Patients coming to my office need only glance around to notice my intense interest in the history of medicine and nursing and the many mid-19th century and Victorian medical and nursing artifacts and textbooks.
Because of this interest, I have opted to focus this column on a major medical condition that is taking on epidemic proportions in this country tracing its evolution in American medicine in terms of theory as well as treatment.
Even through ancient Egyptians were aware that the urine of some ill people smelled very sweet, it is the Greeks who get credit for naming this disorder "diabetes" from their root word that means to siphon off, in reference to the excessive urination that diabetics experience.
In spite of this keen observation, ancient physicians were at a loss to explain the cause, let alone successfully treat their patients with this malady.
Throughout the 1700s physicians of the day and anatomists who studied human physiology by way of autopsies were divided in their belief that either the kidneys or the pancreas had to be responsible for diabetes.
Even through a deceased diabetic's pancreas may have appeared damaged in some way, the obvious symptom of excessive urination helped maintain the belief that the kidneys held the answer to treatments and cures.
Well into the 1800s the most widely held treatment plan was a diet very high in carbohydrate rich foods; the more carbohydrates a diabetic patient ate, the more the sugar in his urine could be soaked up and replaced instead of losing it with each trip to the outhouse.
In the latter half of the 19th century, it was generally accepted that the seat of the problem is within the pancreas.
Then, in 1910, a hormone from the pancreas was isolated as one that could be "anti-diabetic." It was named insulin, and its purpose was presumed to bring sugar to the body's cells for metabolism.
It would take another 12 years of research and study before the essential components of this hormone could be purified and used to treat humans with diabetes.
By the 1940s-50s American diabetics were self-administering their insulin shots. In spite of the advancement, this treatment was seen as a shameful, last resort by patients.
Those who had to "go on insulin" felt as though they had been given a death sentence. In 1958 the first oral anti-diabetic medications were developed. These actually stimulate the pancreas to produce more insulin, so the dreaded shots could be postponed.
Not much more happened in the understanding and treatment of diabetes until the mid- to late-1980s. It was about this time that a tremendous surge of research findings came about to elucidate the facts that the origin of diabetes is actually multi factorial.
Because of this, treatments evolved that do not involve only insulin or the pancreas.
It was learned that diabetes is not solely a disease due to a lack of insulin, but concomitantly a disease where tissue and muscle cells become unresponsive to the insulin that is circulating and, therefore, unable to utilize the sugar that is presented to it by the insulin.
Now we understand that diabetes develops because of this two-pronged process: The pancreas failing in its production of insulin as well as cells not being responsive to the insulin as it attempts to deliver the sugar to the cells. Or, as we now call it: Insulin resistance.
Finally, around the time of the turn of this century, research found another reason for the development of diabetes. That being a hormone that is found in the gut that regulates blood sugar levels. New medicines can now manipulate the hormone that helps control diabetes.
Who knows what the next 50 years will bring in the knowledge and understanding of diabetes and from that the new treatments that will evolve? Stay tuned.
• Agnes Oblas is an adult nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call (602) 405-6320 or email firstname.lastname@example.org. Her website is www.newpathshealth.com.