history

Would this Kill Me in the 1800s: Diabetes

Diabetes–both Type 1 & Type 2–are very common diseases in the US today. Changes in diet and lifestyle have led to an increase of Type 2 diagnoses in the past few decades.  If, for some reason you aren’t familiar with diabetes or the difference between the two forms, I’ll give you a minute to check out the Wiki for the basics.

In general with careful diet Type 2 diabetes can be managed with relative ease. Even for insulin dependent Type 1 patients, the invention of things like the insulin pump has made treatment and daily life significantly easier. Monitoring and maintaining a healthy blood glucose level as simple as pushing a button in many cases.

But it’s not a modern problem. Diabetes, in both forms, have been around much longer, right? We already know that Type 1 is passed down in our DNA, and our genetics can also make us more prone to developing Type 2 later in life.

So what about early diabetics? What about people a hundred or even a thousand years ago?

[Note: while there are many different types of diabetes and more specific diagnoses other than just Types 1 & 2 (ex. gestational diabetes), I’m going to concentrate on just those two umbrella terms for the sake of this blog post.]

The first description we have of diabetic symptoms come from an ancient Egyptian papyrus dated to around 1500 BC. Both the Egyptians and the Greeks noted a sweetness of the urine (from the excess sugar the body couldn’t process), frequent urination, and a wasting away of the patient.

None of my sources list how old these patients are. But I think it is safe to assume they were very, very young. No treatments existed at this time, and no cause could be determined so it was, to the ancients, just another mysterious “wasting disease,” much like TB would become later. In fact Galen, a Greek physician living in the Roman Empire noted that he only saw 2 cases in his entire career. Whether this was because it was simply less common at the time, or because the patients died at such a young age, or their deaths were attributed to other things is unclear. With one of the major symptoms being emaciation, and this being at a time when people regularly died of starvation, anything is possible.

Another Greek physician (Apollonius) in 250 BC was the first to give the disease a name. From Apollonius all the way up until the 1600s, very little progress was made with the disease. Dr. Thomas Willis referred to it as “pissing evil.” During the Renaissance, “water tasters” would test people’s urine if a case was suspected. And yes, that entails just what you think it does. I think I’ll keep my day job, thanks.

In the 1700s we have the first rough division between Type 1 and Type 2 diabetes, though the line was pretty blurry. It basically boiled down to Type 1 being related to youth and being much more severe, while Type 2 was associated with the obese and considered less dangerous.

Also during this time it was realized that changes in diet could improve the symptoms. Leave it to those crazy Victorians to come up with the most ridiculous “cures:”

  • Exercise, especially on horseback, was thought to cure the excessive urination.
  • Overeating (to make up for the water weight lost/the thinness of Type 1 patients)
  • Starvation or partial starvation
  • All meat diets
  • All sugar diets (obviously, this school of thought was pretty short lived. Much like their trial patients)
  • Apollinaire Bouchardat (what a name!) studied diabetic patients during the Franco-Prussian war and developed several specialized diets for them–early fad diets, including the “oat-cure,” “potato therapy,” and “The starvation diet.” Doesn’t that last one just sound like fun? These diets were used to treat all sorts of problems, from physical disabilities to chronic illness to mental illnesses.
  • Opium
  • “The milk diet”
  • “The rice cure”

It wasn’t until 1889 that real progress began to happen. Joseph von Mering and Oskar Minkowski were able to tie the pancreas to diabetic symptoms by removing it in dogs. The dogs would develop diabetic symptoms and then die soon after. Further steps were taken when Sir Edward Albert Sharpey-Schafer (The names on these guys!) was able to isolate what exactly the pancreas was producing–insulin–and it’s impact on the body in 1910.

The end of WWI through the 1920s saw the biggest leaps in treatment. A combination of starvation and exercise was used to treat patients, giving them nothing but whiskey and coffee for 5-7 days until the excess sugar was no longer present in their urine. At that point a specially regulated, protein-heavy diet and exercise regimen would be prescribed. This was helpful, but the life expectancy of a diabetic patient was still incredibly low, and the quality of life wasn’t good.

Then in 1921 Frederick Grant Banting and Charles Herbert Best of Toronto,Canada successfully removed insulin from a healthy dog and gave it to one with diabetes, effectively managing the second dog’s blood sugar. Within months they were treating their first human patient, a 65lb boy of 14 named Leonard Thompson. His health rapidly recovered and by 1923 insulin was available for patients.

In 1936 Sir Harold Percival Himsworth positively identified the difference between Type 1 and Type 2 diabetes, clearly defining both and creating the system of classification we use today.

In 1943 the first oral medication for diabetes was developed. Rather than replacing insulin, it triggers the pancreas to produce insulin itself.

Diabetes research wouldn’t have another major break through until the 1960s, however. In the first part of the 1900s, testing was done using urine in a lab. Urine strips and single use syringes made it easier to test glucose levels and paving the way for the first portable glucose meter in 1967. Those meters were only available in doctors offices. They were big, heavy pieces of equipment and incredibly expensive.

It wasn’t until 1981 that home monitors became available, and this is largely due to a single man who was not credited in most of the papers and articles I read. In poor health due to his condition, Dr. Richard Bernstein was a Type 1 patient and an engineer. His wife was a psychiatrist, and he convinced her to get a hold of one of the ARM meters typically used in medical practices. The Ames Reflectance Meter took 50 seconds to analyze a drop of blood and cost $650. Bernstein spent years researching and testing on himself, becoming an advocate for self-management for diabetes patients. Unfortunately, because he was not an MD it was incredibly difficult for him to get anyone to listen to him. So, at the age of 43 he went back to school to become an endocrinologist.

Kadish artificial pancreas from 1960s
Yes, that giant thing is an insulin pump.

Another breakthrough of the 1960s was the prototype of the insulin pump. Today they are about the size of a deck of playing cards, but the first insulin pumps were backpack-like monstrosities. Needless to say, they were not particularly common.

Today there are a variety of medications and treatments for both Type 1 and Type 2 diabetes ranging from specialized diets to hormone therapy or replacement, and the outlook is much improved even in just the past 50 years.

 

Further reading:

Diabetes Mellitus Though Time 
History of Type 1 Diabetes
Trivia Facts About Diabetes
History of Diabetes
Medical News Today: Diabetes
Diabetes.org: History of Diabetes


Like what you see? Check out Would this Kill Me in the 1800s: Thyroid edition.