Fatal Thirst: Diabetes in Britain until Insulin

Changing social and scientific discourses on type 2 diabetes between 1800 and 1950: a socio‐historical analysis

“…The final methodological challenge encountered relates to establishing what physicians understood and meant by the term diabetes as a disease category; a problem that is complicated by the fact that conventional western medicine did not begin to differentiate ‘type 1’ and ‘type 2’ versions of the condition until the early to mid‐20 th century (Furdell ). This raises the possibility that the writings of some physicians prior to this date may not in fact be referring to type 2 diabetes, but instead to the less common type 1 version of the condition, the onset of which appears to be less influenced by socioeconomic position.…”

“…Firstly, type 1 diabetes is an acute illness that usually occurs in childhood and is characterised by the breakdown of the pancreas and an inability to produce insulin. It was a grave, crippling disorder with no effective cure until the discovery of insulin in the 1920s (Furdell ) Anyone unfortunate to develop the illness prior to the 1920s probably had their young life cut short within a matter of months – if not weeks – of diagnosis, despite the best interventions of their doctor. In contrast, type 2 diabetes generally occurs in middle age and is characterised by insulin resistance; the symptoms of which may not manifest for many years.…”

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Sick, isolated in their misery… dysfunctional in their personal habits, and unwelcome among strangers and friends alike, diabetics of the past caused serious consternation in their families and incurred social judgments about who or what was to blame. (Furdell : 121)

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Balance and the ‘good’ diabetic in Britain, c.1900–60

“…41 Followers of humoral traditions had prescribed a mixture of regimen changes, drug treatments and dietary plans in a bid to restore equilibrium, a broad outline that persisted through to the twentieth century despite radical changes in content and rationale. 42 With the development of the hospital system in Britain, and the spread of scientific dieting for diabetes in the early 1900s, initiating treatment could require lengthy institutionalisation, at least where patients received charitable admission to hospital or could afford private care. Doctors gradually placed less emphasis on hospital admission over the interwar period, even for starting insulin, but once admitted patients could stay for weeks to titrate dose and receive education about injections.…”

“…80 Texts in the 1900s and 1910s tended to couch discussions of cause and treatment of diabetes in traditions that linked overstimulation to bodily disturbance via the nervous system. 81 For instance, discussing the aetiology of diabetes in 1913, one textbook suggested that diabetes had 'been observed to follow … traumatic and other lesions of the nervous centre' and had 'apparently been traceable occasionally to emotional shock, anxiety, and mental strain' . 82 Minimising such nervous disturbances became an important element of treatment.…”