Insulin

“ Therefore, when such complications occur, a patient must have insulin, whether he has been able to do without it before or not, and usually the doses necessary to control these critical emergencies must be large. For instance, a patient on a set diet, whose urine remains free from sugar with 20 units of insulin, may require 40 units daily whenever he takes cold. A serious infection like pneumonia may make it necessary to use 80 units of insulin daily. ”

“ Excessive insulin harmful.—In severe diabetes the pancreas manufactures very little insulin, not more than 20 or 30 units, and the balance necessary for the day’s work must be given by hypodermic syringe in two or three doses. If the total amount of extra insulin necessary daily were 150 units, each hypodermic injection would be 50 units, and it is difficult to give such large doses as this without causing a temporary excess of insulin in the blood. Unfortunately, excessive insulin is as disagreeable as inadequate insulin. ”

“ The hospital management of a case of diabetes is not complete until the patient can live a healthy life in spite of his disease. He may arrive at the hospital in a state of coma and be dragged from the very jaws of death with insulin, but afterwards, when he goes home, unless he has learned how to continue the use of insulin and combine with it an accurate diet, he will slip again into the same dangerous predicament. ”

“ Diabetic men often were dominated by their mothers while being excessively dependent on them. Adult onset diabetes is usually controlled without insulin injections, particularly during the early stages of the disease. Treatment in about one-third of noninsulin-dependent diabetics is possible by diet alone; in others, it is necessary to take oral hypoglycemic drugs that stimulate the release of insulin.
The emotional symptoms of both forms of diabetes may include apathy, depression, personality disorders, or even psychosis as a result of undersecretion of insulin. ”

“ The diet can not be disregarded.—Some persons may ask why dieting is necessary with insulin? If, as seems true, the only metabolic disturbance in diabetes is a lack of sufficient insulin, then we should be able to correct this fault completely by giving sufficient insulin, and to eat what we want. ”

“ Overdose of insulin dangerous.—The effects of an overdose of insulin are striking; there is too great a lowering of the amount of sugar, and severe convulsions ensue which may lead to death. Insulin is a powerful remedy; its effects are certain and accurately measurable. If a human being is given too much, his blood sugar falls to a lower concentration. ”

“ Under normal circumstances, a patient taking 20 or 30 units of insulin daily, does very well when this is divided into two doses of 15 units each, and one dose is injected before breakfast, and the second before the evening meal. During an attack of pneumonia or any other fever-producing complication, it may be necessary to resort to four injections, spaced at six-hour intervals. It is usually necessary to modify and reduce the diet when a patient is sick. It is always wise to eat less. In particular, the fat allowance of the diet should be reduced. It is wise not to reduce the carbohydrate. ”

“ Minkowski’s discovery.—The story of insulin began a generation ago with the discovery of German investigators, Minkowski and von Mehring. This was in 1889, and until then the relation of the pancreas to diabetes was scarcely suspected, and no one had an idea where to look for the means to check the disease. The pancreas is an organ about the size of one’s hand which pours digestive juices into the intestine. ”

“ When the physician decides to place his patient on the insulin treatment, he usually asks that the patient come into a hospital so that he may first find out the patient’s normal ability to digest sugar, and it is this ability that the physician supplements by the giving of insulin. ”

“ The added danger of diabetes may be avoided if the patient is in good condition before he goes to operation, and if acidosis is promptly combated with insulin. It is wise for the diabetic patient to employ only a very skillful surgeon, and to make certain either that he is familiar with the treatment of diabetes, or that he has associated with him some physician who has had a considerable experience with diabetes. ”

“ Diabetes represents the absence from the body, probably as the result of disease, of certain substances which are responsible for the control of the digestion and use of sugar, and insulin cannot restore these tissues or substances any more than the injections of other glands can restore youth to the aged. ”

“ This condition is typically alleviated by yet another hit of sugar which builds an addiction not only to sugar, but to food in general. If the hypoglycemic then keeps on eating sugar to relieve the symptoms of sugar ingestion, eventually the pancreas becomes exhausted, producing an insulin deficiency, called diabetes. Medical doctors treat diabetes with insulin supplements either oral or intramuscular plus a careful diet with very low and measured amounts of sugar and starch for the remainder of the persons inevitably shortened and far less pleasant life. ”

“ Actually a large part of the pancreas may be destroyed before diabetes results. In dogs, little more than one-tenth of the gland remaining intact is sufficient to prevent the excretion of sugar. Men are more susceptible to diabetes than dogs, but even in men the pancreas may be seriously affected by inflammation or cancer before its insulin capacity is reduced to the point where actual insulin shortage is manifest. ”

“ In mild cases of diabetes the results obtainable by diet are entirely satisfactory and the milder the case the less the food restriction necessary. In severe cases of diabetes the dietary treatment alone is less satisfactory because the diet has to be cut so low that the patient is improperly nourished. Before the discovery of insulin was made, every such case presented a bitter dilemma. ”

“ The cost has been reduced to below one cent a unit, so that insulin is now brought within the reach of everyone. Indeed, the cost is negligible when we consider that patients who, without insulin, were helpless invalids, dependent on relatives or charity, are now as fit and strong as their neighbors, and able to work again. ”

“ Recent research advances have included the synthetic production of purified human insulin to ensure adequate supplies of this essential hormone, the development of improved methods for insulin administration, new technologies for monitoring critical blood sugar levels, new therapies for the treatment of diabetes-related kidney, eye, and cardiovascular diseases, and improved clinical capabilities for reducing the increased perinatal morbidity and mortality associated with diabetic pregnancies. ”

“ Sugar is a powerful drug! People who abuse sweets set up a cycle of addiction that can be very hard to break. It starts when the body tries to regulate blood sugar. Kicked up to high levels by eating sugar, the pancreas releases insulin. But that is not the end of the chain reaction. Insulin regulates blood sugar levels but also raises brain levels of an amino acid called tryptophan. Tryptophan is the raw material the brain uses to manufacture a neurotransmitter called serotonin. And serotonin plays a huge role in regulating mood. ”

“ Diabetes a disorder of metabolism.—What is this insulin and what does it do? Before this is answered, the nature of the chemical disorder that is called diabetes must be somewhat understood, and to supply this understanding, a partial review of the chemistry and physiology of nutrition must be made.
The processes of life are largely chemical. The warmth of the body is provided by combustion, oxidation of food. If the supply of food is discontinued, life ends, and the body cools exactly as a gasoline motor stops and cools off when its supply of fuel is exhausted. ”

“ Diabetes centuries old.—Now diabetes is no new disease.
It was described by Aretaeus, a Greek who lived in the third century, A.D., and hundreds of scientists have worked steadily on the problem ever since that time. Indeed the history of the discovery of insulin is typical of all great medical discoveries of modern times. It represents the summation of a vast amount of knowledge contributed bit by bit by scientists all over the world. When Banting conceived his idea, he took it to Dr. MacLeod, director of physiologic research in the University of Toronto. ”

“ Diabetes can lead to severe complications, including heart disease, blindness, kidney failure, and lower-extremity amputations. Up to 1 million Americans have type 1 diabetes, an autoimmune disorder that destroys insulin-producing cells in the pancreas, while an estimated 16 million Americans have type 2 diabetes, in which the body does not sufficiently produce or process enough insulin. Type 2 diabetes is often related to obesity, and it is rising rapidly among men and women of all ages. Type 2 diabetes is also on the rise among children, for whom it was once extremely rare. ”

“ Not since the discovery of insulin over half a century ago, however, has the outlook for advances in the treatment, cure and ultimate prevention of diabetes been as promising as it is today. In recent years, research has yielded new and exciting information about the causes and treatment of diabetes and its complications. ”

“ Keeping the urine sugar-free is the first requisite. Gangrenous ulcers of the feet can be made to heal by vigorous treatment with insulin, and diet. It is of great importance to encourage the circulation in the feet by massage and proper exercises. Finally, care in avoiding bruises and cuts of the skin of the feet will prevent much trouble. Every old diabetic patient should wash his feet daily, wear clean stockings, and very comfortable shoes. Watch and guard the feet. Achilles, the Greek hero, must have been a diabetic. ”

“ This can be reduced by an insulin injection, but as soon as food rich in carbohydrate [Pg 45] is eaten, back comes the sugar to a high level. In order to rest the pancreas, the blood sugar must be kept low, which can only be accomplished when the diet contains relatively little carbohydrate.
THE DIET
Calories and sugar should be low.—All of the principal authorities on diabetes are agreed that a diabetic patient must not overeat and become fat. In other words, the total amount of food energy, that is, calories, must be limited. ”

“ Almost 17 million Americans have diabetes, a disease that prevents the body from using its own insulin to break down sugars. It is the sixth leading cause of death in the United States. During National Diabetes Month, we recognize advancements in preventing, treating, and detecting this disease, and we renew our commitment to helping Americans with diabetes live longer, healthier lives. ”

“ The Islands of Langerhans constitute a small portion of what is relatively a small gland. In stock yards and packing houses this gland is called sweet breads; the sweet breads served under glass in the restaurants are usually the pancreas of the sheep or hog, since these are small. The beef pancreas is a much larger organ, weighing about a pound or a pound and a half.
The method devised by Collip for obtaining insulin from the pancreas involves repeated extraction of the ground-up pancreas with alcohol, in order to remove the unnecessary tissue substances. ”

“ Each year, an estimated 500,000 more Americans are told by their physicians that they have diabetes. This chronic disease interferes with the body's ability to derive energy from glucose, a type of sugar and an important product of digested food. When diabetes strikes children, it is in a form that can soon be fatal without daily injections of the life-saving hormone insulin. Most people with diabetes have another form of the disease that begins in adulthood and that, over the years, can insidiously and progressively damage the heart, eyes, kidneys, and nervous system. ”

“ Insulin, which is vital in the treatment of diabetes, can now be produced inexpensively and in large quantities through the use of genetically engineered bacteria. In addition, exciting gains in the understanding of the human body's genetic code show significant promise in finding treatments and eventually a cure for many diseases. ”

“ These symptoms often occur a few hours after eating and disappear after eating again.
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Hypoglycemia has become almost a fad disease among "psychonutritionists." The condition is believed by most physicians, however, to be confined mainly to diabetics who have not kept to a prescribed routine and have allowed their levels of insulin to become too high. Sometimes stomach surgery, liver disease, pregnancy, and periods of high fever can cause attacks of hypoglycemia. ”

“ To list all the great discoveries in the field of science and medicine during the past century, such as aspirin, insulin, penicillin, and the streptomycin drugs would require the undivided attention of a medical historian and a veritable encyclopedia to record them.
And yet, there are still many diseases that plague man of which he has no knowledge. They eat and ravage his mind and body with excruciating pain and torture, and he is utterly helpless against [Pg 49] them. ”

“ No inflammation has occurred in the pancreas of these patients, so far as any good evidence shows; they are young and therefore not afflicted with arterial disease, and they have never been overweight and have not overeaten. How can we explain the diabetes of these children and young persons, and how can we explain why some fat persons and not all escape diabetes, and why some patients with very little disease of their pancreas have diabetes and others with very extensive destruction of the pancreas do not have it? ”