Diabetes: The Revenge!

That titles needs a tagline. "Diabetes is back, and this time it's out for blood!" Because diabetics should check their sugar four times a day. Get it? "Out for blood"?

Yeah, it's non-stop laughs here.

When last we left off, Dr. Needles had just told a woman who'd buried her eldest child four years prior that her current oldest "could be dying."

The afternoon turned into madness after the doctor visit. The incubator called my Dad and left a message at his job in Brooklyn that I needed to be hospitalized. Dad tried to call back, but the incubator already had me in the car and on the way to the hospital that was on the Nassau County/Queens border. Dad drove all the way home from Brooklyn, was told where I was being taken, and drove almost half the distance back toward his workplace to meet us at the hospital.

Before leaving the doctor's office, he warned that I shouldn't be fed anything. Food was bad. So what was the first thing that happened when I was admitted to the hospital? They fed me. Two hot dogs and some milk. They also gave me a shot of... something. (We know what it was, but seven-year-old me didn't.) They also started an IV, which I wasn't happy about, but the nurse told me that the IV bottle - yes, this was back in the "IV bottle days" - had a steak dinner in it, so I was technically eating even more! Her trick kind of worked. I was still hungry, what with my body not being able to process fuel at the moment, but the thought that the IV was feeding me continuously kept me from complaining about the lack of food.

I slept that first night in the pediatric ward hallway. They were full up, so I had to wait for someone to be discharged the next morning. And who did they put the newly diagnosed diabetic in with? A kid who'd just had some kind of throat surgery and was basically being fed a steady diet of hard candies and ice cream.

It occurs to me that I failed to say how much time had passed between the strep throat and the diabetes diagnosis. In that time, my immune system was chewing up my beta cells, obliterating my ability to make insulin. And what kept me from slipping into a hyperglycemic coma in those two week? Once again, all I have is a theory that's impossible to prove. It's called "the honeymoon period." It's brief period after the onset/diagnosis of diabetes when the diabetic seemingly gets better. They might even experience perfectly normal blood sugars during this period. Almost like the pancreas is going through its death throes, coughing up the last of its insulin. It's my belief that that's how I survived before my official diagnosis.

Back to my diagnosis and hospitalization...

On the day I was relocated to a room, I was handed Mister Hypo is My Friend. This was the beginning of the gods-awful diabetes education I'd receive. Y'see, reading was all well and good, but that didn’t mean I was comprehending the words. The book was supposed to be telling me that I had a serious chronic illness, but I wasn’t getting that message. There was a line inside the cover to put the patient’s name, but no one filled out that part when the booklet was handed to me. As a result, it didn’t seem to have anything to do with me, and I couldn’t fathom why it’d been given to me. And how is anyone, adult or child, supposed to take “Mr. Test Tube” and “Dora Dropper” seriously?

No, the thing I remember most clearly during that week in the hospital - the part of my education that really struck home - was when I was told there'd be no more cake, candy, or ice cream in my life. Those things had been staples in my childhood diet. Now they were to go the way of the dodo. What's more, the thing that a child dreads most about anything medical was now going to be a daily part of my day: injections.

Well, I did what any other kid would do receiving all of this "good" news: I lost it. Through a great many tears, I started screaming denials about the restraints being placed on my existence, stood from the conference table where my parents and I were being educated, and stormed out of the room... completely forgetting to bring my IV pole with me. The pole followed because it was connected to my forearm, top first, falling over and luckily being stopped by a lounge chair before it could shatter on the tiled floor. After ensuring that a new IV wouldn’t need to be started, the incubator yelled at me for being... well, an upset child. That I was upset and a child didn't seem to matter to her.

I wouldn't understand my psychological state at that time until much later in life. And what brought clarity to me was the large envelope filled with letters from my second grade classmates that I received. Their crayon inscribed notes wished me well and a speedy recovery. What I seemed to notice most was that many misspelled “hospital.” There was also the fact that somewhere in my gray matter was the knowledge that my classmates had been coerced into writing those notes, making their well-wishes hollow sentiments. As for a speedy recovery, that wasn’t going to happen. I was going to have diabetes forever!

This ends the tale of my diagnosis. Despite being well-read in general and self-educated specifically on the topic of diabetes, those things came later. Instead, I was about to embark on some of the dumbest behavior a diabetic can engage in. Monumentally destructive things that were assisted by still worsening diabetes education and the incubator.

I'd like to remind you, however, that this isn't necessarily a linear story, and that I might well discuss one of my other favorite aspects of being a diabetic next time: depression or diabetic neuropathy. Oooh! Or maybe diabetic retinopathy! Yeah, that could be fun!

I'll see all of you non-existent readers in the near future with another exciting post.

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. 😉

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!