A Case Report on Type 1 Diabetes with Extra Long Duration

This case report concentrated on a woman who lived for 91 years, was insulin-dependent for 86 years, and was managed for over 55 years by the same physician, the author. She was diagnosed with diabetes when she was five years old, in 1932. Her diabetes was treated with rapid-acting insulin three times a day at first, then once a day from 1940 with rapid-acting and protamine zinc insulin, then pork, then human crystalline zinc insulin, and finally a combination of rapid-acting and NPH insulin for the last 16 years. The reason for the above treatment plan was that the patient insisted on a once-daily insulin dose, and the duration of action for all insulins was determined to be 24 hours. For decades, continual overdosing of a single insulin has resulted in hypoglycemic episodes practically everyday, with excessive blood glucose variations as a result. She used a polarimeter to test urine glucose from the mid-1930s to the 1960s, then test strips until the early 1980s, and then converted to blood glucose self-testing. For the past 25 years, her HbA1c readings have been about 7% (53 mmol/mol). She did not acquire retinopathy or nephropathy; instead, she suffered from severe neuropathy in her later years. In addition, due to age-related dry macular degeneration, her vision continued to decline.