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!