Bob Krause and his wife, Kathleen.

Ask Bob Krause how he’s doing today and he’ll answer, “Well, I’m 90,” as if his age explains exactly how he feels. The number, however, belies the real story: The nonagenarian has lived with type 1 diabetes for 85 years.

Krause is believed to have lived with diabetes longer than any person alive in America today—maybe longer than anyone else in the world. He received a special 85-year Victory Medal from the Joslin Diabetes Center this year and was honored at the American Diabetes Association’s Community Volunteer Leadership Conference for his near lifetime of diligence in taking care of his health and maintaining strict control of his diabetes. In fact, Krause, who lives in San Diego, is much healthier than the average 30-year-old, says his endocrinologist, Patricia Wu, MD.

That’s partly because Krause takes meticulous care of himself every day, and has for nearly his entire life. Krause was diagnosed in 1926, just five years after the discovery of insulin and shortly after it became available on the market. He was 5 years old, and his brother Jackie had just died from complications of diabetes.

His parents were determined to keep Krause healthy and instilled in him a rigorous health regimen. To this day, Krause eats just two meals, always the same: a cup of nuts, five prunes, and a piece of whole wheat bread with cheese for breakfast, and a salad with beans for dinner. It is a diet he maintained even as a child in Michigan, when his mother worked in a bakery.

He took daily walks until recently, when arthritis began to give him a little trouble, and he still works in his garden. In his lifetime, he has seen the development of commercial insulin, blood glucose meters, the insulin pump, and many other medical breakthroughs. Though he says he’s “wearing out—being 90 makes you wear out,” Krause is mentally sharp and physically active.

He says diabetes has steered his life in unexpected and welcome directions. When Krause graduated from high school in 1937, he says, no one would hire him because of his diabetes. So Krause went into business for himself, doing woodworking. When World War II broke out, many men were drafted, and he was then able to pick up a few jobs, saving enough money for night school and eventually full-time classes at the University of Detroit–Mercy. He graduated with an engineering degree in 1947, just in time for the GI Bill to give hundreds of newly returned soldiers an opportunity to attend college—and to offer Krause an opportunity to teach mechanical engineering at the college level. He married his wife, Kathleen, in 1953, and the family moved to the state of Washington, where Krause taught at the University of Seattle.

Maybe it’s that engineering background, or maybe it’s his parents’ adherence to strict diet guidelines, but for years, Krause has kept a journal noting every blood glucose measurement and every dose from his insulin pump (he’s been pumping for 28 years). His attention to detail is one of the many things working in his health’s favor, says Wu. “He comes to the office with daily logs of all his doses, everything he eats, his daily blood sugar [readings],” she says. “Motivation and consistency have been what’s seen him through.” Krause says his family (his wife, three children, and eight grandchildren) and his faith also play a role in his success.

Krause is an exceptional case in part because he has avoided many of the issues that face elderly people with diabetes. Managing diabetes 24 hours a day requires careful attention to diet, exercise, blood glucose levels, and medication—and that can be tough to keep track of, for example, for someone whose memory is slipping. Vision problems and loss of dexterity can also create difficulties, as can new and unfamiliar technology. Plus, a limited income can lead to struggles for seniors because, as Kathleen Krause notes, “it’s very expensive to be sick.” 

Bob Krause’s note-taking, strict scheduling, and skilled pump use make him “as good a model as we ever can hope for,” Wu says. “He’s outlived normal expectations for any person born in 1921 and he has diabetes. I think he’s exemplary.”