A Brief History of Diabetes and Diabetes Treatments

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A Brief History of Diabetes and Diabetes Treatments

Nowadays, given a robust health care infrastructure, diabetics can treat and manage their diabetes very well - allowing them to live relatively normal, long and healthy lives. But what happened to diabetics before doctors understood this chronic disease and discovered insulin? How much exactly was understood about diabetes and what did it take to get to today’s understanding and treatment of diabetes? In order to answer these questions and gain more appreciation for how far we have come, we are taking a look at the history of diabetes and diabetes treatments.

Circa 1550 BC: The first documentation of diabetes by the Egyptians

In 1862 AD, Ebers Papyrus was excavated from an ancient grave in Thebes, Egypt and subsequently published by Egyptologist Georg Ebers in 1874. The ancient Egyptian manuscript mentions “The passing of too much urine” - This is now believed to be the first reference to diabetes. The Egyptian physicians of the time recommended the consumption of fruit, wheat grains and sweet beer to treat the condition.

Circa 700 BC: Ancient Indian physicians first distinguish between two types of diabetes

Ancient Indian physicians described a condition in which urine contained sugar, which would attract ants - they gave it the name “madhumeha” (“honey urine”). The ancient Indian physicians Sushrutha and Charaka also first described two different types of diabetes - This is now believed to be the first reference to diabetes type 1 and 2.

Circa late 300 - early 100 BC: The condition is first termed “diabetes”

Some believe the term “diabetes” was first coined by Demetrius of Apamea, a Hellenistic physiologist of the Herophilean school.

Circa 200 AD: First detailed and accurate description of diabetes

Others believe Aretaeus of Cappadocia first gave the disease its name. The name originates from the Greek word “diabetes” - which means “siphon” (to pass through) when translated from Ionic dialect. The term arose from the large quantities of fluids consumed by diabetics that passed through their body as if flowing through a siphon. Aretaeus - one of the greatest physicians of the Greco-Roman antiquity - was the first to precisely describe and clinically present and interpret diabetes. His proposed course of treatment was consuming cereals, milk and wine, the topical application of cataplasms and the administration of Theriac (a medical concoction made of opium, flesh of viper and a large number of other ingredients).

1674: First differentiation of diabetes from other causes polyuria (frequent passage of large volumes of urine) and subsequent renaming of disease to include “mellitus” Thomas Willis - an Oxford University physician - rediscovered the connection between diabetes and sweetness by conducting taste tests of urine in which he discovered that the urine of diabetics was “wonderfully sweet like sugar or honey”. This led him to rename the disease “diabetes mellitus” as “mellitus” is Greek for “like honey”.

1776: Discovery of sugar in urine and blood of diabetics

Matthew Dobson - a celebrated physician of 17th century England - treated nine diabetics and described five experiments he conducted on them in a medical journal. His experiments revealed that urine was sweet to taste and left over sugar when evaporated. He also observed that the blood serum was sweet to taste - the discovery of hyperglycemia. His simple observation that diabetes is associated with a persistently raised blood sugar concentration, greatly helped diabetes research move in the right direction.

1794: First differentiation between diabetes mellitus and diabetes insipidus

Johann Peter Frank was the first to clinically describe and define diabetes insipidus - an uncommon disorder which causes the passing of large quantities of insipid (tasteless) urine.

1869: The islets of Langerhans are first discovered

Paul Langerhans, made the first detailed description of the pancreas. Specifically, he described a group of nine different types of cells for which he however did not find a name or function. They only later became known as the islets de Langerhans.

1889: Discovery of the role of pancreas in diabetes

Josef von Mering and Oskar Minkowski worked on the study of diabetes at the University of Strasbourg when they removed the pancreas from a dog and noticed its frequent urination along with all the other diabetes symptoms that also arise in humans. This led them to conclude that the pancreas also secretes a substance into the bloodstream, which is crucial for the sugar metabolism.

1893: Discovery of the Islets of Langerhans and their endocrine role

Edouard Laguesse, a French histophysiologist, decided to name the peculiar tiny heaps of cells of pancreas after Langerhans who had discovered them in 1869 - coining the term islets of Langerhans. He was also the first to deduce the concept of the endocrine role of the islands of Langerhans, hypothesizing that the “islands” of cells produced secretions that played a regulatory role in digestion.

1901: Discovery of link between Diabetes and damage to the Islets of Langerhans

Eugene L. Opie, member of the first graduating class of the Johns Hopkins Medical School, was trained in experimental pathology and pioneered research on diseases of the pancreas. He investigated organs removed at autopsy from people who had suffered from diabetes and who had pancreatic disease. He found lesions in the islets of Langerhans, providing him with convincing evidence that the islets of Langerhans were the source of a so-called internal secretion—a hormone—that was the link between diabetes and carbohydrate metabolism.

1910: The term “insulin” is coined and “insulin”

Sir Edward Albert Sharpey-Schafer suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas. He proposed calling this substance insulin (derived from the Latin word for island - insula) in reference to the insulin-producing islets of Langerhans in the pancreas. However, he did not discover insulin as insulin was still a hypothetical substance.

Until 1921: Until the introduction of insulin, the only treatment for diabetes were diets. However, despite doctors’ best efforts, prior to insulin’s discovery, children and adults who developed diabetes most often died within days to months, a few years at the most.

Note:

1915-1922: Starvation Diets

Frederick M. Allen and Elliott P. Joslin were among the most prominent diabetes specialists in America who believed that severely calorie-restricted diets were the best therapy for diabetes. They promoted so-called "starvation diets" - diets based on repeated fasting and prolonged undernourishment -- as the most advanced treatment for diabetes mellitus, not as a cure, but for relief of symptoms and maximum extension of life. Although it was possible to extend diabetics’ lives with these diets, oftentimes the patients would - as the name already indicates - eventually die of starvation.

1921: Discovery of Insulin

A young orthopedic surgeon named Frederick G. Banting was given laboratory space by J.J.R. Macleod, the head of physiology at the University of Toronto. Banting and his student assistant Charles Best’s experiments produced an extract of pancreas that reduced the hyperglycemia and glycosuria in dogs made diabetic by the removal of their pancreases. Next, they developed a procedure for extraction from the entire pancreas without the need for duct ligation. This extract, now made from whole beef pancreas, was successful for treating humans with diabetes. With the help of their colleague J.B. Collip, they were able to purify their insulin extract enough so that in 1922 they were able to start treating human diabetes.

January 1922: First diabetic successfully treated with insulin

Leonard Thompson, a 14-year-old boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin. Within 24 hours, Leonard’s dangerously high blood glucose levels dropped to near-normal levels.

As news of the University of Toronto’s group spread worldwide, demand for their extract grew. To respond to this demand and improve their product, the team reached an agreement with Eli Lilly and Company to establish a partnership. Furthermore, for $1 each, the three discoverers assigned their patent rights to the Board of Governors of the University of Toronto.

1923: Nobel Prize received for discovery of insulin

Banting and Macleod received the Nobel Prize in Medicine, which they shared with Best and Collip.

Sources:

https://pubmed.ncbi.nlm.nih.gov/26913870/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707300/

https://www.diabetes.org.uk/research/research-impact/insulin

https://www.news-medical.net/health/History-of-Diabetes.aspx

https://en.wikipedia.org/wiki/History_of_diabetes

https://www.medicalnewstoday.com/articles/317484#early-science

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/653771

https://en.wikipedia.org/wiki/Oskar_Minkowski#Discovery_of_the_role_of_pancreas_in_diabetes

https://en.wikipedia.org/wiki/Joseph_von_Mering