One of the miracles of the last century was the discovery of insulin by Canadian surgeon Banting and his assistant Best. The 19 th and 20 th centuries heralded galloping advances in medicine in general and in diabetes treatment in particular. 15, 16 The rationale could only have been an easing of the symptoms originating from complications like gangrene. It may sound bizarre today, but opium (‘syrup of poppies’) was prescribed liberally for the malady for over two hundred years from Willis (1675) to Joslin (1898). 15 This advice still remains an important component of diabetic management. Diet and exercise advocacy was the hallmark of treatment by 19 th century physicians led by Joslin and Fitz from the Massachusetts General Hospital, among others. 4 Later, in the pre-insulin era, calorie restriction reigned supreme, and graphic accounts of the terminal gasping and sighing and sweet smell ( ketosis) surrounding the patient in a diabetic coma abound in the volumes written on the disease. With little understanding of pathophysiology, early remedies for diabetes included diverse and interesting prescriptions like “oil of roses, dates, raw quinces and gruel, jelly of viper’s flesh, broken red coral, sweet almonds and fresh flowers of blind nettles” representing a variety of beliefs and practices of the times. 14 The latter directly determined the risk of the occurrence of devastating complications of target organs like the eyes, vessels, nerves and kidneys that ultimately influenced morbidity and mortality.
That test, which measured blood glucose control over the previous three months (linked to the life of red blood cells), defined an extremely important aspect of diabetes management-tight control of blood glucose levels. Routine blood sugar tests at prescribed intervals continued for a long time until the introduction of the glycosylated haemoglobin (HbA1c) estimation. It imbued diabetic patients with a new sense of freedom, making the disease more comprehensible and manageable. Urine strips in the 1960s and the automated ‘do-it-yourself’ measurement of blood glucose through glucometers, produced by Ames Diagnostics in 1969, brought glucose control from the emergency room to the patient’s living room. Willis, a London physician, epitomised the true spirit of scientific enquiry by his bold action of tasting the urine of his patients-possibly because the passage of copious urine seemed to be the hallmark of the disease! This was a supreme and extreme example of bedside testing leading to labelling a patient as diabetic if his urine was ‘honeyed’. 7 The term mellitus (Latin, ‘sweet like honey’) was coined by the British Surgeon-General, John Rollo in 1798, to distinguish this diabetes from the other diabetes ( insipidus) in which the urine was tasteless. 4– 6 Avicenna (980–1037 A.D.), the great Persian physician, in The Canon of Medicine not only referred to abnormal appetite and observed diabetic gangrene but also concocted a mixture of seeds (lupin, fenugreek, zedoary) as a panacea. to Aretaeus the Cappadocian, who coined the word diabetes (Greek, ‘siphon’) and dramatically stated “… no essential part of the drink is absorbed by the body while great masses of the flesh are liquefied into urine”. 2, 3 Recognised for the last three millennia, recorded history attributes the first complete descriptions in the first century A.D. The ancient Indian physician, Sushruta, and the surgeon Charaka (400–500 A.D.) were able to identify the two types, later to be named Type I and Type II diabetes. 1 Indian physicians called it madhumeha (‘honey urine’) because it attracted ants. A disease characterised by the ‘too great emptying of urine’ finds its place in antiquity through Egyptian manuscripts dating back to 1500 B.C.
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