Type 1 Diabetes

The next step was to test insulin in humans. So on 11 January 1922, insulin was administrated to Leonard Thompson a 14-year-old boy treated for diabetes in Toronto Hospital[13]. It’s worth mentioning that after the introduction of Apollinaire Bouchardat’s (1806-1886) pioneering dietary treatment for diabetes, physicians repeated in several generations of diabetics his motto: “mangez le moins possible” (eat as little as possible)[21,22]. Thomson was also following a strict fasting diet proposed by Frederick Madison Allen (1879-1964) and he was in critical state. He received 15 mL of insulin, injected in his buttock but he developed abscesses at the injection site and became even sicker. Collip further improved the quality of insulin and on January 23, Thompson received a second injection. The results were excellent. His blood glucose from 520 mg/dL fell to 120 mg/dL in 24 h and urinary ketones disappeared. Thompson continued the treatment with insulin and lived another 13 years. He died of pneumonia at 27 years old[13].

Similar is the story of Elizabeth Hughes Gossett (1907-1981). Daughter of the United States politician Charles Evans Hughes, Elizabeth was diagnosed with diabetes at age 11. Initially she was also treated by Allen and in August 1922 began the use of insulin. She survived, graduated from College, got married, had three children and died suddenly of a heart attack at 74 years old[23].

https://en.wikipedia.org/wiki/Elizabeth_Hughes_Gossett

Elizabeth Hughes Gossett (August 19, 1907 – April 21, 1981), the daughter of U.S. politician Charles Evans Hughes, was the first American, and one of the first people in the world, treated with insulin for type 1 diabetes. She received over 42,000 insulin shots before she died in 1981.[1]

Elizabeth Hughes was born August 19, 1907, in the New York State Executive Mansion in Albany, New York, to Antoinette (Carter) and Charles Evans Hughes, who was Governor of New York at the time.

Elizabeth developed diabetes in 1918 at age 11. At the time, the life expectancy of a Type 1 diabetic without treatment was usually no more than a few months. Since it was unable to metabolize sugars, the diabetic body would instead begin to burn fats. The dependence on fat would eventually lead to acidosis, followed by coma and death. The only known treatment was a starvation diet, in which the caloric intake was reduced to a level that the patient could tolerate without showing sugar in the urine. If the diet was followed religiously, a diabetic could expect to live for a couple of years before eventually succumbing to an infectious disease in her malnourished state.[2]

In spring 1919, Elizabeth was brought to Dr. Frederick M. Allen at his special clinic, the Physiatric Institute in Morristown, New Jersey. Dr. Allen put Elizabeth on a strict diet and continued to monitor her condition over the next three years while she lived at home with a private nurse. Elizabeth was 4 feet 11.5 inches (1.511 m) and 75 pounds (34 kg) when she developed diabetes. Under diets that averaged 800 calories per day, her weight fell to 45 pounds (20 kg) by August 1922.[2]

From summer 1921 to spring 1922, a team at the University of Toronto succeeded in isolating the hormone insulin, which type 1 diabetics are unable to produce on their own. Elizabeth's mother contacted Canadian doctor Frederick Banting, who agreed to take her as a private patient. Elizabeth arrived in Toronto with her mother on August 15, 1922, and began receiving insulin from Dr. Banting. She recovered rapidly, and she was placed on a 2200–2400 calorie weight-gain diet within two weeks. She returned home to Washington, D.C., on Thanksgiving Day 1922.[2][3]

Elizabeth Gossett died of a heart attack on April 21, 1981, at the age of 73.[4] By the time of her death, she had received approximately 42,000 insulin injections over 58 years. Although her name had been prominently mentioned in the newspaper coverage of insulin in 1922, she later hid her diabetes from her friends and associates. She destroyed most of the material that documented her treatments, and even removed references to diabetes in her father's papers.[6]

Carbohydrate.- 

From the preceding statements it will be seen that 55 per cent of the energy of the diet of the normal individual consists of carbohydrate . These figures are only approximate , but they leave no doubt as to how large a place sugar and starch occupy in the daily ration. (See p.415.) What percentage of carbohydrate is furnished by sugar is problematical . We do know, however, that the average individual was supposed to consume 84 pounds of cane sugar during the year 1921. This would amount to 105 grams, or 0.2 pounds, per day, which would amount to about one - fourth of the carbohydrate calories. 

The proportion of carbohydrate in the normal diet varies in different countries, reaching its maximum in the tropics and its minimum in the arctic zones. The people in India take 484 grams carbohydrate daily , while the Eskimos get along very comfortably upon 52 grams . Table 159 is arranged by modifying somewhat a similar table of Lusk's. It shows well the adaptability of different races to different diets . That the Eskimos live upon 52 grams of carbohydrate daily should greatly encourage diabetic patients . All who treat diabetics should be very thankful that there is a race of Eskimos through which proof is afforded that it is perfectly possible to maintain life on a diet in which carbohydrate is largely replaced by fat. The composition of the diet also varies in the same race from time to time and this has been interestingly described by Mendel.

Attention has already been called to the increase in the consumption of sugar in the United States during the last century. Rübner noted that the consumption of meat per capita in Germany had risen three and one - half times during a hundred years prior to the war. The effects of undernutrition during the war were manifest generally in Europe and America, but the total dietary restriction obscures the results of qualitative changes. (See p115.)

The pioneering work of Banting and Best saved millions of lives and diabetics started to live a normal life. Lilly Pharmaceutical Company collaborated with the two scientists and in 1923 introduced Iletin, the world’s first commercially available insulin product[13].

However in 1923 the Nobel Committee decided to award Banting and MacLeod for insulin’s discovery. Banting became furious as he believed that he should share the prize with Best instead of MacLeod and he decided to share with Best his cash award. In his turn, MacLeod shared also his award with Collip[13].

To prevent these symptoms of undernourishment, KARL PETREN (1868-1927) advocated a veritable "fat diet" (WILDER), with, as its chief feature, a drastic reduction of proteins. The carbohydrates were restricted to leaf vegetables, and in spite of its lack of balance, the diet did enable diabetics to work and allowed diabetic children to grow more or less normally (NEWBURGH and MARSH).

Karl Petren. 

A Leader in Pre-Insulin Dietary Therapy of Diabetes by RUSSELL M. WILDER 

One of the most distinguished medical teachers and clinical investigators of his time was Karl Petrén. Some of his biographers have called him the most distinguished in Sweden. We know him in America principally because of his studies of diabetes and his advocacy in the very early nineteen twenties of a diet very high in fat. He was even more renowned, however, in neurology, and participated actively in Swedish public health affairs, notably in programs for the control of tuberculosis. 

Born in 1868 of a line of clergymen on his mother's side, one of five brothers all of whom became outstanding, his medical training in Lund was followed by a year of study under the guidance of Dejerine, in Charcot's former clinic, the Salpetriere, in Paris. An equally lengthy sojourn was with Naunyn in Strassburg, then in Germany. He was called in 1902 to the professorship of internal medicine at Upsala, and in 1910 to the chair of medicine in his alma mater, the University of Lund. It was not until he took the professorship at Lund that Petren's scientific interest was drawn to diabetes. Thereafter this became a major concern to him, largely because of dissatisfaction with the then current treatment by starvation. Extensive facilities and many patients with diabetes of severity, whom he could maintain for months and years under continuous supervision, enabled him to conduct extensive clinical and laboratory observations, employing various dietary procedures and ultimately arriving at conclusions of significance. 

It is true that others, before Petren, among them especially Weintraud, also a pupil of Naunyn, had found protein restriction to be beneficial in diabetes; but Petren's studies went much further in revealing, as they did, that an increase of the nitrogen exchange would aggravate pre-existing acidosis, and that, with a rigidly restricted protein intake, even in patients with diabetes of severity, fat possessed a nitrogen sparing effect not much inferior to that possessed by carbohydrates in the normal. Thus the Petren diet, as finally developed, became sufficiently high in fat to provide the calories required to maintain near normal body weight and this diet, to the surprise of everyone, could be tolerated without augmenting acidosis. Petren's diets also were restricted in their carbohydrate content to that contained in leafy vegetables, and almost always, by these means, blood sugar levels, in chronic cases of severity, could be held near normal. Because of the war (1914-1918) Petrem's early work on diabetes came to our attention late. The procedure, developed independently by Newburgh and Marsh [1], closely resembled that which he was recommending; also, without knowledge at the time of Petren's observations, I conducted a metabolic study with Boothby and Beeler [2], and our findings were in support of his conclusions. His high fat diets were opposed, nevertheless, in many quarters and controversy raged until the discovery of insulin, in 1922, which soon permitted liberal diabetic diets and put an end to further need for such procedure. However, certain facts, brought to light by Petren's studies and those of the others to whom I have referred, ought not to be forgotten: that fat like carbohydrate spares protein and that uncompensated acidosis, even when diabetes is severe, does not follow fat combustion if the nitrogen exchange is low and a minimal amount of carbohydrate is tolerated. Petren traveled widely and became an intimate of many of the foremost internists and neurologists in Germany, France, England and Scandinavia. He visited the United States and Canada before his death and left most pleasant memories of him here. Those who went to see him and his gracious wife, in their friendly home in Lund, found a generous and charming host. He was a gourmet nonpareil. He loved good food and vintage wines, which explains perhaps his indignation at the starvation of the diabetic patients of the period. 

Petren was said by those who studied under him to have been a forceful teacher. I can well believe it, recalling as I do an apt analogy he drew between the defenses of the body and those of a European state, in danger always of sudden invasion by a foreign power. The buffers of the blood, bicarbonates and phosphates, are like the standing army of the state, ready for battle at a moment's notice; the ammonia mechanism, whereby the fixed bases of the blood are preserved in long-standing ketogenic acidosis, like the army of reserves, takes time to mobilize. Also, just as the country's army of reserves, its national army when mobilized, takes over and permits the standing army to be brought back to former strength, so too the carbon dioxide combining power of the blood, though depleted in the early combat with accumulating keto-acids, again may be restored to normal levels when the rate of mobilization of ammonia has been sufficiently increased. 

Petren was a fervent advocate of international cooperation, especially in the world of science. Following World War I he labored mightily to bring together, as promptly as might be, the colleagues from the opposing sides in that dreadful conflict. He nevertheless was a nationalist at heart, the civilized type of nationalist. I well recall his enthusiastic pleasure at the rolling landscapes of southeastern Minnesota. "Just like Sweden," he would say. "I have seen nothing so lovely since I left my home." Petren's magnum opus, his "Diabetes-studier," a volume of 1000 pages, published in Copenhagen in 1923, with his assistants, Smith, Otterstrom, Odin and Malmros, with a foreword by B. Naunyn, stands as a landmark, as Naunyn expressed it there, between two eras of research on diabetes