Diabetes is a disease known since ancient times. It was part of what was then called the anomalies of water vessels of the body, as described in the Ebers Papyrus. Amenhotep III, the ninth pharaoh of the Eighteenth Dynasty of Egypt who lived between 1700 and 1600 years before Christ, suffered of diabetes.
The father of Western medicine, Hippocrates, gave him the name diabetes as patients seemed always thirsty and urinate soon after drinking as if the water was passing through their body (dia - baina in Greek means "to pass through").
Diabetes and sugar
The association between diabetes and sugar was also noticed quite early in history. In one of the founding texts of Ayurveda, two famous Indian doctors of the fifth and sixth century AD, Sushruta and Chakura, said that the urine of patients with polyuria dripped like honey, was sticky to the touch and attracted ants in large numbers.
Chinese doctors made the same observation, but according to them, it was dogs that were attracted by the urine. Avicenna, a Persian physician, described two common complications of diabetes: gangrene and reduced sexual function.
Ten centuries later, the Swiss doctor von Hohenheim (1494-1541), better known as the Paracelsus, noticed that the evaporation of diabetic urine left abnormal white powder. However, he thought it was salt which, according to him, also explained the thirst of diabetics.
Finally, it was Dr. Thomas Willis (1621-1675), an eminent anatomist and British pathologist who brought again the concepts of sugar in urine after observing the taste of sugar that emanated from diabetic urines. He was the first to link diabetes with lifestyle. He said that diabetes was a rare disease in antiquity and the Middle Ages. It had become more common in his day because people ate more and consumed more wine.
The patient Dickonson
By the late eighteenth century, Mathew Dobson (1735-1784) admitted a patient named Peter Dickonson at the hospital. The 33-year-old man showed to the extreme all the symptoms of diabetes, and his volume of daily urine exceeded 15 litres (a figure that seems somewhat exaggerated, even for the time).
Nevertheless, Peter allowed Dr. Dobson to engage in a host of experiments and analysis of his blood and his urine. In 1776, the doctor published his observations in Medical Observations and Inquiries. Some of these observations highlight that there are two forms of diabetes, one in a very rapid development (Dobson shared that one of his patients died in less than five weeks) and one in chronic course.
He also noted that urine and blood plasma contained an abnormally high blood sugar, revealing the concept of hyperglycemia. With the results of this doctor, various cures appeared attempting to modify diet and daily water intake.
Anatomy and Physiology 101
Paul Langherhans, a German pathologist, discovered the existence of islets within the pancreas. As for the bonds of this body with diabetes, it is due to von Oskar Minkowski in the late 1880s. His assistant reported that a dog, from which he had removed the pancreas, woke up with a great thirst and its urine attracted flies.
In 1871, the French Apollinaire Bouchardat remarked that patients with diabetes no longer displayed glycosuria as food rationing ran rampant during the siege of Paris during the Franco-Prussian War. He speculated that it would be possible to control diabetes with proper diet food.
Then, in Toronto,
Military hero of the First World War, Frederick Grant Banting, a young doctor, began his medical practice in orthopedics in London, Ontario. During the war, in France at the Battle of Cambrai, he had come to the aid of his garrison at the risk of his own life and was injured. He was also honoured with the Military Cross for heroism.
Back home, the clientele was scarce (there was no Medicare at the time), so he accepted a position as a research assistant for a Professor Miller at the University of Western Ontario. In 1920 he was called to give a course on the pancreas.
In preparing for his lectures, the idea crossed his mind that the pancreas actually has two functions: the exocrine's secretion of gastric juices and the endocrine's production of a hormone capable of lowering the blood sugar.
From then on, Banting had only one passion: to devote all his energies to finding a cure against diabetes. He needed a laboratory and animals to do his research. Professor Macleod of the University of Toronto decided in May 1921 to provide Banting with a laboratory, 10 dogs and a research assistant, one of his most brilliant student named Charles Best.
In less than six months, Banting presented his preliminary report of research at the Physiological Journal Club of Toronto. In 1923, he, together with Professor Mcleod, received the Nobel Prize in Physiology and Medicine for the discovery of insulin.
From Discovery to Commercialization
The first insulins were handcrafted directly from the laboratories of the University of Toronto. Early on, the Eli Lilly company in the United States and Connaught in Ontario began commercial manufacturing of the product. Back then, they used pig or beef pancreases, from which insulin was extracted and purified.
In 1976, the methods would change dramatically. A young American company revolutionized the production of insulin by biotechnology. By modifying the DNA of certain microorganisms and by grafting the genes encoding for the synthesis of insulin in humans pancreas, it was possible to synthesize human insulin rapidly and effectively.
Genentech saw its shares climb more than any other company, inaugurating a new era in drug manufacturing.
The arrival of insulin has played a major role in improving both the longevity and quality of life for diabetics: In the mid-twentieth century, the life expectancy of diabetics was not very good. Most could not expect to live beyond 40 or 50 years. Today, the life expectancy of type 1 diabetes is shortened by 10 years compared to the general population.
Although it has considerably extended, as evidenced by the study Pittsburgh Epidemiology of Diabetes Complications: between the 1950-1964 period and the 1965-1980 period, mortality at 30 years decreased from 36 per cent to 12 per cent.
At the symposium, an 86-year-old patient, Kathryn Ham, testified and spoke of her past 78 years with type 1 diabetes. In conclusion, Professor Pierre Gourdy, endocrinologist at the University Hospital of Toulouse (Haute-Garonne) said: "The data are very encouraging, particularly the reduction of the occurrence of various complications."
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Commonly referred to as Juvenile Diabetes, because it’s often diagnosed in childhood. However, it can also be diagnosed in adults. Type 1 diabetics have a pancreas that produces little or no insulin, which requires insulin management through medication that is usually injected.
Type 2 diabetes is a chronic condition that almost always develops in adulthood — which is why it’s sometimes referred to as adult-onset diabetes. "About 90 per cent of diabetics are Type 2, meaning that their ability to produce adequate levels of insulin is highly compromised and they have significant levels of insulin resistance,” says Dr. Barry Sears, president of the Inflammation Research Foundation. "The combination leads to significant increases in a variety of additional disorders — in particular heart disease and Alzheimer’s — in addition to the standard problems of loss of vision, increased amputation, and kidney failure."
Insulin is a hormone. It’s produced by the islet cells of the pancreas, and its role is to regulate glucose levels in the blood. The pancreas secretes insulin into the bloodstream, where it works to allow sugar to enter the cells and lowers the level of sugar in your bloodstream. As blood sugar drops, the secretion of insulin from the pancreas does too. While both types of diabetes involve insulin and the functioning of the pancreas, there are key differences in their causes and treatments.
Symptoms of type 1 diabetes include the emergence of bedwetting in children, frequent thirst, frequent urination, unintended weight loss, extreme hunger, blurred vision, and fatigue.
With type 2 diabetes, the condition can exist for years before diagnosis. But many of the symptoms are the same as with type 1: blurred vision, unexplained weight loss, excess thirst and urination, fatigue. Also watch for sores or infections that are slow to heal, as type 2 diabetes can affect your ability to heal and fight infection. As well, areas of darkened skin (acanthosis nigrican) in creased areas like the armpits and neck are a sign of insulin resistance.
A variety of factors may contribute to the development of type 1 diabetes, according to the Mayo Clinic, including possible genetics and exposure to certain viruses. Risk factors for the disease include family history and young age, with peaks in outset occurring between ages 4 and 7 and ages 10 and 14.
With type 2 diabetes, the risk factors include having excess fatty tissue, carrying fat around the abdomen, having a family history of diabetes, being inactive, having polycystic ovary syndrome, and getting older. As well, people of black, Asian, Hispanic, and Aboriginal backgrounds are at higher risk of developing type 2 diabetes, though it’s not known why.
Interestingly, the incidence of type 1 diabetes increases as you travel away from the equator, according to the Mayo Clinic, leading some researchers to think it could develop more readily in winter than summer. The highest incidences of type 1 diabetes are found in Finland and Sardinia, for example, where rates are about double or triple those in the U.S. and 400 times those in Venezuela.
It’s unknown exactly what causes type 1 diabetes, but in those with the condition, the immune system attacks the insulin-producing cells of the pancreas. In type 2 diabetes, the islet cells are still functioning as they should, to release insulin — the problem instead is that the pancreas doesn’t produce enough insulin, the body becomes resistant to the insulin, or both. But while we know about some contributing factors, it’s also not known exactly what causes type 2 diabetes.
Type 1 and type 2 diabetes can both have serious effects on your health if not managed. Diabetes can affect your eyes, heart, blood vessels, nerves, and kidneys, though keeping your blood sugar levels well managed does a lot to mitigate these effects. Nerve damage can manifest in loss of feeling or pain, usually beginning in the feet or hands. It could cause gastrointestinal problems or erectile dysfunction. Damage to the blood vessels in the kidneys can lead to kidney failure or kidney disease. Eye problems are also seen in some diabetics, and problems in pregnancy are also a risk.
Prevention of type 2 diabetes can be done in part through dietary choices, and making sure you get enough magnesium may be one of them. "Magnesium plays a pivotal role in the secretion and function of insulin,” Dean says. “Without it, Type 2 diabetes is inevitable.” Measurable magnesium deficiencies is common with the condition, she says, and related to many of the related complications.
Managing stress and anxiety can also help to keep your overall health steady, including possibly staving off type 2 diabetes. "The connection between stress, obesity and diabetes cannot be overlooked,” Dean says. "The stress chemical cortisol signals a metabolic shutdown that makes losing weight almost impossible. Magnesium can neutralize the effects of stress and is known as the anti-stress mineral.” And of course, if you do have diabetes, it’s easier to manage your condition if you aren’t overwhelmed.
There is no cure for type 1 diabetes, though the disease is manageable and treatment has advanced considerably in recent decades. Those with type 1 diabetes must take insulin for the duration of their lives; the physician works with the patient to find the best insulin and dose for blood sugar maintenance. Other medications may be required for related conditions. Not all type 2 diabetics require insulin therapy, but some do. For both types, regular exercise and a healthy diet, along with weight control, can also help keep glucose levels consistent.
For some type 2 diabetics, bariatric surgery may be an option to lose weight and control the disease. However, the surgery does involve serious risks that should be discussed with your physician.
If you suspect you or a family member has type 1 or type 2 diabetes, it’s important to seek medical help as soon as possible. It may be helpful to keep track of your symptoms leading up to the appointment, and go in with a list of your medications and general information about your diet and exercise routines.