Before insulin’s groundbreaking discovery, a diabetes diagnosis presented a stark and often fatal prognosis. The disease, characterized by the body’s inability to regulate blood sugar, forced individuals and medical practitioners to employ rudimentary and often desperate measures, highlighting the immense medical challenge it posed for centuries.
Early Recognition of Diabetes
Observations of diabetes can be traced back thousands of years, with ancient civilizations noting its symptoms. Egyptian manuscripts from around 1550 B.C. described excessive thirst and frequent urination. Around 600 B.C., Indian physicians identified “madhumeha,” or “honey urine,” due to its sweet taste; ants were even used to test for this sweetness.
Greek physicians, such as Aretaeus of Cappadocia in the 2nd century AD, described the disease, coining “diabetes” (meaning “to go through” or “siphon”) to reference rapid fluid loss. He noted the “melting down of the flesh and limbs into urine” and the illness’s chronic, often fatal nature.
In the 17th century, Thomas Willis added “mellitus” to the term, acknowledging the urine’s sweet taste. These early recognitions were based purely on observable symptoms.
Dietary Management as the Primary Approach
Without understanding diabetes’s internal mechanisms, dietary interventions became the primary survival strategy. Early attempts included exercise (like horseback riding) or varied feeding approaches. These methods were largely ineffective. By the late 19th and early 20th centuries, before insulin, dietary management became more formalized, focusing on carbohydrate restriction.
Physicians like Frederick Allen developed “starvation” or “under-nutrition” diets. These diets drastically limited caloric intake (sometimes 400-800 calories daily) with minimal carbohydrates. The rationale was to reduce blood and urine sugar, lessening symptoms. Patients on these strict diets often consumed only small amounts of protein and fat, such as eggs, meat, and leafy green vegetables.
While such extreme measures could briefly prolong life by mitigating severe hyperglycemia and ketoacidosis, they came at a severe cost. Patients suffered extreme hunger, weakness, and significant weight loss, becoming emaciated. Adherence was challenging, and the diets did not cure the disease; they merely delayed its progression.
The Harsh Realities of Pre-Insulin Life
Life for individuals diagnosed with diabetes before insulin was difficult and typically short. Children, especially those with what is now known as Type 1 diabetes, had a grim prognosis, often succumbing within months or a few years. Their bodies, unable to utilize glucose, wasted away, leading to severe emaciation.
Complications were frequent. Patients experienced constant thirst, frequent urination, and weakness. They were highly susceptible to infections. Metabolic imbalance often led to toxic byproduct accumulation, resulting in diabetic ketoacidosis. This severe state caused abdominal pain, nausea, vomiting, and eventually, a coma, which was almost always fatal. Even with stringent dietary controls, the disease relentlessly progressed, making a normal lifespan impossible.
The Transformative Discovery of Insulin
The landscape of diabetes treatment was revolutionized in 1921 with the discovery of insulin. A team of researchers at the University of Toronto, including Frederick Banting, Charles Best, John Macleod, and James Collip, isolated insulin from the pancreas. This breakthrough demonstrated that the pancreas produced a substance that regulated blood sugar, and its absence led to diabetes.
Insulin’s immediate impact was dramatic. The first human patient, a 14-year-old boy named Leonard Thompson, received insulin in 1922 and showed remarkable improvement. What had been a death sentence transformed into a manageable chronic condition.
Patients who were on the brink of death, emaciated and comatose, were brought back to health, gaining weight and strength. This discovery saved countless lives and fundamentally changed diabetes understanding and treatment.