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#diabetes
macgyvermedical · 3 days
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Do you know how our understanding and treatment of diabetes has changed through history?
Oooh good question, anon!
As you may guess, diabetes mellitus is not new.
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We've known about it since at least the Ebers Papyrus (1550 BCE) when the disease and a treatment was first described. This treatment was: "a liquid extract of bones, grain, grit, wheat, green lead and earth." I did not look these up, but I would guess they did not do a whole lot for the treatment of diabetes.
Later during the 6th century BCE it was first given a name when it was described by Hindu physician Sushruta as madhumeh or "honey urine."
Honey urine is a very apt descriptor for diabetes. In any type, one of the most measurable symptoms is that the person urinates a lot, and the urine tastes sweet (or, if one didn't feel like tasting, that it ferments, or that it attracts ants). This was also the first test for diabetes.
The reason for the sweetness of the urine (as well as a lot of other general info about diabetes) is spelled out more clearly in my "Don't Be That Guy Who Wrote Hansel and Gretel: Witch Hunters" post.
A Greek physician Apolonius of Memphis named it Diabetes, meaning "to siphon" (referring to the large amount of urine lost).
Roman physician Aretaeus later made the first precise description of diabetes. This included the classic symptoms of incessant thirst, copious urination, and constant hunger leading to emaciation and death. He also notes that if deprived of water, the patient will continue to urinate until they become so dehydrated that they die.
The term "Mellitus" was not added until the 1600s by an English physician Thomas Willis. This was again due to the sweetness of the expressed urine. Willis prescribed a diet of "slimy vegetables, rice, and white starch. He also suggested a milk drink which was distilled with cypress tops and egg whites, two powders (a mixture of gum arabic and gum dragant), rhubarb and cinnamon". Supposedly his patients improved if they kept to this diet, though few managed it long term. I honestly don't know how it would have worked, even temporarily.
A major breakthrough came in 1889 when it was discovered that if you removed the pancreas from a dog, the dog would become diabetic (particularly, that it would urinate large quantities of sweet urine). Up until this point it was thought that diabetes stemmed from the kidneys and bladder, or perhaps the lungs. This was the first time it had been shown experimentally that the pancreas was the problem.
Speaking of this, this was also part of a series of experiments where an English physician named Merkowski implanted a small amount of pancreas in the pancreas-less dog's fat, which reversed the diabetes temporarily. This proved that the pancreas was making something that helped regulate blood (and thus urine) sugar.
What this was wasn't figured out until 1921, when Canadian scientists Banting and Best (with help from McLeod and Collip) isolated something they called insletin (after the islets of langerhans, where the substance was being produced). It's important to note that all of these scientists hated each other so much they almost refused a Nobel Prize over it. Later, Collip would refine the substance and McLeod would rename it insulin.
Prior to insulin existing there was basically 1 vaguely useful treatment for diabetes. Unfortunately, that was starvation. So you could either die a slow and painful death by diabetes or you could die a slightly less slow but still painful death due to eating about 500 calories per day. Either way, diabetes was fatal, usually within a couple of years of diagnosis.
By 1923, the first commercial insulin product, Iletin, had been developed. Iletin was a U10 insulin (10 units per 1 milliliter- less potent than today's U100 and U500 insulins) and was made from pork pancreases. It took nearly a ton of pork pancreas to make 1oz of insulin. Fortunately, as a byproduct of the meat industry, pancreases were readily available.
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Now, you might be thinking- no one has mentioned type 1 or type 2 yet in this entire post!
Well, you would be right, because diabetes wouldn't be split into 2 forms (insulin-dependent and non-insulin dependent) until 1979, and wouldn't be classified as types 1 and 2 until 1995. That's right- some of you were alive when there was only one kind of diabetes out there.
Now, there's more about the types in the Hansel and Gretel post, but essentially type 1 diabetes occurs when the pancreas itself stops producing insulin, usually in childhood. When this happens, the body stops being able to use sugar (insulin, a hormone, acts as a "key" to let sugar into cells for use). Without replacing that insulin, the person dies because their cells starve.
Type 2 diabetes occurs when the pancreas still produces insulin, but the cells stop responding to it correctly. This causes high sugar levels in the blood, which causes longer-term complications (infections, ulcers, blindness, neuropathy, heart and kidney disease, hyperosmolar syndrome, etc..) which eventually lead to death.
We started discovering oral drugs that worked on what would later become type 2 in the 1950s. Particularly those that worked by increasing the insulin output of the pancreas, but only when the pancreas was still producing some insulin.
Predicting which diabetics would benefit from oral therapies was challenging, but it was recognized that when the onset of diabetes was slow and came on in adulthood, the oral agents would work, while if it came on suddenly in childhood, the oral agents wouldn't. Terms like "adult onset" and "maturity onset" were common:
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(Side note: if you have ever read Alas, Babylon (1955) there is a diabetic character who by today's standards clearly has type 1 diabetes, but wants to switch to the "new oral pill" (called "orinase" in the book, though they are likely referring to diabinese pictured above).)
From 1923 into the 1980s, insulin was given once or twice per day, and not particularly titrated to blood sugar. This was probably just because we didn't have a great way to measure blood sugar in real time. Pre-1970s, there was no way to test blood sugar outside of a lab setting.
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Urine testing was common starting in the 1940s, but was cumbersome as it required a flame for heating the urine. By the 1950s, a test had been developed that didn't require a flame, but was still not practical for home use. In the 1960s, paper strips were developed that changed color for different amounts of sugar in the urine. The problem with this was that the strips couldn't change color until there was sugar in the urine- a blood sugar level of over 200 by today's measurements. Low blood sugar readings were impossible at this time, and had to be treated based on symptoms.
In the 1970s, blood sugar could finally be measured by putting a drop of blood on a test strip, wiping it off, and matching the color of the test strip to a chart. While less cumbersome than urine tests, this was still something that would generally only be done at a doctor's office.
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In 1983, the first home blood glucometer is developed. Finally, it was practical to take one's sugar multiple times per day, and it becomes possible to experiment with "sliding scale" insulin injections that keep tighter control of blood sugar. By the late 90s, continuous glucose monitors became available- though unlike today's CGMs that allow readings in real time on a smartphone or monitor, these had to be downloaded to a computer at regular intervals.
The 1980s were the first decade where insulin pumps become widely available. The very first pump was large and had to be carried in a backpack, but it represented a huge step forward in glucose control, as it more closely mimicked the function of a working pancreas than once-daily injections.
For the next 30 or so years you really had to work to qualify for an insulin pump, but recently it's been found that pumps greatly improve compliance with blood glucose control whether or not the person had good compliance before getting the pumps, and insurance has gotten better about covering them (though CGMs are still a pain to get insurance to cover).
The 1980s was also the decade that recombinant human insulin (insulin made by genetically modified bacteria) was first used. Up until that point the only insulins were pork and beef insulins, which some people had allergic reactions to. Recombinant insulin was closer to regular human insulin than beef or pork, and represented a big change in how insulin was made.
Today for people who take insulin to manage their diabetes, insulin is usually given as a single injection of a long-acting basal insulin, coupled with smaller doses of ultra-short-acting insulins with meals or snacks. This is the closest we've gotten to mimicking the way a pancreas would work in the wild, and keeps very tight control of blood sugar. This can be done by fingerstick blood sugar tests and individual injections of insulin, or it can be done with a CGM and pump- it just depends on the resources available to the person and their personal preference.
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demiboydemon · 2 days
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Me: *wears an insulin pump*
My cat: is snack?? To nibble?? Yum yum yum 😋
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sayruq · 2 months
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If you want to help diabetics in Gaza, please donate or boost
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longlivepalestina · 2 months
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I hate this world.
fuck the USA. fuck Israel
death to all colonizers
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ashenprincx · 9 months
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god I really wish people weren't so fucking judgmental and cruel towards diabetic people who still eat a lot of sugar. partially because it's not their business, and because how much they clearly don't understand how diabetes works.
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urlocalllama · 8 months
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Diabetes isnt the 'ate too many sweets disease'. It just fucking is not. It's your body slowly losing an integral function needed to nuture and energize it. Its your pancreas shutting down, its your blood cells rejecting your attempts to feed itself, its not enough insulin to go around. Its you slowly getting colder and weaker, gorging yourself with healthy food and getting next to no benefit, its being so exhausted you cant sleep. Diabetes used to kill, straight-up KILL. So no, I don't think I will be laughing at your diabetes joke.
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sugas6thtooth · 2 months
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It is no secret that Israel attacks the most vulnerable and will do so by any means. The truth is in everyone's face yet so many people refuse to see this as a genocide.
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fatliberation · 1 year
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I saw a comment on your blog that says 'the way you eat does not cause diabetes'...are you able to expand on that or provide a source I could read? I've been told by doctors that my pre-diabetes was due to weight gain because I get more hungry on my anti psychotics and I'd like to fact check what they've told me! Thank you so much!
Pre-diabetes was rejected as a diagnosis by the World Health Organization (although it is used by the US and UK) - the correct term for the condition is impaired glucose tolerance. Approximately 2% of people with "pre-diabetes" go on to develop diabetes per year. You heard that right - TWO PERCENT. Most diabetics actually skip the pre-diabetic phase.
There are currently no treatments for pre-diabetes besides intentional weight loss. (Hmm, that's convenient, right?) There has yet to be evidence that losing weight prevents progression from pre-diabetes to T2DM beyond a year. Interestingly, drug companies are trying to persuade the medical world to start treating patients earlier and earlier. They are using the term “pre-diabetes” to sell their drugs (including Wegovy, a weight-loss drug). Surgeons are using it to sell weight loss surgery. Everyone’s a winner, right? Not patients. Especially fat patients.
Check out these articles:
Prediabetes: The epidemic that never was, and shouldn’t be
The war on ‘prediabetes' could be a boon for pharma—but is it good medicine?
Also - I love what Dr. Asher Larmie @fatdoctorUK has to say about T2DM and insulin resistance, so here's one of their threads I pulled from Twitter:
1️⃣ You can't prevent insulin resistance. It's coded in your DNA. It may be impacted by your environment. Studies have shown it has nothing to do with your BMI.
2️⃣ The term "pre-diabetes" is a PR stunt. The correct term is impaired glucose tolerance (or impaired fasting glucose) which is sometimes referred to as intermittent hyperglycemia. It does not predict T2DM. It is best ignored and tested for every 3-5yrs.
3️⃣ there is no evidence that losing weight prevents diabetes. That's because you can't reverse insulin resistance. You can possibly postpone it by 2yrs? Furthermore there is evidence that those who are fat at the time of diagnosis fair much better than those who are thin.
4️⃣ Weight loss does not reverse diabetes in the VAST majority of people. Those that do reverse it are usually thinner with recent onset T2DM and a low A1c. Only a tiny minority can sustain that over 2yrs. Weight loss does not improve A1c levels beyond 2 yrs either.
5️⃣ Weight loss in T2DM does not improve macrovascular or microvascular health outcomes beyond 2 years. In fact, weight loss in diabetics is associated with increased mortality and morbidity (although it is not clear why). Weight cycling is known to impacts A1c levels.
6️⃣ Weight GAIN does NOT increase the risk of cardiovascular OR all causes mortality in diabetics. In fact, one might even go so far as to say that it's better to be fat and diabetic than to be thin and diabetic.
Dr. Larmie cites 18 peer reviewed journal articles (most from the last decade) that are included in their webinar on the subject, linked below.
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mysharona1987 · 1 year
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Getting fact checked by your own website that you paid 44 billion dollars for.
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crippledpunks · 5 months
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i love you so much if you are diabetic, or pre-diabetic. our society treats diabetes so poorly. it's such a readily mocked condition, people often times resort to blaming the individual for having it, even going so far as to pass judgment on the diabetic's character, regardless of what type of diabetes they have.
diabetics are wonderful and deserve to love themselves regardless of whether or not they 'gave' themselves their diabetes. whether or not the person is "unhealthy" whether or not the person eats "right" or knows how to eat in ways that are safer for their body doesn't matter, they still deserve love, respect, and compassion.
diabetes is not a fucking judge of character. diabetics deserve better. diabetics deserve respect. diabetics deserve to be recognized as disabled. diabetics deserve kindness, love, care, compassion, and support. no matter what.
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bobby-luv · 1 year
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macgyvermedical · 2 days
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Hey babe, wanna hear something hot? *whispers* history of metformin
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Ok okay I'll talk
So metformin is commonly thought of as the most boring of diabetes drugs. Like, everyone who has ever thought about maybe having type 2 diabetes is taking it unless it gives them diarrhea, and even then their doctor still probably wants them to take it. But it's a first line because it's old, it's cheap, it doesn't often cause hypoglycemia, and it has relatively few side effects compared to other diabetes drugs. Also, like a lot of older drugs, it does way more than it says on the packaging. And a lot of stuff we're still learning about.
In order to talk about metformin, we have to talk about a plant called goat's rue. Goat's rue is a plant native to Europe, Africa, and Asia, and currently grows just about everywhere. In ancient times it was used as an anti-parasitic, a plague remedy, and to relieve the excessive urination caused by what might have been diabetes. In 1918 it was found to contain a chemical called galegine, which did lower blood sugar. Galegine as an anti-diabetes medication is probably too toxic to use long term. However, with a few chemical tweaks, it could become a drug that lowered blood sugar without the toxic effects. Metformin was born.
Metformin came out in 1923 and is a type of drug called a biguanide. it's actually the only type in it's class still available as an anti-diabetic agent, because the other drugs in it's class that came out in the 1920s and 30s caused lactic acidosis and liver problems (similar to the types of reactions seen with galegine), and were taken off the market.
Metformin (and pretty much all oral antidiabetic agents in development at this time) didn't do well initially, probably because they came out the same decade as insulin, and insulin was a lot more effective at treating any kind of diabetes.
It fell out of use extremely quickly, and didn't get picked up again until the 1940s, when US access to antimalarial drugs was cut off, just as a war in the pacific was ramping up. Metformin was evaluated as an antimalarial during WWII, and while noted to have some anti-malarial properties (particularly as a malaria preventative) it also was noted to significantly lower blood sugar in diabetic patients- while not lowering blood sugar very much at all in non-diabetic patients.
This effect, rather than it's antimalarial properties, was what got scientists really interested. Unfortunately, it would not be until 1957 in France that metformin had its first major studies to determine that it did, indeed, work against diabetes. Metformin lost the race to the "first" (successful) oral antidiabetic agent by a year, to a different drug that was found while looking for a new antibiotic- Diabenese.
Metformin became a commercial success in France, while Diabenese became successful in the United States. Metformin would actually not be approved for use in the US until 1995.
But now we get to talk about what metformin does and why it's so freaking cool.
Type 2 Diabetes- lowers A1C (a measure of blood sugar control) by 1-2 full points
Prevents/reverses weight gain due to antipsychotics
Prevents and treats malaria
Makes the flu shot work better
Decreases severity of respiratory illness and complications related to the flu
Changes gut microbiome for the better
Regulates periods and reduces other symptoms in people with PCOS
Lowers risk of breast, colon, and prostate cancer
Lowers risk of dementia
Lowers risk of stroke
May increase lifespan
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cheekios · 2 months
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Please Bring Kaiser Home.
I have been having complications with managing my diabetes that have led me to be hospitalized twice. I live alone. Kaiser is a precious pup that specializes in detecting when blood sugar is too high or too low before it leads to complications. Something I have been struggling with. Kaiser would not only improve my quality of life but also be my companion and friend
I’m asking for community support get a Medical Alert Dog. It is a huge ask but any support is appreciated 💗
CA: $HushEmu
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fatphobiabusters · 7 months
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If your activism for diabetics stops as soon as you have to include type 2 diabetics, then not only is your "activism" ableist and almost certainly fatphobic, your efforts are also useless. You will never improve how society treats diabetic people if you only care about the diabetic people who are viewed more favorably in this fatphobic, ableist, and dieting-obsessed world.
-Mod Worthy
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I find it an interesting commentary that the creation of more "healthy" food has left disabled people behind.
Diabetic people usually grab apple juice to balance their blood sugar. But in order to make apple juice more "healthy" for the kids, they've started adding less sugar to apple juice, making it a less viable option to raise their blood sugar.
I'm sure there's other instances too.
-fae
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