A Tale for the Ages: How the Mystery of Diabetes Was Unraveled

By Mary Green

Although it seems to have gained notoriety only recently as increasing numbers of people across the globe have fallen prey to the disease, countless brilliant minds have played a part in the fascinating history of diabetes mellitus. Scientists and physicians have been chronicling this devastating medical condition for more than 3,000 years, from the origins of its discovery to the dramatic breakthroughs in its treatment.

The earliest known mention of diabetes appeared in 1552 B.C. in a 3rd Dynasty Egyptian papyrus authored by Hesy-Ra, one of the world’s first documented physicians, who wrote about an illness resulting in frequent urination...which we now know is one of the key symptoms of the condition. And in the first century A.D., ancient Greek physician Aretaeus vividly described the destructive nature of an illness which he named “diabetes,” derived from the Greek word “siphon” (meaning flowing through), and rendered the earliest account of diabetic patients’ intense thirst and “melting down of flesh and limbs into urine.” Diabetes indeed appears to have been a death sentence in the ancient era: Aretaeus did attempt to treat it, but could not provide a good prognosis. He commented that "life (with diabetes) is short, disgusting and painful.”

In the Middle Ages, diabetes was known as the “pissing evil.” And until the 11th century, diabetes was commonly diagnosed by “water tasters,” who tasted the urine of people thought to have diabetes to see if the excretion was sweet like honey. Thus, the Latin word “mellitus,” meaning honey, was added to the term diabetes.

Early Treatment of Diabetes

As physicians learned more about diabetes, they began to understand how it could be managed. One of the first diabetes treatments involved prescribed exercise, often horseback riding, which was thought to relieve excessive urination.

And one of the earlier connections between diabetes and diet was identified in 1870 while Paris was under siege by Germany during the Franco-Prussian war. French physician Apollonaire Bouchardat noted that glucose disappeared from the urine in some of his diabetes patients as a result of war-related food rationing. Bouchardat’s advice to his patients was “mangez le moins possible,” meaning “eat the least possible.” Consequently, a number of fad diabetes diets were introduced to treat diabetes, among them the “oat cure,” in which the majority of the diet was made up of oatmeal; the milk diet; the rice cure; and “potato therapy.” Italian diabetes specialist Catoni even went so far to isolate his patients under lock and key in order to get them to follow their special, low-carbohydrate diets.

At about the same time as Bouchardt’s discovery, German medical student Paul Langerhaus revealed in a dissertation that the pancreas–the gland responsible for producing the hormone insulin and releasing it into the bloodstream to regulate the body’s sugar level, among other functions–contains several systems of cells that were different than others in the pancreas and whose functions were unknown. Some of these cell clusters were eventually shown to be insulin-producing beta cells and became known as the “islets of Langerhans” in honor of the person who discovered them.

Despite these discoveries, diabetes continued to inevitably lead to premature death.

Discovering Insulin

The first big breakthrough that ultimately led to the use of insulin in treating diabetes occurred in 1889. German physiologist Oskar Minkowski and physician Joseph von Mering, researchers at the University of Strasbourg in France, were the first to remove the pancreas of a dog to determine the effect on digestion. The animal developed signs of diabetes and died soon thereafter, providing the first clue that the pancreas plays a key role in regulating the concentration of glucose.

Once the connection between the pancreas and diabetes was established, researchers’ efforts were focused on treating diabetes with pancreas extracts. Eventually researchers developed experimental pancreatic extracts that allowed diabetic dogs to properly digest food. In 1921, a young Canadian physician named Frederick

Banting theorized that pancreatic digestive juices could be harmful to the pancreas secretion produced by the islets of Langerhans. He wanted to ligate (bind with a bandage or ligature) the pancreatic ducts in order to stop the flow of nourishment to the pancreas, causing the pancreas to degenerate and lose its ability to secrete the digestive juices. The cells thought to produce an antidiabetic secretion could then be extracted from the pancreas without being harmed.

For the next year, Banting, medical assistant Charles Best and biochemist Bertram Collip tested his hypothesis and refined their approach in the laboratory, ultimately developing and purifying a pancreatic extract until the “insulin” treatment–named by Banting’s research sponsor Professor John Macleod–was refined and ready for human testing. They gave it to a young boy dying of diabetes, and within 24 hours the boy’s blood sugar had dropped to within normal limits.

The following year, Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine and, shortly thereafter, medical firm Eli Lilly began large-scale production of the extract and was producing enough insulin for patients throughout the North American continent within the year. Banting is honored for his extraordinary contribution by World Diabetes Day, which is held on his birthday, November 14.

Additional advancements in the diagnosis and treatment of diabetes mellitus followed the discovery of insulin. In the 1940s the link was made between diabetes and long-term complications with kidney and eye disease. In 1944, the standard insulin syringe was developed, ensuring diabetes management was more uniform. In 1953, tablets for testing urine glucose became widely available, and urine test strips appeared on the market the next few years. Sulfonylureas, oral drugs that help lower blood glucose levels, were introduced in 1955, which helped sufferers of type 2 diabetes control their blood sugar levels by stimulating the pancreas to develop more insulin. And in 1959, two major types of diabetes were recognized: type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes. In 1964, the first strips for testing blood glucose were used. The first blood glucose meter, costing approximately $500 and intended for use in doctors’ offices, was introduced in 1970, as was the insulin pump. The hemoglobin A1c test was devised in 1979 in order to create a more precise blood sugar measurement.

Where We Are Today

There’s no question that insulin is one of the most significant medical (and humanitarian) discoveries in history, but the path to a cure has remained elusive. And there are still many variables to diabetes that the medical community doesn’t fully understand.

Yet, although diabetes is still associated with a reduced life expectancy, the outlook for patients with the disease has improved dramatically. People with diabetes have a number of tools at their disposal to reduce their risk of health complications and can usually lead active and productive lives for many years after an initial diagnosis has been made.

As the 100th anniversary of the discovery of insulin approaches, diabetes researchers continue to work in earnest to find the answers to why we develop diabetes, with the goal to end diabetes forever.