Diabetes, Inc.

The discovery of insulin by Canadian Frederick Banting in 1921 transformed diabetes from a fatal to a chronic disease. Colleen Fuller explores how both culture and commercial interests have shaped the clinical history of the disease since that momentous discovery nearly 100 years ago. 

Her forthcoming book, Diabetes, Inc. argues that the medical practices surrounding diabetes have reflected, not the wisdom of objective clinicians, but rather, the agendas of stakeholders ranging from biased medical professionals to profit-driven drug manufacturers. The author explores, for instance, how the then-popular eugenics movement informed early clinical advice related to diabetic pregnancy; how the concept of “brittle diabetes” developed from nineteenth-century notions of female hysteria; and how the fabrication of “pre-diabetes” reflects various racial, class, and gender prejudices, while creating a market in the absence of any medical condition.  

Fuller also examines how global insulin-makers like Sanofi, Eli Lilly, and Novo Nordisk have shaped diabetes medicine and even disease experience over the course of the century since insulin was discovered. She explores how manufacturers steered physicians to adopt the standard insulin “unit” and how, with the help of PR firms, they have dismissed adverse drug reactions as symptoms of the disease or unfounded complaints of troublemakers. By insisting upon the safety and efficacy of their products and blaming users for any negative outcomes, drug makers have increased tension between patients and providers, as well as between patients and the organizations that claim to represent them. 

The controversial introduction of biosynthetic “human” insulin in the 1980s offers a case in point. Approved by regulators for commercial reasons, rather than clinical ones, genetically engineered insulin caused many individuals across the globe to experience a loss of hypoglycaemia warning signals. Many experienced fainting; muscular and/or nerve pain; loss of mobility; or even death. This led to three attempted class action lawsuits and the emergence of the term “dead in bed” to describe the spike in sudden, unexplained deaths among individuals with diabetes. The drug industry swiftly launched campaigns to dismiss individuals’ experiences, and it wasn’t long before the medical profession and industry-funded patient organizations fell in line.   

Reflecting on different moments of transition within the modern history of diabetes, Diabetes, Inc. asks readers the following: To what extent have changes in treatment or practice benefited individuals with diabetes and their families? Does “new” necessarily equal “better”? What counts as evidence when it comes to evaluating the outcomes of certain drugs or clinical practices? Who is excluded from the foundation of evidence, and how might their voices be fully integrated? 

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