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BOOK REVIEW

Diabetes examination is political, personal

James S. Hirsch is an investigative reporter. (BOBBIE BUSH)

Cheating Destiny: Living With Diabetes, America’s Biggest Epidemic, By James S. Hirsch, Houghton Mifflin, 307 pp., $25

As a teenager in St. Louis, James S. Hirsch learned that he was diabetic. After working as a reporter for The New York Times and The Wall Street Journal, Hirsch settled in Boston with his wife. They started a family. Hirsch wrote books about the wrongful conviction of Rubin "Hurricane" Carter and about a 1921 race riot in Tulsa, Okla. He had learned to manage his diabetes well. Furthermore, he felt informed about medical advances, because his older brother, Irl , also a diabetic, specialized in treating the disease at his Seattle 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 Garrett, Hirsch flipped his car while in 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 determine what resources can be allocated to each disease, from breast cancer to multiple sclerosis to Parkinson's to, yes, diabetes. Given limited resources, which becomes a priority? Who decides?

In "Cheating Destiny," Hirsch makes a persuasive case that diabetes deserves more resources 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, maybe downright nonsensical. But poor diets and lack of exercise contribute to the problem. Minority and low-income populations suffer disproportionately. Even well-to-do patients, highly educated, fail to care for themselves properly, leading to episodes such as the near-fatal car flip by Hirsch.

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 diabetes sufferer or medical researcher or pharmaceutical executive.

The book is also 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."

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

Steve Weinberg is a director of the National Book Critics Circle.

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