CHEATING DESTINY: Living With Diabetes, America’s Biggest Epidemic

Houghton Mifflin, 307 pages, $25
Reviewed by Steve Weinberg

As a teenager in St. Louis, James S. Hirsch learned that he was diabetic. After reporting for the New York Times and Wall Street Journal, Hirsch settled in Boston with his wife. They started a family. Hirsch felt he had learned to manage his diabetes pretty well. Furthermore, he felt informed about medical advances because his older brother, Irl, also a diabetic, specialized in treating the disease from his Seattle, Wash., medical practice.

Then, suddenly, Hirsch sensed his life spinning out of control because of diabetes. His infant son, Garrett, tested positive for the disease. Not long after, while driving with Garrett in the car, Hirsch flipped the car because of a semi-blackout due to blood sugar imbalance.
To fight back, Hirsch decided to do what he does best: write a book to inform the masses.

Every disease reaches a critical mass when it ruins so many lives that its prevention, treatment and cure become public policy issues. Legislatures, executive branch agencies, university research laboratories, medical schools, hospitals and other institutions must determine how many resources can be allocated to each disease, from breast cancer to multiple sclerosis to Parkinson’s to, yes, diabetes. Given limited resources, which disease becomes a public policy priority? Who decides? After all, every disease has its advocates for increased research dollars.

Hirsch makes a persuasive case that diabetes deserves more resources throughout society than it currently receives. The widely perceived notion that insulin injections have alleviated the diabetes problem is incorrect. More people suffer from diabetes now than in the past. Furthermore, those diagnosed in a timely manner often suffer progressively worse health despite improved therapeutic tools.

That sounds counterintuitive and maybe downright nonsensical. But it is true. Poor diets and lack of exercise contribute to the problem. Minority and low-income populations suffer disproportionately. Even well-to-do, highly educated patients often fail to care for themselves in the right way, leading to episodes such as the near-fatal car flip by Hirsch.

For those inclined to see it as such, Hirsch’s book can be read as a public policy tome. It will never bore because the public policy exploration is wrapped skillfully around narratives of individual sufferers. Each chapter contains at least one unforgettable character—a diabetes sufferer or medical researcher or pharmaceutical executive.

The book is simultaneously an intensely personal saga about the daily grind of the diabetic: “Insulin and food, food and insulin. I imagine them like armies in the night, battling inside a diabetic’s body,” Hirsch says.

“Survival requires a balance of forces. If one becomes too strong (for example, if you overeat), then reinforcements are needed (you require more insulin.). And if one army has retreated entirely (you skip several shots or meals), the remaining brigade of rampaging food or unchecked insulin unleashes its destructive force on the body itself, causing ketoacidosis or hypoglycemic coma. The battles never produce a winner. The armies simply live to fight another day.”

Non-diabetics have written technical and popular books about the disease. But only a diabetic could have written Cheating Destiny. Granted, the book is mostly written in the third-person omniscient mode, as is the case with almost all investigative reporting. I, as an investigative reporter myself, could have uncovered much of the same research Hirsch did. But I never could have understood the material I gathered in the same way Hirsch does—in his bones, his gut, his heart and his brain. v

Steve Weinberg, an investigative reporter, teaches journalism at the University of Missouri-Columbia.