Diabetes Before and After Insulin

Abstract

FiPTy YEARS AGO, a research project was under way at the University of Toronto that would soon revolutionize the treatment of diabetes. The first public announcement was made on 14 November 1921. The reports that an extract of pancreas had demonstrated life-saving effects were at first received with scepticism, incredulity, and faint hope. But soon the miracle of insulin was everywhere acclaimed. THE STATUS OF A DIABETES TREATMENT BEFORE INSULIN After five decades, it may be difficult for those who were unacquainted with diabetes in the pre-insulin days, to realize how much of a miracle was this discovery that transformed a disease, so often hopeless, to a disorder now subject to control or alleviation. I find myself among the dwindling numbers of active physicians who can recall from direct observation what the management of diabetes was like in those days. Having been admitted to medical school as a teenager, I also had the good fortune to be an eyewitness of events at the University of Toronto. My own boyhood memories bring to mind three examples of diabetic disasters, then not uncommon. First, a neighbour, a man in his late fifties, began to have severe pain in one of his toes, causing constant suffering and loss of sleep. Then to his horror it began to turn black. His family doctor called it gangrene and confirmed the diagnosis of diabetes which he himself had feared, since a brother and several members of his family had been diabetic. A surgeon, consulted in the hope that the gangrenous toe could be amputated, was unwilling to operate. He stated that, with diabetes, healing would fail to occur. The man was bedridden for months as the gangrene extended into his foot. Finally death came to end his suffering. Second, this man's daughter was found, years later, to have diabetes and tuberculosis. She died from so-called galloping consumption. Third, a young sister of one of my schoolmates, with diabetes in an early stage, was treated with the Allen 'starvation diet' then in vogue. Introduced by Dr. Frederick M. Allen, and promoted by Dr. Elliott P. Joslin, dietary restriction of extreme degree was then the chief hope for juvenile diabetics. The results for this girl at first appeared successful, but suddenly diabetic coma developed and she was gone. Cases such as these were known in every community. When I became a medical student, I studied The Principles and Practice ofMedicine written by Osler and McCrae,1 a textbook universally used at that time by medical students in Toronto. I read with particular interest the section on diabetes. This book * Presented at the Annual Symposium of the

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“…Thus, he proposed that DM treatment should be based on a high fat and protein rich diet with low carbohydrates. This modification of diet became the recommended treatment for diabetes until the discovery of insulin[65].…”

Predictors of Success for Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy: A Retrospective Review

“…A patient diagnosed with diabetes could expect a shortened life, often enduring extreme diets and many infections and complications [4,5].The discovery and first extraction of insulin in 1921 by scientists Fredrick G. Banting, Charles H. Best, James B. Collip, and J.J.R. MacLeod began a new era in the treatment of diabetes [4,6]. Prior to this time, many extreme treatments were attempted, including the use of opium, exceptional personal hygiene, and extreme starvation diets; however, none of these treatments proved to provide effective diabetes management and extend the lives of those inflicted with the condition [6].…”

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