Diabetische Augenerkrankungen 2

Introducing diabetes: The story of sugar and insulin in the body

A brief history of diabetes mellitus

Diabetes has a long history in the medical literature. In ancient Egypt, about 1500 years before the common era (BCE), diabetes was described as a condition linked with weight loss and excessive urination. During the same period, Indian physicians noted that the urine from these patients attracted ants and classified it as ‘madhumeha’ or honey urine. Until the 11th century, diagnosis was often made by ‘water tasters’, who drank the urine of someone suspected of having diabetes and confirmed if it tasted sweet.

The word diabetes comes from ancient Greece and means to pass through, a reference to the frequent urination. Mellitus means honeyed in Latin, a reference to the sweet urine. The modern medical term ‘Diabetes Mellitus’ captures both the symptoms and the signs of the condition.

1700 to 1800: Understanding the condition

Around 1776, Dobson observed that in some people, diabetes was fatal in less than five weeks and, for others, it remained as a chronic condition. This is the first time a distinction was made between type 1 and type 2 diabetes. However, it took another 80 years, before Claude Bernard made the link between diabetes and glycogen metabolism for the first time. This was followed in 1869 by the discovery of two types of cells in the pancreas (the islets of Langerhans) by a German medical student.

Early 1900s: Linking diabetes with insulin

The link between the pancreas and diabetes was made through Dr Banting’s experiments. He demonstrates that administering secretions from the pancreas of healthy dogs to dogs whose pancreases had been removed, could treat high sugar levels. This discovery led to an award of a Nobel prize in 1923.

Jean de Meyer and Sir Edward Albert Sharpey-Schafer both independently proposed the name “insulin”. It is believed, the name is in reference to the tiny cell islands in the pancreas – the islets of Langerhans. Insulin is latin for “insula”, meaning island.

20th century: Developments in the management of diabetes

In the early 1900s, treatments for diabetes included: the oat-cure, the milk diet, the rice cure, potato therapy, opium and overfeeding to compensate for the loss of fluids and weight. There was also a popular and widely treatment of a restricted diet. Dr Fredrick Allen, tried out more extreme starvation diets till there was no sugar in the urine were also used but often with fatal outcomes for patients with type 1 diabetes.

  • By 1923, Eli Lilly a pharmaceutical company, undertook the first mass production of insulin

  • By 1955, first oral drug, Carbutamide, was developed to help lower blood glucose levels

  • By the 1970s the first synthetic human insulin was being produced using recombinant DNA techniques. Prior to this, insulin manufacturers had to stockpile pancreatic tissue from animals

  • 1980s: Humulin, the first biosynthetic Human insulin, was approved for distribution. It was identical to the structure of human insulin and with the advantage of being less likely to lead to allergic reactions than animal insulin

  • 1985: The first insulin pen delivery system, the NovoPen, allowed patients to inject themselves.

The Diabetes Control and Complications Trial (DCCT) report of 1993 clearly highlighted the need for self-management through good nutrition, activity and monitoring of blood sugar levels to delay the onset and progression of long-term complications in the eyes, kidneys and nerves in people with type 1 diabetes.

Progress to date and the future

By the late 20th century, huge advances in diabetes care had taken place, from the development of insulin pumps to the introduction of genetically engineered insulin. In fact more than 300 insulin analogues had been identified, including 70 from animals, 80 which are chemically modified and 150 biosynthetic insulins.

Looking ahead, there are ongoing advances to achieve the ideal diabetes management. This includes the work of Dr Damiano to introduce a bionic pancreas (iLet) which can deliver both insulin and glucagon every 5 minutes.

Reflection

Watch the video to learn how diabetes develops as a disease and the functional changes that occur in people with diabetes. We also introduce you to the basic disease classification - Type 1, Type 2 and gestational diabetes – and diagnoses.

As you watch, consider how important control of blood sugars is for managing diabetes. How feasible is self-management of blood sugar levels for people with diabetes in your local setting?

© London School of Hygiene & Tropical Medicine CC-BY-NC-SA 4.0

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