DIABETES RISING

Updates on the growing prevalence of diabetes, putative contributing factors, current treatments and ways of prevention.

Science writer Hurley has type 1 diabetes, the autoimmune form of the disease formerly called “juvenile” diabetes. Type 1 patients survive by continually monitoring their blood glucose levels and injecting insulin to meet the body’s demands. To combat type 2 diabetes, the adult form, there are oral drugs available in addition to insulin injections. Hurley adeptly covers the history of the disease—beginning with the earliest observations that the urine of symptomatic patients smelled, or tasted, sweet—and provides an illuminating aside on the Nobel Prize–winning Canadian doctors Charles Best and Frederick Grant Banting, who discovered insulin in the early 1920s. The story gets complicated with the discovery of insulin resistance in some patients (requiring higher dosages), the risks associated with drug treatments and the downside of “tight control” (dangerously low blood glucose levels) and the many other complications that can stem from diabetes—heart and kidney disease, blindness, painful neuropathies, amputation and more. Here some explanation of how and why these complications occur would have helped. But the real zingers in Hurley’s account are the variety of new studies he reports in connection with the astonishing increase in overt or potential diabetes in nearly 25 percent of the world’s adult population. Of course obesity and lack of exercise loom large as risk factors for type 2, but Hurley notes dramatic increases in type 1 as well. Diabetes has also been linked to persistent organic pollutants, cow’s-milk allergies and lack of vitamin D. With no cure in sight, the author argues for prevention, a road he sees paved by such public-health measures as mandatory calorie counts on menus and physical exercise in schools. He also has high hopes for an artificial pancreas, a computer-controlled device combining continuous glucose monitoring with an insulin pump.

A fine primer for patients, but also instructive for anyone interested in the social/environmental determinants of disease.