A Short History of Diabetes and Insulin.
A diagnosis of diabetes was a death sentence for thousands of years until scientists developed insulin injections in the 1920’s.
WHAT IS DIABETES?
Before we discuss the history of this disease let’s remind ourselves what diabetes is. (If you already know this then to feel free to skip this bit.)
Type One
Type One Diabetes, previously known as Insulin Dependent Diabetes Mellitus (IDDM) or Juvenile Onset Diabetes affects approximately 0.1% of the world’s population (1). In these individuals the pancreas stops producing the hormone insulin and the metabolism of glucose in the body is severely affected. The glucose is unable to enter the cells where it is needed, and the levels in the bloodstream rise to dangerous levels. Glucose “spills over” into the urine, giving the urine a distinctive sweet smell.
Classic symptoms are excessive thirst, polyuria (excessive urination), fatigue and weight loss. If left untreated, an individual will become seriously ill, develop severe organ damage and die. Until very recently there has been no treatment for Type 1 Diabetes other than the administration of insulin.
This type of diabetes usually occurs in childhood, adolescence or young adulthood. The exact cause remains unknown but experts agree that it is almost certainly an autoimmune disorder.
Type Two
Type 2 Diabetes refers to a condition where the pancreas secretes insufficient insulin, or where the body cannot use the insulin effectively. It was previously known as Adult Onset Diabetes or Non-Insulin Dependant Diabetes Mellitus (NIDDM) as individuals with Type 2 do not usually require injections of insulin. Rather, oral medications, lifestyle changes and regular monitoring are recommended. The incidence of this condition has risen dramatically over the last few decades, and is increasingly being diagnosed in young people and even children.
Gestational
Gestational Diabetes only occurs during pregnancy. Once the baby is born, the mother’s glucose and insulin levels return to normal.
Pre-Diabetes
This refers to individuals whose blood sugar is higher than recommended and who will likely develop Type 2 Diabetes if lifestyle changes are not implemented.
(There is another type of Diabetes called Diabetes Insipidus. Although it also causes excessive urination, it is completely unrelated to glucose or insulin.)
HISTORY
Early History
Symptoms of Diabetes Mellitus were first documented by an Egyptian physician in 1552 B.C. He described a disease that caused excessive urination, excessive thirst and emaciation.
Other later historical references to the disease describe additional symptoms such as excessive hunger, blindness and gangrene. In 150 A.D. a Greek physician referred to it as “the melting down of flesh and limbs into urine"(2). It was also noted that ants were strongly attracted to the urine of these patients.
Most children and adults who developed the condition became seriously ill and died within a few weeks or months. Physicians found that severely restricting their patients’ diets could lessen the severity of their symptoms; however malnutrition and starvation often killed them instead.
The term “Diabetes" was first coined in 250 B.C. The word “Mellitus” was added later; the word comes from the Latin for “honey”, meaning “sweet".
Testing and Treatment
It was not until 1776 that Dr Matthew Dobson from Liverpool confirmed that the sweetness of urine was due to the presence of sugar.
Up until the 1800’s, the method of detecting sugar in urine was to taste it. The people who were allocated this task were known as “water tasters". In the 19th century a chemical test became available that could detect sugar in urine, thus relieving the tasters from this unpleasant task.
By this time it had been established that a low carbohydrate diet could help lower blood glucose levels in some diabetic individuals. However not all diabetics benefited from the diet, with many of the patients going on to suffer from severe complications including nerve damage and blindness, and often death.
It is safe to assume that the patients whose blood glucose levels were succesfully lowered were those with the yet undiscovered Type Two diabetes rather than Type One. Type 2 was not identified until 1936.
Experiments
For years it was incorrectly assumed, quite understandably, that the disease originated in the kidneys. In 1673, Swiss physician Johann Brunner documented that a dog who had undergone surgery to remove its spleen and pancreas developed polyuria. He was unable to confirm which organ removal was responsible for this symptom.
In 1889, scientists von Merring and Minkowski decided to repeat this experiment. They took the pancreas out of several different dogs to see what would happen to their blood glucose levels. The dogs all developed diabetes. The role of the pancreas in diabetes was confirmed.
A few years later, in 1893, specific cells in the pancreas named the Islets of Langerhans were found to be responsible for secreting a chemical that regulated glucose levels within the blood. Eight years later the specific hormone was identified. Canadians Frederick Banting and Charles Best administered it to rabbits and dogs, and all their blood glucose levels dropped. This hormone was purified by James Collip, and the name given to it was insulin.
The first patient
In January 1922 in Toronto General Hospital, a critically ill fourteen-year old diabetic boy called Leonard Thompson was the first human to receive an insulin injection by Banting and his team. Although the treatment required some refinement, it was considered successful and Thompson, after receiving regular insulin injections, went on to live for another thirteen years; a long time in those days for someone with diabetes.
TODAY
Medical and technological advancements over the last 100 years have dramatically improved the quality of life for people with Type One diabetes. Scientists, pharmacologists and endocrinologists are amongst the professionals who have been striving to find a cure. Within the last few months a new drug Teplizumab that aims to treat the actual cause of the disease has been approved in the U.S. (3). Only time will tell how successful this new drug will be.
References
Other Sources
- Parker, S. (2016) Medicine: The Definitive Illustrated History. DK books. Penguin Random House. London. ISBN: 978–0–2412–2596–7.
