Diabetes: This Time It's Personal!

It's the post you've all been waiting for: the tale of my diagnosis! There's actually a lot to the story, so I don't know if it'll fit in a single post, but it was also unnecessarily dramatic. This is some VERY personal stuff, with A LOT that seems to have nothing to do with diabetes. In fact, let's dive right into the drama!

EXT. 1960's CANARSIE, BROOKLYN, NY - ESTABLISHING

Whoops. I taught myself how to write screenplays a couple of decades ago... but scene headings are a great way of setting the scene. EXT. tells us we're outdoors. 1960's CANARSIE, BROOKLYN, NY, let's us know exactly what part of the world we're in. ESTABLISHING  would be a screenwriter's way of saying that the scene doesn't focus on any one aspect and that stock footage could be used.

So here's the subtext that couldn't and wouldn't be in a screenplay... Canarsie was predominantly Jewish back then, and a 30-year-old man who wasn't married was easily rumored to be a fagelah. That's the Yiddish derogatory world for homosexual. The man in question was my father.

A few years younger than him was my incubator, who was seemingly perpetually single.

Okay, let's get this out of the way. She performed the functions of a mother in my early years, but she was never a "mom," and she was so toxic that even calling her "mother" is too much of a stretch for me. She performed the minimal function of giving birth to children, but she continued the cycle of psychological abuse that she endured, with some mild physical abuse mixed in. She was an incubator. That's it.

Anyway, they met on a blind date and kind of forced themselves to stay together. If they hadn't, my father might have had the rumor of being gay hanging over him further, and she risked becoming a spinster. As I heard it - third hand, so take it with a grain of salt - they dated, got married, started fighting the night of the honeymoon, and never stopped fighting thereafter.

I'm not even an itch in my father's pants and I'm off to a great start!

The Plan: they were going to have three kids no matter what. Here is their reproductive efforts summarized:

1. Unnamed child - miscarried
2. Unnamed child - miscarried
3. Unnamed child - miscarried
4. Unnamed child - miscarried
5. Unnamed child - miscarried
6. Unnamed child - stillborn
7. Mike - died of leukemia when he was five and I was three.
8. Me - became a Type 1 diabetic at age seven.
9. Eddie - developed a bone tumor that turned out to be benign, but scared the bejeezus out of everyone because; until it was revealed to be benign, could have been cancerous. With his birth, the incubator was warned that any more pregnancies would put her in a wheelchair for the remainder of her life; the result of a herniated pelvic bone.
10. Scott - adopted

Note that the names have been altered to protect the guilty.

In truth, Mike's death was the end of any possibility that we'd be a "family." Eddie and I were already present, so when Mike died, she refused to so much as shed a single tear. When asked by an aunt why she didn't cry, she answered, and this is a direct quote, "Someone has to take care of these kids."

These events help you frame everyone's emotional status when I developed a nasty case of streptococcal pharyngitis. Okay, now I'm just showing off. It was strep throat. A very, very, very, VERY bad case of strep throat. I remember breathing hurt. When my youngest brother Scott caught it, he was almost hospitalized because it was so bad!

What comes next is pure conjecture. It's a good theory, but because it can't be duplicated in the same subject - me - there's no way of proving it. You see, Type 1 diabetes is classified as an autoimmune disease. Our bodies' immune system malfunctions, leaving us without a way to make insulin. So in my case, imagine the virus I had had a similar protein structure to my beta cells. Not identical. Similar. When the immune system goes on the offensive, it reads protein structures and attacks anything it believes is foreign. My body, confused by the terrible virus I was dealing with, killed the infection AND my beta cells simultaneously.

Voilà. Type 1 diabetes.

The incubator noticed several things. I wasn't as active as my seven-year-old self normally was and I seemed extremely thirsty. I'm told I took a container of milk from the fridge and drank right from the carton. (Mmm... All that lactose, (the sugar in milk, remember?), to make me even sicker!)

Weirdest detail for me to remember: the empty jar of baby food I was told to pee in was mashed carrots.

We rushed to the doctor's office with that sample and it was tested. And Dr. Needles - name unchanged because of its existential irony - said to the incubator, "You have to get him to the hospital. He may be dying."

One of the things a new patient has to do is submit a family history of illnesses. Subtracting the miscarriages and stillborn, which probably weren't included, Mike's death would be in there. So this utterly brilliant pediatrician used those words to describe the situation. "He may be dying." Fan-freakin'-tastic!

There's more to tell, but this post is long enough for now. And we really need something uplifting after all of that drama. So here's one foxy photographer.

Whatever he's shooting, it's

gonna look amazing in his

portfolio!

LATE EDIT: What is with this bizarre reformatting?!? I haven't a clue as to what I'm doing or how to fix it. 😠

Ketoacidosis (DKA) - Metabolisms Gone Wild Vol. 3

Looking at the analytics of this blog to date, I'm gonna assume this is the one billionth diabetes blog and all of them aren't being read. I have a very personal reason for continuing. All the things I'm writing now are the very things I wish I'd learned when I was younger. Not the partial information that's given in the most common diabetes education. I'm sure you know what I'm talking about. "You could lose a foot." "You could go blind." Wanna know what they skip completely? HOW IT ALL HAPPENS! 

Yeah, not my usual attempt at a humorous opening, but I'm having a bit of a rough day. Every day is rough, but this one's a bit rougher. I'll try to lighten up before I end this post.

So today's subject: diabetic ketoacidosis. My last two posts discussed the symptoms of high blood sugar (hyperglycemia) and too many ketones in the blood (ketosis). The next step is when you finally reach this state from Mr. Hypo:

"That silly clown" is officially

trying to kill you now.

Well, he's not killing you. You're killing you. If you're skipping insulin, eating sugary crap, and all-around ignoring the fact that you have diabetes, you are actively killing yourself. And you're not doing it quickly. It's suicide in slow motion.

Now let me contradict that last paragraph. Very few people die from diabetes. The majority dies from the complications of diabetes. That said, there are two ways diabetes can kill. The first, which I'm not covering this time around, is extreme hypoglycemia. The other is diabetic ketoacidosis, also known as DKA, 

Review time! No insulin leads to an increase in blood glucose and a reduction in cellular energy. The cells demand fuel. The diabetic eats. Food gets broken down into more sugar, and the blood sugar levels rise even higher. The kidneys desperately try to keep up with the retrieval of glucose, but can’t. The body responds by increasing the fluid intake and the need to urinate to flush out the extra sugar. Throughout all of this, the body is getting tired. It needs the sugar it’s receiving but cannot use. As the body demands more, the diabetic tries to meet those needs, but can't meet them met no matter how hard they try because... No insulin leads to... 

Rinse and repeat. 

When deprived of sugar, one of the products the liver provides in an attempt to fuel the body is acetone. Acetone. Sound familiar? It's the very chemical that’s used in nail polish remover and will successfully ruin the painted finish of a car. It's used as an industrial solvent! And if a diabetic lets things progress far enough, their blood starts becoming acidic. Their body is literally being poisoned.

I'll personalize this so that it's my experiences and doesn't sound like it's coming off a Wikipedia page.

When I would enter DKA, I couldn't drink enough fluids, (polydipsia, extreme thirst). My mouth felt nearly as dry as a desert. I would need to pee every 10 to 15 minutes, (polyuria, frequent urination). On rare occasion, I'd feel the need to stuff my face, (polyphagia, extreme hunger), but this was very rare. There was also Kussmaul breathing, which involved me taking uncontrollable deep breathes; this is another method of trying to purge the acid and the source of the "fruity" breath smell. 

And finally... Nausea and vomiting. This symptom gets its very own paragraph because of how extreme it would become. I'd be vomiting even when there was nothing left but digestive juices. Puking so hard I'd burst capillaries - very small blood vessels - in my face. With or without diabetes, I'm sure everyone knows what it's like to throw up. It can really wipe a person out. So imagine how tired I'd get from puking repeatedly while I was already exhausted! I would occasionally lose consciousness during any breaks in the vomit marathon.

Between the ages of 12 and 20, I'd become acidotic, (the state of being in DKA), countless times because I was DUUUUUMB! It took decades for me to get my diabetes act together, but by then it was very much a case of closing the barn doors after all of the horses had escaped.

Hmmm... Looks like I wasn't able top locate the funny in today's post. Probably because of the extreme guilt I feel of purposely making myself sick throughout my adolescence. Yes, all of the above...? Did it on purpose. "Why?" That, my friends, is a story for another day.

Ketosis - Metabolisms Gone Wild Vol. 2

That's right, dear reader! Barely legal chemical compounds doing what comes naturally to them!

Y'know, sometimes I wonder if my sense of humor is designed for an audience of one: me.

Aaaaanyway, we need to talk about what this previously shared image represents:

Your friend KETOSTIX has

some bad news for you.

He forgot his wallet, so

can you spot him $20?

Hyperglycemia, high blood sugar, is just the beginning of things going awry when there's no insulin to feed cells their sugar. Those pesky cells demand energy. Without sugar, the body goes after fat, entering a state of ketosis.

"That's great, Rob! I wanna lose some fat. BRING ON THE KETOSIS!" 

Well, if you were aiming for a controlled ketogenic diet, I'd say that's great. A very mild state of ketosis can help you lose weight. The keto diet, in case you were wondering, reduces the intake of carbohydrates, forcing the body to burn off that fat.

HOWEVER... when a diabetic enters a state of uncontrolled ketosis, they've started down a path of destruction. Because instead of a low presence in the blood and urine, ketones just keeps climbing.

Let's look at ketosis symptoms, shall we?

Bad breath - To be honest, I don't know what this smells like. It's commonly described as a "fruity" smell, but that makes me think of Froot Loops, and who wouldn't want their breath to smell like Froot Loops? (Confession: I first wrote "Foot Loops," which I'm assuming would make for TERRIBLE breath!)

Fatigue - Just like with hyperglycemia, your body isn't getting the energy it needs. Machines both mechanical and biological don't function without power. This is simply cranking the fatigue higher.

Ketones in blood and urine - A diabetic won't feel this one. Once upon a time, a long time ago, the only way to test for spilling ketones was using Ketostix or putting a single drop of urine on an acetone tablet. Both methods then required the use of a color chart. The darker the color, the worse the situation was. (I'll cover why it's so bad in my next post. I promise.) Today, there's a device very much like a glucometer that can detect ketones in the blood.

Let's compare controlled and uncontrolled. For the former, if you start experiencing the signs of ketosis, you just eat some carbs and your body will return to the use of carbs for energy. A diabetic without or with too little insulin, however, doesn't have that kind of control available. Carbohydrates will simply add more sugar to the bloodstream, driving the body to increase its production of ketones. It changes from a minor metabolic issue to poisoning one's self.

I'm going to close this post because there's only so much I can say about this middle ground of chemical imbalance without tripping directly into the next phase. Not only will I have plenty to explain, but more than a little experience to share.

~ monotone ~ That'll be fun.

Hyperglycemia - Metabolisms Gone Wild Vol. 1

No, this is not where I'll show you a scantily clad or partially naked pancreas. Heck, a fully clothed pancreas wouldn't be all that appealing. It's an internal organ, after all.

Now that I've explained what diabetes IS, I think I need to take a deeper dive into some of the things that make it an illness; what it initially does internally. "INITIALLY!" I want to make this very clear that this is the beginning of a debilitating path. The crippling aspects of diabetes can sneak in much later. Sorry, there's no funny way to say that. I can't cheerfully say, "Hey, everyone! Let's look at how a lack of insulin destroys your body!"

I'll take this symptom by symptom. Keep in mind that there's going to be more medical technobabble. I've used some of the words in previous posts; I'm kind of hoping repetition will hammer some of the information into those gray databanks in people's heads. 😉

Fatigue - I've said this before: our bodies need sugar for everything. Walking, talking, breathing... We need energy all the way down to the cellular level to function. We even need sugar to think, as the mind will fail to function without fuel, just as it would fail if the oxygen supply were cut off. Without insulin, cells throughout the body won’t open up and get their sugar fix. With the fuel being withheld, things don't function. The body literally becomes exhausted.

Frequent urination - Polyuria, AKA peeing  a lot, contributes to fatigue. To be more accurate, it’s actually glycosuria, the passing of sugar into the urine. Y'see, the kidneys are wonderful organs that that absorb all kinds of waste, and this filtration includes the reclamation of certain nutrients, such as sugar. But like a filter that you'd find in a mechanical device, the kidneys can only handle so much. When that limit is reached in terms of sugar, the renal threshold is crossed and sugar starts spilling into the urine. The body knows it has too much sugar and neither wants it nor needs it. Thus, a kind of cry for help goes out from the kidneys. “Help us get rid of all this extra garbage!”  The body responds by trying to dilute the glycosuria with an increase in fluids. And that leads to...

Extreme thirst - Have you ever become so thirsty that you might consider drinking motor oil? Okay, no one has, not even a thirsty diabetic. But when polydipsia occurs, a person will consider drinking just about any fluid that has been ingested by humans in the past. Water, juice, coffee, tea, soft drinks, milk... "Quench the thirst!" That's the only goal. The problem is that some of a diabetic's desperate choices to end the unshakeable thirst can be deadly. Coffee, tea, and soft drinks might have sugar. But juice and milk definitely have sugar in them! Fructose and lactose respectively. (Glucose. Seeing a pattern there? That O-S-E at the end tends to indicate a form of sugar.)

Hunger - Extreme hunger, AKA polyphagia, is often associated more with low blood sugar (hypoglycemia), but can occur when blood sugar also climbs. That's because the body can't use the existing sugar thanks to a lack of insulin, so it demands something else. When all of the above is occurring and a diabetic starts eating whatever they can get their hands on, it will compound the problems. Any carbohydrates will be broken down into sugar that the body still can't use! 

Allow me to summarize: No insulin 🠞🠞🠞 No energy to function and buildup of sugar in the blood 🠞🠞🠞 Kidneys go into overdrive to get rid of the sugar 🠞🠞🠞 Extreme thirst kicks in to provide the kidneys with fluid to flush out the sugar 🠞🠞🠞 Body becomes exhausted from all of this extra work 🠞🠞🠞 Hunger makes the diabetic eat in a desperate quest for energy  🠞🠞🠞 But there's no insulin 🠞🠞🠞 No energy to function and buildup of sugar in the blood...

What a fun little circle of destruction! This is the process of hyperglycemia, high blood sugar. It's the beginning of a metabolic disaster. THE BEGINNING! Tune in next time when things get much worse!

"Mr. Hypo is My Friend"

You read this post's title correctly. Mr. Hypo is My Friend. Mr. Heroine and Ms. Morphine were NOT my friends. Just Mr. Hypo. He sucked then. He sucks now. He is NEVER invited over for the holidays... the jerk.

I was diagnosed with Type 1 diabetes in September of 1974. Certainly not the dark age of diabetes, but still far from modern methods of controlling it. And this short book was what constituted diabetes education for children back in the day. I have lots to say about diabetes education, but that's a rant for a different day. Today, I'm going to share with you this supposed educational booklet and my opinions of it.

Something to keep in mind is that some of this material was out of date when it was given to me!

Yeah, the bowtie really made Mr.

Hypo oh so endearing. 🤨

I don't care if they'd engaged the talents behind Looney Tunes; there was no way they were going to make insulin injections appealing to a seven-year-old.

Wait. Edison had juvenile diabetes?!?

How'd he live long enough to

"invent" anything?!?

Of those "very famous people," the only name I recognized was Edison. If he had juvenile diabetes, which is obviously not the case, then it was before insulin was available. (He lived between 11 February 1847 and 18 October 1931.) There was no way he would have lived long enough to steal from and malign Nikola Tesla... and electrocute an elephant. Oh, you don't know about that one? Yeah, Edison killed an elephant in a publicity stunt to try and embarrass Tesla.

I dunno if I want Mr. Hypo to be my friend.

He's actually looking pretty sinister here.

My doctor wasn't my friend. He was an idiot. One day I'll tell the tale of my diagnosis, but there's one special fact I'll share right now. He was a pediatrician named - of all the things to be named when diagnosing an insulin dependent diabetic - Dr. Needles. No joke! Y'know what children fear most about doctor visits? Shots and needles! So what part of this man's demented psyche made him think pediatrics was his perfect calling?!?

My teacher looked nothing like that.

"Mother and Daddy are your best friends." Ummm... No. They were my parents, not my best friends. My best friends would have joined me in drawing on the bedroom walls with crayons, not punish me for it. That's also some genuinely weird wording there. Pick a lane, book. "Mother and Father" or "Mommy and Daddy." Mixing the two causes me physical pain.

I'm not exactly sure what page 11 is referring to. My assumption is that this book was first made when syringes were made of glass and had to be boiled to sterilize them. That, or his "special house" was actually a condo in Miami.

Insulin is clearly in dire need of the

restroom in the upper left corner.

As far as I know, no insulin needs to be mixed today. Back in the day, however, I took an insulin called "NPH," (not Neil Patrick Harris), that had to be mixed before drawing up the dose.

Fluffy Cotton and her bedroom eyes.

The shameless harlot!

Drawing back the plunger, also know as aspirating, was meant to avoid injecting directly into a blood vessel. This was such an important step in taking an insulin dose that they abandoned it complete with the invention of insulin pens.

The only time a clock was my friend was

at 3:00 PM on a school day.

Page 19 is trying to describe Medic Alert bracelets and necklaces. In well over 47 years of being a diabetic, a Medic Alert bracelet helped me once. ONCE. It was back when I was 16. Y'see, I was...

Different story for another day.

Eating six meals a day might be why

you're a Type 2 diabetic today.

Just sayin'.

"Testing your urine is important and fun." Ummm... No. Testing your urine was gross and inaccurate. It takes a while for the body to create urine. During that time, blood glucose levels can vary drastically. Unfortunately, the Clinitest Set was the only testing method available at the time to chart glucose levels.

Dr. Needles did NOT love to read about

diabetes. Terrorizing children and

parents was more his style.

Amidst these pages, the only part that's still viable is testing for ketones, and if your insurance will spring for it, you can test your blood instead of urine with modern technology. And ketones are some dangerous juju, but explaining that in detail will come another day. For now, don't let that happen. "But Rob, I don't even know what it is that I shouldn't let happen!" Don't start! This is the exact kind of thing that has stopped me from inviting you to my birthday parties.

No, I cannot.

There you have it. Mr. Hypo is My Friend. Want to know what I learned from this little book when I was a kid? Not a damn thing. Nothing. Nada. Zilch. What little I DID learn about diabetes back then was from the hospital's diabetes educator, Doreen Small. A lovely woman for a brat of a patient. When she told me that sweets were no longer permitted, I stormed out of the room!

...without my IV pole.

Don't look at me like that. I got smarter... eventually. 😉

Diabetes History 3: The Rise of Insulin

You've returned! Welcome back to the nail-biting conclusion of diabetes history. When I say "history," I'm talking a hundred years ago or more. "History" could also include more recent events, like synthetic insulins, the failed attempt at an insulin nasal spray, and the grotesque price gouging pharmaceutical companies engage in with life-sustaining medicine. But I'm writing about The Dark Times, when a diagnosis of diabetes meant death.

Y'know... the good times! 😁

We've reached the miracle for which all diabetics were waiting. I’m not religious. I have continuously stated that if I could just have the mailing address and phone number of whatever divine being that made the universe, I’d be a lot better with the whole "faith thing." However, not all miracles need be a parting of the seas, a pillar of fire, or the killing of the first born of one’s enemies. Sometimes miracles are a series of unusual twists of fate.

I mentioned the births of Frederick Banting and Charles Best in my last post, but said nothing else about them. That’s because up until this moment in the timeline, there was nothing else to say. Now I need to backtrack a bit to say more about Dr. Banting and his lab assistant. These two men, specifically Dr. Frederick Banting, are what constitute a miracle for me and all diabetics. His life could have, and should have, taken him down a very different path. Instead, there will be several twists along his life’s course that are what I consider miraculous. I'll even enumerate them. Just... don’t let my calling them Fred or Chuck seem irreverent; I have nothing but the greatest respect for these men.

Oh... for you kids out there, your hashtag symbol was once called the pound sign and substituted the word "number."

Twist #1: Once Fred was done with public education, he attempted to join the Canadian army. Thankfully, they rejected him because of his poor eyesight. I’m sure there were plenty of soldiers in the field with corrective lenses, so... I don’t know. Maybe his weren’t stylish enough for the Canadian Army? Your guess is as good as mine.

Twist #2: At the urging of his devout Methodist parents, the then Mr. Banting entered into the University of Toronto to study divinity with the goal of becoming a priest. Luckily for diabetics around the globe, he didn’t hear the calling and transferred out of his religious studies to tackle medicine.

Twist #3: File this one under Just Damned Lucky: Fred Banting joined the Canadian Army Medical Corps because World War I created a need for army medics. He, himself, was wounded at the Battle of Cambrai. Despite his injury, he aided other wounded men for up to 16 hours before another doctor forced him to rest. His actions won him one of the 2,877 Military Crosses that were given for heroism under fire (out of the 150,000 nominations). Considering the lack of medical technology and the less-than-sterile conditions on the battlefield, I consider it “providence” that his wound and lack of care for numerous hours didn’t cripple or kill him.

Twist #4: After the war, Banting, as I understand it, became... something. There seems to be a jumble of information that occurs between 1920 and 1922. One source said he was a surgeon. Another said he was also a lecturer at the University of Western Ontario on the subjects of pharmacology and anthropology. Yet another says he didn’t earn his M.D. until 1922, which leaves me to wonder how he was permitted to practice medicine at all up until then! I dunno... Maybe the requirements to be called "doctor" were a lot less stringent than they are today.

Twist #5: While Banting was either doing one thing or many things during those years, he eventually sat down to read The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis by Moses Barron. Not only a title that just rolls off the tongue, but had to be a real page turner! (If you think I was able to read and understand it, you got another think coming.) This medical treatise gave Dr. Banting an idea, so he went to his boss, Dr. J. J. R. Macleod, and requested the resources to pursue it.

Twist #6: Research resources were tight. Macleod said that Fred could have 10 dogs and one assistant. At the time, Banting had two assistants available to him, both medical students. So how did he choose between the two? A coin toss. I’m not even kidding. The winner was Charles Herbert Best.

The dynamic duo of Banting and Best went to work, and while I could go into details of that work, I won’t. It’s the animal lover in me that makes me refrain from discussing what was done to those 10 dogs, some of the best boys and girls ever! Besides, what matters are the results. They were able to extract insulin from the islets of Langerhans of the dogs’ pancreases. Their extract was then refined by Dr. James Collip.

On 23 January 1922, 14-year-old Leonard Thompson became the very first diabetic to receive a dose of insulin. Thanks to the starvation diet, Leonard weighed all of 66 pounds at the time. From then on, diabetes would no longer be a death sentence. Instead, it would be a disease that could either be merely troublesome or extremely serious... but very few people would ever die from diabetes again. In fact, Mr. Thompson died 13 years later from pneumonia, not diabetes!

That sounds weird, right? “Very few people would ever die from diabetes again.” It’s true, and I’ll try to explain it later, but people rarely die directly from diabetes!

Our hero, Dr. Frederick Banting,

seen here wearing the glasses that

kept him out of the Canadian Army.

In October of 1923, Banting and Macleod received the Nobel Prize in Physiology or Medicine. Dr. Banting initially declined the award, feeling that Charles Best should have been named as well in the achievement. In fact, he insisted that Best’s work was pivotal to their overall accomplishments. In the end, Banting shared the monetary award with Best, while Macleod shared his award with Collip.

Dr. Banting was knighted in 1934, becoming Sir Fredrick Banting. Or was it Sir Dr. Frederick Banting? Dr. Sir Frederick Banting? Dr. Frederick Sir Banting? One of those, I'm sure.

He was killed in a plane crash on February 21, 1941.

The fates and fortunes of the other doctors are yours to research if you'd like. Fred was the idea man who got the ball rolling on finding a medication to treat diabetes. We are alive today because of him! That's not hyperbole. It's a fact.

And so we come to the end of our journey through the annals of diabetes history. Join me for my next post, where I explore why diabetics were forced to wear roller skates and listen to disco throughout the 70's.

They weren't. I'm just in a weird mood as I type this. 😉

Laughing historically at doctors

Welcome back, sugar bear! Crap. You could be a diabetic like me. Ummm... Sugar-free bear? Maybe?! Y'know, maybe pet names aren't something I should try. That, or lean into them WAY too hard to offset the awkwardness. I dunno. Could be fun.

Anyway, I was covering the history of diabetes, which I'm sure you'll all agree is some edge-of-your-seat, steal-your-breath-away material. However, history helps us put the present into perspective. Think for a moment about what was and what is. Last post I said, "Those who were diagnosed with diabetes ... were almost immediately written off as terminal." I was diagnosed when I was seven. Given a proper diabetic starvation diet, I could have lived to the ripe old age of 12... if I was lucky.

That said, let's get into it with the subject of... Oh, look. The aforementioned starvation diets!

During the Franco-Prussian War, which was between 19 July 1870 to 10 May 1871, another French physician, Apollinaire Bouchardat, noticed a decrease of glycosuria, (sweet urine), in diabetic patients when food was being rationed in Paris. It’s at this point that the concept of a diet for diabetics was born, and not the idea of simply eating any one food item as treatment. So you can blame him for why cake and candy have been removed from our menus. Catoni, a diabetes specialist of Italian decent, would actually go as far as to place his patients under lock and key to enforce their diets. (Other inmates: "What you in for, man?" Diabetic: "First degree polyuria and polydipsia, and second degree glycosuria.") 

While studying for his doctorate at the Berlin Pathological Institute in 1869, Paul Langerhans isolated regions of the pancreas composed of cells that did... something. No, he didn’t know exactly what their functions were, but he’d narrowed them down, and they would eventually play an important role in diabetes treatment. They’re called - surprise, surprise - the islets of Langerhans. When and if I get around to discussing the function of the pancreas in relation to diabetes, the islets of Langerhans will be important. So write that down.

Why aren't you writing that down? Don't tell me you are; I can see you're not! I'll bet you haven't been taking any notes at all. What's polyuria? I see you opening up Google!

Okay, I'll stop.

Twenty years after Langerhans, Oskar Minkowski and Josef von Mering, while working at the University of Strasbourg, Austria, induced diabetes in dogs by removing their pancreas. Mind you, I’m no fan of vivisection, (experimentation on animals), but when it affects my life directly, I manage to tolerate such things. It was this study that isolated the pancreas as the gland responsible for glucose control within the body.

Now here are a pair of red-letter dates in diabetes history: 14 November 1891 and 28 February 1899. Those are the days that Frederick Banting and Charles Best were born respectively. You may not care all that much about them right now, but if you're a diabetic, you will! But more about them later.

The start of the 20th century saw many “fad” diets being used to treat diabetes. All probably saw to the deaths of numerous patients, as well. The “oat cure,” the “rice cure,” and “potato therapy” were all rich with carbohydrates, which the patients couldn’t process properly to start with. (Fear not, my information-hungry friend. I will get to "What is diabetes?" eventually.) And since opium was seen as a virtual panacea (cure-all) at the time, it was also used in the treatment of diabetes. That last probably had diabetics skipping along, singing, “I’m gonna die and I don’t care.” The only thing I can say in a positive manner about using opiates to treat diabetes is that the diabetics probably suffered a lot less pain.

NOTE: Opioids are their very own can of worms that I may or may not open later. But I will state this much: they are NOT an answer; they are a stop-gap.

Between the years of 1910 and 1920, Frederick Madison Allen and Elliot P. Joslin became the leading diabetes experts in the United States. Oh... and in 1910, saccharin becomes available. Just thought you’d want to know that coffee could be safely sweetened for diabetics once more, as they had in days of old.

Dr. Allen was the first to truly develop a diet that would prolong the lives of diabetics. His “starvation diet” focused on a severe reduction of carbohydrates. This didn’t change the overall fact that diabetes mellitus was a terminal illness, but it gave them a few extra years. As a side note, in almost everything I've read while researching the history of diabetes, there is mention that he also opened the Physiatric Institute, (not psychiatric), in Morristown, New Jersey, which was the first clinic solely dedicated to those diagnosed with diabetes mellitus.

To be clear, and to demonstrate how well we diabetics have it today, allow me to explain how the starvation diet worked. This data comes from a New York Times article that was published 13 February 1916. (Because I'm using old notes, I don't know if this is a direct quote.) "The patient would begin with a period of fasting for eight to 10 days. Coffee, tea, water, and very small amounts of fruit were permitted. This was done in an effort to come as close to the elimination of sugar as possible in patients. Following that, diabetic patients were given an incredibly strict diet to follow. Should their glucose levels start to rise abnormally once more, they would repeat the process all over again, starting with the fasting."

Sounds like a real treat, doesn't it?

Dr. Joslin’s work essentially confirmed the findings of Dr. Allen, but he was more of a mind that what should be reduced in the diabetic’s diet was fat. Who would have guessed that both were correct, and that limiting both would help maintain control of diabetes? Dr. Joslin was also an advocate of educating patients to care for themselves. In 1956, his practice was moved to One Joslin Place in Boston, MA, where it would become, and remain, the largest facility dedicated to the care and education of diabetics.

I would, however, like to note something that Dr. Joslin said. Despite all of his great work as a “diabetologist,” there is a quote from him that I find staggeringly dumb. He claimed diabetes mellitus was “the best of the chronic diseases” because it was “clean, seldom unsightly, not contagious, often painless and susceptible to treatment.” This may have been a perfectly justifiable statement from his observations, and he was, after all, a diabetes expert... but until he could experience the effects of the illness on himself, I personally think he should have said no such thing. “Clean.” Was putting out urine lousy with sugar a neat process? “Seldom unsightly.” Patients emaciated by the dehydration process were looking good to him, were they? “Not contagious.” Well, he couldn't be 100% wrong, but then a broken clock is right at least twice a day. “Often painless.” The description given by Aretaeus didn’t sound all that painless to me, with patients literally dying of what seemed to be an unquenchable thirst. “Susceptible to treatment.” Diet was all they had in 1920. Until the era of “Joslin and Allen,” only a German doctor, Georg Ludwig Zueler, had come close to a medicinal treatment, injecting a comatose patient with a pancreatic extract called “Acomatrol.” There were severe side effects, (the actual side effects remain unknown and immune to a Google search), and the patient died when the supply of the drug was exhausted.

I'm going to stop here to allow you to absorb some of the medieval things diabetics had to endure in the past. Try - TRY - to put yourself in their shoes. "The oat cure"?!? "The rice cure"?!? "Potato therapy"?!? Look, I don't know about you, but my body metabolizes potatoes into glucose at an astounding rate! Imagine if all they still had were their absurd guesses. "Well, the commercial says that Snickers really satisfies. Have we tried 'the Snickers' diet yet?" But fear not! Banting, Best, Macleod, and Collip are up next, so brace yourself for some hot chemical and hormonal history!

Getting completely historical

I know what you're thinking. Rob, you mentioned the history of diabetes in your first post. Is there really all that much history? Well, dear reader, there's at least enough for a blog post or two. 😉

The first documentation of diabetes was made in 1552 B.C. A piece of papyrus from the 3rd Egyptian Dynasty, written by a physician named Hesy-Ra, mentions the symptom of polyuria, AKA frequent urination. (You might want to remember that one, as polyuria plays a major role in the life of a diabetic.) The cause of the illness was unknown, but that didn’t stop Hesy-Ra from attempting treatment. He prescribed a special diet of fruits, grains, and honey. The patients probably died shortly thereafter because there was so much sugar in their blood that it flowed like tree sap. And while I'm making a joke about his treatment, my reading indicates that this diet actually helped, although I have absolutely NO idea how. It's completely counterproductive to what I know about diabetes. That many carbs and sugars should have had diabetics dying by the cartload.

In or around 1500 B.C., healers began to notice that ants were attracted to the urine of those who were diagnosed with diabetes. With our current knowledge, we understand this as the ants being attracted to the excessive sugar in the liquid waste.

The next time diabetes received any recognition was in or around 150 A.D. A Greek physician, Aretaeus of Cappadocia, inappropriately described the disease as the melting of the body into urine. His notes, translated by Francis Adams in 1856, say the following.  “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 the 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. If for a while they abstain from drinking, their mouths become parched and their bodies dry; the viscera seem scorched up, the patients are affected by nausea, restlessness and a burning thirst, and within a short time they expire.” ("Making water," by the way, was their way of saying "peeing.") Factually, in terms of the flesh and limbs melting down into urine, he was completely off the mark, but it’s not as though he had an electron microscope with which to study slides of urine samples. If he did, he would have noted a distinct lack of material that was the patient's supposedly “melting body.” Still, Aretaeus was accurate in his description of the symptoms. Because it seemed as though the human body was acting as a siphon, he gave the disease the first part of its name, “diabetes.” 

NOTE: There is conflicting information on this, but I only found one note giving credit to Apollonius of Memphis, Egypt, in the naming of the disease in 250 B.C. All others seem to credit Aretaeus.

Yet another error in diagnosis occurred in 164 A.D., when another Greek, Galen of Pergamum, mistakenly diagnosed diabetes as a disease of the kidneys. As per what translation I could find, “Diabetes is a genuine kidney disease, analogous to voracious appetite.” Let's face it. It was the most logical guess to be made, since polyuria is THE big symptom of diabetes. SPOLIER WARNING: I know you want to wait to see how it ends on your own, but it turns out diabetes is a pancreatic illness. (Yeah, I'm sure I ruined the whole story.)

Assuming the wrong organ was behind the illness is only one of many wrong, unusual, or downright weird ideas pertaining to diabetes mellitus. Try this one on for size: To relieve the problem of frequent urination, it was suggested around 1000 A.D. that patients take up horseback riding. I... I just... I mean... Just imagine your bladder nearly full to bursting and some lunatic suggests you go bouncing around on the back of a horse! I can't find anything about the success of this "treatment," but I'm going to assume there were a lot of pee-covered horses.

There seems to be some confusion as to exactly when “mellitus,” the Ancient Greek word for “honey,” was added to the disease’s name. Some sources say it occurred as early as the 11th century, while others specifically credit Thomas Willis for it in 1675. A number of my sources said outright, “We don’t really know who added it.” This reference to honey was because those with diabetes had very sweet urine. If you’re anything like me, you have to wonder how anyone would even know that. Well, one of the ways to test for diabetes was to have a “water tester” come in and give the urine a taste. (And you thought your job sucked!) As disgusting as this may seem, urine is sterile when it leaves the body... for the most part. Okay, not always, but... We're getting off track! 

Those who were diagnosed with diabetes, “sweet urine,” “honey urine,” or one of several other monikers it carried at the time, were almost immediately written off as terminal. Their deaths would be excruciating, but relatively short. 

And if you really must know in order to shake off the idea of "water testers," Francis Home of Edinburgh in the U.K. developed a chemical test to measure sugar in urine in the 19th century.

In 1685, the sloppy work of Swiss doctor Johann Conrad Brunner dictated that the pancreas wasn’t essential to live. Ooooops! What he had done was extract the pancreases of dogs, and then sat back to see what happened. His initial expectations were that the dogs would die. Instead, they experienced polydipsia (excessive thirst) and polyuria, but these symptoms later regressed. Because the animals lived, he made his medical declaration that the pancreas wasn’t all that important.

BIG goof! His error was uncovered 200 years later, when it was found that the smallest remnants of pancreatic tissue would suffice to provide the body with insulin. Dr. Brunner failed to remove every remnant of the organ, thereby skewing his results.

Then came the brilliance of French physician, Priorry, in the late 1850's. For the life of me, I can’t find the reason why, but he advised his diabetic patients to intake copious amounts of sugar as a treatment. I can only imagine that his medical practice took a serious dive, as he didn’t have many living patients to pay their bills after such a recommendation. It was reported he had to get a newspaper route to help pay for his medical malpractice insurance.

Okay, that last sentence may not be factual. 😜 

There's more to the story, but I'm guessing this post is long enough. You may not get this one right now, but I assure you that the Banting and the Best is yet to come!