Sunday, July 18, 2010

Diabetes Rising by Dan Hurley

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iconI recently read Diabetes Rising by Dan Hurley, a book that takes a harsh look at the rise in diabetes and what is (or isn't) being done about it. Most of us have heard that type 2 diabetes is on the rise, which we blame on the poor American diet. We also know that 9 out of 10 diabetics are type 2, which those of us with type 1 diabetes tend to think puts us in the clear. Ours is considered a genetic disease.

But Hurley turns that theory on its head in his book. First of all, he talks about how the incidence of type 1 diabetes is going up remarkably quickly. Some people would say that's because of medical advancements — e.g., we know what it is now, people can survive long enough to pass the genes on to their kids, etc. — but Hurley goes through a whole list of factors that have been shown in studies to increase the likelihood of someone developing type 1 diabetes.

For example, an increased chance of developing diabetes is linked to:

* Wealth - Statistics show that children from wealthier families are more likely to develop diabetes.

* Milk - Babies who are nursed for the first year are less likely to develop diabetes than babies who are fed formula. There is a theory that until a certain age (6 months? I can't remember what he said) our children's bodies are not made to digest any protein other than what is in our own breast milk, and feeding babies with formula — which is made from cow's milk — makes a child more likely to develop diabetes later on.

* Lack of sunlight/vitamin D - Diabetes rates are highest in the northeastern U.S. and northern countries where kids don't get a lot of exposure to the sun, and a study in Europe (Sweden? Finland? I can't remember where) showed that vitamin D supplements decreased the risk.

I think there were others, but these are the ones I remember offhand. Hurley also discussed one man's theory that type 1 and type 2 are not, in fact, different diseases — that type 2 is simply what people prone to diabetes develop when they don't get type 1. The chapter describes it better than I ever could, but basically, people who have type 2 also tend to have the antibodies that cause type 1 (autoimmune) diabetes, and people with type 1 also tend to have resistance to insulin. The thought is that, whatever the trigger is, if you develop diabetes early in life, it shows up as an autoimmune response, while later in life it shows up as insulin resistance.

Hurley also spends a great deal of time talking about scientific advancements for treating diabetes, versus advancements for curing diabetes. He points out that more of the effort is focused on treatments than cures, presumably because there is more money in treating it than in curing it. He also discusses non-biological cures, such as combining pump and CGM technology to create an artificial pancreas. The FDA won't approve such a device, because it claims that a human needs to be involved in making decisions about treatment, but Hurley has participated in studies on such software and says that it is far more accurate than any human could ever be.

The history of diabetes treatment is also pretty interesting. The "tight control" era is a fairly recent phenomenon, made possible by the small miracle we call a glucose monitor. Insulin, on the other hand, has been around for nearly a century — although not nearly as effective or as precise as it is now.

I highly recommend Diabetes Rising for any diabetic, anyone who has diabetes in the family, or — heck — anyone who knows a diabetic. It is fascinating stuff, written in a fairly brief but engaging format — an easy, interesting read for anyone who is invested in the subject.

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