When I Decided to Live With Diabetes...

Other symptoms of diabetes may include frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in the hands or feet, a frequent lack of energy, very dry skin, sores that are slow to heal, and an increase of infections.

50. Case one of exhibit

There are three primary types of diabetes:

• Type 1 diabetes or insulin-dependent diabetes mellitus is juvenile-onset and accounts for 5-10% of all diagnosed cases. Its risk factors are relatively undefined.
• Type 2 diabetes or non-insulin-dependent diabetes mellitus is adult-onset and accounts for 90-95% of all diagnosed cases. Risk factors include older age, obesity, family history of diabetes, history of gestational diabetes, and impaired glucose tolerance. African Americans, Latino Americans, Native Americans, and some Asian Americans and Pacific Islanders are at particularly high risk.
• Gestational diabetes develops in 2-5% of all pregnant women, usually disappearing when the pregnancy ends. Nearly 40% of women who develop gestational diabetes develop Type 2 diabetes later.

Diabetes can lead to amputations of the lower limbs and other serious health problems such as heart disease, blindness, and kidney failure. It is the seventh leading cause of death in the United States.

Currently, there is no known cure for diabetes. Dietary adjustments and insulin injections simply make an average lifespan and relatively normal existence possible for a diabetic. However, successful treatment of the disease most often involves radical adjustments to one's lifestyle because of the required exercise, diet, blood sugar testing, medication and medical expenses.

Diabetes: A history

In the 17th century, diabetes was called "the pissing evile" because a person with severe diabetes would urinate as much as 10-15 quarts per day. Later, it became known as "the sugar disease" when physicians found diabetics' urine to be sweet to the taste. This "taste-test" became the primary check for diabetes. For centuries, the treatment of diabetes met continual failure. In the 19th century, doctors advised extra nourishment to compensate for the body's lack. This idea was refined in the 1850s to recommend large quantities of sugar. Progress began only when the reverse was suggested and patients were put on diets free of carbohydrates. Until 1889, the physiological characteristics of diabetes were unknown and its connection to the pancreas was uncertain. That year, two researchers, arguing about the digestion of fat, removed the pancreas of a laboratory dog, who immediately became diabetic. After that, treatments for diabetes developed in two camps: the more traditional "starvation treatments," where nutrition was dramatically reduced until sugar in the urine was eliminated; and the "pancreatic extract treatments," where fluids produced by the pancreases of dogs were injected to compensate for a patient's dysfunctional pancreas. This latter method was inspired as much by successful thyroid extracts as by the 1889 laboratory dog experiment; but it consistently caused such toxic effects as severe fever and shock, and even death.

51. Case two of exhibit containing scale

52. Frederick Grant Banting (1891-1941) Bliss, Michael. The Discovery of Insulin. Toronto: McClelland and Stewart Limited, 1982.

In 1920, Frederick Banting, a Canadian physician and surgeon, developed an idea for separating what is now known as insulin from other pancreatic enzymes. This step was needed to reduce the toxic effect of the extracts. Because his medical training had been cut short by World War I and his experience was mainly in performing surgery on wounded soldiers, Banting was not considered qualified to do medical research. Nevertheless, J.J.R. Macleod, Professor of Physiology at the University of Toronto, gave him a laboratory and a research assistant in May of 1921 to test his idea. By the end of the summer, they noted the first signs of success; in May of 1922, they announced their discoveries to the medical world and began to collaborate with Eli Lilly and Company for the production and purification of insulin.

For months, even after their discovery was announced, the production of insulin was problematic. By October of 1922, several hundred diabetics were being treated with insulin. However, the hormone was difficult to obtain because an effective method for mass production had not yet been found. By 1923, a wider distribution of insulin became possible and Banting and Macleod were awarded the Nobel Prize. Skeptics remained, however, for several reasons: pancreatic extracts had a long history of failure; diabetics were not cured by insulin but, instead, were dependent on it; side effects persisted as better purification methods were pursued. It is this skepticism that prevented John Dannenfelser's use of insulin until 1927, when it was administered against his doctor's recommendation and saved his life.

53. John James Rickard Macleod (1876-1935) Bliss, Michael. The Discovery of Insulin. Toronto: McClelland and Stewart Limited, 1982.

Excerpts from Dannenfelser's manuscript.