Living for 50 years with diabetes

Robert G. Spiro is a physician and research scientist who has lived with type 1 diabetes for 54 years without developing any complications of this disease. 
Professor Spiro was born in Berlin in 1929 but had to flee Germany because of Nazi religious persecution although his family had resided in that country since the early Middle Ages and traces its ancestry to the Rhineland city of Speyer (which at that time went by the Latin name of Spira). He came to the USA in 1940 via Switzerland and England. His birth name was Günter but he had to change it to Robert because anglophones have difficulty in pronouncing the umlaut.

In the USA he obtained an excellent education and was able to pursue a career in medicine and biological science. Since 1956 he has been at the Harvard Medical School in Boston where he is now Professor Emeritus. In his laboratory, located at the Joslin Diabetes Center, he has carried out fundamental research on the diabetic complications. His studies on the kidney provided a biochemical rationale for tight blood sugar control which is now a universally accepted concept; his work was recognized by several prestigious scientific awards.

While in medical school he met his wife (Mary Jane Paisley Spiro) who was working for her Ph.D. in biochemistry and they were married in 1952. Throughout his long career he has frequently collaborated with his wife on research projects but perhaps even more importantly during the 56 years of their life together she has been the source of constant help and encouragement in the management of his diabetes. They have two sons, both of whom received advanced degrees in the biological sciences, as well as four grandchildren who give them much pleasure.

Although Dr. Spiro developed his diabetes as a young man (age 25) he has strongly felt that diabetic summer camps, for those who incur the disease in childhood, represent a defining experience; in the presence of peers and devoted counselors the campers develop habits and acquire knowledge which makes possible long and productive lives. Moreover they learn that they are not alone in having to live with this lifetime disease. Accordingly when he was awarded the 50-year medal from the Joslin Diabetes Center in 1954 he initiated an Endowed Campership Fund which provides financial support for youngsters who want to attend the Joslin camp. Recently, as he was approaching his 80th birthday, a group of physicians and scientists who trained in Professor Spiro’s laboratory made additional contributions to supplement the Fund in his honor.

Dr. Spiro has a number of web sites in which he relates his experience with diabetes and offers advice. These have resulted in many letters of inquiry which give him much satisfaction to answer.

DPJ: What do you remember from the time that you were diagnosed with diabetes in the year 1954? 

Prof. Spiro: I remember distinctly the time my diabetes was diagnosed. Indeed I made my own diagnosis. In the fall of 1954, while I was in my last year of medical school, I noticed a dramatic onset of pronounced weight loss, thirst, hunger for sweets and large urine volume; all of a sudden during my busy clinical schedule I realized that these are the characteristic symptoms of diabetes which have been recognized since the time of Hippocrates. Indeed when I tested my urine for sugar it confirmed my apprehension as it tested strongly positive. When I mentioned my finding to the Chief of the Department of Medicine he was amused and told me that medical students often believe that they have the diseases which they are learning about. Unfortunately he was wrong in my case and I prepared myself to live with the diabetes with a minimum disruption of my career plans even though I knew that my lifestyle would be altered for the remainder of my existence.

Since I understood the nature of the disease I was intellectually prepared to tackle it in a rational manner and I never hesitated in my optimism as to the outcome of my approach as I was convinced that tight control of my blood sugar would prevent the dreaded complications which poorly managed type 1 diabetes can bring on. Sadly at that time the consensus among physicians was that there was no relation between control of blood sugar and the complications; my conviction put me into a distinct minority. Of course no one today fails to believe that strict control is essential to the management of diabetes. Unfortunately this enlightenment in thinking came too late for those who died of the complications because of this earlier misunderstanding. Today patients with type 1 diabetes can look forward to a long and productive life if they subscribe to the concept of tight sugar control.

From the very beginning I kept a daily record of meals, blood sugars, insulin doses, hypoglycemic reactions etc. with many timed entries for each day and now I have 54 years of these documentations in my possession. Needless to say these records have helped me in planning my day to day management. With the help of the insulin pump I have kept my hemoglobin A1c at levels close to 5.0.

The advances which have been made in the technology of home glucose testing and insulin delivery since the 1950’s are immense and have considerably improved the lives of diabetic patients. When I developed diabetes tedious chemical tests requiring about 70 times the amount of blood that is needed today were needed to measure blood sugar. Although my wife and I were unusual in setting up a home laboratory for these measurements most diabetic patients had to go to their physician or hospital to have their blood glucose determined and of course these random assays were next to meaningless in bringing about good control. Most relied on urine glucose measurements which of course are very misleading since sugar only appears in the urine when already high levels of blood glucose have been reached.

Delivery of insulin used to be achieved with multiple quite painful daily injections. The bore of the needles was large and they had to be frequently sharpened; the syringes were made out of glass with inaccurate scales and they had to be sterilized by boiling or autoclaving. Of course the valuable concept of measuring control by hemoglobin A1c only came into wide use in the 1980’s.

DPJ: Did your diabetes influence your career path in any way?

Prof. Spiro: My diabetes did not alter my career plans and indeed it probably caused me to be more committed to medicine and the biological sciences. My philosophy of tight blood sugar control has been the source of frequent hypoglycemic episodes but I have learned to recognize them in their early stages and to offset them with small quantities of orange juice. I have never, in the 54 years of my disease, been unconscious nor have I ever been hospitalized for my diabetes except during the initial diagnosis in 1954.The hypoglycemia which I have incurred have not at all interfered with my intellectual function.

DPJ: What advice would you give a student if found to have diabetes? 

Prof. Spiro: I would advise a university student who develops type 1 diabetes not to be in any way deterred from following his chosen intellectual pursuit as long as he/she recognizes that the lifestyle will have to be altered if good control is to be achieved i.e. multiple daily blood sugar analyses, carefully timed and planned meals, adjustment of insulin dosage with preplanned exercise, availability day and night of juice or candy in moderation in case of hypoglycemia, use of the insulin pump, keeping daily records etc. Perhaps most importantly for those who move into adulthood, beyond the help of parents, is to have an understanding and supportive lifetime companion.

DPJ: Who or what helped you the most over the years? 

Prof. Spiro: Fortunately I did not require much outside help in the management of my diabetes since I have devoted my professional life to the study of this disease; the pivotal role which my wife played over the years has already been mentioned. Except for the broad outlines of management and the treatment of complications, individuals with type 1 diabetes will know more of their disease than any outsider. Therefore, in general I would say that after reaching maturity they should as much as possible be their own “doctors”. Diabetes is the prime disorder where the patient should be in charge on a day to day basis.

DPJ: What attitude helped you the most over the years?

Prof. Spiro: You have to develop an optimistic frame of mind. Type1 diabetes, although a very demanding disorder, is not a lethal or mutilating disease and indeed it is not inconsistent with a normal life span. A well controlled diabetic cannot be distinguished from a normal person to an outsider in professional or routine social interactions. The successful management of the disease can become a matter of personal pride and accomplishment.

DPJ: What do you think the future holds for diabetology today? 

Prof. Spiro: I am sure that the future holds further advances in the instrumental delivery of insulin and the continuous measurement of blood glucose. However, I am considerably less sanguine about the much talked about “cure” of the disease. Many basic biological and immunological problems need to be solved before a cellular replacement of the insulin producing cells becomes a reality. I believe it is a grave mistake to expect that a “cure” will come within a few years; it tends to be a mirage and leads only to recurrent disappointments and indeed serves as an excuse for not full heartedly using the excellent tools at hand. In the more than half a century of my diabetes I have repeatedly heard mothers of diabetic children talk about an impending “cure” only to ultimately be disappointed. My philosophy is not to rely on such hopes and if it does come one day to consider it a wonderful surprise.

DPJ: On behalf of our readers, we thank you for this impressive report, and wish you all the best on the occasion of your 80th birthday.

Further information on Prof. Dr. Spiro can be found in internet at:

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