Two types of diabetes: Different strokes for folks
The observation that there are two distinct types of diabetes was first made in 600 B.C. by two Indian physicians. This awareness was lost in subsequent centuries because up until the 18th and 19th centuries references to diabetes seem to have been to the disease that we now call type 1 diabetes. In 1875 a Frenchman named Appolinaire Bouchardat wrote a book on the disease, clearly distinguishing the two types: in type 1, later called juvenile diabetes, the patients were relatively young – children, adolescents, young adults; the onset of symptoms was sudden and acute; weight loss was striking; and death followed rapidly after the onset of symptoms. Most type 1 diabetics did not live longer than a year after the onset of symptoms. In type 2, later called adult-onset diabetes, patients were older – middle aged and older; the onset of symptoms was slow and gradual; patients were usually overweight or obese; and they could control the sugar in their urine with a low carbohydrate diet.
Two choices: Death from starvation or death from diabetes
Indeed, the low calorie, low carbohydrate diet prescribed by the leading 19th century diabetes physician, Frederick Allen, did allow some type 2 diabetics to live with their disease for years without too much discomfort. Whereas, type 1 diabetics could at most hope to buy a few more years of life no matter how strictly they adhered to the diet. In fact, when I said in the first article in this series that diabetics who went on Allen’s starvation diet no longer died of diabetes, they died of starvation, for type 1 diabetics this was quite literally true. The terrible choice they had was death from diabetes or death from starvation. Many of them chose starvation, first because it did buy them a few more years of life and the hope that they might survive till a cure could be found, and second because it was a less painful death than death from diabetes. To quote from an historical account, The Discovery of Insulin, by Michael Bliss, “In those situations where the awful choice between death from diabetes and death from starvation could not be avoided, ‘comparative observations of patients dying under extreme inanition (starvation) and those dying with active diabetic symptoms produced by lax diets or violations of diet have convinced us that suffering is distinctly less under the former program.'”
The quote within quotes is from Frederick Allen, the 19th century physician who advocated a starvation diet for diabetics before the discovery of insulin. The author of The Discovery of Insulin, Michael Bliss, goes on to say that in general diabetics on Allen’s starvation diet did feel better than those who broke it because “the simple hunger” from careful fasting or dieting was less tormenting than the sick hunger, or polyphagia, as it is technically called, of diabetes. And besides, there was no other alternative. Up until the advent of insulin, nobody had a better way.
Two types of diabetesbut same treatmentfor both
With the advent of insulin, it was assumed that an insufficiency of insulin was responsible for both juvenile and adult-onset diabetes. Therefore, the commonly prescribed treatment for adult-onset or type 2 diabetes was daily injections of animal insulin, just as it was for juvenile or type 1 diabetes.
It was not until the 1930s that anyone questioned this protocol. The man who didand the theory he proposed will be the subject of next week’s column.
Mary Lou Williams, M. Ed., is a lecturer and writer in the field of nutrition;. She welcomes inquiries. She can be reached at 267-6480.