I was diagnosed with type 1 diabetes in 1966, and so I spent the first 20 years of my ‘adventure’ with diabetes without home blood sugar meters. This meant that ’strict control’ was simply impossible, and the medical profession recognized this. All we had to measure our metabolic status was home urine sugar devices, which measured the amount of water we had drunk as much as the amount of sugar in the body. The changing renal glucose threshold also constantly changed the ratio between the amount of glucose in the blood and that which was registered in the urine. The urine sugar test only measured the accumulated sugar since the last urination and would of course be higher the less frequently the patient was urinating. So testing urine sugar amounted to an empty ritual to keep the patient busy, make the doctors seem less helpless, and create a false sense of efficacy in diabetics. We were forbidden to take insulin any more often than once a day, in the morning, since bolusing insulin was thought simply to generate more chaos. Instead, blood sugar ‘control’ consisted of adjusting the daily insulin dose up or down a few units the following morning according to the previous day’s results.

Every few years I would report in to the Joslin’s Clinic for an actual blood glucose determination, and the result was usually around 240. I expressed concern to one of the staff physicians about this, and he reassured me that that was not all that high, since the average among patients reporting into the clinic was around 280. I smile now when I hear of patients in a state of panic over a single result above 200.

But, although blood sugar control was poor, my life then was excellent. I truly felt and functioned like a normal person. All I had to do was take a single injection in the morning — at the same time as it was normal for people to set aside some private time for morning ablutions — and then, beyond avoiding sweets, that was the last time I was bothered with diabetes for the rest of the day, since the pointless ritual of urine sugar testing could safely be neglected. Hypoglycemia was rare, since I could not deliberately hug the razor’s edge of unconsciousness all day and all night, the way we are supposed to do today.

But then came the home blood sugar meter, the DCCT, and suddenly medical journals were filled with medical sadism about ‘aggressive management,’ ’strict control,’ and ‘intense interventions.’ My life rapidly degenerated into constant blood sugar testing, constant injecting and re-injecting of insulin, frequent and often catastrophic hypoglycemic episodes, carbohydrate counting, rituals of shaming and blaming over HbA1c values, and I was essentially transformed from a normal person who had to take one injection in the morning between showering and shaving into a medicalized freak burdened with a thousand gadgets, measurements, medical interventions, and self-torments a day, every day, forever.

So has there really been any progress in diabetology? All medical interventions are rated for their costs and benefits in terms of QUALYs, that is, ‘quality adjusted life years.’ For example, a year of life for a normal, productive, healthy person is set at 1.0, while a life so burdened with medical interventions that it is only worth half a normal life is set at 0.5. I suspect that in my own case and in that of many other diabetics, especially those with labile type 1 diabetes, my quality of life, which was 0.8 prior to the home glucose meter and strict control, has fallen by 50% to 0.4 after that regimen became possible and required. If you add the QUALYs I may have gained from strict blood sugar control postponing the lethal complications and their reduction in life quality prior to death, but subtract the QUALYs I have lost by intensive management of the disease, I suspect that the net impact of the home glucose meter has been profoundly negative. Interestingly, beyond a single letter to the editor of the Lancet in 1994 entitled ‘Good Control or Good Life?’ I have never seen any indication that the medical profession is aware of this problem.