History of Diabetes
The first written record we have of Type I Diabetes describes a condition that leaves it's victims in a state of constant thirst, severe urination, extreme weight loss, coma, and death. Polyuria, "excessive urination" as it was categorized by the Egyptian physician Hesy-Ra in 1552 BCE was one of the first recorded diseases in written history.
It was renamed Diabetes (meaning syphon in ancient Greek), and in the first century A.D. Aerateus the Cappadocian, a physician and student of the teachings of Hippocrates, had this to say...
"Diabetes is … not very frequent ... being a melting down of the flesh and limbs into urine … for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. It consists in the flesh and bones running together into the urine. The nature of the disease is chronic, but the patient does not live long once the disease is fully established; for the melting is rapid, the death speedy. Moreover life is disgusting and painful; thirst, unquenchable … and one cannot stop them either from drinking or making water".
Diabetes had worldwide recognition, and was also mentioned in the Ayur Veda of Susruta, India in the 6th century A.D..
It was observed in ancient China that the urine of untreated Diabetics attracts ants to the sugar it contains. The word Mellitus (Latin for sweetness) was added after sugar in the urine was confirmed. Thus the term sweet syphon was cretaed to describe the sugar lost in urine of those who suffered from Diabetes Mellitus.
In the Middle Ages in Europe "water tasters" were hired to diagnose Diabetes Mellitus.
Medical practice of the time was fraught with well intentioned but inadequate treatments and theories. In some cases sugar was given in large quantities in an attempt to replace that lost in the urine.... with catastrophic results.
The physiological response created by lack of insulin was that the body succumbed to catabolism; a breaking down of it's own muscle, body tissues, fat and cells to create the energy necessary for function and life. This led to rapid severe keto-acidosis and carbon dioxide/carbonic acid poisoning, vascular collapse, coma and swelling of the brain with attenuating neurological damage; which in all Type I Diabetes cases prior to insulin ended in early death in diagnosed children.
Over the next 300 years research about Diabetes was primarily directed towards extending an acute terminal prognosis, inhibiting blood sugar elevation, the symptoms of stomach issues, gut dysfunction, functional and nutritional deficiency, and mitigating the damage caused by these deficiencies and excess glucose in the blood.
By the 1800's treatment was primarily focused on correcting abnormalities in the body chemistry of the person with Diabetes seen in newly created laboratory testing. These included pulling all of a patient's teeth at the first signs of infection, and arsenic, alkali and ammonia given intravenously. Opium was prescribed to shut down appetite and lessen pain. Lyme and bicarbonate of soda enemas were performed to purge dysfunctional bowels, remove toxins and restore ph (alkaline) levels. Diets of whiskey, putrefied meat, rancid animal fat, milk, and prolonged fasting were normal protocols (Allen, 1919, p 10-79). The hypothesis in leading centers of the time was that Diabetes was caused by problems in the gut.
Astute physicians who had a good understanding of the mechanisms of Diabetes might place the person on a no carbohydrate, high fat diet to protect cells and lower blood sugars as much as possible. This could extend life expectancy as much as 24 months.
It became common practice to lock those with Diabetes in cells (usually sanitoriums), as a more humane way of preventing them from procuring the food they were desperate for, that accelerated the condition (Allen, 1919, p 10-79).
Some families financially able, would admit their children to asylums, or they would be admitted to sick children hospitals. For most families this was a place of hope... and for most it soon became the place where their children died.
An incorrect public perception of people with Diabetes being "weak" and "cheaters" and "mentally ill" was born from their starvation, physical illness, and medical treatment. These ideas have been socialized over decades into the fabric of society and the lives of those suffering from Diabetes, and are still very prevalent although less obvious today, in spite of the flaws in this perception of the illness, the difficulty it presents to the patient, and the nature of the metabolic dis-regulation it causes..
Many with Diabetes lived, and died, in isolation, with severe disability, catastrophic system failure, pain, social stigma, abandonment and institutionalization for a physical illness they had no control over, and no effective treatment for.
Diabetes had a lot of medical attention, as it was a non-infectious, acute terminal illness, with a short (48 hours to 24 months) prognosis in children and a relatively short prognosis once diagnosed in older adults. Patients were assigned case numbers and lost their names, which allowed for intensive experimentation with no personal attachment.
When a patient succumbed, it was simply referred to as the end of treatment (Allen, 1919, p 10-79).
In the early 1900's in a public address, U.S. President Franklin D. Roosevelt appealed to the country to cure polio. He personally suffered from polio and much attention was given to the condition. World War I broke out... polio research advanced, and Diabetes remained relatively silent in the public arena.
Enter Dr. Frederick Grant Banting, war hero and surgeon.
Banting was disillusioned with his recent experience of war and struggling to secure a position as a surgeon upon his return home. He was unsatisfied with the thought of becoming a general practitioner and felt that he needed to make a bigger contribution in the medical field of surgery.
Dr. Banting petitioned the University of Toronto, where J.R.R. McLeod, his future supervisor, was one of the leading Diabetes researchers of the time. He was granted an assistant (Charles Best) and was given a small lab. He was required to teach a pancreatic function physiology class to students (something he didn't have prior knowledge of), so he started to learn as fast as he could about how the pancreas worked. In exchange for this he was given 10 experiment animals, and a short time limit to prove the hypothesis (unproven idea about how something works), which he had developed from his study of the pancreas.
As Banting and Best worked, it became evident that they were running short on time and lab animals allotted them, so Banting started to work around the clock and purchased animals with his own meager pocket change. He was also spending time at The Sick Children's Hospital and witnessed the ravages of Diabetes on the patients there.
When news revealed his progress, Banting received a letter from the mother of a young girl dying from severe Diabetes Mellitus, pleading for his help in curing her daughter of the disease that was killing her. The girl was Elizabeth Hughes, her father was the Governor of New York, and combined with the constraints of Banting's circumstances, her plea was to change the world for all those with Diabetes.
On October 30, 1920 Dr. Banting made medical history with a note he scrawled on a piece of paper at his bedside after waking in the middle of the night.
Banting discovered that past failures were due to the reaction of trypsin, (a digestive enzyme) in the donor pancreas, destroying the insulin in the final reduced product, so he developed a specialized apparatus to separate the insulin without harm. This resulted in successful harvesting of life giving insulin. The new substance was harvested from pigs and cattle to create a usable form for humans. It was later discovered that calves had not yet developed trypsin and that insulin could be harvested from young animals without harm to the secretion.
The first person to receive insulin was Leonard Thomson.
Banting and Best then created patents to prohibit profit from the sale of insulin, making it readily available to all diabetics who needed it (Levine, 1959, p 120), and donated the product to the University of Toronto, who used the proceeds to further Diabetes research. The miracle hormone was released to the public in 1927 (Banting, McLeod, 1921). As it was a first line (naturally derived product) it was inexpensive to buy.
Insulin was proclaimed the cure for Diabetes by media, in spite of Dr. Banting's insistence that it was only a lifesaving treatment in need of further research.
The new designation IDDM (Insulin Dependent Diabetes Mellitus) was created to describe the children who now had hope for survival on the new hormone.
In 1923 Banting was awarded the Nobel prize in physiology and medicine, exceptional for a 31 year old surgeon who was unsure he would be able to teach a physiology class. He insisted that his assistant, Charles Best, be included as the co-discoverer of the new substance. As his educational supervisor, J.R.R. McLeod was also named, and he included another researcher named Kullip who had participated in isolating insulin in the Nobel award.
Sir Frederick Grant Banting M.D. died in a plane crash at the age of 49. He held at least seven honorary doctorates and a knighthood before his death in February of 1941.
Upon the release of insulin for public use in 1927, the treatments and ideas of the past, which included digestive system problems as a cohort in Diabetes and it's expression, were abandoned or changed. Diets and treatments were tailored to individual doctor's ideologies. The environment again became one of experimentation and forgetfulness of past research valuable to Diabetes advancement. Treatment centers were built, and Diabetes became sustainable, big business.
After the expiration of Dr. Banting's patents in the late 1940's, the world of insulin production was opened up to pharmaceutical companies. The race was on to develop synthesized insulin that could be produced cheaply and sold for profit.
Diabetes was not infectious so it presented an interesting opportunity, as providers were not personally impacted by it. Proctor Elliott Joslin MD, a leading endocrinologist of the late 1800's who did not have diabetes stated...
"Diabetes is the best of the chronic diseases because it is clean, seldom unsightly, not contagious, often painless and susceptible to treatment (CDA, 2008).
This ideology among many propagated further marginalization of the serious nature of Diabetes and created in its sufferers a major dilemma due to the incongruity of beliefs with the reality of those who suffered from Diabetes. It subsequently trickled into mainstream society as both lack of understanding and lack of support for the person with Diabetes.
To the present day many with Diabetes who are able, "pass" as normal or spend vast amounts of energy trying to prove they can function as normal, rather than risk the onslaught of stigma or discrimination they suffer due to this societal ignorance and the need to maintain a life that will financially support any chance at health or longevity.
We currently know that while it is not contagious, Diabetes is very painful, it is the number one cause of blindness, heart attack, stroke, kidney failure, amputation, vascular disease and is implicated in conditions such as cancer and other organ and endocrine gland failure. Daily management requires a multitude of invasive tests and self-delivery of medication on an ongoing 24 hour a day schedule with no breaks. This sets a stage for infection and compromise of immune function.
It is now understood that autoimmune diseases "cluster" with other autoimmune diseases. Those who have Diabetes are predisposed to Multiple Sclerosis, Lupus, Rheumatoid Arthritis, Sjogren's, Scleroderma, Hashimoto's Thyroiditis, Fibromyalgia, bone diseases and a bevy of other autoimmune and degenerative diseases, all of them crippling and serious but more so when combined with complications of Diabetes.
Current reporting of deaths related to Diabetes with the U.S. Bureau of Vital Statistics is highly inaccurate and does not reflect actual deaths as a result of Diabetes related conditions unless demanded by the family.
The recent projected numbers are: For every one death listed 4 go unlisted.
The Current Paradigm
If you ask most people they will tell you that those with Diabetes have received good medical treatment, drugs, and technological advances to assist them. Many who do not have Diabetes believe that the suffering and complications of Diabetes are preventable and those who struggle, do so because they refuse to follow recommendations.
Providers will state that management of Diabetes is not difficult, and those with the disease simply do not follow recommendations, emphasizing that patient compliance is the biggest problem in treating Diabetes. Nothing could be further from the truth of Diabetes... created by the socialization of Diabetes and it's treatment.
In 1974 a study was "attempted" by Dr. Allen (the psychiatrist not to be confused with the endocrinologist) on the socio-economic impact of Diabetes. This study was done to try to determine the real impact of Diabetes on an emotional and financial level for people with Diabetes and their families.
The study was subsequently halted and abandoned as "there was no way to establish a control (a normal to compare against) in the Diabetes environment" according to Dr. Allen. The findings were stated as follows: "The life of a person with Diabetes is so drastically impacted on every level that there is no way to compare it to what we consider "normal" in society. The impact of Diabetes is profound and cascades down through the whole family system".
Societal and medical mis-understandings and beliefs about Diabetes have created disconnect from the larger community and lack of support by society, which tends to view this serious illness as a moral/behavioral/lifestyle issue of weakness, and lack of self restraint, rather than the difficult to manage lifetime issue it presents.
These incorrectly biased perspectives undermine community support for people who are required to orchestrate a very complex survival program.
In 1980 new synthetic insulin's were released to the Diabetes population. These products today are grown on e-coli bacteria and suspended in phenols, poly-sorbates, propylene glycol and m-cresol compounds, for preservation and sterilization... chemicals the body is unable to process and eliminate effectively because no one makes the enzyme that metabolizes them, and they convert to formaldehyde in the body, which is toxic at very low levels.
People with Diabetes were not gaining ground on staying healthy longer than the first 15-25 years of diagnosis bought for them by Dr. Banting or lifestyle recommendations.
Synthetic insulin was becoming more expensive but not getting better at extending mortality or quality of life. Type 1 and II drugs were starting to prove detrimental causing heart attacks, Vitamin B deficiency dementia and other serious issues.
After the creation of the food pyramid in 1981 and it's subsequent application to the American diet, the Type II Diabetes dilemma accelerated, approaching today's pandemic status. This was parallel to a trend among Americans toward obesity, and sub-nutrition.
By 1987 American doctors... the good ones, were admitting that the food pyramid was the largest non-clinical experiment in history, and a failure. The corporate food industry was still warring over who got the biggest territory on the "pyramid/plate", and the most attention grabbing color.... using big money and lobbying to buy votes (consumer spending) by manipulating belief systems, wallets and the FDA. Today's plate does not even show fat, an essential nutrient.
Cognitive dissonance on a societal level became the norm as none of the theories about obesity paralleled the results of recommendations based on those same theories. The patient was blamed for his or her suffering resulting in victimizing the victim.
Over the next 20 years Corporate Food companies started building drive-through doughnut shops on freeway off ramps.
A discussion about normal levels of insulin in a non-diabetic body and how to maintain those levels was not offered and is still not offered amid the loose ideas about food to insulin dosing. This is still true and for the first time in 90 years of Type I Diabetes treatment there are now obese Type I patients who also have metabolic syndrome and pre-Type II Diabetes.
Flame of Hope
In 1989 Queen Elizabeth lit the Flame of Hope in London Ontario, Canada, at the Sir Frederick Grant Banting Memorial Park, to be extinguished when the cure for Diabetes was found.
It is still burning. There is no cure for Type I, Type II, or any other form of Diabetes... only management.
Lifting The Veil
From 1983 to 1993 the largest clinical study of Diabetes to date was launched.
The Diabetes Control and Complications Trial (DCCT) was a major clinical study conducted from 1983 to 1993 and funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The study attempted to show that keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage associated with Diabetes. The study compared the effects of standard control of blood glucose versus intensive control on the complications of Diabetes. Intensive control meant keeping hemoglobin A1C levels as close as possible to the "normal" (non-diabetic) value of 6 percent or less.
[The obvious problem here is that non-Diabetics do not have the other deficiencies and issues associated with Diabetes. An assumption was being made about what should constitute "normal" for a Diabetic], and also that blood sugar control and insulin would be the instruments to attain "normal" in a physiology that has many complex dynamics creating the disease state.
The results surprised the researchers. They found that reducing blood sugar levels was minimally helpful in slowing complications but did not prevent them. What the study did show was that the risk was very high of neurological damage as blood sugar levels consistently dropped into the low to borderline low ranges, and that in Diabetics it was difficult to stop the drop when levels were close to "non-Diabetic normal". They also had to acknowledge that many of the family members were terrified as they watched their loved one's experiencing life threatening seizures, and coma, as a result of the new study protocol.
We now know that low blood sugars over long periods deplete neurotransmitters important to other functions such as fight or flight response. Serotonin, dopamine, cortisol, adrenaline, epinephrine, and norepinephrine which are recruited when multiple low blood sugars deplete glycogen stores in the liver and the body has to bring blood sugars up were sacrificed, causing Hypoglycemic unawareness.
Further complicating this, the first attempt at the study had to be aborted, as the criteria were so intensive the participants could not accomplish them. The researchers started over, massaged the criteria, got a new group of even more intensive adherence patients, and off they went... to prove a point... without consideration for the other issues of Diabetes... or the effects of the insulin that were now presenting themselves as a question for further attention.
At the three year post study follow up, they found that no participant was able to successfully apply the criteria principles to everyday life over the three year period.
We consider this study to be a failure as it did not prove the original study hypothesis to be correct.
It also showed that no matter what research might think, the study criteria is not applicable in real life for extended periods; in our estimation changing the value of it for Diabetes health and requiring a new perspective of it as a poor behavior modification tool.
It was valuable because in meta-analysis it showed that to try to normalize Diabetic blood sugar levels to non-Diabetic blood sugar levels was a potentially disastrous action that needed reconsideration.
It also revealed that blood sugars were not the only participant in Diabetes complications.
To further compound this, in studies, the standard requirements are that 44% of participants have to experience success for the results of the study to be considered effective. That leaves out 56% of the study population. This number increases as the study results are applied in the general population.
This study had almost no long term applicability success.
But... the DCCT criteria has still been used as the gold standard in patient practice and compliance in spite of its failure, and is the communicated goal expected of those with Diabetes... in spite of understanding that it can bring on hypoglycemic unawareness, neurological damage, coma and death in a compliant patient, as low blood sugar response to tight control and the attenuating insulin reactions exhaust hormones, steroids and neurotransmitters that act as the primary and secondary low blood sugar response/recovery systems. If this is not addressed it can be permanent and also life threatening.
A statement was later released by medical professionals that stabilization of blood glucose is important, even if blood sugars are at slightly higher levels.
Cutting edge providers have relaxed the HA1c level to less than 7.0 rather than the original proposed 5.5, and without proper explanation created chaos and confusion in the Diabetes community based on the discrepancy between media publicizing of goal numbers and information given to patients by providers which ranges profoundly based upon their own understanding, or lack of it.
This does not begin to look at the difference between HA1c and blood sugar stability (standard deviation), or other causes of complications... the more important overarching issues.
The Tipping Point
In the 2005 edition of Joslin's Diabetes Mellitus textbook, Jeffrey Flier, dean of Harvard Medical School and an obesity researcher, and his wife and fellow researcher Terry Maratos - Flier, commented that "caloric reduction was the cornerstone of any therapy for obesity and then concluded that calorie restriction had no proven merit", exposing the dilemma of current thinking regarding obesity and ignorance of the actual mechanisms of health.
From 2003 - 2006 The United Nations seriously acknowledged Diabetes as an escalating crisis, rivaling any previously imagined in its ability to compromise nations, bankrupt governments, and render individuals disabled.
Diabetes was declared the only non-communicable disease in the history of the United Nations mandated for immediate action on a global level (sixty-first session of the general assembly, agenda item 113).
According to the World Health Organization and the United Nations, the disease has reached pandemic status. Deaths from Diabetes have surpassed those of Breast Cancer and Aids combined.
World Diabetes Day was established, and is recognized on November 14th (the birth date of Dr. Frederick Grant Banting).
We are now faced on a global level with the physical burden and financial impact of failure to understand the nature of Diabetes, and public silencing and shaming of Diabetes.
Diagnosis of all diabetes is now crossing age, fitness, geographic, ethnic and socio-economic boundaries once thought to be static.
Children are dying due to misdiagnosis by a medical community not educated to respond when parents bring them in due to illness, because they believe them to be too young... in an environment where diagnosis of both Type I and Type II is happening at increasingly higher rates and younger ages.
The Diabetes community has splintered as those with Diabetes and their families desperately try to gain advocacy and support for, and acknowledgement of, the nature of Diabetes in an environment that has buried it's head firmly in the sands of denial, and refusal to understand the disease as anything other than a behavioral and compliance issue.
The accelerating increase in both Type I and Type II Diabetes diagnosis is being acknowledged as unsustainable at a societal level as healthcare systems and governments buckle under the burden that families of those with Diabetes have carried for 94 years... and yet...
Most people in the USA do not know what the blue circle of Unite for Diabetes is... unless they have the disease and have looked for it.
A New Day
The Joslin Center, a leading U.S. Diabetes clinic since the late 1800's, now states that "further medical research has shown little correlation between blood sugar control and complication prevention or expression of the disease". In other words.... you can do everything right, according to treatment methods, and still suffer the complications of Diabetes. The Joslin Center has also listed high levels of insulin as a possible cohort in diabetes complications. This is not even looked at as the other side of the insulin coin currently.
After 80 years, and much pressure by patients, allopathic medicine is starting to take a second look at the gut and other factors of Diabetes, considered important all the way through the early 1900's, prior to insulin therapy; but it will take them a long time to catch up due to the constraints within the medical paradigm. Medical practice is known to be 50 -75 years behind science and functional medicine in these areas.
Current research has identified the T- cell that directly attacks beta cells as well as genes implicated in some secondary complications of Diabetes. It has also revealed that many people with long standing Diabetes still make insulin (a contradiction of current treatment ideology) and that insulin lack is due to ongoing immune attack; which has also brought understanding that if these T- cells can be "stopped" (Dr. Denise Faustman), or retrained (Dr. Shabahang), the pancreas would heal and beta cells would heal, reversing insulin dependence through a new treatment (currently in Phase II clinical human trials to determine dosing) that would be a better (but perhaps not complete) treatment, although a potentially better one than insulin.
Integrated Medicine, Naturopathy, and Holistic Medicine are ahead of the learning curve in many ways but still miss components of Type I Diabetes understanding, having gained their knowledge primarily with Type II Diabetes experience, and still lacking a complete understanding of Diabetes and particularly Type I.
Insurance companies have refused to provide the coverage that can make a world of difference in the management of Diabetes and complications outcomes of a person with Diabetes, and conversely, their own bottom line in the form of claims payouts.
Life saving insulin is not covered by many insurance companies and test strips that determine insulin dosing are also not covered by most insurance. As patients are both required to test in order to self treat with this hormone that can give or just as quickly take life determining the actual dosing themselves, this creates struggle for, and victimization of, the patient as the cost of these items is unnecessarily high.
Government understanding of Diabetes and ways to assist the Diabetes community, and government support, is sadly lacking, and the Diabetes community is grossly under-served.
Support on a societal level is almost absent and those with Diabetes are shamed and further victimized by an ignorant public, including friends and family even if well meaning because no one has asked what they really need to succeed. They are locked in a secondary battle to defend a disease they had no choice about... added to daily survival.
Medical practice, bio-technology and insurance coverage are only three of many components of Diabetes health. Combined with media they have done a huge disservice to the environment of diabetes in an attempt to make diabetes appear as if it is a problem that can be solved by patient diligence and buy in to products.
All Diabetics no matter the type want a cure... but until that day they want quality of life. The ability to live quality of life is what allows them to realize their dreams and desires, and fulfill their societal obligations... the fruition of their existence as humans. They agree that current medical and support paradigms are inadequate and want better options.
Most are so busy hoping... and working out of their own pockets... for the treatment and a cure, that they aren't aware of the abundance of options available to turn back the clock, or how to fight for a better paradigm, because their primary medical resources are unable to teach them due to licensing parameters.
In The Present
We are at the whim of the environment we live in when we choose not to engage the right battles... It is up to us to change the environment to maximize it and gain the edge. It is our mandate to rewrite our own history, for we who have Diabetes are the ones who have a genuine vested interest in it. In the present we are given the opportunity to change the way we and others perceive and navigate Diabetes to a new ideology based upon reality, accuracy, knowledge, experience, and compassion.
If "the cure" is still in the future... our beliefs and choices today are vitally important.
Silence and passing for normal are no longer a good option because it only buys us the illusion of "normal" from the perspective of the outside world...for a brief period. It also robs us of valuable support on all levels.
Engaging the right battles is our true chance at longevity and health.
In the current environment there is a wealth of information both new and historical, and a select group of people who can assist in navigating it. We can choose to build a better wheel, rather than settling for ever increasing disease treatment, or brittle hope and the infinite wait for a cure.
In a worldview that values the hero, we can benefit immensely from redefining ours to include those who successfully walk the paths long-term without the aid of immense financial resources, for they are the everyday heros, along with those who are challenging the current beliefs, modeling them and learning from them, so that we might emerge as a new breed ... our own hero... birthed from the triumphs and mistakes of those who have gone before us to show us where to tread... or not.
For a list of these and other valuable sources please send request to: firstname.lastname@example.org