History Of Diabetes: From Raw Quinces and Gruel to Insulin

Nearly 5,000 years ago in India, the physician Susruta described a disease “brought on by gluttonous overindulgence in rice, flour, and sugar,” in which urine is “like an elephant’s in quantity.”

A Greek, Aretaeus, in the first century A.D. gave us the name “diabetes” from the Greek word for “siphon.” Observing his patient’s extreme thirst, he reasoned that the body acts like a siphon, sucking in water at one end and discharging it at the other.

Ancient physicians knew some of the symptoms of diabetes, but they had no effective way to treat it. Aretaeus recommended dates, raw quinces, and gruel. As late as 1690, doctors prescribed “gelly of viper’s flesh,” broken red coral, sweet almonds, and “fresh flowers of blind nettles.”

Progress accelerated with the age of scientific experimentation. In the 17th century, Thomas Willis called attention to the sweetness of diabetic urine, and in 1776, Dr. Dobson of Liverpool identified this sweetness as that of sugar. In 1796, Dr. John Rollo, using a urine glucose test devised by Dobson, came up with the first effective treatment for diabetes: a diet high in what he called “animal food” (fat and meat) and low in “vegetable matter” (grains and breads). This diet prolonged life for many diabetics (those with what we now call Type 2 or non-insulin-dependent diabetes), and with modifications, was the only treatment for diabetes until the 1920s.

Treatment of Type I diabetes awaited a better understanding of the disease. For many years, no one was sure what part of the body was ill. The stomach, as John Rollo had thought? The kidneys, because of the urination? Perhaps the liver? It wasn’t until 1889 that the matter was settled. That year, two German physiologists, Oskar Minkowski and Joseph von Mering, were investigating the digestion of fat. They knew that the pancreas played a role, so they experimented by removing the pancreases of two dogs. To their surprise, the dogs became diabetic.

The next step was to find out what it was in the pancreas that kept people from developing diabetes. An obscure article published 23 years before provided the answer. In it, Paul Langerhans described some “heaps of cells” in the pancreas for which he could see no function (Later these would be called the islets of Langerhans.) Scientists all over the world began searching for the “antidiabetic substance” they thought must be secreted by these cells.

Canadians Frederick Banting and Charles Best achieved success. They extracted a substance from the pancreas-insulin-that when injected into diabetic dogs, lowered blood sugar and prevented death. In January,1922, Banting and Best tried their extract on Leonard Thompson, a 14-year old boy dying of diabetes, and saved his life. The insulin era had begun, and for thousands, Type I diabetes was no longer a quickly fatal disease.

The history of diabetes since 1921 has not yet been capped off by a discovery as dramatic as that of insulin, but these years have yielded greater understanding of diabetes and much-improved treatments.

Especially noteworthy was the realization that diabetes is not a single disease. In 1935 Roger Himsworth divided diabetes into two categories: “insulin sensitive” (today’s Type I) and “insulin insensitive” (the modern Type 2). This division opened up a whole new area of research.

Other scientists are turning their minds to ways of preventing the complications of diabetes-blindness, kidney failure, gangrene and heart attacks. The search is on for better insulin delivery-through insulin pumps, the artificial pancreas, or pancreas transplants.

One day, the history of diabetes will end with the tale of how diabetes and its complications were cured for good.