'Doctor's orders', type 1 diabetes and the consultative relationship, 1948-2002 [thesis]

Stuart Bradwel
Since 1922, insulin has saved the lives of countless individuals diagnosed with what we now know as Type 1 Diabetes. It is, however, not a cure. Insulin therapy is a lifelong commitment that involves regular self-medication. This treatment can be complex, as dose titration and timing must be balanced with carbohydrate intake to prevent dangerous longand short-term complications. In Britain, for much of the twentieth century, the medical profession sought to achieve this via the imposition of
more » ... efully prescribed, and usually highly restrictive, treatment regimens that precisely outlined a timetable of diet and insulin, deviation from which was strongly discouraged. By the mid-2000s, however, orthodox management tended to eschew such an approach, encouraging a more autonomous framework in which the individual was taught to determine personal therapeutic requirements according to their own diet and lifestyle, while healthcare professionals were reconceptualised as remote sources of support should advice or assistance be required. This thesis analyses the process by which this transition occurred, arguing that from the late 1970s a confluence of factors both within and without diabetology provided the practical, scientific, and political rationale for the cautious enlistment of the patient as a medical auxiliary, and that, moreover, due to the material conditions of insulin therapy, this development inadvertently rendered laypeople a distinct political and moral force in their own right, able not only to exert influence over the framework of care but also over the construction of value within it, and in doing so often directly challenged the fundamental assumptions of professional practice. Twenty-first century 'patient-led' approaches to care, it concludes, reflect an imperfect compromise that attempts, but often fails, to reconcile orthodox medical power structures to an increasingly alienated patient-body with which it often has profound ideological differences, and upon which it struggles to impose its traditional authority.
doi:10.48730/k3y9-xt77 fatcat:wjwkqh3qszcmdiihwitgmh4nte