History Of Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitusclinical Presentation

Type 1 Diabetes MellitusClinical Presentation Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The most common symptoms of type 1 diabetes mellitus (DM) are polyuria, polydipsia, and polyphagia, along with lassitude, nausea, and blurred vision, all of which result from the hyperglycemia itself. Polyuria is caused by osmotic diuresis secondary to hyperglycemia. Severe nocturnal enuresis secondary to polyuria can be an indication of onset of diabetes in young children. Thirst is a response to the hyperosmolar state and dehydration. Fatigue and weakness may be caused by muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Muscle cramps are caused by electrolyte imbalance. Blurred vision results from the effect of the hyperosmolar state on the lens and vitreous humor. Glucose and its metabolites cause osmotic swelling of the lens, altering its normal focal length. Symptoms at the time of the first clinical presentation can usually be traced back several days to several weeks. However, beta-cell destruction may have started months, or even years, before the onset of clinical symptoms. The onset of symptomatic disease may be sudden. It is not unusual for patients with type 1 DM to present with diabetic ketoacidosis (DKA), which may occur de novo or secondary to the stress of illness or surgery. An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM. Over time, patients with new-onset type 1 DM will lose weight, despite normal or increased appetite, because of depletion of water and a catabolic state with reduced glycogen, proteins, and triglycerides. Weight loss may not occur if treatment is initiated promptly after the onset of the Continue reading >>

Patient Education: Diabetes Mellitus Type 1: Overview (beyond The Basics)

TYPE 1 DIABETES OVERVIEW Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin (figure 1). Insulin is a hormone that helps the body to absorb and use glucose and other nutrients from food, store fat, and build up protein. Without insulin, blood glucose (sugar) levels become higher than normal. Type 1 diabetes requires regular blood sugar monitoring and treatment with insulin. Treatment, lifestyle adjustments, and self-care can control blood sugar levels and minimize the risk of disease-related complications. Type 1 diabetes usually begins in childhood or young adulthood but can develop at any age. In the United States, Canada, and Europe, type 1 diabetes accounts for 5 to 10 percent of all cases of diabetes. Other topics that discuss type 1 diabetes are available: (See "Patient education: Diabetes mellitus type 1: Insulin treatment (Beyond the Basics)".) (See "Patient education: Care during pregnancy for women with type 1 or 2 diabetes mellitus (Beyond the Basics)".) THE IMPACT OF TYPE 1 DIABETES Being diagnosed with type 1 diabetes can be a frightening and overwhelming experience, and it is common to have questions about why it developed, what it means for long-term health, and how it will affect everyday life. For most patients, the first few months after being diagnosed are filled with emotional highs and lows. You and your family can use this time to learn as much as possible so that diabetes-related care (eg, self-blood sugar testing, medical appointments, daily insulin) becomes a "normal" part of your routine. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) In addition, you should talk with your doctor or nurse about re Continue reading >>

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 >>

Diabetes Mellitus Type 1

Diabetes mellitus type 1 (also known as type 1 diabetes) is a form of diabetes mellitus in which not enough insulin is produced.[4] This results in high blood sugar levels in the body.[1] The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss.[4] Additional symptoms may include blurry vision, feeling tired, and poor healing.[2] Symptoms typically develop over a short period of time.[1] The cause of type 1 diabetes is unknown.[4] However, it is believed to involve a combination of genetic and environmental factors.[1] Risk factors include having a family member with the condition.[5] The underlying mechanism involves an autoimmune destruction of the insulin-producing beta cells in the pancreas.[2] Diabetes is diagnosed by testing the level of sugar or A1C in the blood.[5][7] Type 1 diabetes can be distinguished from type 2 by testing for the presence of autoantibodies.[5] There is no known way to prevent type 1 diabetes.[4] Treatment with insulin is required for survival.[1] Insulin therapy is usually given by injection just under the skin but can also be delivered by an insulin pump.[9] A diabetic diet and exercise are an important part of management.[2] Untreated, diabetes can cause many complications.[4] Complications of relatively rapid onset include diabetic ketoacidosis and nonketotic hyperosmolar coma.[5] Long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.[4] Furthermore, complications may arise from low blood sugar caused by excessive dosing of insulin.[5] Type 1 diabetes makes up an estimated 5–10% of all diabetes cases.[8] The number of people affected globally is unknown, although it is estimated that about 80,000 children develop the disease each year.[5] With Continue reading >>

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 >>

Type 1 Diabetes

Print Overview Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy. Different factors, including genetics and some viruses, may contribute to type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults. Despite active research, type 1 diabetes has no cure. Treatment focuses on managing blood sugar levels with insulin, diet and lifestyle to prevent complications. Symptoms Type 1 diabetes signs and symptoms can appear relatively suddenly and may include: Increased thirst Frequent urination Bed-wetting in children who previously didn't wet the bed during the night Extreme hunger Unintended weight loss Irritability and other mood changes Fatigue and weakness Blurred vision When to see a doctor Consult your doctor if you notice any of the above signs and symptoms in you or your child. Causes The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet, or islets of Langerhans) cells in the pancreas. Other possible causes include: Genetics Exposure to viruses and other environmental factors The role of insulin Once a significant number of islet cells are destroyed, you'll produce little or no insulin. Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas). The pancreas secretes insulin into the bloodstream. Insulin circulates, allowing sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secre Continue reading >>

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 >>

The Pathogenesis And Natural History Of Type 1 Diabetes

Abstract 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. 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% (Thu Continue reading >>

The 3 Stages Of Type 1 Diabetes Development

Home / The 3 Stages of Type 1 Diabetes Development The 3 Stages of Type 1 Diabetes Development Type 1 diabetes is a medical disorder characterized by the autoimmune destruction of the pancreatic islet cells, eventually leading to the absence of the production of insulin and other important hormones. The lack of insulin results in a decreased ability of glucose to enter the cells, leading to hyperglycemia , or high blood glucose levels. Type 1 diabetes is believed to be caused by the combination of a genetic predisposition and an environmental trigger. Formerly known as juvenile diabetes, type 1 diabetes can be diagnosed in childhood, as well as in adulthood. In fact, between 25% and 50% of type 1 diabetes diagnoses today occur in individuals over 18 years old. The main symptoms of untreated type 1 diabetes include: Frequent infections and slow wound healing Individuals with type 1 diabetes must monitor their blood glucose levels and administer exogenous insulin via injections or an insulin pump to allow for glucose metabolism. Left untreated, the condition is deadly and suboptimal management can result in numerous complications, including micro- and macrovascular problems in numerous organ systems as well as nerve damage. However, with optimal blood glucose control, the likelihood of complications can be minimized. There are several main steps in the typical pattern of developing of type 1 diabetes: Islet cell autoimmunity, characterized by the presence of autoantibodies, A decrease in beta cell mass that reduces insulin production and results in slightly elevated blood glucose levels, and Overt hyperglycemia accompanied by the clinical symptoms of diabetes. A diabetes diagnosis is typically made based on blood glucose levels and the hemoglobin A1c test. In general, tw Continue reading >>

The History Of Diabetes Mellitus

Go to: Diagnosis Willis, a London physician, epitomised the true spirit of scientific enquiry by his bold action of tasting the urine of his patients—possibly because the passage of copious urine seemed to be the hallmark of the disease! This was a supreme and extreme example of bedside testing leading to labelling a patient as diabetic if his urine was ‘honeyed’.13 Urine strips in the 1960s and the automated ‘do-it-yourself’ measurement of blood glucose through glucometers, produced by Ames Diagnostics in 1969, brought glucose control from the emergency room to the patient’s living room. It imbued diabetic patients with a new sense of freedom, making the disease more comprehensible and manageable. Routine blood sugar tests at prescribed intervals continued for a long time until the introduction of the glycosylated haemoglobin (HbA1c) estimation. That test, which measured blood glucose control over the previous three months (linked to the life of red blood cells), defined an extremely important aspect of diabetes management—tight control of blood glucose levels.14 The latter directly determined the risk of the occurrence of devastating complications of target organs like the eyes, vessels, nerves and kidneys that ultimately influenced morbidity and mortality. Continue reading >>

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 >>

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 >>

History Of Diabetes: Past Treatments And New Discoveries

Diabetes is a condition characterized by high blood sugar levels. It affects millions of people around the world. Research into diabetes is ongoing but diabetes is simple to manage for most people. Since diabetes was first discovered, there have been huge improvements in the way it is treated. This article looks at the history of diabetes and how these treatments developed. Contents of this article: Diabetes affects blood sugar levels The body gets energy from sugar (glucose), which is broken down from the food people eat. Diabetes affects insulin. Insulin is a hormone produced in the pancreas that helps in the process of using this sugar efficiently. People with type 1 diabetes do not produce insulin. People who have type 2 diabetes do produce insulin, but their body is unable to use it efficiently. When a person has diabetes, the lack of insulin or the body's inability to use it properly, causes sugar to stay in the blood rather than entering the cells to be used for energy. This excess sugar in the blood results in higher than normal blood sugar levels. Having high blood sugar levels for an extended period can cause serious and even life-threatening problems. However, there are many ways the condition can be managed so that these problems are avoided. Early science around diabetes Understanding the history of diabetes and how it was first treated can help us to appreciate how well it is understood and managed today. Discovery of diabetes The full name for diabetes is diabetes mellitus. This term comes from the Greek word "diabetes" (to siphon or pass through) and the Latin word "mellitus" (honey or sweet). The first use of the term "diabetes" can be traced back to Apollonius of Memphis around 250 BC. The first English record of diabetes in a medical text occurred aro Continue reading >>

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 >>

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 >>