Rethinking Diabetes

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Mendenhall argues that the link between sugar and diabetes overshadows the ways in which underlying biological processes linking hunger, oppression, trauma, unbridled stress, and chronic mental distress produce diabetes.

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The life history narratives in the book show how deeply embedded these factors are in the ways diabetes is experienced and re produced among poor communities around the world. Rethinking Diabetes focuses on the stories of women living with diabetes near or below the poverty line in urban settings in the United States, India, South Africa, and Kenya.

Mendenhall shows how women's experiences of living with diabetes cannot be dissociated from their social responsibilities of caregiving, demanding family roles, expectations, and gendered experiences of violence that often displace their ability to care for themselves first. These case studies reveal the ways in which a global story of diabetes overlooks the unique social, political, and cultural factors that produce syndemic diabetes differently across contexts.

From the case studies, Rethinking Diabetes clearly provides some important parallels for scholars to consider: At the same time, Mendenhall asks us to unpack how social, cultural, and epidemiological factors shape people's experiences and why we need to take these differences seriously when we think about what drives diabetes and how it affects the lives of the poor. Foreword by Mark Nichter.


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Her approach transcends epidemiological associations and paves the way for consideration of similar entanglements of disease, poverty, and local experience. Each node, by virtue of being connected to other nodes, caused various changes in the state of other nodes.

When such perturbations continued for a longer duration, the system was seen to eventually settle into one out of the only two possible stable states. Their aim was simple: The most surprising implication of their research was the fact that it might be impossible to prevent diabetic complications by a sole focus on regulating glucose levels in the body.

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The model also goes on to propose different neuro-endocrine and behavioural interventions that could be promising targets for combating diabetes. Examples of such interventions include metabolites as diverse as sex hormones like testosterone and oestrogen, neurotransmitters like dopamine and serotonin, hormones like melatonin, ghrelin and growth hormone, and even behaviours like aggression! Both the states are reinforced and stabilized by several mechanisms.

The emergence of bistability in such a system has far-reaching consequences to our understanding of diabetes. What this means is that an insulin-resistance state of the body — long thought to be the underlying cause of diabetes — is actually not a disease state, but instead an evolutionary adaptation acquired under some environmental circumstances, which have now become obsolete or detrimental.

Rethinking Diabetes

The very fact that diabetes at its core could be an evolutionary adaptation can fundamentally change our outlook towards its treatment and even its prevention. On the other hand, the transition could be achieved easily by targeting the desired levels of dopamine, testosterone, aggressive behaviour and the likes in isolation, or even more effectively, when used in combinations.

When enquired about the possibility that rigorous control of blood glucose levels in diabetics was not significantly improving the lives of these patients, Dr. If the findings of Prof. The focus could then soon shift from just regulating insulin and glucose levels, towards a more holistic approach of nudging the body from an insulin resistant state to an insulin sensitive state.

Rethinking diabetes care in Canada

Not only would this open up more unconventional and better ways to combat diabetes, but also help remove the unnecessary stigma attached with the dietary and lifestyle restrictions that most diabetics face. When asked about how the medical community is going to react to these findings, Prof. Sharada on the other hand felt that it would take a very long time to change our views in India.