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History Of Type 1 Diabetes

Treating Diabetes: 1921 To The Present Day

Treating Diabetes: 1921 To The Present Day

The lives of people with diabetes has changed considerably in 50 years. They now have specific tools and easier access to information than ever before. The healthcare professionals who treat them also know more about the complexity of the disease, and which treatments work best. Pending the next medical revolution, Diabetes Québec is demanding the implementation of a national strategy to fight diabetes – a strategy founded on education, prevention, support and treatment. The last 60 years have clearly demonstrated that people with diabetes who are well informed, properly supported and treated appropriately live longer lives in better health. The discovery of insulin and glycemic control Insulin, discovered in 1921 by the legendary Banting, Best and MacLeod collaboration, is nothing short of a miracle. Worldwide, it has saved thousands of patients from certain death. Before the discovery of insulin, diabetics were doomed. Even on a strict diet, they could last no more than three or four years. However, despite the many types of insulin and the first oral hypoglycemic agents that came to market around 1957 in Canada, glycemia control – the control of blood glucose (sugar) levels – still remains an imprecise science. In the 1950s, the method a person used to control his blood glucose levels was to drop a reagent tablet into a small test tube containing a few drops of urine mixed with water. The resulting colour – from dark blue to orange – indicated the amount of sugar in the urine. Even when they monitored their patients closely, doctors realized that blood glucose levels had to be much better controlled in order to delay the major complications significantly affecting their patients’ lives: blindness, kidney disease, gangrene, heart attack and stroke. A disc Continue reading >>

The History Of Type 1: Where We’ve Been And Where We’re Going

The History Of Type 1: Where We’ve Been And Where We’re Going

WRITTEN BY: Alexi Melvin If you’re a person with Type 1 diabetes, or have a loved one with it — you’ve certainly witnessed advancements in care as well as improved advocacy for the disease over the years. Things seem to be looking up, (and I’m not talking about our A1Cs)! It wasn’t always this way though. In fact, it took thousands of years from its first mention in history for the development of insulin, which permitted basic management of the disease. Here is a look at the secret history of diabetes and how we got to where we are today. You may be surprised by the T1D journey on this bumpy road. Life before Insulin 1550 BC: Earliest Mention The earliest traceable mention of diabetes in history came from an ancient Egyptian papyrus, speaking of a disease that causes rapid weight loss and frequent urination. Sound familiar? Unfortunately, no remedy is mentioned. 1000s AD: Diagnosis Early physicians used the “uroscopy” method by examining the urine to diagnose diabetes mellitus (mellitus meaning “honey” in Latin). One tactic was to taste the urine to determine if there was sweetness. 1915: The Starvation Diet Shortly before the discovery of insulin, diabetes specialists would often promote an extremely low-calorie diet, and prolonged fasting to minimize symptoms. The downside of this remedy was — not surprisingly — starvation. 1916: Dogs really are our best friends! The first experimental tests with extracts of the pancreas were performed on diabetic dogs – successfully lowering their blood sugar. These experiments were the basis for other work that lead to the first successful treatment in a human with Type 1 in 1922. Today, trained service dogs continue to be our furry allies as Diabetic Alert Dogs, aka “DADs!” These pups are taught to recog Continue reading >>

Type 1 Diabetes: Medical History And Physical Exam - Topic Overview

Type 1 Diabetes: Medical History And Physical Exam - Topic Overview

Symptoms of type 1 diabetes usually happen quickly. If ignored, the diagnosis of type 1 diabetes may happen in an emergency room or hospital. If your doctor thinks that you might have type 1 diabetes, he or she may ask questions about your symptoms, family history of the disease, and personal medical history. Questions for the medical history may include the following: Have you had increased thirst, increased urination, and fatigue? How long have the symptoms been present? Have you had an increase in appetite? Have you lost weight lately? Is there a family history of diabetes? What other medical conditions do you have? What medicines are you are currently taking? Have you been ill recently? Has growth and development progressed normally (if the person is a child)? Your doctor will also give you a complete physical exam. You will continue having exams on a regular basis if you are diagnosed with this disease. The physical exam includes: Measuring your height and weight. Children and teens will have their height and weight compared to standards that are normal for their age groups. Checking your blood pressure. For adults, blood pressure may be checked while standing and sitting. Checking your eyes. Feeling your neck to evaluate your thyroid gland. Thyroid problems sometimes develop in people who have diabetes. Listening to your heart and lung sounds and checking the blood flow (pulses) in your arms, legs, and feet. Checking for signs of dehydration, such as loose skin, a dry mouth, or sunken eyeballs. Checking alertness, if you are very ill. Checking your feet for problems including corns, calluses, blisters, cuts, cracks, or sores. Continue reading >>

The Pathogenesis And Natural History Of Type 1 Diabetes.

The Pathogenesis And Natural History Of Type 1 Diabetes.

Cold Spring Harb Perspect Med. 2012 Nov 1;2(11). pii: a007641. doi: 10.1101/cshperspect.a007641. The pathogenesis and natural history of type 1 diabetes. College of Medicine, Departments of Pathology and Pediatrics, The University of Florida, Gainesville, 32610-0275, USA. [email protected] The purpose of this article is to provide an overview that summarizes much in the way of our current state of knowledge regarding the pathogenesis and natural history of type 1 diabetes in humans. This information is presented to the reader as a series of seminal historical discoveries that, when advanced through research, transformed our understanding of the roles for the immune system, genes, and environment in the formation of this disease. In addition, where longitudinal investigations of these three facets occurred, their roles within the development of type 1 diabetes, from birth to symptomatic onset and beyond, are discussed, including their most controversial elements. Having an understanding of this disorder's pathogenesis and natural history is key for attempts seeking to understand the issues of what causes type 1 diabetes, as well as to develop a means to prevent and cure the disorder. Images from this publication. See all images (4) Free text Model of the pathogenesis and natural history of type 1 diabetes. The modern model expands and updates the traditional model by inclusion of information gained through an improved understanding of the roles for genetics, immunology, and environment in the natural history of T1D. (Adapted from ; with permission.) Cold Spring Harb Perspect Med. 2012 Nov;2(11):a007641. Model for type 1 diabetes as a relapsing-remitting disease. (A) Graph showing the stepwise, nonlinear decline of -cell mass over time, as well as the development of autoa Continue reading >>

History Of Diabetes

History Of Diabetes

The beginnings Diabetes has been affecting lives for thousands of years. An ailment suspected to be diabetes was recognized by the Egyptians in manuscripts dating to approximately 1550 B.C. According to one study, ancient Indians (circa 400–500 A.D.) were well aware of the condition, and had even identified two types of the condition. They tested for diabetes — which they called “honey urine” — by determining if ants were attracted to a person’s urine. The term “diabetes” In Greek, “diabetes” means “to go through.” Greek physician Apollonius of Memphis is credited with naming the disorder for its top symptom: the excessive passing of urine through the body’s system. Historical documents show that Greek, Indian, Arab, Egyptian, and Chinese doctors were aware of the condition, but none could determine its cause. In earlier times, a diagnosis of diabetes was likely a death sentence. Insulin deficiency In the early years of the 20th century, medical professionals took the first steps toward discovering a cause and treatment mode for diabetes. In 1926, Edward Albert Sharpey-Schafer announced that the pancreas of a patient with diabetes was unable to produce what he termed “insulin,” a chemical the body uses to break down sugar. Thus, excess sugar ended up in the urine. Physicians promoted a fasting diet combined with regular exercise to combat the disorder. Diabetes in dogs Despite attempts to manage the disorder through diet and exercise, people with diabetes inevitably died prematurely. In 1921, scientists experimenting with dogs had a breakthrough in reversing the effects of diabetes. Two Canadian researchers, Frederick Grant Banting and Charles Herbert Best, successfully extracted insulin from healthy dogs. They then injected it into dogs th Continue reading >>

The History Of Diabetes

The History Of Diabetes

Scientists and physicians have been documenting the condition now known as diabetes for thousands of years. From the origins of its discovery to the dramatic breakthroughs in its treatment, many brilliant minds have played a part in the fascinating history of diabetes. Diabetes: Its Beginnings The first known mention of diabetes symptoms was in 1552 B.C., when Hesy-Ra, an Egyptian physician, documented frequent urination as a symptom of a mysterious disease that also caused emaciation. Also around this time, ancient healers noted that ants seemed to be attracted to the urine of people who had this disease. In 150 AD, the Greek physician Arateus described what we now call diabetes as "the melting down of flesh and limbs into urine." From then on, physicians began to gain a better understanding about diabetes. Centuries later, people known as "water tasters" diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word "mellitus," meaning honey, was added to the name "diabetes," meaning siphon. It wasn't until the 1800s that scientists developed chemical tests to detect the presence of sugar in the urine. Diabetes: Early Treatments As physicians learned more about diabetes, they began to understand how it could be managed. The first diabetes treatment involved prescribed exercise, often horseback riding, which was thought to relieve excessive urination. In the 1700s and 1800s, physicians began to realize that dietary changes could help manage diabetes, and they advised their patients to do things like eat only the fat and meat of animals or consume large amounts of sugar. During the Franco-Prussian War of the early 1870s, the French physician Apollinaire Bouchardat noted Continue reading >>

History Of Diabetes

History Of Diabetes

Origin of the term ‘diabetes’ The term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from the Greek word diabetes meaning siphon - to pass through and the Latin word mellitus meaning honeyed or sweet. This is because in diabetes excess sugar is found in blood as well as the urine. It was known in the 17th century as the “pissing evil”. The term diabetes was probably coined by Apollonius of Memphis around 250 BC. Diabetes is first recorded in English, in the form diabete, in a medical text written around 1425. It was in 1675 that Thomas Willis added the word “'mellitus'” to the word diabetes. This was because of the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians as is evident from their literature. History of the treatment of diabetes Sushruta, Arataeus, and Thomas Willis were the early pioneers of the treatment of diabetes. Greek physicians prescribed exercise - preferably on horseback to alleviate excess urination. Some other forms of therapy applied to diabetes include wine, overfeeding to compensate for loss of fluid weight, starvation diet, etc. In 1776, Matthew Dobson confirmed that the sweet taste of urine of diabetics was due to excess of a kind of sugar in the urine and blood of people with diabetes. In ancient times and medieval ages diabetes was usually a death sentence. Aretaeus did attempt to treat it but could not give a good outcome. Sushruta (6th century BCE) an Indian healer identified diabetes and classified it as “Madhumeha”. Here the word “madhu” means honey and combined the term means sweet urine. The ancient Indians tested for diabetes by looking at whether ants were attracted to a person's u Continue reading >>

The 30-year Natural History Of Type 1 Diabetes Complications

The 30-year Natural History Of Type 1 Diabetes Complications

The 30-Year Natural History of Type 1 Diabetes Complications Georgia Pambianco; Tina Costacou; Demetrius Ellis; Dorothy J. Becker; Ronald Klein; Trevor J. Orchard Declining incidences in Europe of overt nephropathy, proliferative retinopathy, and mortality in type 1 diabetes have recently been reported. However, comparable data for the U.S. and trend data for neuropathy and macrovascular complications are lacking. These issues are addressed using the prospective observational Pittsburgh Epidemiology of Childhood-Onset Diabetes Complications Study. Participants were stratified into five cohorts by diagnosis year: 19501959, 19601964, 19651969, 19701974, and 19751980. Mortality, renal failure, and coronary artery disease (CAD) status were determined on the complete cohort (n = 906) at 20, 25, and 30 years. Overt nephropathy, proliferative retinopathy, and neuropathy were assessed at 20 and 25 years on the subset of participants with a clinical examination. There was a decreasing trend by diagnosis year for mortality, renal failure, and neuropathy across all time intervals (P < 0.05), with the 19501959 cohort having a fivefold higher mortality at 25 years than the 1970s' cohorts. Proliferative retinopathy and overt nephropathy showed nonsignificant declines at 20 years (P < 0.16 and P < 0.13, respectively) and no change at 25 years. CAD event rates, which were lower than the other complications, also showed no trend. Although some type 1 diabetes complications (mortality, renal failure, and neuropathy) are declining, others (CAD, overt nephropathy, and proliferative retinopathy) show less favorable changes by 30 years. A decreasing incidence of diabetes complications, particularly overt nephropathy and proliferative retinopathy, has been reported in the type 1 diabetes pop Continue reading >>

Natural History Of Type 1 Diabetes.

Natural History Of Type 1 Diabetes.

Abstract The natural history of autoimmune type 1 diabetes in children is associated with the appearance of islet autoantibodies early in life, which is influenced by genetic and environmental factors. Once islet autoantibodies have developed, the progression to diabetes in antibody-positive individuals is determined by the age of antibody appearance and by the magnitude of the autoimmunity, in turn related to the age of the subject. Characteristics that describe the magnitude of the autoimmunity can stage progression to type 1 diabetes in islet autoantibody-positive subjects regardless of genetic background or age. Continue reading >>

History Of Type 1 Diabetes Treatments

History Of Type 1 Diabetes Treatments

by Huong-Thao Le, 2011 Doctor of Pharmacy Candidate LEECOM, Bradenton, FL The discovery of insulin in 1921 was one of the greatest medical breakthroughs in history. Individuals, mostly children with Type 1 diabetes, whose life expectancies were measured in months were now able to prevent fatal ketoacidosis by taking injections of crude “soluble” (later known as regular) insulin. Of course, new problems were soon noted. Hypoglycemia, occasionally life-threatening, was encountered as diabetes monitoring by urine testing for glycosuria was crude at best during those first years after the discovery of insulin. The insulin itself was often impure and varied in potency from lot to lot. Allergic reactions were common and occasionally anaphylaxis would occur. Even more concerning was the appreciation that these patients often succumbed to chronic vascular complications which either dramatically reduced quality of life or resulted in a fatal cardiovascular event. The tools to manage individuals with Type 1 diabetes have improved over the decades since the discovery of insulin. These initial insulins were all manufactured from bovine or porcine pancreata and production techniques have also become more efficient. Insulins with longer durations of action were first introduced in the 1930s, and over time these insulins improved in their purity and consistency of potency. Nevertheless, “standard” animal insulins prior to 1972 contained 80,000 parts per million (8%) impurities, enough to elicit local reactions when injected as well as systemic effects. By way of comparison, all insulins sold in the United States today contain less than 10 parts per million impurities. Major improvements in the tools to manage Type 1 diabetes were developed in the late 1970s and early 1980s. No Continue reading >>

History Of Diabetes

History Of Diabetes

Frederick Banting (right) joined by Charles Best in office, 1924 Diabetes is one of the first diseases described[1] with an Egyptian manuscript from c. 1500 BCE mentioning “too great emptying of the urine.”[2] The first described cases are believed to be of type 1 diabetes.[2] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[2] The term "diabetes" or "to pass through" was first used in 250 BC by the Greek Apollonius of Memphis.[2] Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 CE with type 1 associated with youth and type 2 with obesity.[2] The term "mellitus" or "from honey" was added by Thomas Willis in the late 1600s to separate the condition from diabetes insipidus which is also associated with frequent urination.[2] Further history[edit] Plaque in Strasbourg commemorating the 1889 discovery by Minkowski and Von Mering The first complete clinical description of diabetes was given by the Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE), who also noted the excessive amount of urine which passed through the kidneys.”[3] Diabetes mellitus appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the disease was incurable. Aretaeus did attempt to treat it but could not give a good prognosis; he commented that "life (with diabetes) is short, disgusting and painful."[4] The disease must have been rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[2] In medieval Persia, Avicenna (980–1037) provided a detailed account on diabet Continue reading >>

Natural History Of Type 1 Diabetes

Natural History Of Type 1 Diabetes

The natural history of autoimmune type 1 diabetes in children is associated with the appearance of islet autoantibodies early in life, which is influenced by genetic and environmental factors. Once islet autoantibodies have developed, the progression to diabetes in antibody-positive individuals is determined by the age of antibody appearance and by the magnitude of the autoimmunity, in turn related to the age of the subject. Characteristics that describe the magnitude of the autoimmunity can stage progression to type 1 diabetes in islet autoantibody–positive subjects regardless of genetic background or age. Type 1 diabetes is a chronic inflammatory disease caused by a selective destruction of the insulin-producing β-cells in the islets of Langerhans (1). The incidence of type 1 diabetes has consistently increased worldwide during the last decades, especially in children and developed countries (2). Type 1 diabetes is associated with the appearance of humoral and cellular islet autoimmunity (1), and a defective immunoregulation appears to be involved (3). The exact etiology and pathogenesis of type 1 diabetes, however, is still unknown. The model of the natural history of type 1 diabetes suggests stages that commence with a genetic susceptibility, autoimmunity without clinical disease, and finally clinical diabetes (4). Over the last 15 years, several groups have initiated prospective studies from birth examining the development of islet autoimmunity and diabetes (5–8), providing an opportunity to test such theoretical models in patients developing type 1 diabetes. Findings from these studies have significantly contributed to our current understanding of the pathogenesis of childhood diabetes. We now know when islet autoantibodies first appear in life, some of the g Continue reading >>

Extended Family History Of Type 1 Diabetes And Phenotype And Genotype Of Newly Diagnosed Children

Extended Family History Of Type 1 Diabetes And Phenotype And Genotype Of Newly Diagnosed Children

Extended Family History of Type 1 Diabetes and Phenotype and Genotype of Newly Diagnosed Children Anna Parkkola , MD,1 Taina Hrknen , PHD,1 Samppa J. Ryhnen , MD, PHD,1 Jorma Ilonen , MD, PHD,2,3 Mikael Knip , MD, PHD,1,4,5 and the Finnish Pediatric Diabetes Register* 2Immunogenetics Laboratory, University of Turku, Turku, Finland 3Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland 1Childrens Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland 4Folkhlsan Research Center, Helsinki, Finland 5Department of Pediatrics, Tampere University Hospital, Tampere, Finland 1Childrens Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland 2Immunogenetics Laboratory, University of Turku, Turku, Finland 3Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland 4Folkhlsan Research Center, Helsinki, Finland 5Department of Pediatrics, Tampere University Hospital, Tampere, Finland Corresponding author: Mikael Knip, [email protected] . Received 2012 Mar 6; Accepted 2012 Jul 26. Copyright 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. To determine the frequency of newly diagnosed diabetic children with first- and second-degree relatives affected by type 1 diabetes and to characterize the effects of this positive family history on clinical markers, signs of -cell autoimmunity, and HLA genotype in the index case. Children (n = 1,488) with type 1 diabetes diagnosed under 15 years of age were included in a cross-sectional study from the Finnish Pedi Continue reading >>

The Pathogenesis And Natural History Of Type 1 Diabetes

The Pathogenesis And Natural History Of Type 1 Diabetes

Type 1 diabetes (T1D) is a disorder that arises following the autoimmune destruction of insulin-producing pancreatic β cells (Atkinson 2001; Bluestone et al. 2010). The disease is most often diagnosed in children and adolescents, usually presenting with a classic trio of symptoms (i.e., polydypsia, polyphagia, polyuria) alongside of overt hyperglycemia, positing the immediate need for exogenous insulin replacement—a medicinal introduction to the disorder whose therapeutic practice lasts a lifetime. These introductory facets having been said, many other etiological and typology-based aspects for this disease remain either unclear or subject to significant debate within the medical research community. Among these are questions related to the percentage of T1D cases that are diagnosed in adults, a figure whose estimates range from a low of 25% to as much as 50% (Thunandera et al. 2008). Indeed, multiple factors contribute to this knowledge void, one being a failure in understanding the percentage of T1D cases that are errantly misclassified as type 2 diabetes (T2D). Specifically, it has been proposed that ∼5%–15% of adults diagnosed with T2D may, in actuality, have T1D (for review, see Palmer et al. 2005). Were this true, the notion that 90%–95% of all diabetes cases are diagnosed as T2D would mean that the number of T1D cases is likely far underestimated. Attempts to distinguish T1D cases from those with T2D have also resulted in a proposed new disease classification, Latent Autoimmune Disease of Adults (LADA) (for review, see Leslie et al. 2008). However, over this past decade, the lack of firm diagnostic criteria for LADA, taken together with other notions (e.g., genetic similarity between those with T1D and the so-called LADA patients), have dramatically decre Continue reading >>

Historical Aspects Of Type 1 Diabetes

Historical Aspects Of Type 1 Diabetes

The first recognisable reports of type 1 diabetes – a condition presenting in children or young adults and terminating in fatal ketoacidosis – appeared towards the end of the 19th century. Clinicians were soon able to distinguish this aggressive form of diabetes from the more indolent late-onset type, but the link between insulin sensitivity, susceptibility to diabetic ketoacidosis and body-build was not made until the mid-20th century. Final acceptance that there were two main forms of diabetes was delayed until the 1970s, by which time juvenile diabetes was seen to have the characteristic hallmarks of an autoimmune disease. Diabetes presenting in children or young adults and terminating in fatal ketoacidosis first appeared in the medical literature in the 19th century, but this was a very rare clinical condition. Physicians were already aware that there were different types of diabetes. Harley commented in 1866 that 'there are at least two distinct forms of the disease requiring diametrically opposing forms of treatment', and Etienne Lancereaux made the distinction between fat (diabete gras) and thin (diabete maigre) diabetes. At that time, overweight adults could manage reasonably well with diet restriction, but there was no effective treatment for children. The starvation regimen introduced by Frank Allen in 1911 could prolong a miserable life, but the children typically died of ketoacidosis, tuberculosis or starvation within months of diagnosis. The discovery of insulin in 1921–2 was one of the closest approaches to a secular miracle in the history of medicine.[1] Survival was closely related to age at diagnosis (see Figure). Clinicians struggled to understand the difference between young thin patients who required insulin for life, and the older fatter indiv Continue reading >>

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