Diabetes has been with us for a long time. Here’s diabetes history in a convenient timeline.
1552 BC – Written on a 3rd Dynasty Egyptian papyrus, physician Hesy-Ra mentions frequent urination as a symptom. This is the earliest known record of diabetes.
1500 BC — Ancient Hindu writings note that ants are attracted to the urine of people with a mysterious emaciating disease.
500 BC — The first descriptions of sugar in the urine and its occurrence in obese individuals.
250 BC — Apollonius of Memphis is credited with coining the term “diabetes”, meaning to go through, or siphon, for a disease that drains patients of more fluid than they can consume.
1st Century AD – The Greeks describe the disease as “a melting down of the flesh and limbs into urine.”
164 AD – Greek physician, Galen of Pergamum, diagnoses diabetes as a kidney ailment.
Up to 11th Century – Since the urine of people with diabetes is thought to be sweet tasting, diagnosis is often made by “water tasters” who drink the urine of those suspected of having diabetes. Mellitus, the Latin word for honey, is added to the term “diabetes”.
16th Century – Paracelsus identifies diabetes as a serious general disorder.
For thousands of years, no one knows how to live with diabetes, let alone treat or cure it. Children with diabetes often die within days of onset and older people deal with devastating complications. Remedies range from herbs to bleeding.
1776 – Dobson finds a substance like brown sugar in appearance and taste when diabetic urine evaporates. He also notes a sweetish taste of sugar in the blood of diabetics. He observes that, for some people, diabetes is fatal in less than five weeks and, for others, is a chronic condition. This is the first time that a distinction between Type 1 and Type 2 has been made.
1797 – Rollo applies the first significant dietary approach to the treatment of diabetes. He successfully treats a patient using a high fat and protein diet after observing that sugar in the urine increases after eating starchy food.
1798 – Rollo documents excess sugar in the blood, as well as the urine.
Early 1800’s – Researchers develop the first chemical tests to indicate and measure the presence of sugar in the urine.
1848 – Bernard discovers that glycogen is formed by the liver and speculates that this is the same sugar found in the urine of diabetics. This is the first linking of diabetes and glycogen metabolism.
Late 1850s – The French physician, Priorry, advises diabetes patients to eat extra large quantities of sugar as a treatment. Oops! This won’t be the last time that strange and unhelpful treatments for diabetes will be tried.
1869 – Langerhans, a German medical student, announces the pancreas contains two types of cells – one set secretes the normal pancreatic fluids, while the function of the other is unknown. Later, these cells are identified as the “islets of Langerhans”, which help produce the hormone insulin.
1870s – French physician, Bouchardat, notices the disappearance of sugar in the urine of his diabetes patients during the food rationing in Paris during the Franco-Prussian War and formulates the idea of individualized diets.
1889 – Minkowski and von Mering, at the University of Strasbourg, France, remove the pancreas from a dog to determine the effect on digestion and discover that diabetes develops.
In 1897, the average life expectancy for a 10-year-old child with diabetes is about 1 year. Diagnosis at age 30 carries a life expectancy of about 4 years. A newly diagnosed 50-year-old might live 8 more years.
1908 – Zuelzer extracts a pancreatic “substance” and injects it into five diabetes patients. Although sugar in the urine is reduced or disappears, the side effects of treatment are extreme and unacceptable.
1909 – de Meyer of Belgium proposes the name “insulin” (Latin: insula, island) for the unknown pancreatic substance.
1911 – Benedict devises a new method to measure urine sugar (Benedict’s Solution).
1900-1915 – Diabetes treatment includes: the “oat-cure” (daily allowance is approximately eight ounces of oatmeal mixed with eight ounces of butter, eaten every two hours), the milk diet, the rice cure, “potato therapy”, opium, and overfeeding to compensate for the loss of fluids and weight.
1913 – Allen’s book, Studies Concerning Glycosuria and Diabetes, stimulates a revolution in diabetes therapy.
1910-1920 – Allen and Joslin are considered the two leading diabetes specialists in the United States. Joslin believes that diabetes is “the best of the chronic diseases” because it was “clean, seldom unsightly, not contagious, often painless and susceptible to treatment”.
1916 – Allen promotes a strict diet regimen, which is soon widely adopted. Allen believes that the diabetic’s body cannot use food, so he limits the amount of food allowed patients. Patients were admitted to the hospital and given only whiskey mixed with black coffee (or clear soup for teetotalers) every two hours from 7 am to 7 pm. This diet is followed until there is no sign of sugar in the urine – usually 5 days or less. A strict diet follows. Outcomes are better than ever seen before for those with Type 2 diabetes. Unfortunately, those patients with Type 1 commonly die during the treatment, likely from starvation. A few young people do survive and become the first insulin users.
1919 – Allen publishes Total Dietary Regulation in the Treatment of Diabetes, with exhaustive case records and observations of 76 of his 100 diabetes patients. He becomes the director of diabetes research at the Rockefeller Institute.
1920 – Banting conceives of the idea of insulin after reading Moses Barron’s The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis in the journal: Surgery, Gynecology and Obstetrics. With help from Best, Collip and Macleod, Banting continues experimenting with different pancreatic extracts on de-pancreatized dogs.
1921 – Paulescu, a distinguished Romanian scientist, publishes an article describing his successful isolation of “pancreine” – insulin.
1921 – Insulin is “discovered”. A de-pancreatized dog is successfully treated with insulin.
1921 – Banting presents The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes, summarizing his work at a session of the American Physiological Society at Yale University.
1922 – In Toronto, one of Collip’s insulin extracts is tested on a human being, a 14-year-old boy named Leonard Thompson. This test is considered a success by the end of the following February.
1922 – Eli Lilly and the University of Toronto strike a deal for the mass production of insulin in North America.
1923 – Banting and his colleague, Macleod, are awarded the Nobel Prize in Physiology or Medicine. Banting shares his award with Best; Macleod shares his with Collip.
While insulin can prevent early death from diabetic coma, insulin treatment does not prevent the chronic, disabling and sometimes deadly complications of the disease.
1923 – Eli Lilly begins commercial production of insulin. The Toronto group calls the substance “insulin”; Eli Lilly calls their product “Isletin Insulin.”
1925 – Home testing for sugar in the urine is introduced. Eight drops of urine is mixed in a test tube with 6 cc of Benedict’s solution provided by the doctor. The tube is put into boiling water for five minutes. The color of the liquid indicates the presence of sugar: greenish (light sugar), yellow (moderate) or red/orange (heavy).
1930s – Insulin is further refined. Protamine zinc insulin, a long acting insulin that provides greater flexibility for diabetics, is introduced. (It actually remained on the market until several years ago.)
1936 – Research by Himsworth (UK) divides diabetics into two types based on “insulin sensitivity.”
1940’s – The connection is made between diabetes and long-term complications such as kidney and eye disease.
1944 – A uniform insulin syringe is developed and diabetes management becomes more standardized.
By 1945, a newly diagnosed 10-year-old has a life expectancy of 45 years; a 30-year-old has 30.5 more years; and a 50-year-old might have 16 more years to live.
1948 – Joslin writes about the “unknown diabetic” in Postgraduate Medicine. Although a million people are known to have diabetes, he speculates a million more have it but don’t know it. He is the first expert to emphasize that insulin alone cannot solve all diabetes-related issues.
Late 1940’s – Helen Free develops the “dip-and-read” urine test (Clinistix), allowing instant monitoring of blood glucose levels.
1950s – Specialists still recommend against marriage for people “with hereditary diabetes”.
1951 – Lawrence and Bornstein measure the amount of insulin in the blood. They find that older and obese patients with diabetes do have insulin, but those who are young have none.
1955 – Oral drugs that help lower blood glucose levels are introduced.
1959 – Two major types of diabetes are recognized: Type 1 (insulin-dependent) diabetes and Type 2 (non-insulin-dependent) diabetes.
1960’s – Home testing for glucose levels in the urine increases the level of control for people with diabetes.
1964 – The first strips for testing blood glucose are used. A drop of blood is placed on the paper strip for 1 minute, and then washed off. Comparing the color to a color chart provides a rough indication of blood glucose levels.
1965 – Instant glucose is developed.
1966 – Doctors at the University of Manitoba perform the first pancreas transplant.
1970 – First blood glucose meter (Ames) is introduced. It is intended for use in doctors’ offices and costs around $500.
1970 – Insulin pumps are developed.
The development of testing equipment and supplies provides patients with much greater control and flexibility in the management of their diabetes.
1970 – Laser therapy is used to help slow or prevent blindness resulting from diabetes.
1973 – U-100 insulin is introduced.
1976 – HbA1c test is introduced.
1978 – Testing of the first recombinant DNA insulin is announced.
Until this date manufacturers of insulin have had to stockpile animal pancreatic tissue. This changes dramatically with the development of DNA technology that allows the manufacturing of a genetically engineered “human” type of insulin.
1978 – The National Diabetes Information Clearinghouse (NDIC) is established to increase knowledge and understanding about diabetes among patients, health care professionals and the general public.
1983 – The first biosynthetic human insulin is introduced.
1983 – “Reflolux”, later known as “Accu-Chek”, is introduced allowing relatively easy and accurate blood glucose self-monitoring.
1986 – Insulin pen delivery system is introduced.
1990 – Defeat Diabetes Foundation established to address the issue of prevention, which was not being met by existing diabetes related organizations.
1993 – The landmark clinical trial Diabetes Control and Complications Trial (DCCT) publishes its report. The study clearly demonstrates that more active self-management through nutrition, activity and monitoring of glucose levels (and adjustments) delays the onset and progression of long-term complications in Type 1 individuals. The study results shows proper management reduces risk complications significantly for eye disease (76%), kidney disease (50%) and nerve disease (60%).
1993 – Instant Glucose tablets are introduced.
1996 – The FDA approves the first recombinant DNA human insulin analogue, lispro (Humalog).
1990-1997 – External insulin pumps allow closer control and freedom from multiple injections. More sophisticated insulin analogues are introduced which offer faster action, less risk of reactions and more flexibility for diabetes management.
More than 300 insulin analogues have been identified, including 70 animal insulin’s, 80 chemically modified insulin’s and 150 biosynthetic insulin’s. These allow physicians the ability to customize treatment, reduce side effects and have improved outcomes.
2003 – The names Insulin Dependent Diabetes Mellitus (IDDM) for Type 1 and Non Insulin Dependent Diabetes Mellitus (NIDDM) for Type 2 diabetes are formally dropped.
The life expectancy for people with diabetes in 2004 is still lower than that for the general population by about 15 years.
2014 – 26 million Americans have diabetes and 1 in 3 of them don’t know it. Another 79 million Americans are categorized as “pre-diabetic” and are at risk of developing diabetes in the next ten years if they don’t make appropriate lifestyle changes.