Type 2 Diabetes

Aretaeus of Cappadocia (30–90 A.D.), living under the emperor Nero, and writing in Ionian Greek, was the second to describe diabetes, and the first known to have called it by the name (to run through; a siphon). In a passage translated by Schnée", Aretaeus outlines some of the principal symptoms, the progressive course, and the fatal prognosis. He anticipates modern conceptions of a failure of assimilation, conversion of tissue into urinary products, and possible origin of some cases in acute infections. He was retrograde in treatment, for he advised a non-irritating diet of milk and carbohydrates, and hiera, nardum, mastix, and theriak (opium?sugar?) as drugs. He is commonly credited with being the first to regard diabetes as a disease of the stomach; but his vague notion of a disorder akin to ascites hardly entitles him to a claim upon this false idea which was productive of so much truth in the period from Rollo to Cantani.

“Diabetes is a strange disease, which fortunately is not very frequent. It consists in the flesh and bones running together into urine. It is like dropsy in that the the cause of both is moisture and coldness, but in diabetes the moisture escapes through the kidneys and bladder. The patients urinate unceasingly; the urine keeps running like a rivulet. The illness develops very slowly. Its final outcome is death. The emaciation increases very rapidly, so that the existence of the patients is a sad and painful one. The patients are tortured by an unquenchable thirst; they never cease drinking and urinating, and the quantity of the urine ex ceeds that of the liquid imbibed. Neither is there any use in trying to prevent the patient from urinating and from drinking; for if he abstains only a short time from drinking his mouth becomes parched, and he feels as if a consuming fire were raging in his bowels. The patient is tortured in a terrible manner by thirst. If he re tains the urine, the hips, loins, and testicles begin to swell; the swelling subsides as soon as he passes the urine. When the illness begins, the mouth begins to be parched, and the saliva is white and frothy. A sensation of heat and cold extends down into the bladder as the illness progresses; and as it progresses still more there is a consuming heat in the bowels. The integuments of the abdomen become wrinkled, and the whole body wastes away. The secretion of the urine becomes more copious, and the thirst increases more and more. The disease was called diabetes, as though it were a siphon, because it converts the human body into a pipe for the transflux of liquid humors. Now, since the patient goes on drinking and urinating, while only the smallest portion of what he drinks is assimilated by the body, life naturally cannot be preserved very long, for a portion of the flesh also is excreted through the urine. The cause of the disease may be that some malignity has been left in the system by some acute malady, which afterward is developed into this disease. It is possible also that it is caused by a poison con tained in the kidneys or bladder, or by the bite of the thirst-adder or dipsas.”

"Aretaeus’ writings were unknown in Europe until 1552. His aim in treating what was clearly type 1 diabetes was to overcome the  diabetes: the intense thirst, and to this end he began with a purge and followed it with a variety of mixtures to soothe the stomach."

Diabetes: The Biography

1674 - Diabetes Mellitus by Sir Thomas Willis - Oxford

"In 1674, Thomas Willis treated diabetes by recommending a diet high in sugar, in order to replace the sugar being leaked by the kidneys, thereby inadvertently hastening patients’ deaths." via David Haslam

"Thomas Willis pensively sipped from his glass. It was sweet, even a little delicious. In 1674 the Oxford University physician was far from the first doctor to taste urine, but he was the first Western doctor we know of to connect the sweetness of urine to the condition of its owner, a person suffering the effects of diabetes. Willis was baffled by his findings and recorded his experience in Pharmaceutice rationalis: “But why that it is wonderfully sweet like sugar or honey, this difficulty is worthy of explanation.” Sickening Sweet
 

Thomas Sydenham (1624-1689), hailed as a second Hippocrates in general medicine, contributed nothing of value in diabetes except a clearer definition as a disease of metabolism. Because the nutritive elements of the blood are not properly prepared for assimilation, they pour out through the kidneys, and the flesh and strength melt away. Later hypotheses of free versus combined sugar are here antipated.

Thomas Sydenham prescribed narcotics and theriak and said, “Let the patient eat food easy of digestion, such as veal, mutton, and the like, and abstain from all sorts of fruits and garden stuff” , but no effective dietetic treatment grew out of this advice. (6).

https://care.diabetesjournals.org/content/diacare/40/10/1302.full.pdf

"The demonstration of sugar in the blood and urine of diabetics by Robert Wyatt in 1774"

"Nevertheless, it was the simple observation of Willis that gave the disease its new name “diabetes mellitus,” but it was more than a century later that his argument was substantiated by the demonstration of sugar in the blood and urine of diabetics by Robert Wyatt in 1774 and subsequently by the more thorough studies of Matthew Dobson (1732–1784), who had a fairly good of knowledge of chemistry. In 1776, Dobson showed that the sweetness of urine is caused by sugar, which he quantified and showed to be subject to alcohol and acetate fermentation, and that its appearance in the urine is preceded and accompanied by a similar sweetness and sugar in the blood, albeit not as much as that detected in the urine. Diabetes now came to be viewed as a disorder of nutrition in which sugar accumulates in the blood and is excreted in the urine. This was to launch a whole new approach for the dietary treatment of diabetics and with it a shift to the digestive organs as the site of the disease and more specifically to the absorption of “saccharine matter” in the stomach."