I was lucky enough to find a copy of the 4th edition of Bilous' Handbook of Diabetes in a charity shop recently. In the fiction section (!) and only £1. Over £50 new. As the 5th edition came out a year or two ago, I assume someone got rid of the older 2011 edition. It's an interesting read. These comments are from my T2 perspective.
Being a medical textbook there is, as you might expect, lots about biochemistry and endocrinology. There is next to nothing - half a page or so - about diet and lifestyle. There's a lot of discussion about the late stage complications of diabetes and the usual number of photos of the dreadful things that high blood glucose can do to the human body given enough time. And there's lots about medication. Some of this is very interesting - I learnt that they don't actually know how metformin works - it works, yes, and it helps to lower blood glucose by inhibiting glucose production in the liver...but not how that inhibition happens.
Given that this handbook focuses so much on medication and appears to assume that all T2s will steadily progress towards insulin and amputations it's probably not surprising that many of us have had the experiences with blinkered clinical professionals that we've had. Medication as the first step. No advice about reducing carbs, changing lifestyle factors etc. Being told to follow the "healthy" Eatwell approach and base all meals around "starchy carbohydrates". In short, the approach becomes self-fulfilling - get T2s to keep on eating carbohydrates, and then wonder why people's conditions get worse.
Having this book has helped me understand more of what I read in published research papers. It also is a really clear statement about the medical approach to "managing" T2 diabetes, and therefore also why it fails. Maybe the 5th edition has a bit more about avoiding raised blood glucose in the first place, not basing diets around carbs (for the insulin resistant at least) and starting off with the assumption that high blood glucose can easily be reduced relatively simply without drugs. I hope so, but I don't think there's any money in it.
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