November is diabetes awareness month. Nearly 26 million U.S. children and adults are living with diabetes today, and another 79 million Americans are at risk for developing type 2 diabetes, the American Diabetes Association reports. Diagnosed diabetes cases cost the United States an estimated $174 billion annually, and the disorder continues to be a common disease managed by primary care providers.

A few months ago, I came across a list of recommended books for health-care providers. One of the titles on the list, Breakthrough by Thea Cooper and Arthur Ainsberg, describes the discovery of insulin as a diabetes treatment. A central character is 11 year-old Elizabeth Hughes, daughter of Charles Evans Hughes, who served as the governor of New York, Secretary of State, Chief Justice, and ran as the 1916 Republican presidential candidate.

Elizabeth Hughes was diagnosed with juvenile diabetes in the early 1900s, at which time treatment consisted of severe dietary restriction. “Begin to reconcile yourselves with the idea that food, previously seen as the staff of life, is now a deadly poison. The less food, the more life. To starve is to survive,” Cooper and Ainsberg quoted a physician from that time as saying.

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For a typical 11-year-old girl, the amount of calories needed is about 2,200 calories a day, but the proposed daily caloric intake for Elizabeth was just 400 calories.

Luckily, Ms. Hughes was one of the first children to receive insulin in 1922, thanks to the efforts of Canadian researchers Banting and Best, and the influence of Charles Evans Hughes and Eli Lilly on insulin manufacturing and production in the US.

Although insulin and other oral anti-hyperglycemics have dramatically changed and improved life for patients with diabetes, a low-carbohydrate, low-calorie diet continues to be central in diabetes prevention and management. While starvation is no longer the diabetes treatment of choice, patients today may consider the diet and lifestyle changes necessary to control the disease to be as dramatic as considering food a deadly poison.

The physician quoted in Cooper and Ainsberg’s book calls dietary measures to control diabetes before insulin, “an extremely difficult regimen to maintain,” noting that food preparation, meals, exercise, weight, blood glucose levels and urine testing “must be followed to the letter and carefully recorded.”

These sentiments mirror the conversations about diabetes management that I have with my patients today. Questions about diet, exercise and exercise frequency, testing blood sugar at home, keeping a log, and determining the latest HbA1c and micralbuminuria readings are still commonplace.

Insulin’s discovery was truly a medical miracle, but more interventions are still needed to make diabetes a more manageable condition, to reduce the risk for developing type 2 diabetes population-wide, and to improve total national costs associated with the condition.

Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.