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Studies in Social Medicine
Bittersweet: Diabetes, Insulin, and the Transformation of Illness
A fascinating portrayal of a medical miracle traces the influence of insulin on the world, from its discovery in 1921 through its widespread dissemination as a treatment for diabetes. (Health & Fitness)
312 pages, Hardcover
First published May 26, 2003
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Displaying 1 - 7 of 7 reviews
August 9, 2018
Written in an academic style and so not as approachable for a reader like me but thoroughly researched and very insightful about the transformation of illness, specifically Diabetes in the 20th century, from a terminal to a chronic disease and how this transformation impacted patients with bittersweet, natch, results. As the parent of two type 1 diabetics, I found it particular affecting and relatable, but I think this book is also valuable for medical professionals or anyone interested in healthcare. I’d love to see the book updated to take into account more recent developments in diabetic care, particularly involving patients and social media as exemplified by the #WeAreNotWaiting movement.
March 10, 2023
This is a history of early 20th century diabetes treatment told through the lens of individual stories (patients of the famous Elliott Joslin in Boston). The stories are important in part to help us understand what the discovery of insulin meant for people with diabetes.
Prior to insulin, the telltale signs of diabetes--dramatic weight loss, polyuria, the "melting" of flesh and limbs--represented a death sentence. Prior to 1922, the probability of surviving 2 years with diabetes was around 50 percent, if you were diagnosed in time; and stretching life beyond even a few months required a draconian diet regimen that left many patients unable to even walk. Then "insulin arrived like a thunderbolt. Joslin quickly perceived that his world had changed--changed utterly" (p18). Joslin characterized the post-insulin portion of his career as working "with the erstwhile dead."
A main argument of this book is that the symptoms of a disease are heavily dependent on how that disease is treated. We think of diseases as natural entities that do their deadly work independent of us. But after insulin, the old symptoms of weight loss, polyuria, thirst, ultimate coma, and so on gave way to hypoglycemia and, in the long run, organ failure, blindness, and amputation as high average blood sugar levels gradually destroy tissue. These latter symptoms would have been largely unknown to the pre-insulin person with diabetes, who couldn't imagine the experience of hypoglycemia and wouldn't expect to live long enough to see high average blood sugar slowly destroy their insides. Hypoglycemia, in particular, is a good example of a symptom that is entirely the result of treatment method--only exogenous insulin can cause hypoglycemia, with few exceptions. That great immediate fear that characterizes life with diabetes--low blood sugar--is not a natural consequence of diabetes itself but is instead the symptom of insulin use. The book's author wants us to think harder about how our view of a disease's effects depends on choices we make about treatment. It is a great insight.
I gave the book only 4 stars for two reasons. First, at times the author's tone feels overly dour or critical of medical innovation: yes, insulin dramatically extended the life expectancy of people with diabetes, but look at these other bad symptoms they now experience, like heart failure after decades of insulin use. To me, the author seems overly pessimistic. I don't think any person with diabetes today would trade be willing to trade places with a pre-1922 person with diabetes, and it's not a close call.
Second, the author gets repetitive in defending his approach to history of focusing on patient experiences. We get the point! It's a good approach that is complementary to other historical work. Now, get on with the actual stories.
I very much enjoyed the book and highly recommend it to anyone interested in the topic of diabetes or medical treatment innovation.
Prior to insulin, the telltale signs of diabetes--dramatic weight loss, polyuria, the "melting" of flesh and limbs--represented a death sentence. Prior to 1922, the probability of surviving 2 years with diabetes was around 50 percent, if you were diagnosed in time; and stretching life beyond even a few months required a draconian diet regimen that left many patients unable to even walk. Then "insulin arrived like a thunderbolt. Joslin quickly perceived that his world had changed--changed utterly" (p18). Joslin characterized the post-insulin portion of his career as working "with the erstwhile dead."
A main argument of this book is that the symptoms of a disease are heavily dependent on how that disease is treated. We think of diseases as natural entities that do their deadly work independent of us. But after insulin, the old symptoms of weight loss, polyuria, thirst, ultimate coma, and so on gave way to hypoglycemia and, in the long run, organ failure, blindness, and amputation as high average blood sugar levels gradually destroy tissue. These latter symptoms would have been largely unknown to the pre-insulin person with diabetes, who couldn't imagine the experience of hypoglycemia and wouldn't expect to live long enough to see high average blood sugar slowly destroy their insides. Hypoglycemia, in particular, is a good example of a symptom that is entirely the result of treatment method--only exogenous insulin can cause hypoglycemia, with few exceptions. That great immediate fear that characterizes life with diabetes--low blood sugar--is not a natural consequence of diabetes itself but is instead the symptom of insulin use. The book's author wants us to think harder about how our view of a disease's effects depends on choices we make about treatment. It is a great insight.
I gave the book only 4 stars for two reasons. First, at times the author's tone feels overly dour or critical of medical innovation: yes, insulin dramatically extended the life expectancy of people with diabetes, but look at these other bad symptoms they now experience, like heart failure after decades of insulin use. To me, the author seems overly pessimistic. I don't think any person with diabetes today would trade be willing to trade places with a pre-1922 person with diabetes, and it's not a close call.
Second, the author gets repetitive in defending his approach to history of focusing on patient experiences. We get the point! It's a good approach that is complementary to other historical work. Now, get on with the actual stories.
I very much enjoyed the book and highly recommend it to anyone interested in the topic of diabetes or medical treatment innovation.
September 5, 2021
I have insulin-dependent diabetes and read this book while learning how to cope with the diagnosis and live with the disease. I would say that the author offers profound insights that have continued to help me when diabetes burnout hits.
Today, as COVID rages across the planet and governments, like Pilate or Lady MacBeth, try desperately to wash the dead from their hands, this book seems even more relevant. To understand that people live with chronic illnesses because so many more of us survive provides a context for the inhumanity of State and medical systems bent on suggesting that people with chronic conditions are disposable. The ideas in this book also helped me better understand why the medical system that gave us insulin is, 99 years later, profiteering on the lives of those with diabetes.
The author makes an argument for the need for health systems to transform to meet the challenges of living well with chronic conditions. I do not think U.S. healthcare systems changed in the ways the author suggests, and I find it helpful for finding ground during this time when public health is the political battleground.
Today, as COVID rages across the planet and governments, like Pilate or Lady MacBeth, try desperately to wash the dead from their hands, this book seems even more relevant. To understand that people live with chronic illnesses because so many more of us survive provides a context for the inhumanity of State and medical systems bent on suggesting that people with chronic conditions are disposable. The ideas in this book also helped me better understand why the medical system that gave us insulin is, 99 years later, profiteering on the lives of those with diabetes.
The author makes an argument for the need for health systems to transform to meet the challenges of living well with chronic conditions. I do not think U.S. healthcare systems changed in the ways the author suggests, and I find it helpful for finding ground during this time when public health is the political battleground.
July 3, 2021
Sadly this book didn’t live up to my expectations. It was very repetitive and the writer didn’t go too in depth. It was more a compilation of dr. Joslin’s cases and how he was as a doctor then about diabetes itself.
September 23, 2018
Medical history isn't my normal reading area, but I appreciated the chance to learn more about the social-medical aspects of this condition that's defined my life in many ways.
October 7, 2014
I read this book quite a while back and still remember it. It describes early treatments of type one diabetes (of course type twos can relate as well) with the personal stories of patients intertwined. A great read.
March 13, 2013
Best diabetes book ever.
Displaying 1 - 7 of 7 reviews