A Diabetes Tale of Survival and Triumph
Susanne Francis recalls her life, from wartime Germany to California today
I was born in Senftenberg, Germany, in 1931. When my parents got divorced, my mother and I moved to a small town to live with my grandparents. During World War II, all trade with neighboring food-producing countries ceased. For everybody, being chronically hungry and losing a lot of weight were common. I also had urinary frequency, and my grandmother, a very down-to-earth person, one day said to my mother, “I think the girl has sugar.” Two days before Christmas 1945, my grandma took me to our family physician and her “diagnosis” was confirmed. A serious problem was the fact that insulin was available only in limited amounts at the local hospital emergency room and intensive care unit. I was admitted to the hospital, put on a starvation diet, and given scant instructions on how to manage without insulin at home. There existed no local diabetes society or Diabetes Forecast that could have taught me how to properly care for myself and how to handle my food intake.
The crops of the farmland surrounding the city consisted mostly of potatoes and sugar beets, and after the harvest we hiked there to collect scattered potato and sugar beet pieces, the latter used by my grandma to make syrup—food I was not allowed to eat. I was at the time 5 feet 7 inches tall and weighed 68 pounds. My father had died in 1943, following stomach ulcer surgery and pneumonia (penicillin was not available at that time). My mother exchanged my father’s clothing on the black market for vegetables, eggs, and meat. I “sold” my Steiff teddy bear and Käthe Kruse dolls to our milkman for his rather spoiled little daughter. His payments consisted of cheese and milk. For a while, these maneuvers helped us to survive, but I kept losing weight and feeling poorly. My uncle, the chief surgeon at the hospital, admitted me to the hospital on several occasions so that I could benefit from temporary insulin injections and a higher calorie intake.
After many attempts, my mother succeeded in locating my godfather who, shortly before the war, had left Germany for Switzerland, where he got his doctor’s degree, after which he moved to Cuba. When he heard about my predicament, he immediately contacted his friends in the United States and made arrangements for them to supply me with parcels of insulin on a regular basis. What still amazes me is the fact that despite the lengthy shipping time without refrigeration, the insulin always arrived intact, without losing its potency. This insulin kept me alive, and I began to feel better and look like a normal teenager.
My routine as a diabetic, however, was still not easy. Once a month I had to get up very early before school and walk a mile to the hospital laboratory for fasting blood glucose tests. Glucometers and test strips for glucose testing at home were not yet available, and the glass syringe and giant needle I used had to be boiled after each injection in order to sterilize them.
In June 1948, following the German “money reform,” after years of war and postwar food deprivation, insulin became available in pharmacies and so did healthy food in stores. Unfortunately, there was still no local diabetes society to teach proper carbohydrate counting and blood glucose control, nor was there any literature. I will never forget an extended school outing when I experienced my first episode of hypoglycemia, fainted, and had to be rushed to the hospital.
Somehow, I managed to do fairly well. After graduation from the University of Mainz Interpreter’s College and working for quite a few years at the 7100th U.S. Air Force Hospital in Wiesbaden, Germany, I decided to visit the United States and work there for a year. In May 1961, I arrived in San Francisco and initially stayed with the family of a college friend. I met my husband-to-be, George, in 1962, and the one-year visit to the United States has become a 53-year stay! George (pictured above) was an “outdoors” man, and his love for hiking, mountain climbing, and skiing was simply contagious. Most important, he became familiar with diabetes care and helped me to improve my health and blood glucose control tremendously. George passed away in 2013 and I miss him so very much.
I worked until retirement in the newly established Internal Medicine Residency Program of the Kaiser Permanente health maintenance organization, where I learned a great deal from my wonderful supervisor, Elliott Wolfe, MD, and other health care providers. I benefited tremendously from the up-to-date medical information always available to me. Dr. Wolfe, the residents, nurses, and my office coworkers of course knew about my diabetes. When on two occasions I had an episode of hypoglycemia without being aware of it, they quickly handled it. There was one occasion when I began to perspire profusely and simply took off my blouse, but even that was taken care of without embarrassing me. My memories also include a very intelligent young resident, Ronald P. Monsaert, MD. After graduation from our program, he specialized in endocrinology, and in 2003, I noticed his name under associate editor in the masthead of Diabetes Forecast!
In 1997, my kidney values became slightly abnormal, and my physician suggested I switch to an insulin pump to improve my blood sugar control; I have been a “pumper” every since. To facilitate my blood glucose management via pump, I designed a personal daily log sheet for blood glucose results, basal rate, boluses, and carbohydrate, fat, and protein intake, infusion set changes, exercise, and ketones. I created a smaller, booklet version for making such entries when not at home, and a pocket-size food value list. I am now 82 years old, have learned a lot about diabetes care, and hope that I will be able to remain in control.
Susanne M. Francis is a resident of Santa Clara, Calif. “Having diabetes and managing it well is not easy,” she says. “It takes 100 percent determination of the patient and the understanding and cooperation of family, friends, and employers so that the patient can cope successfully.” After many years with diabetes, her biggest management challenge is avoiding hypoglycemia. “My testing plan is consistent and will remain since I have hypoglycemia unawareness,” she says. Francis tests before each meal, two hours after each meal, after exercising, at bedtime, and at 1 a.m. She always tests before driving.