Thus, by the early 20th century, as historian Michael Bliss dismally reported in The Discovery of Insulin, “the total dietary approach to diabetes was the best therapy available at that time.

However, processing pancreatic tissue and its enzymes was extremely difficult and typically produced results too toxic to be of any practical use. Several reported limited success on both counts one clinician claimed to temporarily bring a patient out of a diabetic coma. With the suspect organ identified, many attempted to create pancreatic extracts to treat diabetes, in animal models and then clinically. In the last third of the 19th century researchers connected pancreatic function to diabetes. German researchers Oskar Minkowski (left), 1858-1931, and Joseph von Mering, 1849-1908, whose work shed light on the connection between diabetes and the pancreasĪnother approach to treating diabetes followed from physiological research and the nascence of endocrinology, when scientists identified links between internal secretions from different organs to various physiological functions. Yet it often came down to death by diabetes or death by starvation. Allen’s research suggested that this therapy, which became known as “starvation treatment,” offered the best hope available for the patient. Physician Frederick Allen’s research in the late 19th and early 20th centuries contradicted that approach, focusing instead on a reduction of all food components to aim for an optimum point of malnourishment to sustain the diabetic. As chemistry advanced and the role of carbohydrates in this process became better understood, a popular approach was to reduce carbohydrates while increasing fats to help fortify the patient, leading to a variety of fad diets. Some 19th century physicians urged replenishment to reverse the wasting through aggressive feeding, even with sugar. Treatments followed the therapeutic philosophies in mode at the time, such as bloodletting or opium administration.

A more detailed understanding of the pathology of diabetes grew over the years, such as its effect on the micro- and macrovascular vessels that could lead to a host of problems, including cardiovascular and cerebrovascular disease and death.

A recognition that those suffering this affliction also had sweetened urine came quite early as well. The symptoms often associated with uncontrolled diabetes, including extreme thirst, hunger, and the need for urination, along with fatigue and systematic wasting, have been known for millennia. Allen, 1879-1964 (National Library of Medicine)

Michael bliss the discovery of insulin