If not diagnosed, high sugars can lead to nausea and vomiting with a condition known as ketoacidosis requiring hospitalization.
“The latest technology with blood testing can prevent low blood sugars and help avoid high blood sugars.” Dr. Ryan said. “This is a life changing treatment for those who have lived with severe low sugar reactions that can cause confusion or seizures.’’
Doctors find a serious problem now is the epidemic of Type 2 diabetes mellitus. This is due to obesity and can occur at any age. In Type 2 diabetes, the pancreas cannot produce enough insulin to overcome the negative effects of obesity. Most people with Type 2 diabetes make too much insulin, but not enough to keep blood sugars normal. If weight loss occurs the insulin production comes into balance with body requirements.
Diabetes is diagnosed if sugars are over 125 percent of milligrams consistently. Pre-diabetes is the term for persons at increased risk for future diabetes with sugars ranging from 100 to 125 milligram percentage. Normal fasting sugar is 70 to 99 milligrams.
Both Type 1 and Type 2 diabetes are inherited, Dr. Ryan said. Type 1 cannot be prevented yet. Type 2 can be prevented with good diet, exercise and staying within 15 percent of ideal body weight.
Prevention is extremely important, according to doctors. They say uncontrolled diabetes can lead to kidney failure requiring dialysis, blindness, leg amputation, heart attack, stroke and increased infections.
It has been reported that 68,000 in North Dakota have diabetes. Another 180,000 are termed as pre-diabetic.
With all of the problems, Dr. Ryan says the treatment is good. He talks of the progress in monitoring blood sugar. Patients can tell if their percentage is in the 70 to 100 range. High sugar is 150.
“A lot of people aren’t aware of it with all the obesity,” Ryan said. “The reading of 100 to 125 percent is considered pre-diabetic.’’
Being within 15 percent of ideal body weight is best. Dr. Ryan is concerned about the huge underlying problem of diabetes. More than 90 percent of people with diabetes are Type 2.
Most diabetes reflected by high readings can be reduced by losing weight. And most Type 2 diabetes is caused by overweight conditions.
Dr. Ryan’s concern about diabetes stems from the high incidence. He cares, just as others who treat diabetes. His thoughts to back to the words of the late Dr. Haunz. He would point out that with proper treatment, a diabetic can live a longer, more successful and relatively normal life than a person with any other human disorder.
Looking back, Dr. Ryan says a thank you is due to Dr. Haunz for the care he started in Grand Forks and this region.
“And the thanks,” Dr. Ryan says, “goes also to physicians, diabetes educators and dietitians who have followed in the path of Dr. Haunz.”