I was killing time in the local hospital library recently when I saw a book on display called Diabetes: the Biography, by Robert Tattersall, and started reading it. Tattersall is "Special Professor of Metabolic Medicine at the University of Nottingham, and a leading authority on diabetes," according to the publisher, Oxford University Press.
There's a lot about both type 1 and type 2 in this book, and the author comes across as a person with real compassion who understands that diabetes comes in many forms and that every patient is different. No one size fits all. The book is pricey for its size, but if you can find a copy, it makes for good reading.
The book is written in a conversational style, with lots of annecdotes about people with diabetes through the ages. And it gives information about diabetes treatment in the early days of the 20th century, before insulin was discovered.
I was fascinated to read how patronizing many physicians of those days were. They didn't want to relinquish control to patients; they didn't trust them; and they didn't give them all the facts.
For example, according to Tattersall, complications in people with type 1 diabetes, which had previously not been seen simply because everyone with type 1 diabetes died within a few years, began showing up in the 1940s and 1950s, 20 or more years after the patients had been put on insulin therapy.
But the idea of diabetic complications was not published in the lay press, so the public, and undoubtedly many of the patients, believed that their diabetes had been cured with insulin.
Even diabetes associations kept quiet. The British Diabetes Association, founded in 1935, published a magazine for lay readers called Diabetes Journal. But between 1940 and 1960, not a single article mentioned complications, according to Tattersall. Instead they wrote glowing articles about people with type 1 who were doing wonderful things, trying to emphasize that people with diabetes can have fulfilling lives.
Of course they can, and it's nice to inspire people. But if patients go blind or die from kidney disease in their 30s, their lives will not be as wonderful as the BDA wanted people to think.
Many physicians were also patronizing. After the discovery of insulin, as now, diabetic diets were controversial. Most physicians continued to keep their patients on the low-carbohydrate, high-fat low-calorie diets that had helped patients survive a few years before the discovery of insulin. They reasoned that carbohydrate was bad for people with diabetes, and also because of a concern "that diabetic patients are untrustworthy and that if given an inch, they would take a mile."
Unfortunately, this attitude that if blood sugar isn't perfect it's the patient's fault has persisted until today among some medical professionals.
I'm trying to find out what percentage of type 1 patients were kept on low-carb diets in the 1920s and 1930s. It's very difficult to find that information. While in a hospital library, a woman who said she was a pharmacist helped me to log on to the library computer, which requires a password. She asked what I was looking for, and I told her. I said I had found the level of carbohydrate recommended by professional organizations through the years, but of course there was no proof that the recommendations were being followed.
