THE IRVING MUSHLIN STORY: 68 YEARS WITH DIABETES

Too many people still believe that diabetes inevitably means a shortened, traumatized life. That is not true. Today's diabetes treatment modalities do a superb job of reducing the odds of complications, but there are also a lot of folks out there who've had diabetes 40, 50, even 60+ years, and are doing fine. They must have been doing something right all along! Let's meet one of them.

Irving Mushlin is 81 years old. He has had type 1, insulin-dependent diabetes, for 68 of those years. As he describes:

"Around 1930, when I was 12 years old, I had symptoms. I had the classical symptoms of excessive urination, hunger, thirst, loss of weight, and fatigue. However, the first doctor my parents called in picked up right away that I had a bad taste in my mouth. He gave me some mouthwash so I could rinse three or four times a day, and that would take care of the problem.

"I was actually diagnosed in January of 1931. We lived in Astoria, New York, but I was taken to a pediatrician at Columbia Presbyterian Medical Center, in New York City. The big city had doctors who practiced the latest medicine. They kept me in the hospital, in the pediatrics department, about two weeks.

"There, they taught me how to take insulin. They taught my mother a good deal about diet, probably more than she needed to know, it appears today. When I was discharged, she had a gram scale, and she used to weigh the bread, meat, and nearly everything that went into my stomach. It was all weighed, measured, and calculated.

"They had me on four doses of insulin a day, right from the beginning. In 1931, there was only regular insulin. I used to take one dose before each meal, and another at midnight.

"We had glass insulin syringes, with steel needles that got dull and had to be sharpened on a stone, which I learned how to do. But those needles were never really sharp; they couldn't compare to the great ones we're using today. And I was taught how to do urine tests [for glucose]. I remember filling the test tube with Benedict's solution and a few drops of urine, and then heating it for three or four minutes, to see what the color changes would be. I didn't use the fizzy pills then; they came later. Benedict's was a solution you bought by the quart. I used 5cc for each urine test...

"When I was a College Freshman, I developed tuberculosis. I was sent to a sanitorium, the famous Trudeau Sanitorium at Saranac Lake, New York. There, they treated my diabetes; my tuberculosis needed only bed rest then. But I experienced an earth-shaking event--I met a student nurse, and her name was Rose. Rose has been my partner and wife now for 53 years.

"I was there at age 17, but we were not married until I was 27. Nothing hasty about us! We wanted to be sure that my tuberculosis and diabetes were behaving... so I got a part-time job, in another sanitorium, doing statistical work, in exchange for room, board, and medical care. So I had an extra extended stay out of college!

"I was a college freshman when all this started, but by ten years, I had been back to college, gotten my bachelor's and master's degrees, and we were ready to marry, the week I started on a full-time job. And that job was a result of these experiences! I went to the National Tuberculosis Association, probably the first non-profit health promotion agency in the U.S., apart from the American Red Cross. They were expanding, forming new chapters all over the country, and they took me on as a trainee...

"They placed me in my first job, in Newark, New Jersey, where we stayed some seven years. Then there was a vacancy on the staff of the national office, in New York City. I went to their personnel department, where I was put in charge of the staff training program...

"I was sent out to recruit young people, college seniors, for a career with the organization. They would undergo our training program, which was held a few weeks at a time in different locations all over the country. Sessions lasted from two to six weeks. We would have 30 or so trainees in a hotel, and would bring in experts in the various subjects these people had to learn. And there I was, like a little school principal, having a good time with my students, and learning a lot about the disease and the organization...

"We wound up in Florida in two steps. When our director of personnel and training resigned, I was promoted into that position, after which I had the opportunity to become the executive director of the New York City chapter, one of the largest in the country. I held that position 19 years, until the children were fully grown and married, and we had no further need to stay in the Northeast.

"I have to tell you that before we were married, we went to see a "diabetic specialist," who, when he found out I was on insulin, said to me: 'Don't worry, you don't need to think about having children. All diabetic men are sterile...' He was very positive, and we didn't think that was particularly encouraging... but we went ahead and got married. Now we have two children and five wonderful grandchildren! Our son is a prominent MD in Boston, and our daughter is a consultant teacher in special education in Maine.

"So we got to Florida because there was no need for me to commute the long distances to the New York metropolitan area. There was a vacancy for an executive director in the Miami area--and I took the post 25 years ago. I retired at age 65, went back to school, and became a paralegal. I've worked for 14 years for Legal Aid Service of Broward County (Fort Lauderdale) Florida. I work in the Elderly Department, and my clients are over 60, some in their 90s... In April I was 81 years old.

"Here is one incident Rose and I thought you might like. We were married the day Japan signed General MacArthur's surrender documents aboard the U.S.S. Missouri. We had a great big celebration, because everybody was celebrating not only our wedding, but more so the end of the war. I don't remember why this happened, but a few hours after we retired for the night, I had a low blood sugar. We searched the room, but in the excitement, we'd forgotten to bring any candy (I don't think there were glucose tablets in those days)--and the hotel restaurant was closed, as it was very late. We both got up, dressed, walked the city streets, until we found an all night eatery. We laughed about it later, but still wonder if this insulin shock was caused by too much insulin, not enough food, or sexual activity...

"I don't have any serious diabetic complications. I did have a coronary, a heart attack, in 1981, and some circulatory problems around the heart. I had bypass surgery about 10 years ago. I've recovered well, and that's not a problem. I have no neuropathy, and my feet are in good shape. My eyes are in poor shape, but not from my diabetes. I have age-related type macular degeneration, that's from just living, not from being a diabetic.

"I take four shots a day. I take one dose in the morning before breakfast, the new Humalog, the quick-acting stuff. At noon and dinnertime I take R, Regular, and at bedtime I take N, a slower-acting insulin. I do this regularly, and I do my blood sugars usually four times a day. I use the Accu-Chek Advantage meter, and its new curved test strip, the Comfort Curve.

"I record every test result, and every dose of insulin, on a sheet I submit every two weeks to my doctor, who has a wonderful expert diabetic educator on his staff. This helps them give me sliding scale advice, so I can adjust insulin doses as needed.

"Though I'm still working, three days a week, I don't get enough exercise, not as much as I should. I have some arthritic problems in my back, and walking is not as comfortable as it used to be. But when I've done regular exercise, I found it enabled me to reduce my insulin requirements. I recommend it highly--but you have to be as regular as you are with your insulin--because if you're erratic in doing it, you'll get erratic results. The same dosages, the same diet, the same exercise.

"Thank God we're no longer in need of having to weigh and measure food by grams of calories--grams of carbohydrate and calorie units. But food still needs consistency. Rose, my wife, is very good at this. I'm not as precise as some, but I have standard things I eat, and I won't eat some things at random. I'll have my toast, and egg and sausage (or, better, a couple of "Egg-Beaters"), and coffee with milk in it, but I usually won't eat a sweet muffin in the morning; that's not standard. If I wanted a sweet muffin, I'd reduce my volume of toast. I may vary the exact food, but not the effective value.

"And my family has been invaluable to me. A man needs to have the right partner. Rose hasn't 'taken care of me' but has understood what I need, and what I should do--and we move together on it.

"Now most people don't get the chance to marry as well as we did--it happens by divine action. But I think it is the most important thing a diabetic can do--have the best kind of family understanding and family comprehension, where no one gets overly worried or tries to ignore the whole thing! Teamwork--its a family affair. It couldn't be stronger than that.

"You know, controlling diabetes, taking tests and shots, once you get accustomed to it, it's not a burden, not a problem. It only looks like a problem the first time you hear about it, because it is such a radical change for most people. I had an advantage, because I learned how to do a lot of it while young. Young people are more adaptable. I just went ahead with it, and did what they showed me how to do. I didn't think much about it... Still, there's no reason older people can't do the same things, no reason to stop learning, at any age."