When I was first diagnosed with type 1 diabetes in 1966, there was considerable persistence of outmoded ideas more appropriate to the pre-insulin era, even though it had been over even then for more than 40 years. For example, I was put on a starvation diet more appropriate for treating patients before insulin became available, when the goal was just to strike a balance between death from ketoacidosis and death from starvation. As a result, I was skeletally thin with a body mass index of only 18 by the time I was 18, and photos taken of me look positively frightening. I was required to weigh all my food and to observe the prescribed balance of carbohydrates, proteins, and fats, so I could not eat any more than that unless I wanted to ‘cheat’ on my diet, which was unthinkable. I used to plead with my endocrinologist that I was not being allowed enough food, but he would just toss his pen down in disgust and say, “But then I would just be artificially increasing your insulin dose,” as though this was something poisonous.
During the whole period of living under that regimen, before I went off to university and found I simply could no longer live with that diet, I never dreamed about anything other than food, which was also a constant, nagging desire, all day every day. The degree of starvation I was required to observe was so obviously ridiculous to everyone who saw me that I suspect my endocrinologist may have been trying to do me a favor, since experiments in the 1950s had shown that if mice early in life were maintained on a starvation diet, they lived 20% longer than normal, so perhaps he was trying to counter the life-shortening effects of diabetes without telling me.