Book Reviews

Showdown with Diabetes By Deb Butterfield. Review by Alberto Hayek, MD

"It is just diabetes. Don't worry, just take your insulin shots, follow a diet, and you will be just like everybody else." Words like these were commonly heard when I was a pediatrics house officer. In those days, children with diabetes were seen in the general pediatrics clinic. Then, with great reluctance, the pediatric endocrine clinic began to see diabetic children. It was in this medical era that Deb Butterfield was first diagnosed with childhood diabetes. This book is a vigorous statement about her own fight with Type 1 diabetes and about how a person who is motivated to change the status quo may be energized to do so by her own personal experience and by the sincere motivation to help others.

In the decades of the 1960s and 1970s, very little research in diabetes was being done in areas critical to clinical care. Current standards such as daily, multiple, home-based glucose measurements were not easy to implement. Unfortunately, we doctors played a major role in slowing the changes that allowed patients and their families to become more involved with their treatment and its outcome. Because the medical community widely accepted the intensive insulin therapy supported by the Diabetes Control and Complications Trial (DCCT)^1-3 around 1990, we might well assume that more definitive procedures to treat Type 1 diabetes would have been pursued more vigorously in the late 1990s. However, this has not been the case, and procedures such as pancreas transplantation are still not widely available to patients with Type 1 diabetes.

Out of the "health consumer" field now comes the voice of Deb Butterfield, Executive Director of the Insulin-free World Foundation. Her book, Showdown with Diabetes, tells the story of a dramatic treatment advance--and who better than a diabetic patient can authoritatively tell the diabetic community that great strides are being taken in the battle to actually cure Type 1 diabetes? The author's description of her improved quality of life after receiving two pancreas transplantations--the first ending in rejection--is so well described that this description serves as the subjective counterpoint to the scientific data presented later in the book. This counterpoint technique shows that in diabetic patients monitored for ten years after pancreas transplantation, complications of diabetes were reversed. Indeed, conventional views of diabetes undoubtedly limit our understanding of the full benefits of pancreas transplantation. In the author's instance, pancreas transplantation resulted in an unexpected but clinically significant reversal of diabetic neuropathy.

Because of advocates like Deb Butterfield, we can be honest with our patients and agree that conventional treatment of insulin-dependent diabetes with multiple daily doses of insulin (whether by syringe or pump) is time-consuming, demanding, and creates constant worry about hypoglycemic coma. In the daily lives of diabetic persons, insulin allows no breaks from treatment. The great success of pancreas transplantation (today equal to that of kidney transplantation) and the more recent success of islet-cell transplantation (invigorated by results obtained in Edmonton, Alberta, Canada⁴) are the best indication that a new era in the treatment of insulin-dependent diabetes is beginning at several progressive transplantation centers. In its July 27 lead article, The New England Journal of Medicine published the best results ever reported for diabetic transplantation recipients: after islet-cell transplantation, all seven patients in one series became independent of the need for insulin injections.^4,5 A procedure with a former success rate under 8% has suddenly become the most promising approach to curing diabetes.^4,5 Because a major requisite step--immunosuppression--will already be in place, pancreas transplantation must now be given serious consideration for all patients with Type 1 diabetes who undergo renal transplantation.⁶ We are approaching the point where stopping short of cure will seem unreasonable.

This book enlightens, provides an intimate account of the daily tribulations of living with diabetes, and allows the reader to participate in a real-life story in which a determined person makes the world a better place for people affected with chronic disease. The author is a champion of hope based on her personal knowledge of diabetes. If her book carries but one message--that perseverance, knowledge, and a passion to help others can advance medical practice--then this book can be considered an overwhelming success.

New York, London: WW Norton; 1999. 264 pages. ISBN: 0393047539

Dr Hayek is Whittier Investigator in Diabetes and Professor of Pediatrics at the UCSD School of Medicine

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