History of Diabetes and Where to go Next

Kyle Javenes

BIOL-4500

History of Diabetes and Where to go Next

The history of disease is often overlooked by many individuals. Looking at where we have built off of can be quite inspirational, especially when looking at more recent history. It can tell us how diseases can evolve biologically, but also how they change our culture. For example, we used to refer to sailors as “limeys”. This cultural norm was caused by the finding of scurvy being prevented by citrus fruits and sailors were the population most at risk. When they started consuming more of these fruits the name came with it.  More relevant though would be the change in naming for diabetes. We used to say type 2 diabetes was adult onset diabetes, but now we see children with the same etiology. This dismisses the prior naming and we settle on calling it type 2. Disease can leave a huge impact on the world we live, whether historically, presently, and or in our futures.

The first recorded mention of what we know to be diabetes is over 3500 years ago in Egypt by Hesy-ra (McCoy, 2009). He described the urine as sweet, but aside from that nothing about treatment was mentioned. This isn’t meant to say no one was trying to understand the disease, but the options weren’t great. In 150 AD a Greek physician by the name of Arateus said that diabetes is “the melting down of flesh and limbs into urine” (McCoy, 2009). This was a fairly accurate description of what happened to people until 1921 when the first insulin treatment was done by Banting and colleagues (ADA, 2014). There is still a lot that happened though prior to this huge success, but in comparison they are small changes. In 1675 it was no longer referred to as diabetes, but diabetes mellitus (which translates to “siphon honey”) ( (McCoy, 2009). What would have driven this change? Likely “water tasters” had something to do with this because they were often sampling the urine for their work. In 1776 Matthew Dobson measured for glucose contents in the urine and found higher levels in diabetics (Polonsky, 2012). This identified what created that sweet taste in the urine. Knowing what was in the urine set up for some chemical testing and in the early 1800s just this happened putting water tasters out of business to some extent.

By 1812 the New England Journal of Medicine and Surgery established diabetes as a disease (Polonsky, 2012). The world doesn’t quite revolve around this journal though as treatments were already being given out prior to that by clinicians who recognized it as a disease. In the 1700s diabetes patients started to receive recommendations on changing diet and exercise (McCoy, 2009). This has had some lasting impacts in how we treat diabetics today even. The primary recommendation was to not consume sugary foods and shift the diet over to largely fats and proteins. There was another recommendation though which was to overload on carbs.  Treatments were starting to be developed more and more at this point. In 1889 someone thought to remove a dog’s pancreas and see how they died (McCoy, 2009). This is eerily similar to the concept of gene knockouts, but a bit bigger. Well they found out that it was by diabetes. We would not be able to have done this in today’s time. Just like how our understanding of diseases has grown so has our understanding of ethics and this hinders many developments in science to a more morally correct model.

Some situations arise for researchers to make great use out of. Around the time of WW1 Apollinaire found that his diabetic patients’ symptoms were alleviating when they were starving (McCoy, 2009). The cause of this alleviation seems a bit counter intuitive, but nonetheless low calorie diets appeared to be an effective treatment for the patients and it is still recommended to lower calories and spread out eating times throughout the day. Sadly, many people developed some pretty bad misconceptions on starving. This continued into today where a lot of diets are starvation diets, which are definitely not recommended by good clinicians. This seems to be a very common occurrence in transferring/translating information though. More recently was gluten being bad for you, but in reality it only hurts those with celiac disease. The first publication about low rations and exercise was made by Elliot Joslin in 1916 validating Apollinaire’s observations (McCoy, 2009).

Things drastically changed though for diabetics in 1921 as mentioned earlier with Banting and colleagues’ discovery of insulin as a form of a treatment (ADA, 2014). In 1936 was the first alternative insulin which functions at a different speed (ADA, 2014). By 1966 the first cure of sorts came about which was a pancreatic transplant (ADA, 2014). 1970 though was one of the first steps towards diabetics getting some direct control over their condition. This was the invention of a glucose meter (ADA, 2014). Insulin pumps were invented in 1976 further developing patient control over their disease (ADA, 2014). What these do is maintain a constant blood glucose for the patient which is in a healthy range limiting hazardous conditions for them. Insulin wasn’t high in supply though making treatment hard to receive until 1982. At this point the FDA approved human insulin production by bacteria for us to use on people (ADA, 2014). Treatments and access to them changed the most in the 1900s comparatively to the previous 3000+ years

            The names associated with diabetes also changed quite a bit along with the treatments that came about. In 1979 the different types were as follows: 1) insulin-dependent 2) noninsulin-dependent 3) Gestational Diabetes and 4) serving as an “other” category (ADA, 2014). This naming didn’t stick though. Instead the names again changed in 1997 to type 1 and type 2 diabetes (ADA, 2014). This was essentially after their different types of treatment instead of the etiology of the disease like previously. With all this though where do we go from here and where is here?

            Well as of 2012 10% of diabetic patients are treatable with insulin (Polonsky, 2012). That means 90% of diabetics largely have a health problem as a result of life style choices such as diet and exercise. What is happening to make this such a large trend? Well, this is a multilayered issue, but many schools are starting to eliminate their physical education programs and recess to increase standardized test scores (Reed, 2013). This is counter to what a lot of research says though about exercise providing large cognitive benefits (Liu-Ambrose & Donaldson, 2012). So not only schools reducing the physical health of their children, but they are also diminishing their mental health. There are also many food deserts in the nation which don’t allow access to healthy varieties of food. There are, of course, ways to remedy these issues and some will likely work better than others. Then there are life style choices; all of these play a factor in diabetes.

            Nutrition is a very large concern to many populations. One thing which can jeopardize nutrition is a food desert. Food deserts are a very large challenge and Ron Finley tackles these head on in his community outreach. What’s being done by him and his volunteers is working in a food desert in LA (TED, 2013). What they are doing in their work is providing fruits and vegetables in public areas where grass had been. The city allows for it as long as maintenance is up kept and many of the community members go out and do this themselves. This has a huge impact on the communities’ nutrition in a very positive way. What else can be done nutritionally? Well, Japan is taking another approach which is education in public school systems (Nerman, 2014). There is a ton of misinformation out there as I stated with things like starvation diets. This would be an amazing way to combat such things and provide children as well as adults with critical thinking skills in regards to what they eat. There are some other policies being proposed as well such as: tax sweetened beverages more, encourage lower calorie diets, and develop stem cell treatment for type 1 diabetics (Polonsky, 2012). The last one can act as a cure without the need for a transplant of an entire pancreas which would be great! We already encourage a low calorie diet a lot of the time, but this doesn’t really deter us from getting an extra-large pizza instead of a medium. Scaring people about potential diseases from making such choices and then informing though is very effective with behavioral change (Aronson, Wilson, & Akert, 2013). So our society could do a better job at encouraging us to stop ruining our pancreas like they do with our lungs via cigarettes. The last one which is increasing taxes on sweetened beverages wouldn’t be very effective. Many people don’t account for tax on an item, but rather their whole bill when grocery shopping. What would make this more effective is if taxes were included in store prices like they are in New Zealand. Things aren’t doom and gloom though and there is still hope for a positive change for the future. As Polonsky puts it “the challenges are still substantial, if we build on past accomplishments, there is every reason for optimism that another breakthrough as dramatic as the discovery of insulin will occur in the foreseeable future, with a similarly dramatic impact” (2012).

Works Cited

Aronson, E., Wilson, T. D., & Akert, R. M. (2013). Social Psychology. London: Pearson.

Association, A. D. (2014, May 9). History of Diabetes. Retrieved from www.diabetes.org: http://www.diabetes.org/research-and-practice/student-resources/history-of-diabetes.html?referrer=https://www.bing.com/

Liu-Ambrose, T., & Donaldson, M. G. (2012). Exercise and cognition in older adults: is there a role for resistance training programmes? Br J Sports Med, 25-27.

McCoy, K. (2009, 11 3). The History of Diabetes. Retrieved from www.everydayhealth.com: http://www.everydayhealth.com/diabetes/understanding/diabetes-mellitus-through-time.aspx

Nerman, D. (2014). Food education the law in Japan. CBC News Health.

Polonsky, K. S. (2012). The Past 200 Years in Diabetes. The New England Journal of Medicine, 1332-1340.

Reed, K. (2013). Physical Education Trend Must Be Reversed. The Huffington Post.

TED (Director). (2013). Ron Finley: A guerilla gardener in South Central LA [Motion Picture].