Before the discovery of insulin in 1922 and its subsequent commercial release in 1923, Type 1 diabetes would kill you. It still can, but until 94 years ago, it absolutely would.
The lives of diabetics before 1922 are grim to think about, but they deserve more than an acknowledgment of their tragedy. I think it’s worth exploring what they went through, and how various healers tried to help them.
Ancient descriptions of diabetes are dire. The 2nd century Greek physician Galen of Pergamon referred to it as “the thirsty disease.” The greek word for diabetes, diabainein, means “siphon,” but can be translated as “to stand with legs apart,” suggesting the (male) posture of urination.
As you might guess, excessive urination was the first thing the ancients noticed in diabetic patients. Aretaeus of Cappadocia described diabetes as “the melting down of flesh and limbs into urine.” He meant this fairly literally. To remove all ambiguity, Aretaeus also said, “life (with diabetes) is short, disgusting and painful.”
Aretaeus was right. Dying from DKA (diabetic ketoacidosis) seems like one of those experiences engineered to maximize and prolong suffering. If we imagine a hypothetical ancient Type 1 diabetic, we know he could expect to die like this: as his blood began to sweeten, the first symptoms would include extreme thirst, vomiting, and of course, excessive urination. The flesh and limbs would begin to “melt down.” He’d lose weight.
He would then begin panting and gasping, which would accelerate the fatal dehydration. Anyone taking care of him would smell the sweetness on his breath. In the final stages of DKA, he would begin passing out and perhaps begin vomiting what the medical literature delicately terms “altered blood.” The less sanitized name for this phenomenon is “coffee ground vomiting.” I’ll spare you an explanation; the name is enough. Soon his organs would fail, and so would he.
(I just asked my brother, a medical researcher, to help me summarize this process in layman’s terms. He suggested, “Your blood turns to poison and you die.”)
Although diabetes was considered rare in the premodern world, it was deadly enough to be noteworthy, and many physicians wanted to know how to treat it. According to the Ebers Papyrus (discovered in 1872), ancient Egypt had several ideas about how to attend to the mysterious sweet-urine disease.
The papyrus tells us that Egyptian remedies included: “A measuring glass filled with Water from the Bird pond, Elderberry, Fibers of the asit plant, Fresh Milk, Beer-Swill, Flower of the Cucumber, and Green Dates.” This prescription leaves one wondering what kind of birds populated the pond, and why their water would make anything in the human body feel better.
The rest of the ingredients (excluding “Beer-Swill”) sound vaguely delicious, but their carbohydrates would only make things worse for the diabetic patient. (This wouldn’t be the last time physicians made such a mistake — an 18th century Frenchman named Pierre Priorry reasoned that diabetics ought to replace the sugar they lost in their urine by eating large quantities of sweet stuff. We can only imagine how this went.)
More helpfully, the famous 5th century BCE Greek physician Hippocrates (yes, from the oath) figured out that a low-starch diet and vigorous exercise could extend the lives of diabetic patients. He also was among the first to suggest that there were two or more types of diabetes.
But remember Aretaeus, the guy who said diabetic life was “short, disgusting, and painful?” He was Hippocrates’ student, so we can infer that despite Hippocrates’ discovery, the prognosis for Type 1 diabetics in ancient Greece was still pretty grim.
Avicenna, the 11th century Persian polymath, was among the first to have any success treating diabetes medicinally. In his 1025 encyclopedia The Canon of Medicine, he prescribed for diabetics an herbaceous blend of lupine (a legume with edible peas and gaudy flower spikes), fenugreek (a small herb with pungent yellow seeds) and zedoaria (a wetland crop whose roots taste like ginger with a bitter aftertaste).
All together, these herbs made more than an aesthetically formidable bouquet: they worked! At least a little. Diabetics who consumed this blend would excrete less sugar, and their symptoms would grow less severe. It’s likely that fenugreek was the most helpful ingredient; recent studies have suggested (but not proven) that its yellow seeds can stimulate insulin production in both Type 1 and Type 2 diabetics. In any case, Avicenna could buy his patients a little time.
Apollinaire Bouchardat (1806-1886), noteworthy for more than his name, was perhaps the first physician in the pre-insulin era to score a genuine success in the treatment of Type 1 diabetes. During the Franco-Prussian war, he noticed that when rations got desperately low, starving soldiers produced very little glucose in their urine. He applied this observation to his diabetic patients. It turned out that a starvation diet could prolong the lives of diabetics (if they could withstand, you know, the starving).
Exercise, herbs, and starvation: these could feebly push back the threshold of the diabetic’s death. The entire edifice of medical history had nothing else to offer until 1922. Every diagnosis meant a person would melt away.
Each time you spill a few droplets of insulin and smell its sour alcohol scent, remember that it isn’t fenugreek, that you may eat (almost) whatever you want, and that you will survive. Though they couldn’t fix diabetes, be grateful to Avicenna, Hippocrates, all of them. Drink fresh milk, eat green dates. You’re lucky to be here.