Bittersweet: Diabetes, Insulin, and the Transformation of Illness

Bittersweet: Diabetes, Insulin, and the Transformation of Illness

Bittersweet: Diabetes, Insulin, and the Transformation of Illness

Bittersweet: Diabetes, Insulin, and the Transformation of Illness


One of medicine's most remarkable therapeutic triumphs was the discovery of insulin in 1921. The drug produced astonishing results, rescuing children and adults from the deadly grip of diabetes. But as Chris Feudtner demonstrates, the subsequent transformation of the disease from a fatal condition into a chronic illness is a story of success tinged with irony, a revealing saga that illuminates the complex human consequences of medical intervention.

Bittersweet chronicles this history of diabetes through the compelling perspectives of people who lived with this disease. Drawing on a remarkable body of letters exchanged between patients or their parents and Dr. Elliot P. Joslin and the staff of physicians at his famed Boston clinic, Feudtner examines the experience of living with diabetes across the twentieth century, highlighting changes in treatment and their profound effects on patients' lives. Although focused on juvenile-onset, or Type 1, diabetes, the themes explored in Bittersweet have implications for our understanding of adult-onset, or Type 2, diabetes, as well as a host of other diseases that, thanks to drugs or medical advances, are being transformed from acute to chronic conditions. Indeed, the tale of diabetes in the post-insulin era provides an ideal opportunity for exploring the larger questions of how medicine changes our lives.


Eight o'clock in the morning. As occurs in many other hospitals across America, a team of physicians, nurses, pharmacists, and students is gathering. I am one of them. Our hospital caters to the needs of sick and injured children, and for the next hour or two, we will discuss each patient under our care. As the ward attending physician, I listen as team members present various aspects of each child's case. Not quite half of the children admitted to the hospital were healthy prior to this recent episode of illness, and if all goes well, they will return to full health shortly. The rest, constituting the majority, live with some form of chronic illness. For many patients, powerful new medications, available only in the past decade or so, can dramatically ameliorate the symptoms of their disease. For others, the most problematic aspects of their condition still elude our control: these children experience intractable seizures, progressive muscle degeneration, recurrent infections, or a slew of other ailments that wrack mind and body.

When we then visit these children and their parents, as a group we consider the current problems that brought them to the hospital and discuss not only what treatments are available but more generally the goals that will guide our care. What are these goals? Each child and family is different. For those patients who can reasonably expect full recovery, that is typically the goal. But for the rest, especially those with severe chronic conditions, clarifying the goals of care is difficult but of paramount importance. The underlying disease may block the path to a long and healthy life, compelling us to define another destination, building a new path as best we can. One conversation rarely suffices, as hopes and fears color our assessment of what are loving and feasible goals. Once these goals are clarified, though, we can then marshal the power of medical technology and the full capacity of our health care system to accomplish them.

This is good work that I enjoy, being a pediatrician who works with individual children and parents to secure a better quality of life. Away . . .

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