History of diabetes: Past treatments and new discoveries

Diabetes is a condition characterized by high blood sugar levels. It affects millions of people around the world. Research into diabetes is ongoing but diabetes is simple to manage for most people.

Since diabetes was first discovered, there have been huge improvements in the way it is treated. This article looks at the history of diabetes and how these treatments developed.

Diabetes affects blood sugar levels
a diagram of the pancreas
The pancreas produces insulin that helps to regulate blood sugar levels.

The body gets energy from sugar (glucose), which is broken down from the food people eat. Diabetes affects insulin. Insulin is a hormone produced in the pancreas that helps in the process of using this sugar efficiently.

People with type 1 diabetes do not produce insulin. People who have type 2 diabetes do produce insulin, but their body is unable to use it efficiently.

When a person has diabetes, the lack of insulin or the body's inability to use it properly, causes sugar to stay in the blood rather than entering the cells to be used for energy. This excess sugar in the blood results in higher than normal blood sugar levels.

Having high blood sugar levels for an extended period can cause serious and even life-threatening problems. However, there are many ways the condition can be managed so that these problems are avoided.
Early science around diabetes

Understanding the history of diabetes and how it was first treated can help us to appreciate how well it is understood and managed today.
Discovery of diabetes

The full name for diabetes is diabetes mellitus. This term comes from the Greek word "diabetes" (to siphon or pass through) and the Latin word "mellitus" (honey or sweet).

The first use of the term "diabetes" can be traced back to Apollonius of Memphis around 250 BC. The first English record of diabetes in a medical text occurred around 1425. In 1675, Thomas Willis added the word "mellitus" because people with diabetes had sweet-tasting urine.

In 1776, Matthew Dobson was able to confirm that the urine of people with diabetes had a sweet taste because it contained excess sugar. He deduced this when he noticed a brown sugar-like substance in the urine.

Dobson also noticed that diabetes proved fatal in some people, while in others it was a chronic condition. This is the first time that a clear difference between type 1 and type 2 diabetes was identified.

Early diabetes treatments:
The early Greek physicians recommended exercise, if possible, on horseback. They believed this would reduce the need for excess urination.

Other treatment options included overfeeding with wine, which was thought to help compensate for the loss of fluid.

Unfortunately, these ways of managing diabetes were not particularly effective. Because of the lack of proper treatment, people with diabetes experienced severe health problems.

Discovery of the pancreas:
In 1889, Joseph von Mering and Oskar Minkowski discovered the role of the pancreas in diabetes. After removing the pancreas from dogs, they found that the animals developed all the signs and symptoms of diabetes. However, they also died shortly afterward.

This discovery helped scientists to understand the role that the pancreas plays in the regulating blood sugar levels.

In 1910, Sir Edward Albert Sharpey-Schafer made another breakthrough. He found that diabetes was caused by a lack of a certain chemical that was produced by the pancreas.

Sharpey-Schafer called this chemical insulin, which is derived from the Latin word "insula." This means island and refers to the insulin-producing cells in the pancreas, known as the islets of Langerhans.
Treatments in the 1900s

Between 1900-1915, a variety of different diabetes treatments were proposed. Early treatments included:

    the oat-cure, which involved eating 8 ounces of oatmeal mixed with 8 ounces of butter every 2 hours
    the milk diet
    the rice cure
    potato therapy
    opium
    overfeeding to replenish lost fluids and increase weight, symptoms that many people with diabetes experienced

It wasn't until 1921 that diabetes management moved beyond these very basic, and largely ineffectual, treatments. In this year, Sir Frederick Grant Banting and Charles Herbert Best demonstrated how to treat diabetes with insulin.

Banting and Best were able to reverse diabetes in dogs. They did this by injecting them with an extract from the pancreatic islets of healthy dogs.

Later, along with James Collip and John Macleod, they extracted and purified insulin taken from cows and used it to treat people with diabetes.
Mass production of insulin

In January 1922, Leonard Thompson age 14 became the first person to receive an injection of insulin to treat diabetes. Thompson lived another 13 years with the condition before succumbing to pneumonia.

Also in 1922, pharmaceutical company Eli Lilly made a deal to mass-produce insulin in North America. This caused insulin and its usage to spread worldwide, helping many people with diabetes to better manage their condition.
Understanding insulin resistance

In 1936, Sir Harold Percival (Harry) Himsworth published some research differentiating type 1 and type 2 diabetes.

He theorized that many people were not insulin deficient but instead had insulin resistance. It is now known that insulin resistance is one factor that causes type 2 diabetes. It results from a combination of insulin resistance as well as impaired beta-cell function.

Research into insulin continued. In 1982, a human biosynthetic insulin known as humulin was created. Humulin is identical in structure to human insulin.

Mass production began for this new form of insulin, and it sold to many different countries. It was at this point that diabetes treatment really took off.

Reflolux, also known as Accu-Chek, was introduced in 1983 as a way to accurately monitor blood sugar. 1986 saw the introduction of the insulin pen delivery system, and in 1993 instant glucose tablets entered the market.

Modern day treatment:
Sir Frederick Grant Banting, alongside Charles Herbert Best, demonstrated the reversal of diabetes in a dog using insulin in 1921.

In recent years, there have been further advances in treatment for diabetes. These include the introduction of insulin analogs and the development of new ways to deliver insulin.

Insulin analogs:
In 1996, the United States Food and Drug Administration (FDA) approved lispro (Humalog), the first human synthetic insulin.

Human synthetic insulin is identical in structure to the insulin found naturally in the body. People with diabetes inject this under their skin.

Though it is a valid treatment option, human synthetic insulin does not work as well as natural insulin because it clumps together when injected. This means it takes longer to absorb.

It is unable to work in synchronization with the body's needs. Unfavorable side effects mean that it is not prescribed for many people with diabetes.

Side effects include:

    delayed onset of action
    variable peak time
    variable duration of action

Insulin analogs were developed to imitate the body's natural insulin release pattern. What sets these analogs apart is that they contain small structural or amino acid changes. These give more desirable results when a person with diabetes injects them under the skin. Once absorbed, they act on cells very much like human insulin and they can be absorbed more predictably.
Insulin pumps

The 1990s brought in external insulin pumps and additional insulin analogs, which had a number of benefits, including:

    better results
    fewer reactions
    more flexibility
    easier treatment management

Currently, there are over 300 analogs that allow doctors and people with diabetes to better customize their treatment plans.

Ongoing research:
Though treatment plans have come a long way since the discovery of diabetes, research is still being done.

Researchers at the Ottawa Hospital and The University of Ottawa are exploring the role of a bacteria-killing protein called cathelicidin antimicrobial peptide (CAMP).

The bacteria-killing protein has been found in the pancreas, where bacteria are not usually present. Scientists are trying to figure out the link between CAMP and type 1 diabetes, but think the protein may help with the production of insulin.

The American Diabetes Association (ADA) have funded a number of research projects, including one that is attempting to identify the possible trigger for type 1 diabetes. Another notable research project is investigating the connection between stress and type 2 diabetes.

In addition, according to The Lancet, research and development of a bionic pancreas is underway. Currently, there is no cure for type 1 diabetes. It would be a major breakthrough, however, if scientists could work out what causes the immune system to attack its own insulin cells.

Diabetes can be treated. However, it can cause additional health problems if it isn't well managed. According to the ADA in 2012, 29.1 million Americans or 9.3 percent of the population had diabetes. So, continual improvement in how to treat, and ultimately prevent, diabetes remains important.

Credit:
Brian Wu