Diabetes mellitus

Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating. All types of diabetes mellitus share similar symptoms and complications at advanced stages. Hyperglycemia itself can lead to dehydration and ketoacidosis. Longer-term complications include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis), retinal damage which can lead to blindness, nerve damage which can lead to erectile dysfunction (impotence), gangrene with risk of amputation of toes, feet, and even legs. The more serious complications are all more common in those with poor glycemic control.

History

Although diabetes has been recognized since antiquity, and treatments were known

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since the Middle Ages, the elucidation of the pathogenesis of diabetes

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occurred mainly in the 20th century7.

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Until 1922, when insulin was first discovered and made clinically available, a clinical diagnosis of diabetes was an invariable death sentence, more or less quickly. Non-progressing type 2 diabetics almost certainly often went undiagnosed then; many still do.

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The discovery of the role of the pancreas in diabetes is generally credited to Joseph Von Mering and Oskar Minkowski, two European researchers who, in 1889, found that when they completely removed the pancreas of dogs, the dogs developed all the signs and symptoms of diabetes and died shortly afterward. In 1910, Sir Edward Albert Sharpey-Schafer of Edinburgh in Scotland suggested diabetics were deficient in a single chemical that was normally produced by the pancreas - he proposed calling this substance insulin.

Related Topics:
Joseph Von Mering - Oskar Minkowski - 1889 - 1910 - Edward Albert Sharpey-Schafer - Edinburgh - Scotland

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The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not fully clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski but went a step further and managed to show that they could reverse the induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs8. They went on to isolate the hormone insulin from bovine pancreases at the University of Toronto in Canada.

Related Topics:
1921 - Frederick Grant Banting - Charles Herbert Best - Islets of Langerhans - University of Toronto

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This led to the availability of an effective treatment - insulin injections - and the first clinical patient was treated in 1922. For this, Banting et al received the Nobel Prize in Physiology or Medicine in 1923. The two researchers did not patent their discovery and insulin therapy rapidly spread around the world.

Related Topics:
1922 - Nobel Prize in Physiology or Medicine - 1923

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The distinction between what is now known as type 1 and type 2 diabetes was made by Sir Harold Percival (Harry) Himsworth in 1935; he published his findings in January 1936 in The Lancet9.

Related Topics:
Harold Percival (Harry) Himsworth - 1935 - The Lancet

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Other landmark discoveries7 include:

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• identification of sulfonylureas in 1942
• the radioimmunoassay for insulin, as discovered by Rosalyn Yalow and Solomon Berson (gaining Yalow the 1977 Nobel Prize in Physiology or Medicine);
• Reaven's introduction of the metabolic syndrome in 1988
• identification of thiazolidinediones as effective antidiabetics in the 1990s.