Diabetes revisited: A review of the history, the current state of medical management and what the future may hold
Submitted by Mary Ellen Buechel Holbrook, RN, BA, BSN, CPAN, CCRN
The History of Diabetes
An article published in "the History of Medicine: from Ancient Egypt to modern medicine", Falk, (2015) states that as early as 1550 BC diabetes was described as a rare disease that causes the patient to lose weight and urinate frequently. The first word "diabetes" which in Greek means "to go through" received its name because Greek physicians observing people with diabetes noted that they drained more fluid than they could consume. Around the Eleventh century, when scientists began examining the quality of urine, the term "mellitus" was added. Mellitus means "honey in urine" which refers to the sweet taste of the urine of a patient with diabetes. Scientists also observed that ants were attracted to the urine of people with diabetes which they deduced was because of the sweetness of the urine.
Less than one hundred years ago, according to Karamanou, Tsoucalas, Androultsos, and Poulakou-Rebelakou (2016) in the "World Journal of Diabetes", two scientists Oskar Minkowski, and Joseph Von Mering conducted experiments with dogs. Through their experiments they demonstrated the role of the pancreas in the maintenance of glucose homeostasis. Less than 100 years ago, in 1923, the pioneering work of two more scientists, Banting and Best led to the world's first commercially available insulin. Thus, the disease that many years earlier was virtually a "death sentence", became a disease that with the administration of insulin would allow diabetics to live a normal life. An article published by the Diabetes Research Institute (2019) states that by the 1940's the life expectancy of a person with diabetes was increasing such that a person diagnosed with diabetes at the age of ten, could live until the age of forty-five.
Less than fifty years ago, several long-acting insulins were developed. In 1972, U-100 insulin was introduced and in 1985 the first insulin pen delivery system became available. By 1996, short acting insulin was discovered and in 2001, long acting insulin was discovered. In 1977, an important development in diabetes testing was the introduction of the HbA1c test. After the first glucose meter was developed in 1969, smaller home glucometers became available.
The Current state of Medical Management
Today, many medications treating Type II diabetes have been introduced. Television advertisements feature happy folks enjoying normal lives because they are taking a new medication. Diabetes education classes teach diabetics and their supportive spouses, partners, and family members how to manage their diabetes through healthy, lower carbohydrate diets, exercise and adhering to prescribed medications.
For many years, scientists thought there were only two types of diabetes, but according to the Diabetes Research Institute, "Diabetes Types" (2019), there are a number of different types of diabetes. The types of diabetes described in this article include Gestational diabetes, Maturity Onset Diabetes of the Young (MODY), Latent Autoimmune Diabetes of adulthood (LADA), Double diabetes, Type 3 Diabetes, Steroid Induced Diabetes, Brittle Diabetes and Secondary Diabetes. In the article Type 1.5 diabetes (2019) the editor states that doctors may mistakenly diagnose LADA as type 2 diabetes and that about 15-20% of people diagnosed with type 2 diabetes may actually have Type 1.5. When I was first diagnosed with Diabetes eight years ago, I had never heard of LADA. My doctor assured me that my athletic lifestyle is what kept me from being diagnosed twenty years earlier. At that time, her assurance was a poor respite, but once I considered all the research and advances in treatment over the past 5-7 years, I realized she was right. For those who are not familiar with LADA, it is a form of diabetes that develops later in adulthood. The article in Diabetes LADA (2019) the principle investigator Professor David Leslie, states that LADA is a form of type I diabetes as it is an autoimmune disease, but initially is non-insulin requiring. It may take 1-2 years before the person with LADA has to start on insulin. For myself, after about one year, I had to begin taking Lantus, a long-acting insulin, and about 6 months later had to start on low dose, short-acting insulin. LADA is often referred to as type 1.5 as it is a form of type 1 insulin with characteristics of type 2. What has been so frustrating to me over these past eight years, is watching TV commercials advertising another new and "wonderful" drug for type 2 Diabetes; but nothing for LADA! However, to my tempered excitement I found articles that describe research into treatments for type 1 diabetes.
What the Future may hold
In an article by Paddock (2018) in Medical News Today, scientists from the University of Copenhagen in Denmark and the Helmholtz Zentrum Munchen in Neuherberg, Germany have mapped the signals that determine the destiny of progenitor cells in the pancreas. According to these scientists immature progenitor cells can develop into either islet cells that make insulin or another type of cell. Professor Henrik Semb from the Institute of Transitional Stem Cell Research has stated that they have been able "to map the signal that determines whether pancreatic progenitor cells will become endocrine, such as insulin-producing beta cells, or duct cells." Another article by Paddock (2018) also in Medical News Today, describes how scientists have developed a way to increase islet transplantation. Because of problems encountered with rejection, other scientists are working on ways to protect transplanted islet cells. One of the obstacles in islet cell transplantation is the fact that just as with organ transplants, recipients would then be on drugs to prevent immune rejection of the transplanted islet cells In this same article, the author describes the work of scientists in developing methods such as microencapsulation to overcome barriers encountered in islet cell transplantation. In an article by Jephcote, (2019) "Blue light used to switch on and off insulin release in new study", the author describes the work of researchers in the transplantation of insulin-producing beta cells. Experimentation with mice has shown that these cells can be switched on and off by blue light.
Living with Diabetes: a Patient's Perspective
According to the "National Diabetes Statistics Report" (2017) published by the Centers for Disease Control and Prevention (CDC), in 2015 there were approximately 30.3 million people in the United States with diabetes. As of eight years ago, I became one of those people. I'm adopted and for years, friends of mine would sometimes ask me if I was ever concerned about the fact that I had no idea regarding my medical history. Being an athlete, I would smugly reply "I just do what makes me fill good." Then one day after my routine yearly labs at my hospital, one of the ARNPs called me. She sounded almost as if she had seen a ghost. The ARNP said, "Mary Ellen, your glucose is 144 and your A1C is 7.4!" I didn't believe it and requested a repeat. The repeated lab was unchanged. Over the last eight years I have experienced a decrease in the strength and energy in my leg muscles. Truly, diabetes has affected the "love of my life"; which is running. I don't ever leave my house without my Gatorade chews in case my sugar drops. But, although I run much slower than I did before diabetes, I keep on running. I just ran a marathon, December 1st and I came in after the awards ceremony had concluded. I did manage to win my age group, but I was the only woman in my age group. Still my husband, family and friends at work were so proud of me. Looking back at the beginnings of even the discovery of diabetes mellitus many centuries ago, I realize that although I despise this disease, had I been diagnosed even 50 years ago, I probably would not be running even slow marathons. So I eagerly look to the brilliant scientists to make their awesome discoveries in my lifetime. With these scientific advances made in recent years, as one who suffers from LADA, I am confident that in my lifetime, these scientists will persevere and through their endeavors I will someday, be free from administering insulin before each meal and at night. In the meantime, I am determined that although LADA has affected my life in so many ways, I will persevere; I am not going to let it defeat me.
- History of Diabetes: From Ancient Egypt to Modern Medicine E. Porter, medically reviewed by S. Falck October 25, 2017.
Retrieved from: www.healthline.com/health/history-type-1-diabetes
- World Journal of Diabetes, January 10, 2016, p1-7,
Retrieved from: www.nlm.nlm.gov/pmc/articles/PMC4707300
- Diabetes History-History of Diabetes Mellitus
Retrieved from: www.diabetes.co.uk/diabetes-history.html
- Diabetes Types-Different Types of Diabetes, January 15, 2019
Retrieved from: www.diabetes.co.uk/diabetes-types.html
- Type 1.5 Diabetes, January 15, 2019
Retrieved from: www.diabetes.co.uk/type15-diabetes.html
- Diabetes LADA, January 15, 2019
Retrieved from: www.diabetes.co.uk/diabetes_lada.html
- C. Paddock, Type 1 diabetes: Drawing nearer to treatment that generates new insulin cells, Medical News today, December 3, 2018
Retrieved from: www.medicalnewstoday.com/articles/323865.php
- C. Paddock, Fact checked by G. D'Emillio Type 1 diabetes: New Pancreatic cell transplant system shows promise, May 17, 2019
Retrieved from: www.medicalnewstoday.com/articles/325204.php
- B. Jephcote, Blue light used to switch on and off insulin release in new study, November 5, 2019
Retrieved from: www.diabetes.co.uk/news/2019/nov/blue-light-used-to-switch-in-and-off-insulin-release-in-new-study-98426947.html
- Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report, 2017