Discovering the history of diabetes

Last week I listened to the Memory Palace's latest podcast about Elizabeth Hughes and it made me interested in the history of diabetes research and treatment. Like most things, I've only become interested in diabetes research since being diagnosed myself. I was ignorant of how doctors use to treat people with diabetes before the discovery of insulin until last week.

Since reading about how the treatment has been developed, I realize that like most of the medicine keeping me alive, I'm lucky to be born in this era in Canada where double lung transplants happen on a regular basis and insulin is readily available.

Elizabeth Hughes was another person who, like me, was fortunate enough to be born at the right time. Unlike me, whose treatments have been around for years and have been studied and tested on those who came before me, was treated at the exact moment when insulin became available to the public.  

Diabetes has been known to doctors since 869 AD when the pancreas was discovered but no one knew what it did. Progress in understanding the body and diagnosing diabetes was made over the years as doctors recognized the patient's sugary urine and that food played a role but there was no treatment. The life expectancy after being diagnosed with diabetes was one year, if you were lucky. 

A major break-through happened when French physician Apollinaire Bouchardat realized his diabetic patients had fewer symptoms, and actually improved, during the food rations of the 1871 Franco-Prussian War. He developed specialized diets to try and curb the symptoms. Fasting became the new treatment.

Dr. Allen of the Rockefeller Institute in New York took the fasting idea to a new level where children with - what we would now call type-1 - diabetes were hospitalized and basically starved to death for their health. The life expectancy after diagnosis went from one year to possibly three as the children no longer died from their diabetes but instead starvation.

I can't imagine how hard it would've been for the doctors, nurses, and families to slowly starve their children to death out of a willingness to keep them alive an extra few months. All in hopes that a treatment would be around the corner. One child, having gone blind from diabetes, requested some song birds to keep him company as he wasted away in the hospital. His request was granted until he was found to have sugar in his urine and it was discovered he was eating the bird's birdseed as a desperate attempt for food. The birds were taken away and he eventually died of starvation.

Elizabeth Hughes, the daughter of wealthy US senators, was one of these patients admitted to the New York hospital in 1919, at the age of 10 under the care of Dr. Allen. She lived at the hospital for three years and weighed 45 pounds and was eating 405 calories a day by 1922.

In 1921, the breakthrough that everyone had been hoping for finally happened. Dr. Banting and Dr. Best (from Canada) discover that an extract from cattle pancreas lowered the blood sugar of dogs who had been given diabetes (by having their pancreas removed). This meant a supply of cheap insulin was suddenly available and it worked.

The first patient to receive an insulin injection was Leonard Thompson, age 14, at the Toronto General Hospital, on January 11, 1922. Not much is known about him but he, like Elizabeth Hughes, had been hospitalized three years prior, weighed 65 pounds, and was drifting in and out of diabetic comas at the time. His father agreed to the experimental treatment in an attempt to save his life. The first injection didn't do much to improve his health but the second, a more pure injection of insulin worked. His glucose levels were restored to normal and he lived another 13 years before dying from pneumonia at 27.

With that success, Dr. Allen rushed his high profile patient, Elizabeth to Toronto in August 1922, to begin injections. She responded immediately and began to eat a normal diet and gained her weight back. She died at the age of 71.

I feel for all the children who were starving in hospitals who would've died during that window from between when insulin was discovered to when it became widely available in October 1923. Only the families with contacts like Elizabeth were able to get treatment. 

Life is so delicate that the balance between life and death can be such a tight rope that we don't always recognize. It often just comes down to being born at the right time, in the right country, to the right parents.

I sometimes think of all the treatments and medications that are currently being developed and wonder if I'll be around when they become widely available. What treatment might I miss by a year or two that would have changed my life dramatically. And then I realize I need to be thankful that I'm alive in a time where CF treatments were available, and lung transplants, and chemotherapy, and, of course, insulin. 

I took it all for granted when I was diagnosed with diabetes and was given an insulin pen and a glucose monitor. I don't have to draw up insulin in vials, or check my urine for my glucose levels. It's all done with machines that have the capability of connecting with a phone to chart the results. 

Another part of the history of diabetes that I thought was interesting and had long-term effects on the culture of medicine for everyone was that diabetes treatment was one of the first times patients wrestled their care away from doctors. 

"The notion of allowing patients to test their own urine for glucose and calculate their own insulin doses was outlandish to most doctors. Diabetes was the first illness which forced them to cede some medical authority to the patient, said Jean Ashton, one of the exhibit’s curators. With insulin, diabetics suddenly acquired both the right and the responsibility to maintain their own health."
- New York Times, 2003




Sources for this blog post:

http://thememorypalace.us/2017/11/elizabeth/

http://www.nytimes.com/2003/03/16/magazine/the-way-we-live-now-3-16-03-body-check-the-bittersweet-science.html

http://www.nytimes.com/2010/10/05/health/05insulin.html?pagewanted=all

http://www.diabetes.ca/about-diabetes/history-of-diabetes