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April 1, 2007

Book Review: Cheating Destiny by James Hirsch

If you are alive and literate in North America in the 21st century, you know that type 2 or adult-onset diabetes is now an epidemic, and that our modern lifestyles are to blame. What you may not know is that type 1 diabetes, an autoimmune disorder, is also on the rise--the incidence has increased at 3.2% per year for decades.

But I'll bet you've never read any passionate newspaper articles decrying this epidemic or what it will take to defeat it.

When I went to the bookstore yesterday (yes, yesterday) I intended to pick up two new releases: Mindset (more on that next week) and Ally (the only actual sci fi series featuring a wiccan protagonist who's not a flake that I've ever come across). Walking through, I saw Cheating Destiny: living with Diabetes, America's Biggest Epidemic by James Hirsch. I picked it up and read the prologue: this is that book I'd heard of last year, I thought; the one where the author's three-year-old son is diagnosed with type 1 while he writes it. The one where entire online diabetic communities eviscerated him for being so stupid as to reproduce while having diabetes.

I picked it up. I had to. I'm glad I did.

If there is one book to convey both type 1 and type 2 diabetes to a non-diabetic audience, this is the one.

It beautifully captures the emotional and psychological whipsaw of living with this chronic condition--the perpetual collision of anger and gratitude, grief and hope, acceptance and denial, terror and courage. Yes, if you are diabetic, you will find vindication in its pages; but if you are not, you might find understanding. And I hope you do. It is so difficult to convey the simultaneous thankfulness for insulin and blood sugar meters and the resentment for the burdens it places on you, the embrace of the promises for new therapies and treatments and the bitter laughter at the glossy photographs in the magazine ads, yet he's done it.

It also captures the doublespeak of the medical establishment with acute clarity--how type 1 diabetics are expected to adhere to the control goals of the Diabetes Control and Complications Trial (which proved that near-normal blood sugar control would help delay or prevent complications), without being informed that even the group studied in that trial could not achieve the original goal of 6.0 for the A1C, and the revised goal of 7.0 was achieved only by providing each diabetic with a full team of diabetes specialists who would call them at home, support them in every way possible, and bribe them with theatre and sports tickets. (Has anyone ever offered you so much as a sugar-free lollipop for adhering to your diabetic regimen?) How, once the trial ended, the group's control eroded in the absence of those supports and average A1cs rose to 8.0; yet 6.0 is still presented as a reasonable goal to type 1 diabetics operating on their own with few resources and often without sufficient insurance or familial support.

I'm sure many of the diabetics in the audience have already read it; it's the non-diabetics I hope will pick it up. Those of you who don't know how it is to simultaneously feel blessed for having been given decades of life you would otherwise not have had, robbed by the knowledge that you are likely to lose decades off the other end regardless, and frustrated or angry at having to deal with the disease moment-to-moment in the meantime.

I'd lend you my copy; but I intend to forcefeed it to my parents two weeks from now.


Posted by Andrea at April 1, 2007 8:16 AM under Books , Pins and Needles

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I wrote a paper a couple of years ago about living with chronic disease, the disease in question was kidney failure. As a part of the paper, we, the students were required to adhere to some sore of a regimen. I chose training for a half marathon, because I was training for a half marathon. It was an eighteen week program that was set out for me. I was highly motivated, knew the end point, really wanted to do this but I was unable to adhere to the schedule, I had to take a few days off, I was sick or just tired of the whole thing. It really helped me to understand what living with a chronic illness is like and the judements that go with it from health care providers.
On a different note, living with my daughter, provides me with the same kind of day in and day out attention to detail, to keep things running smoothly, that just grinds a person down to the very nub of their existence.
There are no easy answers I guess, the most we can do is our best and that varies from day to day.
Thanks for the insight. It helps me as a nurse.

Posted by: deb at April 1, 2007 9:55 AM

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Quick FYI--it was a non-diabetic radio interviewer who gave Hirsch the most publicized hard time for reproducing, and the diabetic community pretty much went after the interviewer for being misinformed. The radio announcer ended up (I think) taking back some of his comments (he'd thought Hirsch's diabetes had more of a genetic component like type 2).

Hirsch's book is great, though--I reviewed it when it came out for the publication I work for and Hirsch himself emailed me to thank me for the review--so you may end up hearing from him yourself.

Posted by: Lyrehca at April 1, 2007 10:46 AM

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You mention Type 2 diabetics - do you think it would be a good read for my mother and father, who are still dealing with dad's unexpected Type 2 diagnosis (unexpected in that he had none of the markers or risk factors for Type 2 - they think it might in part have been induced by medications)?

Its a different thing to be dx'd with Type 2 at 60 than it is to have Type 1 from childhood, I know, but my mom is the type who is looking everywhere now for more reading material on this...

Posted by: Sara at April 1, 2007 11:47 AM

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Deb, IMO, that should be required of every health care provider that works with people with chronic illness. IT's easy to be judgmental about lapses in care until you've tried to adhere to such a regimen yourself. Good for you for doing that.

Lyrehca, that's interesting. I hadn't heard the interview, or heard of it--my only contact with the book prior to seeing it at the store had been some of the reviews of the prologue saying, in essence, what kind of idiot has kids when they have diabetes? Which makes me bristle for obvious reasons--and these were people who had diabetes, and figured that if only no one who has it reproduced, the disease would somehow end.

Sara, I loved it. He does equal air time to type 2, I think. It's not a how-to book, and if that's what she's looking for she might not get much from it; it's more the history of it, the psychology and emotional impact, the medical culture, etc. I'd actually say to read it yourself, and then judge whether you think your parents will like it or not.

Posted by: Andrea at April 1, 2007 12:49 PM

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Thanks for this, Andrea. The CHC I volunteer at has a Diabetes support group, cooking group, etc. I will make sure it also has a copy of this book.
You are *always* worth a visit.

Posted by: Mary G at April 1, 2007 4:16 PM

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Well, you convinced me!
I just ordered it off Amazon!

Posted by: Sara at April 1, 2007 8:47 PM

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Thank you, I will look for this. My mom had Type 1 her whole life and died from it last summer. I am still processing all the ways it affected our relationship--especially at the end when she was so brittle and I was so angry and scared at how she was caring or not caring for herself-- and what she went through over the years, just trying to live a normal life. And I could write a book about her medical care.

Posted by: Andrea at April 1, 2007 9:37 PM

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This is my newest favorite book. I would lend you my copy too, but it's currently with my friend who I have already lent it to.

Posted by: Megan at April 16, 2007 6:58 PM

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Thank you so much for this brief mention of "Ally". It intrigued me enough to go looking, and I've now read "City of Pearl" and "Crossing the Line" - Traviss is my latest favourite author. I'm now searching frantically for the rest of the books in the series, which don't seem to have been published in Australia yet - Amazon here I come.

Posted by: Cee at April 26, 2007 7:00 PM

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Go Berserk




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