Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for Endocrine Today, Endocrine Practice, Journal of Clinical Densitometry, Journal of Women's Health, Osteoporosis International and Calcified Tissue International. Dr. Kleerekoper is also a founding board member of the newly formed Academy of Women’s Health.

Personal memories of diabetes fuel a professional outlook

The February issue of Endocrine Today highlighting the history of diabetes and its management really caught my attention.

Legend has it that my maternal grandmother was the 19th person in England to receive insulin, but I doubt that was true.

When I was 8 years old, my mother was diagnosed with diabetes. Dad had to leave early for work and it was left to me to help her with her insulin. (Why me and not my older brother remains a mystery.)

In those days, there were no glucose meters or blood glucose strips — only urine dip sticks. Giving Mom a hug and a kiss first thing in the morning was OK but sticking a piece of paper in her urine was not fun. Of course, at that time, the degree of glycosuria had no impact on the dose of insulin administered.

Insulin was provided in a glass bottle. The top had to be broken off and I hoped that I wouldn’t cut my finger. The syringe was made of glass and stored overnight in alcohol. Insulin was administered via a 21 gauge, 1 inch needle and used daily until it could no longer penetrate the skin.

Dad spent a lot of time working out what food etc. would be best for someone with diabetes and our eating habits changed markedly with one exception. Mom had to be hospitalized for a few days and Dad ‘upgraded’ our meals dramatically. The downside to Mother’s hospitalization was that we kids were not allowed in to see her. Ouch!

It should come as no surprise that I vowed to have nothing to do with diabetes as I grew older (I haven’t yet grown up) and my clinical and research career has focused on the bone and mineral metabolism.  

Mom did OK with her diabetes but did fall occasionally (who knew about neuropathy in those days) and suffered a fracture of the right upper arm and a few years later she broke her ankle. Fortunately, she recovered fully.

When I moved to the US, my parents came to visit on two occasions and Dad died shortly after his last trip. Mom had a different story – her neighbors noted that her milk, newspaper, and mail had not been picked up for 3 days. They managed to get into the house only to find my Mother on her bed, fully clothed with a shopping list in her hand, though she had died a day or two before.

My recent appointment to the Faculty in the Department of Medicine at the University of Toledo brought me back quickly to diabetes. Appropriately, my colleagues in General Internal Medicine provide excellent care to their patients with diabetes — type 1 and type 2. My involvement in diabetes management is predominantly with patients referred from the surrounding communities — patients who appear to have received less than optimal care. It is uncommon for these patients to bring to their first visit any blood glucose data and more often than not report that they check their CBG maybe once a week. Their complications from poorly controlled diabetes are regrettably as expected. To overcome this, albeit at a late stage, we have received permission to start group treatment of type 2 diabetes with five or six patients being evaluated and taught how best to improve their glycemic control. This approach is being undertaken in many academic institutions with much success and we anticipate the same result here.

Bringing back memories of my mother, underscored by the article in Endocrine Today, serves to point me in a better direction in diabetes care.