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| Categories: History of diabetes |
| History of diabetes | |
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Part I Aretaios of Cappadocia
Our series on the history of diabetes shall begin with the life of the famous doctor who lived from 81 until 138 AD. His education (probably in Alexandria) was determined by old documents that were dogmatically taken over by the young doctors. In this regard Aretaios was an exception. It seems that only Hippokrates was his ideal.
He gave the disease called "diabetes" the name. He precisely described the symptoms, such as thirst and uriesthesis, which today are indications of diabetes. Therefore he called the disease "diabetes" which means "flow".
Until the 16th century Aretaios was forgotten. By that time Iunius Paulus Cassus form Padua found some badly preserved Greek manuscripts. He translated them into Latin and published them. Because of those documents the English doctor Thomas Willis (1621 - 1675) adds the Latin "mellitus" ("honeysweet") to the Greek "diabetes".
Source: Dialog 1/2005, S.22
Part II Prof. Karl Stolte
Stolte was born in 1881 in Strasburg. There he got his doctor's degree in 1904. On the 1st of October in 1916 he became the head of the paediatric clinic in Breslau. In 1929 he began to develop a concept of a flexible treatment of diabetes with children. His concept was called "Freie Diät" which means "free diet". After the 2nd World War he continued his work in Greifswald where he worked as head of the children's clinic of the university until 1948. His last employment was with the University of Rostock where he lead the university clinic until his death in 1951.
The concept he worked on was a treatment of type 1 diabetes which prescribed insulin according to the demand for it. 50 years before the ICT was developed Stolte had already made a similar concept. By that time, the medical viewpoint of the endocrinology did not want to support this development. The 2nd World War prevented the powerful publication and so his success was limited to Breslau and its environment. The work of this outstanding scientist and doctor did not get easier in the GDR. 30 years after his death his treatments were realized throughout the whole republic.
In 1990 the 25th yearly convention of the German Diabetes Association took place in Düsseldorf. On this occasion the "Karl Stolte Preis" was awarded for the first time.
His "free diet" based on the assumption that it must be possible to regulate the metabolism of children on a normal level with the help of insulin. "Therefore shortly after the introduction of insulin we adjusted the children to it. We gave them the same diet they had at home by letting them chose their meals on their own [..] Patients suffering from diabetes mellitus should not be treated like animals in an experiment that day by day receive an exact amount of food."
To get a measuring criterion the urea glucose was checked frequently. The insulin was given in 3 injections adjusted to the measured values. Stolte was the first to discover an unsteady need for insulin (basal insulin). He tried to stabilizes this by fractionally giving rapid-acting insulin and to therewith simulate the metabolism of a non-diabetic. When in 1939 delay insulin ought to be applied, Stolte refused to do it. "The giving of insulin according to the need for is only possible when rapid-acting insulin is used."
In one of his publications he values the pancreas. He claims that the pancreas enables healthy humans to suffer from hunger or to eat too much without getting hypoglycaemia. To handle insulin in such a dynamic way was the aim of his therapy. A further achievement of him was that he developed a therapy for type 1 diabetics independent from a diet (in contrast to Carl von Noorden).
To conclude with, we want to praise this important scientist who was ahead of his time and bravely defended his critics.
Source: Diabetes aktuell 4/2003 S.23-26 (Dr. Heinz Schneider)
Part III Prof. Dr. Oskar Minkowski
On July 6 in 1931 one of the greatest researchers in the field of diabetology in the German-speaking area died. At a meeting of the German Society for internal medicine he was honoured with the following speech: "...Already when being an assistant in Königsberg he found acetethanoic acid in the urine of diabetics. It was in Strasburg where he as a thirty years old together with von Mering discovered pancreatic diabetes. The discovery of the haemolytic icterus was the third of his achievements. [...] Until his death we were able to admire in him the characteristics which enabled his success: the lucid wit that did not admit any myths, harsh criticism but also his fantasy, the artistic feature without which a great researcher is not conceivable [...]"
Here are some facts of his life: Oskar Minkowski was born in January 1958 in Lithuania which was at that time part of zaristic Russia. Because of his Jewish origin his family was forced to emigrate into the liberal East Prussia in the 1870's. After his graduation he studied human medicine in Freiburg and Königsberg as a Prussian citizen. In Königsberg he also gained his doctorate. In 1888 he followed his former mentor to Strasburg where he made his greatest discovery together with Dr. Joseph von Mering. He removed the pancreas of a dog and was able to prove that through this technically difficult operation a real diabetes can be evoked.
Today this is a plausible fact but back the it was a sensation. Then medicine thought that diabetes was a disease of the brain, the stomach or the liver. Minkowski's experiment was the precondition for the discovery of insulin. He had proved by now that insulin must be produced somewhere in the pancreas. [more]
After a stay in Köln (1900 until 1905) he went to the University of Greifswald and in 1909 went to Breslau. Probably there he received the first ampoule of insulin which he presented to his students in the following words: "I once hoped that I would become the father of insulin. But things went different. To day accept with pleasure to be designated the grandfather of insulin by its discoverers Benting and Best." From this time onwards he and his "Deutsche Insulin-Kommitee" (German Insulin-Committee) worked hard on the insulin supply throughout Germany. In 1923 Hoechst produced a high amount of the first old insulin.
Source: Diabetes aktuell 3/2003 S.26-28 (Dr. Heinz Schneider)
Part IV Diabetes in the former GDR
Most oral antidiabetics were created after the 2nd World War. Although already known in the 40's sulfonyl urea and its lowering effect on the blood glucose level was examined in the GDR in the 50's. In the chemical factory von Heyden in Radebeul Haack and Carstens investigated on the effects of depot sulfonamide (CA 1022, Loranil, synthesized in 1951). So that the product later appearing as "Oranil" could be tested. When Haack fled to West Germany this was a starting signal for the medication BZ 55 produced by Boehringer/Mannheim. In Dresden the development too went on. The sulfonyl urea "Tolbutamide", developed in East and West Germany at the same time was produced in the GDR under the name "Orabet". There was a kind of competition which soon led to the next generation of antidiabetics: Glibenclamide. This substance was contained in the product "Euglucon" in West Germany and in "Maninil" in the GDR. "Maninil" and "Orabet" were the only antidiabetics produced in East Germany. On the other side of the wall some special versions of "Euglucon" with certain effects were produced. Despite the increasing number of type 2 diabetics the production of "Maninil" was very successful. It was exported to the Soviet Union and other countries.
How about the biguanides which still today are in use as the medication in metformin. Research in the GDR paid more attention to buformin, although metformin was known. Buformin was produced widely until 1989 and then replaced by metformin.
Antidiabetic drugs such as insulin or oral medications were only prescribed in special district diabetic clinics. So only specialists on the field of diabetic were involved in the treatment and patients had to try diet-conscious measures to cope with their diabetes. A further advantage the centralized care for diabetes had was that statistics were very accurate. 40 percent of the patients were treated with a diet, another 40 percent with oral anti-diabetics and 20 percent were given insulin.
The large number of diabetics treated with a diet was a result of the systematic and repeated national mass examinations with the aim to diagnose type 2 diabetes as early as possible. The conclusion can be drawn that the treatment of diabetics in the GDR had several weaknesses but was on a relatively high level compared to international standards.
source: Diabetes aktuell 3/2004 S.38-30 (Prof. Dr. Waldemar Bruns)
Translated by Jella Eifler
Part V: The history of mmol/l
After the Second World War, an international system for units of measurements has been developed. The basic units have been: metre (length), kilogram (weight), second (time), ampere (energy), celvin (temperature) and candela (power of light). However, this Système International d’Unités does not really work which can one the one hand be seen at the very little use of the unit metre in comparison to miles or feet and on the other hand at the use of celsius rather than celvin. This is the same problem with the unit mmol which has been added as the seventh unit of measurement in 1971. Thus, the system has only prevailed in technical and economical parts of some countries. In terms of diabetes, the system has to compete with the unit mg/dl in almost every country. The unit mmol was introduced by the physician Conte Amadeo Avogadro (1776-1856) from Turin. In Germany, the two different units were used differently during the Cold War. While the former GDR, as well as the Sovjet Union followed the Système International d’Unités, the old West German states kept the conventional unit mg/dl. Therefore, in case of moves or journeys from the old into the new German states and the other way around it is very important to mention measurement units in order to avoid mistakes (25 mmol/l indicate high blood sugar values and the meaning of 25 mg/dl is that the blood sugar is too less).
Source: AccuChek Dialog 3/2005, p.22
Translated by Kristin Henke
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