As a child with type 1 diabetes, Theresa Williard twice survived monthlong comas brought on by extremely high blood-sugar levels.

Into adulthood, she continued battling dangerous bouts of high blood sugar and periodically experienced episodes of low blood sugar that once left her unsure how she got to work that day.

Mrs. Williard admits she's not tightly controlled. As a result, she's suffered two heart attacks, a stroke, laser treatment for eye damage known as retinopathy, numbness of her legs and an ulcerous toe, among other diabetes complications. She currently sees six different doctors for her ailments.

So diabetes remains a challenge for Mrs. Williard.

But she can claim one achievement that only a select few people with diabetes can make: Mrs. Williard has survived 54 long years with type 1.

The 60-year-old Bloomfield resident received a 50-year "Triumph for Man and Medicine" medal from the Joslin Diabetes Center in Boston for surviving diabetes since 1953, when she was 6.

Her battle stories about living with diabetes are not for the faint of heart.

"I'm thankful I'm still here," she said. "Diabetes is a nasty disease, but you have to fight it and can't let it get you down. I'm a pretty good fighter, but a couple of times I could have laid down and died. But I have a lot of things to be thankful for in life."

Dr. Wayne Evron, a Joslin Diabetes Center endocrinologist at West Penn Hospital, said he's working to convince Mrs. Williard, his new patient, to improve her blood-sugar control.

Surviving for 50 years or more with type 1 is a reasonable goal for anyone willing to devote the time and effort necessary to take regular doses of insulin, exercise, eat a healthy diet and be vigilant about blood-glucose levels.

"I always tell them how good they've done," Dr. Evron said. "But no matter how old they are, they can do better."

Type 1 is an autoimmune disease that kills off many of the insulin-producing beta cells in the pancreas. Without enough insulin -- the hormone that allows glucose to enter cells -- glucose builds up in the blood. If left untreated, it can lead to serious health complications and eventual death.

Those using insulin must test their blood often to prevent sugar levels from climbing too high or dipping too low. High blood sugar over time can cause heart disease, strokes, renal failure, blindness and loss of limbs due to circulation problems. Caution is required because low blood sugar can make one unconscious and cause death if emergency action isn't taken to restore blood glucose to normal levels.

As Mrs. Williard admits, diabetes control is easier nowadays with the hgA1c test that provides long-term blood-sugar averages, pumps that provide steady doses of insulin, and blood-glucose meters that help people keep sugar levels close to or within the normal range. But even with these tools, tight control requires daily, even hourly, surveillance and action.

The reward for those dedicated to the task is a longer, healthier lifespan.

Dr. Evron said 20 of his patients have reached the 50-year anniversary. His goal is to make a public announcement each time one reaches the milestone. The Joslin Diabetes Center in Boston awards medals to those who reach 50 and 75 years with the disease.

Since 1970, Joslin has presented 2,632 50-year medals, according to its Web site, www.joslin.org. Since 1996, it's awarded 23 people with 75-year medals. It also provides certificates to 25-year survivors.

Joslin currently is studying more than 400 50-year medalists to determine what factors contribute to longevity. A second study will examine their blood and DNA to predict the risk of complications.

As for Mrs. Williard, Dr. Evron said many people diagnosed before blood-glucose monitors were developed in the early 1980s relied on good luck, strong genes and a daily regimen to get by. In Mrs. Williard's case, she beat the odds and worked 37 years as a respiratory therapy and ambulatory surgery technician.

Even with new tools available to improve control, it's often difficult convincing old timers to change their habits. "But when you're only 60 years old and want to get to 80 years old, you have to learn different things," Dr. Evron said.

There's also a fine line between badgering a patient and providing sound advice: "In the era she comes from, a lot of people have trouble," he said. "You have to win them over and do it slowly."

Patients with good control nowadays can qualify for health insurance, have babies and participate in activities once deemed too dangerous for those with diabetes. As the medals prove, it's a more promising era for people with type 1.

"I now have 100 patients who have had diabetes between 40 and 50 years, and they might outlive me," Dr. Evron said.