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Diabetes: Then and Now

The Spirit

11-09-17

Scientists and physicians have been documenting the condition now known as diabetes for thousands of years. From the origins of its discovery to the dramatic breakthroughs in its treatment, many brilliant minds have played a part in the fascinating history of diabetes.

The first known mention of diabetes symptoms was in 1552 B.C., when Hesy-Ra, an Egyptian physician, documented frequent urination as a symptom of a mysterious disease that also caused emaciation. Also around this time, ancient healers noted that ants seemed to be attracted to the urine of people who had this disease.

In 150 AD, the Greek physician, Arateus, described what we now call diabetes as "the melting down of flesh and limbs into urine." From then on, physicians began to gain a better understanding about diabetes.

Centuries later, people known as "water tasters" diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word "mellitus," meaning honey, was added to the name "diabetes," meaning siphon. It wasn't until the 1800s that scientists developed chemical tests to detect the presence of sugar in the urine.

As physicians learned more about diabetes, they began to understand how it could be managed. The first diabetes treatment involved prescribed exercise, often horseback riding, which was thought to relieve excessive urination.

In the 1700s and 1800s, physicians began to realize that dietary changes could help manage diabetes, and they advised their patients to do things like eat only the fat and meat of animals or consume large amounts of sugar. During the Franco-Prussian War of the early 1870s, the French physician, Apollinaire Bouchardat, noted that his diabetic patients' symptoms improved due to war-related food rationing, and he developed individualized diets as diabetes treatments.

This led to the fad diets of the early 1900s, which included the "oat-cure," "potato therapy," and the "starvation diet."

In 1916, Boston scientist Elliott Joslin established himself as one of the world's leading diabetes experts by creating the textbook, "The Treatment of Diabetes Mellitus," which reported that a fasting diet combined with regular exercise could significantly reduce the risk of death in diabetes patients.

Today, doctors and diabetes educators still use these principles when teaching their patients about lifestyle changes for the management of diabetes.

Despite these advances, before the discovery of insulin, diabetes inevitably led to premature death. The first big breakthrough that eventually led to the use of insulin to treat diabetes was in 1889, when Oskar Minkowski and Joseph von Mering, researchers at the University of Strasbourg in France, showed that the removal of a dog's pancreas could induce diabetes.

In the early 1900s, Georg Zuelzer, a German scientist, found that injecting pancreatic extract into patients could help control diabetes.

Frederick Banting, a physician in Ontario, Canada, first had the idea to use insulin to treat diabetes in 1920, and he and his colleagues began trying out his theory in animal experiments. Banting and his team finally used insulin to successfully treat a diabetic patient in 1922 and were awarded the Nobel Prize in Medicine the following year.

Today, insulin is still the primary therapy used to treat Type 1 diabetes; other medications have since been developed to help control blood glucose levels. Diabetic patients can now test their blood sugar levels at home, and use dietary changes, regular exercise, insulin, and other medications to precisely control their blood glucose levels, thereby reducing their risk of health complications.

Even with all of the advances seen in the treatment of diabetes, management of the disease starts with a diagnosis. Here are some symptoms to watch for:.

? Urinating often.

? Feeling very thirsty.

? Feeling very hungry -even though you are eating.

? Extreme fatigue.

? Blurry vision.

? Cuts/bruises that are slow to heal.

? Weight loss -even though you are eating more (Type 1)

? Tingling, pain, or numbness in the hands/feet (Type 2)

Of course the only definite way to determine if you have diabetes is to talk to your doctor. body's inability to react properly to insulin (insulin resistance). Type 2 diabetes is more prevalent than type 1 diabetes and is therefore seen in roughly 90% of all diabetes cases. Type 2 diabetes is predominantly diagnosed after the age of forty, however, it is now being found in all age ranges, including children and adolescents.

The impact of diabetes goes beyond chronic hyperglycemia. Diabetes is the leading cause of blindness (diabetic retinopathy), end stage kidney diseases (diabetic nephropathy) and non-traumatic lower extremity amputations (diabetic neuropathy) in working-age adults. People with diabetes are also two to four times more likely to experience cardiovascular complications and strokes. Diabetes and its related complications result in an estimated 200,000+ deaths each year, making diabetes one of the major causes of mortality in the U.S.

In 2012, the NIH reported an estimated 29.1 million Americans (9.3% of the population) living with diabetes. Of these, an estimated 8.1 million persons were unaware that they had the disease.

How does my weight relate to type 2 diabetes?

There are many risk factors for type 2 diabetes such as age, race, pregnancy, stress, certain medications, genetics or family history, high cholesterol and obesity. However, the single best predictor of type 2 diabetes is overweight or obesity. Almost 90% of people living with type 2 diabetes are overweight or have obesity. People who are overweight or have obesity have added pressure on their body's ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes. The number of diabetes cases among American adults increased by a third during the 1990s, and additional increases are expected. This rapid increase in the occurrence of diabetes is mostly attributed to the growing prevalence of obesity in the United States.

What can you do to prevent diabetes?

Type 2 diabetes is largely preventable. Studies have found that lifestyle changes and small amounts of weight loss in the range of 5-10% can prevent or delay the development of type 2 diabetes among high-risk adults. Lifestyle interventions including diet and moderate to intense physical activity (such as walking for 150 minutes per week) were used in these studies to produce small amounts of weight loss. The development of diabetes was reduced by 40% to 60% during these studies, which lasted three to six years. Preventing weight gain, increasing activity levels and working toward small amounts of weight loss if you are overweight can have a big impact on the likelihood that you will develop diabetes in the future. Thus far, weight management is the best thing you can do to prevent the development of diabetes.

What can you do if you already have diabetes?

You can have a positive influence on your blood sugar and your overall health by choosing foods wisely, exercising regularly, reducing your stress levels, making modest lifestyle changes and using medications to lower blood glucose levels. Type 1 diabetic patients must have insulin exogenously applied to maintain healthy blood glucose levels. Type 2 diabetic patients, however, can use insulin or drugs that sensitize their bodies to insulin, which work quite well in lowering blood glucose levels. Unfortunately, these drugs are not without risk as they, as well as the exogenous application of insulin, can often cause diabetic patients to suffer from low blood glucose levels (hypoglycemia) if taken improperly, which may result in seizures, unconsciousness, or death. Small amounts of weight loss (losing 10 pounds or more) can decrease the amounts of these medications needed to keep your blood sugar levels within a healthy range by lowering your blood glucose levels, which furthermore reduces the risk of diabetic complications. Ultimately, better nutrition, increased physical activity, and control of blood glucose levels can delay the progression of diabetes and help prevent the complications associated with the disease.

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