Diabetes mellitus has been observed and reported throughout written history since at least 1500 BC.
It is only relatively recently that the perception of this disease has changed. Type 1 diabetes no longer carries the stigma of an a inevitably fast progressing and deadly disease.
Intensive scientific research worldwide has brought new insight into this disease with modern management methods.
Yet, much remains to be done and the cure has remained elusive.
This disease has apparently plagued man for a very long time.
The writings from the earliest civilisations (Asia Minor, China, Egypt, and India) refer to boils and infections, excessive thirst, loss of weight, and the passing of large quantities of honey-sweet urine which often drew ants and flies.
The first known clinical description of diabetes appears to have been made by Aulus Cornelius Celsus (c.30 BC – 50 AD); but it was Aretaeus of Cappadocia (2nd century AD) who provided a detailed and accurate account and introduced the name “diabetes” from the Greek word for “siphon”.
Areteaus described diabetes with the following words: “Diabetes is a dreadful affliction, not very frequent among men, being a melting down of the flesh and limbs into urine. The patients never stop making water and the flow is incessant, like the opening of aqueducts. Life is short, unpleasant and painful, thirst unquenchable, drinking excessive, and disproportionate to the large quantity of urine, for yet more urine is passed…… ……the patients are affected by nausea, restlessness and burning thirst, and within a short time they expire.”
The origin of current understanding of some aspects of diabetes can be traced to discoveries made in Europe between sixteenth and eighteenth centuries.
Aureolus Theophrastus Bombastus von Hohenheim, a Swiss physician better known as Paracelsus (1494–1541), allowed the urine of patients with diabetes to evaporate and observed a white residue. He incorrectly thought that this residue consisted of salt and proceeded to attribute excessive thirst and urination in these patients to salt deposition in the kidneys.
In 1670, Thomas Willis in Oxford noticed the sweet taste of urine of patients with diabetes.
Thomas Cawley, in 1788, was the first to suggest the link between the pancreas and diabetes after he observed that people with pancreatic injury developed diabetes.
In 1776, British physiologist Matthew Dobson (1713–1784) in his Experiments and Observations on the Urine in Diabetics was the first to show that the sweet-tasting substance in the urine of patients with diabetes was sugar.
He also noted the sweet taste of serum in these individuals and thus discovered hyperglycemia.
Dobson put forward the theory that the diabetes was a systemic disease, rather than one of the kidneys.
The term mellitus (Latin, ‘sweet like honey’) was coined by the British Surgeon-General, John Rollo in 1798, to distinguish this diabetes from the other diabetes (insipidus) in which the urine was tasteless.
The Nineteenth and the Early Twentieth Century: Discovery of Insulin
The important elements of current understanding of diabetes mellitus can be traced to nineteenth century when modern scientific disciplines, including biochemistry and experimental physiology, acquired prominence in biological studies.
In 1815, Eugene Chevreul in Paris proved that the sugar in urine of individuals with diabetes was glucose.
Von Fehling developed quantitative test for glucose in urine in 1848.
Thus, in the nineteenth century, glucosuria became an accepted diagnostic criterion for diabetes.
Claude Bernard (1813–1878), professor of physiology at Sorbonne University, was one of the most prominent and prolific experimental physiologists in nineteenth-century Europe.
In the course of his work on the physiology of gastrointestinal tract, Bernard developed an experimental operation during which the pancreatic ducts were ligated. Degeneration of the pancreas followed.
This technique proved invaluable for later experiments searching for pancreatic substance which controlled glucose level.
In addition to developing the technique for pancreatic duct ligation, Bernard also discovered that the liver stored glycogen and secreted sugary substance into the blood.
He assumed that it was an excess of this secretion that caused diabetes.
Bernard’s theory of sugar over-secretion leading to diabetes received wide acceptance.
Before the discovery of insulin, diabetics were doomed. Even on a strict diet, they could last no more than three or four years.
However, despite the many types of insulin and the first oral hypoglycemic agents that came to market around 1957 in Canada, glycemia control – the control of blood glucose (sugar) levels – still remains an imprecise science.
In the 1950s, the method a person used to control his blood glucose levels was to drop a reagent tablet into a small test tube containing a few drops of urine mixed with water. The resulting colour – from dark blue to orange – indicated the amount of sugar in the urine.
Even when they monitored their patients closely, doctors realized that blood glucose levels had to be much better controlled in order to delay the major complications significantly affecting their patients’ lives: blindness, kidney disease, gangrene, heart attack and stroke.
Belgian doctor Jean Pirart, a pioneer in diabetes treatment, discovered the link between good glucose control and the prevention of complications.
Between 1947 and 1973, Dr. Pirart divided more than 4,000 patients into three groups based on their level of blood sugar control: good, fair, poor.
Using reagent tablets as the measurement method, Dr. Pirart’s findings clearly demonstrated a higher incidence and prevalence of complications in patients with poor glycemic control.
We have come a long way from certain death to the discovery of insulin, from impure to purified human insulin, from once daily long-acting insulin to continuous subcutaneous insulin infusion pumps, and from urine glucose testing to real-time continuous glucose sensors.
Different delivery systems have also been invented to enable injection profile similar to the normal insulin secretion of the human body.
Although the accomplishments look great, we still have lots to achieve.
An estimated 250,000 children in developing countries under the age of 14 years have type 1 diabetes.
In 1989 Queen Elizabeth lit the Flame of Hope in London Ontario, Canada, at the Sir Frederick Grant Banting Memorial Park, to be extinguished when the cure for Diabetes was found.
It is still burning. There is no cure for Type 1, Type 2, or other serious forms of Diabetes… only management.
All Diabetics no matter the type want a cure… but until that day they want quality of life!
The last 60 years have clearly demonstrated that people with diabetes who are well informed, properly supported and treated appropriately live longer lives in better health.
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