By: Kristin Lund
Gale Fullerton is a 65-year-old Californian who has the distinction of being a Joslin 50-Year medal winner. Elliott P. Joslin, M.D., knew that good self-management was the key to minimizing long-term diabetes complications, and the medal program was designed as an incentive for those committed to good diabetes care. In 1970, Joslin Diabetes Center expanded the program and began awarding a 50-year bronze medal. They presented the first 75-year medal in 1996.
Since 1970, Joslin Diabetes Center has presented more than 2,632 50-year medals. Joslin has also awarded 23 distinctive 75-year medals from 1996 to the present. More than 636 people have received certificates recognizing 25 years with diabetes.
Diabetes Health interviewed Gale Fullerton to find out the secrets of his success.
Tell us a little about yourself
I was born in 1944 in Pasadena, California, and grew up in Eagle Rock. This was an ideal time and place to grow up-wonderful family and friends, especially great. This idyllic situation was disrupted when I was diagnosed with type 1 diabetes in 1958 at the age of 14. It was the first semester of the ninth grade, and I knew something was wrong when I developed a voracious appetite and yet lost weight. I could hardly make it through the 50-minute classes without having to visit the restroom. When I went to our family physician, he performed tests and promptly referred me to a diabetes specialist. I spent a week in the hospital so that I could learn about diabetes treatment protocols-weighing food, injecting insulin, testing urine, diet, and correcting insulin reactions.
I graduated from college in 1967 and worked for the U.S. government with the Air Force and the U.S. Geological Survey in the human resources field before retiring in the 1990s.
How many units of insulin do you use these days?
Needless to say, the insulin types and timing of injections have changed drastically over the years. In 1958, it was one shot a day. Now, I take many injections daily. Usually I inject about 14 units of slow-acting Lantus before bedtime, which covers the next 24 hours. To take care of mealtime carbs, I take approximately five to six units of fast-acting Humalog before each meal. The amount of Humalog can vary depending on the meal planned, exercise, and my current blood glucose reading. This insulin schedule works most of the time for me. Insulin pumps might be a better alternative, but my physician does not recommend changing because my control is satisfactory. I have few complications, and she does not want to alter something that is working.
Have you ever been embarrassed by diabetes?
I have never been embarrassed about having diabetes, but have been less than pleased regarding the effects of low blood glucose levels. Over the last 34 years of marriage, my wife, Bobbie, has had to rescue me many times when unexpected lows occurred, especially during the night. It is never an enjoyable experience when I do not have control of my diabetes and when I have to depend on others to recognize and resolve the hypoglycemia episodes. Having another person force me to eat or drink substances to correct the problem is not a pleasant experience for me, nor is it a delight for the person providing assistance. I always recommend that people should prevent an embarrassing situation from developing into a serious problem by telling relatives, friends, neighbors, and work peers about their diabetes.
How do your friends and family support you?
Family members have always been very supportive. They accepted my medical condition and have never made a derogatory comment or despaired that I may lose my sight, have kidney failure, or amputations. They expected me to live a long life, live it to the fullest, and encouraged the discipline to do so. They were knowledgeable and especially were cognizant regarding the symptoms and treatment of low blood glucose.
However, family is not enough. While growing up, I always told my friends about the problems of low blood glucose and advised them what to do. Remember, in those days there were no meters to self-test, which made it very difficult to successfully self-identify low blood glucose.
I also have support beyond my friends and family. Since 1971, I have received excellent care from the Palo Alto Medical Clinic and Stanford Hospital. The Clinic recognizes that diabetes is only part of the health picture. They also realize the importance of treating high blood pressure, high cholesterol, and other conditions that go along with diabetes care. The clinic also has an active Diabetic Support Group, which provides practical insights into day-to-day living. However, none of these resources would be available without health insurance. Luckily, I have had coverage since 1968 and would not have been able to afford basic care without it.
One particularly helpful faculty member at Eagle Rock High School was the track coach, John Oden. He encouraged me to join the team and enabled me to participate by obtaining the bureaucratic approval to participate. At that time, people with diabetes were prohibited from participating without medical approval. Track enabled me to meet many life-long friends and to truly discover the value of exercise.
My supervisors and team members at the U.S. Geological Survey were always supportive. It helped that one manager had a spouse who had diabetes, and another had married an individual with diabetes. They especially understood the potential complications of diabetes because both of their spouses died in their late forties. They appreciated how well I took care of myself.Any negative comments about diabetes from other people?
I remember only one negative comment. In 1984, I was raising money for diabetes through a bike-a-thon sponsored by the Santa Clara Valley Diabetes Society. One person at work said that she “did not believe in extending the life of those with medical deficiencies.” I told her that if her wish were granted, I, along with millions of other people with type 1 diabetes, would have died years ago. I then asked if she would like that to happen a friend or family member.
Have you had any low blood sugars?
I have had my share of low blood sugars. I sometimes wonder how I managed from 1958 to 1983-the year I got my first BG meter. I must have had high blood sugars much of the time, but I only knew I was low when I had a reaction. Since 1983, most of my lows have been primarily during the night while asleep. Fortunately, most of the time Bobbie recognizes my lows and provides juice, glucose pills, or another source of carbs. A few times, when I was not cooperative, she called 911 and the fire department came and corrected the problem. They were very knowledgeable about diabetes and had the resources to raise blood sugars quickly.
What can you tell us about diabetes care then and now? Do you see progress?
1958 seems like the Stone Age compared to the present. Then there were glass syringes that were sterilized with alcohol or by boiling. Also, the needles were thick, long, and painful and had to sharpened by hand. Now the disposable plastic syringes combine with a short, thin, and sharp needle that is usually pain-free. Also, the insulin pumps and continuous glucose meters are remarkable advances. Insulin management has changed from one shot a day with two types of insulin: Lente (slower acting), and regular (faster acting). It was difficult to predict when the insulin would peak, and lows and highs were virtually unpredictable without blood glucose meters. Now there is Lantus and Humalog administered several times a day. Back then we had urine tests, which were virtually useless in identifying current blood glucose levels. Now there are a variety of blood glucose meters available.
Tell us about receiving your Joslin 50-year medal.
I felt very honored to receive the medal and certificate through the mail in January, 2009. I am flying to Boston this September to participate in the 50-Year Medalist Study.*
What is the secret to your success?
I believe that exercise is an extremely important part of diabetic care. Having had diabetes for over 50 years, the only complication I have had is blood circulation to the left leg, which was corrected in 2006 by vascular surgery at Stanford Hospital. The surgeon said that the problem cannot be solely attributed to diabetes because I had polio in the left leg in 1946 and now have some symptoms of post-polio syndrome. My ophthalmologist stated after examining my eyes that he would not know that I had diabetes.
I believe the lack of major complications is mostly related to exercise, starting as a teenager and continuing to the present. I ride my bicycle six days a week, lift weights three days a week, kayak in the ocean once a week, and walk with my wife. I enjoy these activities, but I realize they may not be for everyone. I think it is important that all of us (diabetes or no) find some type of enjoyable movement activity and do it regularly.
Do you have any tips or messages for the rest of us?
I feel very fortunate to have been honored by the Joslin Clinic and happy that I have truly lived (not merely existed) for those 50 years. Since retirement, I have volunteered with local senior centers, the National Active and Retired Federal Employees (NARFE), the Eagle Rock High School Alumni Association, and the American Diabetes Association. Stay active, and do not let diabetes care and worries become the only activity in your life. Furthermore, I look forward to receiving the 75-year medal in 2033, at age 89. Then I hope type 1 diabetes may be cured and there will no longer be a need for this recognition.
In the meantime, participate and volunteer in community activities, learn everything you can about diabetes, follow medical advice, exercise, and do not be discouraged. We may not have been the dealt the best health hand, but we can play it to the best of our ability.
*50-Year Medalist Study: Joslin’s 50-year medalists are invited to participate in a special study that examines outcomes of long-term diabetes. The study attempts to understand what factors contribute to the longevity of individuals who have received this honor. Currently, over 400 medalists are interested in participating in the study. To date, over 300 of these have completed an extensive questionnaire about their life with diabetes. Data from this questionnaire suggest that the risk of kidney, eye, and nerve problems is different after 50 years with type 1 diabetes than the risk among all individuals with the disease.
A second study is currently being undertaken, which examines factors in the blood and DNA that may help in modifying the risk for complications and survival. Participation in this study is open to all individuals residing in the United States who have received the Joslin 50-Year Medal.