Most Agreeable – by Olly Double

I recently got hold of a 1944 edition of RD Lawrence’s The Diabetic Life. As you may know, Lawrence was a remarkable man – one of the first people to be treated with insulin, and the co-founder of the organisation which became Diabetes UK. The Diabetic Life was first published in 1925 and became the key text on the treatment of the condition in the UK for decades, running to 17 editions, the last of which was published in 1965.

The 1944 one is a goody, because it contains a special wartime supplement, with advice on how to cope with diabetes under rationing. In fact, the wartime recipes he suggests in the supplement sound slightly nicer than some of the ones in the main text. Curried mince with egg, anyone? Prune jelly? Or how about vermicelli pudding? Just mix vermicelli pasta with milk, water and a saccharin tablet. Yum!

As this might suggest, although Lawrence was a pioneer, some of the attitudes in a book he wrote nearly 70 years ago are a bit quaint. On the very first page, he tells us ‘if one had to choose a severe disease’ diabetes ‘is probably the most agreeable.’ Agreeable? Really? Choose a severe disease? That’s a really weird idea for a game show.

Nowadays, some of us are very sensitive to the language around diabetes. A lot of people believe you should refer to someone as a ‘person with diabetes’ rather than a ‘diabetic’. There’s none of that in the way old RD talks about it. To him, you’re either ‘a diabetic’ or a – wait for it – ‘a normal’. Nice! He’s also less than kind about those who were struggling to control their condition, telling us that they’re ‘stupid, careless or ill-directed’ and thus ‘cast a slur’ on other diabetic people.

Of course, it’s easy to look back at books like this and think how silly or snobby or old fashioned it all is, and feel rather smug about how far we’ve come since then. What really shocks me, though, is how many of the ideas Lawrence expresses are actually still around today. For example, back then they didn’t understand that Type 1 and Type 2 diabetes were different conditions.

Ever seen a news report where they mention diabetes without distinguishing between Type 1 or Type 2, as if they’re both the same thing? Me too. In Lawrence’s time, they used to talk about ‘mild’ or ‘severe’ diabetes. I’ve often been asked if my sons Joe and Tom have ‘bad diabetes’, which is pretty much the same as saying ‘severe diabetes’.

Lawrence’s standard treatment at this time was to prescribe one injection per day of mixed insulin – or two at a push. This would have been a mixture of short-acting soluble insulin, and long-acting protamine zinc insulin, which had only been developed in 1936. He knew that this wouldn’t give as good blood sugar control as four to six injections a day, but argued that ‘insistence on such perfection would produce a distorted existence and mental invalidism’.

The more I read about his methods, the more it reminded me of the clinic Joe and Tom used to go to. Tom was diagnosed much more recently than 1944 – after all he’s only 13 now – but back in December 2000, one of the first things his consultant told us was that of all the chronic conditions he could have, diabetes is the best one. Or ‘most agreeable’, you might say?

Initially, Tom was put onto two injections of mixed insulin per day. Sounds familiar? We found it almost impossible to get any kind of feeling of control over his blood sugar levels. He’d be raging high, and then an hour or two later he’d be severely hypo.

As we became more aware of diabetes, we started to question his treatment. Wouldn’t it be easier to control his blood sugar if he went onto multiple daily injections (MDI), with a daily dose of basal insulin and short-acting insulin before every meal? Yes, it might improve his control, we were told – but it’d be very inconvenient and too much for a little kid like him to cope with. Doesn’t that sound a bit like RD Lawrence’s warning about ‘a distorted existence’? We didn’t manage to get them to prescribe MDI for years, by which time our older son Joe had also been diagnosed. Joe and Tom were the first children they’d ever put onto this treatment.

One of the things we were told very soon after Tom’s diagnosis was that his sugars would soon settle down, and he’d probably get to the stage where he’d only need to test his blood once or twice a week. It didn’t strike me as odd at the time, because everything was so new and confusing. We quickly realised what utter bunkum that was. In order to get any kind of control, you need to test several times a day, and statistics have shown that the simple act of regular testing should lower your HbA1C.

I can’t see what you would learn from two tests per week, and I’ve often wondered where the idea came from. Then I came across a bit in The Diabetic Life where Lawrence recommends two tests per week, although in his time this would have involved boiling urine rather than a simple finger prick test. Maybe the person who told us we’d end up only testing twice a week had tapped into some kind of folk memory from Lawrence’s time?

The methods described in the book are outdated now, but at the time it was written they were cutting edge. Lawrence was clearly excited by the new techniques and technologies that were being developed to improve the lives of people who – like him – were living with diabetes. The doctors in Joe and Tom’s old clinic may have echoed his ideas in the treatment they prescribed, but they were actually nothing like him. Far from embracing new treatments, they seemed to positively discourage them. When we first asked about insulin pumps they talked about them as if they were new, untested and unreliable. In fact, they’d already been in use for decades.

We ended up moving to a different clinic, and within a few weeks of doing so Joe and Tom were on insulin pumps. We’ve never looked back. Must finish there – I’m off to make myself a delicious bowlful of prune jelly.

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Hi! This is my 1st comment here so I just wanted to give
a quick shout out and tell you I genuinely enjoy reading
through your articles. Can you recommend any other
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Thank you so much!

I think as our understanding of the disease has increased with history, the treatments used and holistic care of individuals with diabetes has also increased. Read up on John Rollo, a really unsuing hero in the history of diabetes treatment.

I was diagnosed with ‘juvenile onset’ diabetes at the age of 12 in1966. I’m very grateful to R D Lawrence as I would probably be dead by now if not for him! I have seen so many changes in the treatment of diabetes over the years and really appreciate the care I receive now (and in the past) from my NHS Trust. I’m fortunate in that I have no complications and live a healthy and happy life. Enjoy life to the full and don’t let diabetes rule your life!

I found this article very interesting.I was diagnosed with diabetes in 1976 at the age of 35.At that time diabetes was either “juvenile onset” or “maturity onset”.Since I did not fall into either category in 1976 my GP would not believe that I had diabetes.I was suffering from diabetic keto-acidosis.For years I was treated with twice daily injections of mixed insulins and around 2003 was having severe hypos.Since then I have been on MDI and have been much better.My control has been tight as I have been determined to avoid eye damage.

Not everyone with type 2 is overweight. Many people with type 2, including myself, take multiple daily doses of insulin and need to live with a similar regime to people with type 1 and potentially suffer from the same problems. Please do not blame everyone with type 2 for the failings of the media.

First diagnosed 1970 at Kings (R D Lawrence ward!) v. good start. Things better all the time now. Regular testing essential. Now on pump even better, and less difficulty with hypo’s-that were becoming troublesome. Local service, Scarborough Hosp., and GP diabetic nurse faultless. I used to have to buy meter and strips initially. If it were not for ‘RD’, HG Wells +others in founding the original assoc. I doubt we would have the great service the NHS now provides for type I’s.

Yes he was a pioneer in the treatment and things have changed even in the 54 years of me being a type 1 Diabetic;from the way you tested for glucose levels using urine and a flame with chemicals,great in my case as I like chemistry. Then the different types of syringes and needle size then and now

‘Ever seen a news report where they mention diabetes without distinguishing between Type 1 or Type 2, as if they’re both the same thing?’

Yes, and read many academic papers on health funding which give ‘diabetes’ as an example of a lifestyle illness.

I honestly think the names of type 1 and type 2 diabetes should be changed. Parents watching/reading news reports about all these so-called fat and unhealthy middle-aged people with diabetes are not going to look at their tired and thin looking 4 year old and think ‘ has s/he got diabetes?’