1552 B.C.E.First Mention of DiabetesThis is the earliest known record of diabetes, mentioned on Egyptian papyrus by physician Hesy-Ra who detailed polyuria (frequent urination) as a symptom. Hesy-Ra examined a patient who was urinating frequently. While the doctor did not know what was causing the illness, he prescribed a special diet of fruits, grains, and honey. The diet helped but did not cure the patient. Treatment by other Egyptian doctors included beer swill, cucumber flower, and pond water.
Find out more about a diabetes diet. ]]>nono/files/Timeline/images/Hesy-Ra.jpg600 BCDiabetes DiagnosedSusruta of the Hindus, called the father of medicine in India, diagnosed the condition later known as diabetes. ]]>nono/files/Timeline/images/06---Susruta.jpgnoCharakaDuring this period, the ancient Indian physician Charaka described the disease "madhumeha" (honey urine) or "iksumeha" (sugar cane urine) in his work Charaka Samhita. The doctors of this period used ants or insects to aid in diagnosis. Honey-sweet urine attracted ants, confirming the diagnosis. Susruta and Charaka were the first to differentiate between the two types of diabetes mellitus, observing that thin patients developed diabetes at a younger age in contrast to heavier patients, who had a later onset and lived longer.
Get more information about type 1 diabetes.
Get more information about type 2 diabetes.]]>nono/files/Timeline/images/charaka.jpgLate 3rd CenturyApollonius of MemphisApollonius of Memphis describes a condition with the terms "without retention" (of urine) and "without delay" (of urination).]]>nonono250 B.C.E.Diabetes NamedApollonius of Memphis, Egypt, is believed to have named the disease "diabetes," which means "to go through." The name showed that physicians understood that people with the disease were expelling more fluid than they could drink.]]>nonono230 BCPaul of AeginaPaul of Aegina, a prominent Greek surgeon and physician, makes the connection between diabetes and the weakness of the kidneys, and excess moisture from the body, which leads to dehydration. He prescribes a remedy of pot-herbs, endive, lettuce, rock fishes, juices of knotgrass, elecampane in dark-colored wine, dates, and myrtle to drink in the first stages of the disease, followed by cataplasms over the kidneys consisting of vinegar, rose oil, and navel-wort. He warns against the use of diuretics, but the cutting of veins is permitted.
Learn more about your kidneys.]]>nonono10 ADFirst Clinical Diabetes DescriptionRoman medical writer (possibly physician) Aulus Cornelius Celsus writes the first known clinical description of diabetes in his work, De Medicina.]]>nono/files/Timeline/images/celsus.jpg150 ADFinding the DifferencesAretaeus of Cappadocia was a Greek physician who practiced in Rome and Alexandria in the second century AD. He was the first to distinguish between what we now call diabetes mellitus and diabetes insipidus.
"Diabetes is a dreadful affliction, not very frequent among men, being a melting down of the flesh and limbs into urine. The patients never stop making water and the flow is incessant, like the opening of the aqueducts. Life is short, unpleasant and painful, thirst unquenchable, drinking excessive and disproportionate to the large quantity of urine, for yet more urine is passed. If for a while they abstain from drinking, their mouths become parched and their bodies dry; the viscera seem scorched up, the patients are affected by nausea, restlessness and a burning thirst, and within a short time they expire."]]>nono/files/Timeline/images/Aretaeus.jpg160 ADGalenGreek physician Galen of Pergamum considered that diabetes was not a disease of the stomach, but of the kidneys; like diarrhea, it consisted of an unaltered excretion of fluids. For Galen, treatment consisted of overcoming the acidity of the humors, slowing the movement of the blood, and cooling the overheated kidneys.
Click here to read more about kidney disease.]]>nono/files/Timeline/images/galen_thumb.jpg980-1037AvicennaPersia-born Avicenna was prominent among Arab physicians. He described diabetes based on Galen's work and adds details such as the presence of carbuncles, or skin abscesses. ]]>nono/files/Timeline/images/Avicenna_Persian_Physician.jpg1000A Variety of PrescriptionsGreek physicians prescribe exercise, preferably on horseback, to relieve excess urination. Arab physician Avicenna prescribes emetics (herbs used to induce vomiting) and sudorifics (used to stimulate sweating), directing that all diuretic foods and drugs be avoided. In the latter stages he recommends tepid baths and fragrant wine.
Ready to get fit? Start here!]]>nononoUp to 11th CenturyWater TastersDiabetes is commonly diagnosed by "water tasters," who drank the urine of those suspected of having diabetes because the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), "mellitus," is said to have been added to the term "diabetes" at this time. The term is credited separately to William Cullen, Thomas Willis, and Johann Peter Frank, all in the 17th century. It is not clear to whom credit can actually be given. ]]>nono/files/Timeline/images/William-Cullen.jpg1425It's in the BookThe word diabetes first appears in an English book, although it is in Middle English - "diabete."]]>nonono1500sParacelsusParacelsus, born Theophrastus Philippus Aureolus Bombastus von Hohenheim, was a major Renaissance physician and author who founded the field of pharmacology. For him, diabetes was a systemic disease, a corruption of the humors as the result of a disordered combination of sulfur and salts in the blood, overflowing into the kidneys, which became inflamed, and causing excessive urinary excretion: "Diabetes is nothing other than an excessive eagerness to pass urine, and the cause of this malady is excessive heat of the kidneys."
Paracelsus heated urine from a person with diabetes and found white powder. He therefore believed that the composition of the blood of people with diabetess was altered. He postulated the theory that this salt-like substance "...causes the thirst of the kidneys and promotes the outflow of water." Although he did not comment on the sweetness of the urine, he treated his patients with starvation diets.]]>nono/files/Timeline/images/php-paracelsus.jpg1550Geronimo CardonaGeronimo Cardona, a physician but better known as a mathematician, finds that the volume of urine is less than the fluids consumed by a person with diabetes. The idea that urine volume is greater had been introduced by Galen 14 centuries previously, and persisted into the 19th century.]]>nonono1600sThe Pissing EvileIn the 17th century, diabetes was called "the pissing evile" because a person with severe diabetes would urinate as much as 10-15 quarts per day.]]>nonono1674Sweetness RediscoveredThomas Willis, of England, rediscovers that the urine of people with diabetes is sweet, a fact not recognized since the time of early Hindu medicine. It is said that for the first time the adjunct "mellitus" was added to the word diabetes. (But some experts also credit this description to William Cullen.) Willis himself still believed that the sweetness in the urine was due to a compound of salts and sulphur. (Please see Up to the 11th Century on timeline.)]]>nono/files/Timeline/images/531px-Thomas_Willis_2.jpg1685Necessity of PancreasIn 1685, the Swiss doctor Johann Conrad Brunner (1653-1727) investigated the question of whether the pancreas is essential for life or not. He removed the pancreata from dogs and observed what happened. He determined that the animals initially developed a great thirst and passed a great deal of urine, but that the symptoms then regressed. What he expected to see did not occur. The animals did not die and the pancreas was thus declared a non-essential organ.
More than 200 years later it was proven that the tiniest remnants of pancreas are sufficient to provide the body with an adequate supply of insulin. Brunner's research was incomplete, as he had left remnants of the organ in the animals, allowing him to reach this fatally flawed conclusion. He published the findings concerning his pancreatic research in a treatise titled Experimenta Nova circa Pancreas. Accedit diatribe de lympha & genuino pancreatis usu.]]>nonono1776Brown SugarEnglishman Matthew Dobson evaporates diabetic urine and finds a substance like brown sugar in appearance and taste. He also finds a sweetish taste of sugar in the blood of people with diabetes, observing that diabetes is fatal in less than five weeks in some, and is a chronic condition in others. ]]>nono/files/Timeline/images/dobson.jpg1780Francis HomeMatthew Dobson's observations were taken up immediately by his Edinburgh compatriot Francis Home (1719-1813), who, in 1780, developed the fermentation test, the first clinical method of testing diabetic urine by adding yeast. From one pound of urine, (i.e., about 360g) he was able to extract one ounce of the sugary substance.]]>nono/files/Timeline/images/home.jpg1797John RolloThe English military doctor John Rollo (1749-1809) was able to demonstrate the presence of sugar in the blood indirectly. He devised a low carbohydrate diet, which he tested successfully on an overweight subject, Captain Meredith. The diet consisted of milk and limewater for breakfast and supper; plain blood pudding for lunch; and well-seasoned, preferably even rancid, meats for dinner. He observed that the sugar content in the urine increased when his patient ate an apple cake or drank beer. The conclusion that he drew from the experiment was that diabetes is a disease of the digestive tract.
Since the end of the 18th century, it had been recorded that in the final stage of their illness, people with diabetes exuded a smell like apples, violets, or chloroform. This was described by Johann Peter Frank as early as 1794 and Rollo in 1797.]]>nono/files/Timeline/images/frank1.jpgEarly 1800sUrine TestingThe first chemical tests were developed to indicate and measure the presence of sugar in the urine. Until the middle of the 19th century, the kidneys, the stomach, and the liver were thought to be the site of diabetes. ]]>nonono1800sPavlov Czech researcher I.V. Pavlov discovers the links between the nervous system and gastric secretion, making an important contribution to science's knowledge of the physiology of the digestive system. ]]>nonono1835Felice AmbrosianiItalian Felice Ambrosiani (1790-1843) successfully isolated sugar crystals from the blood and urine of people with diabetes.]]>nonono1837Claude Bernard French researcher Claude Bernard finds that "liver secretes sugar into the blood." This is significant as up until this point it was believed that sugar was formed only in diseased organisms. Bernard also observed that in some nervous lesions excess sugar was found in the urine. (NOTE: The date of this discovery is not certain. This finding has also been dated 1848.) ]]>nono/files/Timeline/images/claudbernard.jpg1838Sugar = GlucoseThe scientific confirmation of the identity of urinary and grape sugar was made independently by both Apollinaire Bouchardat (1806-1886) and Eugene Melchior Peligot (1811-1890). They provided proof that this sugar is, in fact, glucose.]]>nonono1848Hermann Von Feiling Stuttgart chemist Hermann Von Feiling (1819-1885) published the formula named after him, which was already capable of giving a quantitative value for the sugar content in the urine. ]]>nononoLate 1850sPriorryFrench physician, Priorry, advises diabetes patients to eat extra large quantities of sugar as a treatment for diabetes. Later, Ernst Brand (1827-1897) again noticed a strange applelike smell in the breath of people with diabetes, and this came to be recognized as an indisputable symptom of severe diabetes. ]]>nono/files/Timeline/images/ernestBrand.jpg1869Paul LangerhansPaul Langerhans, a German medical student, announces in a dissertation that the pancreas contains two systems of cells. One set secretes the normal pancreatic juice, the function of the other was unknown. Several years later, these island-shaped cells are identified as the "islets of Langerhans." ]]>nono/files/Timeline/images/Paul_Langerhans.jpg1870sApollinaire BouchardatFrench physician Apollinaire Bouchardat notices the disappearance of glycosuria (the presence of glucose in the urine) in some of his diabetes patients during the rationing of food in Paris while under seige by Germany during the Franco-Prussian War. He formulates the idea of individualized diets for his diabetes patients. He told his patients to start eating less.
The diets helped, but patients still had the disease and continued to develop serious problems. Finding laboratory evidence for sugar in the blood was problematic. For his first examination of blood sugar, Bouchardat needed vast quantities of blood to test - about 300 ml, which is equivalent to 14 ounces. Many of today's meters require as little as .03 to 10 L of blood.]]>nono/files/Timeline/images/Appollinaire-Bouchardat.jpgLate 1800s Locked UpItalian diabetes specialist Catoni isolates his patients under lock and key in order to get them to follow their diets. ]]>nonono1889Dog Pancreas RemovedOskar Minkowski and Joseph von Mering (pictured) at the University of Strasbourg, Austria, were the first to remove the pancreas from a dog to determine the effect of an absent pancreas on digestion. Mering and Minkowski undertook their experiment in connection with a completely different problem and, as Minkowski himself admitted, owed its success to chance.
Mering had been concentrating in Strasbourg mainly on re-absorption of fats. But even ligature of the excretory ducts of the pancreas was insufficient to keep pancreatic lymph from the intestine because there were a number of pancreatic channels of which the authors could not yet know. Minkowski suggested to Mering that he should extirpate the pancreas. He had acquired particular dexterity from similar experiments, and so, on the very day of their conversation, the first dog was operated on with Mering's assistance.
Neither of the two physicians imagined that the dog would experience any further problems since it had safely recovered from the operation and the wound had healed. Mering himself had to go away for a week because of illness in his family and the dog, which had been fully housetrained before, urinated several times indoors and made life hell for the laboratory servant. Acting on a sudden hunch, Minkowski examined the urine and found a high proportion of sugar. He quickly operated on a few more dogs, which he tested to make sure they were free of sugar before the operation, and all of them developed severe diabetes.
Minkowski soon found that feeding pancreas to dogs whose own pancreas had been removed did not lead to any improvement in their diabetes. But when he implanted pancreas subcutaneously, the symptoms disappeared relatively soon.
But as early as 1890 Minkowski had to acknowledge that the method of enteral administration was not promising. What he called "pancreatine," dried fresh pancreas, had no effect on diabetes.]]>nono/files/Timeline/images/mering2.jpg1891Fredrick Banting BornNovember 14, 1891, Frederick Banting, the future co-discoverer of insulin, was born near Alliston, Ontario. His parents, devout Methodists, try to pressure their son into joining the ministry. Instead, in 1912, Banting enrolls in medical school at the University of Toronto.]]>nono/files/Timeline/images/Banting-with-dog.jpg1897Life ExpectancyThe average life expectancy for a 10-year-old child diagnosed with diabetes is 1.3 years. People diagnosed at 30 have a life expectancy of an additional 4.1 years and a 50-year-old an additional 8 years.]]>nonono1899Charles BestOn February 28, 1899, Charles Best was born in West Pembroke, Maine. Best, along with Frederick Banting, James Collip, and JJR Macleod would go on to discover insulin in 1921.]]>nono/files/Timeline/images/Charles-Best.jpg1901Eugene OpieEugene Opie links diabetes with islet cells and wrote a standard text on diseases of the pancreas.]]>nono/files/Timeline/images/OpieEL.jpg 1903Von Noorden Introduces New DietThe oatmeal diet (a so-called "cure") is introduced by CJ Von Noorden. The daily allowance is approximately eight ounces of oatmeal mixed with eight ounces of butter, prepared as a gruel, eaten every two hours.]]>nono/files/Timeline/images/CarlNoorden.jpg1908Pancreatic ExtractGerman scientist Georg Zuelzer develops the first injectible pancreatic extract to suppress glycosuria (the presence of glucose in urine). It was called acomatrol. However, there are extreme side effects to the treatment. The acomatrol was injected into a dying patient who got better at first but then died after the acomatrol was gone.]]>nono/files/Timeline/images/zuelzer.jpg1909Naming InsulinJean de Meyer (Belgium) proposes the name "insulin" (Latin: insula, island) for the unknown substance in the pancreas.]]>nono/files/Timeline/images/insulin-2.jpg1910Frederick Madison Allen, Elliot P. Joslin & Sharpey-Shafer Frederick Madison Allen and Elliot P. Joslin (pictured) emerge as the two leading diabetes specialists in the United States. Joslin believes diabetes to be "the best of the chronic diseases" because it was "clean, seldom unsightly, not contagious, often painless and susceptible to treatment."
Watch the story of Elliot Joslin.
Edward Albert Sharpey-Shafer of Edinburgh, pictured at right, suggests a single chemical is missing from the pancreases in people with diabetes. He proposes calling this chemical insulin.
Saccharin becomes available.]]>nono/files/Timeline/images/100072-Elliott-Joslin.jpg1911Benedict SolutionS.R. Benedict devises new method to measure urinary sugar (Benedict's Solution).
Georg Zuelzer takes out an American patent on his . Early results are poor, however, and the German military subsequently takes over his lab during WWII.]]>nonono1913Allen PublishedFrederick Allen, after three years of diabetes study, publishes Studies Concerning Glycosuria and Diabetes, a book which is significant for the revolution in diabetes therapy that developed from it.]]>nonono 1915Starvation DietFrederick Allen introduces "starvation treatment," or "starvation diet," in order to keep people with diabetes alive. It was found that a person who could not burn what was considered normal amounts of food, they should instead only have what they could burn. According to Dr. Allen, people with diabetes could only burn up 800 to 1,000 calories per day for six days and less on the seventh day. While Dr. Allen called it an under-nutrition approach, his patients deemed it starvation and few were able to stay alive an extra year or two.]]>nonono 1919Moses BaronA researcher at the University of Minnesota showed blockage of the duct connecting the two major parts of the pancreas caused shriveling of a second cell type, the acinar. Canadian Frederick Banting believed that by tying off the pancreatic duct to destroy the acinar cells, he could preserve the hormone and extract it from islet cells.
Frederick Allen publishes Total Dietary Regulation in the Treatment of Diabetes. He cites exhaustive case records of 76 of the 100 diabetes patients he observed and becomes the director of diabetes research at the Rockefeller Institute.
Psychiatric Institute in New Jersey - Frederick Allen establishes the first treatment clinic in the USA, the Psychiatric Institute in New Jersey, to treat patients with diabetes, high blood pressure, and Bright's disease. Wealthy and desperate patients flock to it.]]>nonono 1920Dietary Exchange System R.D. Lawrence, co-founder of the British Diabetes Association, now Diabetes UK, develops a ten-gram dietary exchange system. The ADA version did not first appear in the U.S until 1950.
On July 1, Dr. Frederick Banting opens his first office in London, Ontario. He receives his first patient on July 29 and his total earnings for his first month of work is $4.00. On October 31, Dr. Banting conceives of the idea of insulin after reading Moses Barron's The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis in the November issue of Surgery, Gynecology and Obstetrics. For the next year, with the assistance of Best, Collip, and Macleod, Dr. Banting continues his research using a variety of different extracts on de-pancreatized dogs.]]>nonono 1921Banting Presents Paper On December 30, Dr. Frederick Banting presents a paper entitled The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes, summarizing his work to this point at a session of the American Physiological Society at Yale University. Among the attendees are Frederick Allen and Elliot Joslin. Little praise or congratulation is received.
Insulin is "discovered. A de-pancreatized dog is successfully treated with insulin.
Dr. Joseph A. Gilchrist was a friend and classmate of Banting's. He was diagnosed with diabetes after graduation and was the first American patient to be treated with pancreatic extract. Gilchrist was, however, treated by mouth and had no beneficial effects. He then not only became a patient of Banting's and Best's, but also an experimental patient where he tested different types of extract in the spring and summer.]]>yeshttp://www.dlife.com/diabetes/information/dlife_media/tv/video_story_of_insulin.htmlno 1922It Was a Very Good Year January 11, Leonard Thompson, a young Canadian with diabetes, was the first patient to receive injections of pancreatic extract. Thompson was just 14. Until then, he had been kept alive by the starvation diet that was sometimes used to treat people with diabetes at that time. As a result of the diet, he weighed only 66 pounds (30 kilograms) when he was treated. He first received Banting's and Best's extract, and then two weeks later used Collipa's purified extract. Thompson survived on insulin injections for 13 years and died at age 27 as a result of pneumonia.
Eli Lilly and Company researchers collaborated with Frederick Banting and Charles Best of the University of Toronto to isolate and purify insulin. The agreement was finalized May 30 that insulin would be manufactured by Lilly since the Toronto group was unable to keep up with demand using their laboratory method.
On May 21, James Havens was the first person with diabetes in the United States to receive insulin. The pancreatic extract saved Havens' life and he went on to become a famous artist and printmaker.
Elsie Needham was a patient in Toronto at the Hospital for Sick Children in October. She was the first patient to recover from a coma after receiving insulin injections. By January 1923, Needham was well enough to return home and continue to have a productive life.]]>nono/files/Timeline/images/Thompson.jpg 1923Connaught InsulinThe discovery of insulin had an immense impact on the growth of research and development in Canada. It also led to the creation of Connaught Laboratories - the first "spin-off" company and the most renowned among 68 start-up industries born of research conducted at the University of Toronto. Founded in 1913 as a Canadian venue for production of diphtheria antitoxin, Connaught's founders believed it was a Canadian public health mandate to offer large-scale, low-cost distribution of public health products to control deadly diseases afflicting the entire world. Today, Connaught Laboratories Limited, a Pasteur Mrieux company, is no longer involved in the manufacture of insulin but is part of the world's largest producer of human vaccines.
On October 25, 1923, Dr. Fredrick Banting and his collegue Prof. John MacLeod are awarded the Nobel Prize in Physiology or Medicine. Dr. Banting shares his award with Charles Best; Prof. MacLeod shares his award with Dr. James Collip.
Danish scientist August Krog Nordisk traveled to Toronto in hopes of obtaining permission to replicate the process of extracting insulin from bovine pancreases. He was granted a loyalty-free license. Krog's wife, Marie, had been diagnosed with diabetes. From this, Insulin Laboratory (later Nordisk Gentofte) is founded along with Danish physician Hans C. Hagedom.]]>nonono 1924First Insulin SyringeBD manufactured its first syringe made specifically for insulin injection.]]>nonono 1925Home Testing Home testing for sugar in the urine becomes widely available. Procedure is to mix in a test tube 8 drops urine with 6 cc (1 tsp=5 cc) of a solution provided by the doctor (Benedict's solution). The tube is then put into boiling water for five minutes. If sugar is present, the liquid is greenish (light), yellow (moderate), or red/orange (heavy).
Novo Terapeutisk Laboratorium (later Novo Industri) founded. A year later, Novo Terapeutisk Laboratorium was born, and began producing "Insulin Novo" and a special syringe. Over the decades, these two companies grew to be global leaders in insulin production. In January 1989, Novo and Nordisk decided to join forces to form a new company called Novo Nordisk A/S.
Beckton-Dickinson (BD) co-founder Fairleigh S. Dickinson was issued a patent for the LUER-LOK tip, an innovation that securely attached the hypodermic needle to the syringe. Forty years later, the technology was adapted for sterile disposable needles and syringes.]]>nonono 1927Insulin ReplacementAn oral medication called "horment" or "glukohorment" is developed in Europe by a commercial firm. It was originally claimed to be a replacement for insulin, but side effects were unacceptable.]]>nonono 1934Banting KnightedDr. Banting is knighted, becoming Sir Frederick Banting. Author H.G. Wells and Dr. R.D. Lawrence form the first national diabetes association in Britain - The Diabetic Association. It became The British Diabetic Association and is now called Diabetes UK. Wells and Lawrence both had diabetes.
Learn more about H.G. Wells. ]]>nono/files/Timeline/images/H-G-Wells.jpg 1936Two Types of DiabetesIn a series of research papers published from 1936 to 1939, Harold Percival Himsworth (UK) finds that people with diabetes fall into two types based on "insulin sensitivity."
The first long-acting insulin is developed by Danish research scientist Hans Christian Hagedorn. Hagedorn (18881971) developed a process by which the many daily injections of insulin could be reduced to two. Insulin was attached to the protein protamine (derived from the sperm of certain fish species), by means of which a delayed effect with an insulin depot could be achieved. One injection lasted 36 hours. This mechanism is still used today (NPH, or neutral protamine Hagedorn, insulin). Other processes were developed in which insulin is bound to zinc ions, a method that is also used by the healthy pancreas to store insulin.
Protamine Zinc Insulin (PZI), a long-acting insulin made from pig and cow insulin, is developed.
Get the insulin action chart here. ]]>nonono 1938NPH InsulinNPH insulin is created.
Get the insulin action chart here. ]]>nonono 1940Complications Linked Link is made between diabetes and long-term complications (kidney and eye disease).
Learn more about kidney disease.
Learn more about eye disease.
American Diabetes Association is founded.]]>nonono 1941Banting DiesOn February 21, Sir Frederick Banting is killed in an airplane crash over Newfoundland while en route to England.
World War II sees the Japanese invading Shanghai, the home of Victor Saxl, a textile engineer, and his wife, Eva Saxl, who was diagnosed with type 1 diabetes at the age of 20. The invasion caused a shortage of insulin leading Victor to search for his own source of the necessary medication. He succeeded in creating homemade insulin for Eva and continued to do so for the next five years. The couple later moved to New York and became spokespeople for the diabetes community.
Learn more about Eva Saxl.]]>nonono 1943Dialysis Machine The kidney dialysis machine is invented.
See a day in the life of a dialysis patient.
How well do you know your kidneys? Take the quiz!
Learn more about how diabetes affects your kidneys.]]>nono/files/Timeline/images/benGray.jpg 1944Insulin Syringe Developed Standard insulin syringe is developed, helping to make diabetes management more uniform.
August Loubatires (France), while evaluating an anti-bacterial drug for the treatment of typhoid fever finds that some patients died of prolonged low blood sugar. He discusses this with a colleague and research starts that ultimately results in the development of the first acceptable oral medication for type 2 diabetes in the mid-50's.
Get more information about type 2 oral medications.]]>nonono 1945-1949Canadian Diabetes AssociationDr. Helen Free develops the "dip-and-read" urine test (Clinistix) allowing instant monitoring of blood glucose levels.
Dr. Charles Best saw need for an organization to serve the growing needs of Canadians with diabetes. The Diabetic Association of Ontario was formed. It later became the Canadian Diabetes Association.]]>nono/files/Timeline/images/helenfree.jpg 1950sInsulin Developments Researchers produce a type of insulin that acts slightly faster and does not remain in the blood stream as long.
Get the insulin action chart here.
The ADA recommends a diabetic diet of 40% fat, 40% carbohydrate, and 20% protein.
Find out what you can eat now.
The International Diabetes Federation is founded in 1950. The organization represents a multitude of diabetes associations and seeks to promote diabetes care, prevention, and a cure worldwide. The IDF heads the World Diabetes Day campaign.]]>nonono 1951Measuring InsulinR.D. Lawrence and J. Bornstein (UK) are the first to show that diabetes types can be distinguished by the presence or absence of plasma insulin. "The first [type] is severe and is characterized by weight loss and ketosis as well as hyperglycaemia [sic]; it occurs at any age, but mainly in the young, and their plasma contains no available insulin....The second type consists mainly of middle-aged, obese diabetics, females being more numerous, and is distinguished by the absence of ketosis and loss of weight. Their plasma contains available insulin...their diabetic state is easily controlled by diet alone, especially when obesity is thereby reduced." Plasma Insulin in Human Diabetes Mellitus; Br Med J. 1951 December 29; 2(4747): 15411544.
Lente insulins - semilente, lente, and ultra-lente - were developed.]]>nonono 1953Lente Launched Lente, a long-acting insulin-zinc suspension, is launched.
Various branches of Canadian diabetes organizations unite to form the Canadian Diabetes Association.]]>nonono Mid 1950sInsulin GeneResearchers had already decoded the chemical structure of insulin in the mid 1950s. They soon determined the exact location of the insulin gene at the top of the chromosome 11, which is said to contain about 1,500 genes.]]>nono/files/Timeline/images/chr11.jpg 1955 - 1956Oral Drugs Introduced Oral medications - sulfonamide (tolbutamide, carbutamide) and biguanide derivatives (metformin, phenformin) - are developed for people with type 2. Previously, their only course of medication was insulin.
Learn more about type 2 oral medications.
English biochemist Frederick Sanger discovers the amino acid sequence of insulin. He demonstrates that insulin consists of two chains of 30 and 21 amino acids held together by bridges of sulfur atoms. Sanger analysed the chemical structure of cow insulin. This work provided the foundation for the production of synthetic insulin. In 1958 Sanger received the Nobel Prize in Chemistry for his work.
Learn more about type 1 diabetes.
Learn more about type 2 diabetes.]]>nono/files/Timeline/images/sanger.jpg 1959Type 1/Type 2Two major types of diabetes mellitus are recognized, though it is not known who the discovers were: type 1, called insulin-dependent diabetes, or IDDM, and type 2, called non-insulin-dependent, or NIDDM, diabetes.
Learn more about type 1 diabetes.
Learn more about type 2 diabetes.
Learn more about gestational diabetes.
Learn more about prediabetes.
In 1959, isophane NPH (neutral protomine Hagedorn) insulin is developed. It is bound to protomine and has a maximum effect of 24 hours. The insulin can be mixed with any proportion of fast-acting regular insulin.
Radioimmunoassay technology makes it possible to measure insulin levels and to scientifically distinguish the types of diabetes. It finally becomes clear that type 1 diabetes is associated with a lack of insulin, type 2 diabetes is linked with insulin resistance, and gestational diabetes only occurs in pregnancy but predisposes to type 2.]]>nonono 1960Insulin PurityThe purity of insulin is improved.
Home testing for sugar levels in urine increases level of control for people with diabetes. D.S. Nicol and L.F. Smith analyzed the structure of human insulin.]]>nonono 1963Insulin Pump The very first pump, which could deliver both glucagon and insulin was the size of a large backpack. It was invented by Dr. Arnold Kadish.
Get more information about pump therapy.
Insulin is the first human protein to be chemically synthesized in a German laboratory by Meienhofer, in China by Kung, and in the United States by Katsoyannis. However, researchers are unable to produce large amounts of it until 1978 when insulin becomes the first human protein to be manufactured through biotechnology.]]>nono/files/Timeline/images/camp001.jpg 1965Test StripsFirst strips for testing blood glucose, Dextrostix, is manufactured by Ames Company, which was a division of Miles Laboratories that made Alka-Seltzer. It is now part of Bayer Diagnostics. The Dextrostix was designed primarily for doctors' offices. It used drops of blood to give an approximate blood glucose value and gave a blue color, which then needed to be interpreted via a color chart. An article about Dextrostix appeared in an American medical journal. A heated discussion about the dangers of self-testing by people with diabetes ensued. The recommendation of well-known American diabetologists was an absolute "no to self-testing." Dr. Richard Bernstein was an early proponent of self-testing. Click here for more information ]]>nonono 1966Pancreas TransplantFirst pancreas transplant performed at the University of Manitoba.]]>nonono 1967Use of Animal InsulinThe previous mixtures of pig and cow insulin were changed to isolated pure pig or cow insulin. Since pig insulin only differs from human insulin by a single amino acid, it is much better tolerated. Thanks to an additional improvement in the purification of insulin, the number of cases of resistance and allergies was greatly reduced.]]>nonono 1969First MeterAmes Diagnostics creates the first portable blood glucose meter.
Click here to read the Mendosa article.]]>nono/files/Timeline/images/1969.jpg 1970sSynthetic InsulinResearchers began to try to produce an insulin that more closely mimicked how the body's natural insulin worked: releasing a small amount of insulin all day with surges occurring at mealtimes.]]>nonono 1970Laser Therapy Laser therapy is used to help slow or prevent blindness in some people with diabetes.
Get more information about diabetes and vision complications.
Beginning of Joslin Diabetes Center's award program - Joslin Diabetes Center has awarded the 50-Year Medal to more than 2,400 people worldwide since 1970. The Award Program dates back to 1948, when Dr. Joslin, who wanted to acknowledge the accomplishment of managing insulin-dependent diabetes over the long term, began awarding his patients certificates for living with diabetes for more than 25 years. Medal and certificate recipients come from all walks of life and represent a wide spectrum of life experiences, cultural backgrounds, and geographic locations. Joslin has awarded medals to individuals across the United States and around the world, including people living with diabetes in Australia, Brazil, Canada, England, Hungary, Japan, Netherlands, Pakistan, Philippines, Russia, Spain, Sweden, and Switzerland.
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]]>yeshttp://www.google.comno 1971Insulin Receptor The insulin receptor is identified. An insulin receptor is a protein molecule on a cell to which insulin attaches itself.
The Juvenile Diabetes Research Foundation (JDRF) is founded by Lee Ducat and Caroline Lurie.
Meet the two mothers who founded the JDRF.
The Diabetes Research Institute Foundation is created by a group of parents of children with diabetes. The foundation supports the research efforts of the Diabetes Research Institute located in Miami, FL.]]>nonono 1972Islet Transplant SucceedsThe first successful islet transplant in a rodent is performed in Canada at the University of Manitoba.
Learn more about islet cell transplantation.]]>nonono 1973Pure Insulin Developed Novo Nordisk introduces Monocomponent (MC) insulin, the purest insulin available. It was made from animal pancreas.
U-100 insulin is introduced. U-100 is a unit of measure where 1 ml equals 100 units of insulin.
Get the insulin action chart here. ]]>nonono 1974LillyforLifeEli Lilly and Company (Lilly) establishes, the LillyforLife Award Program, an award program to recognize people with diabetes who have been on insulin for at least 50 years.
Chromatographic purification techniques allowed the production of highly purified animal insulin (less than 1 pmol/1 of protein impurities). Novo called this product "monocomponent MC" and Eli Lilly called it "single peak insulin."nono/files/Timeline/images/Lilly_for_Life_Awards.jpg 1976A1C TestInvestigators discover the HbA1C test (now A1C), which provides the ability to assess a person's blood glucose levels in the preceding 3 months. HbA1c stands for glycated hemoglobin. It is a test that measures the amount of glycosylated hemoglobin in your blood. Glycosylated hemoglobin is a molecule in red blood cells that attaches to glucose (blood sugar). You have more glycosylated hemoglobin if you have more glucose in your blood. The test was introduced in 1977.
Get more information on the HbA1C test.]]>nonono 1978AutoSyringe The first portable, commercial pump is made available for general use. It was called the AutoSyringe and it was invented by Dean Kamen. To use this pump, saline had to be mixed in with the insulin. The pump could be used inn the hospital or at home. AutoSyringe was eventually sold to Baxter International Corp. Kamen is more well-known as the inventor of the Segway, a motorized, 2-wheeled scooter.
A fledgling biotechnology company, Genentech, synthesizes human insulin in the laborator using E coli bacteriay. Until this breakthrough, people with diabetes relied on animal insulin, primarily from cattle and pigs. Animal insulin is not an exact match with the human hormone and can cause adverse reactions, such as skin rashes. Recombinant human insulin evolutionized diabetes treatment when it became available in the early 1980s.
The National Diabetes Information Clearinghouse (NDIC) - An information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK - part of the National Institutes of Health (NIH)) - is established to increase knowledge and understanding about diabetes among patients, health care professionals, and the general public.]]>nono/files/Timeline/images/1978.jpg 1979Insulin ClonedThe cDNA for human insulin is cloned.]]>nonono 1980Pump Accuracy PerfectedThe first accurate insulin pumps were introduced in Germany. The Promedeus from Siemens was calibrated with insulin and delivered a constant background, or basal, rate. At the end of the 1970s, pumps such as the Mill Hill infuser or the Auto Syringe 6c were in use, both of which had long been used in the management of chronic pain. These pumps were not calibrated for insulin. Adjustments to the background rate were made by changing the mixing ratio of insulin and saline and peak insulin was delivered by turning a screw.
Al Mann (pictured), founder of Medtronic Minimed, forms a team of engineers to develop an implantable insulin pump with NASA and the Applied Physics Laboratory at Johns Hopkins University per the suggestion of the chief cardiologist at the University of Alabama.]]>nono/files/Timeline/images/al_mann.jpg 1981Type 1 CauseStudies by the British Diabetes Association show that environmental as well as genetic factors are involved in causing type 1 diabetes.]]>nonono 1982More Insulin Changes Human Monocomponent insulin is launched as the world's first insulin preparation identical to human insulin. It is extracted from the pancreas of pigs and converted to human insulin.
In 1982, the Eli Lilly Corporation produced, Humulin, a human insulin that became the first genetically engineered pharmaceutical product cleared by the U.S. Food and Drug Administration. It is produced using human DNA. ]]>nonono 1983Biosynthetic Human Insulin First biosynthetic human insulin is introduced.
MiniMed - owned by Al Mann (see 1980) - introduces its first insulin pump, the MiniMed 502, at the American Diabetes Association convention, shortly followed by the 502A. It was after the release of this pump, that the pump grew in popularity and use.]]>nonono 1984Hoechst MRS1 Insulin PumpThe Hoechst MRS1 insulin pump was launched on the market. Unlike the earlier rather experimental insulin pump therapy, the possibility now existed of a providential insulin pump therapy. The MRS1 permitted an hourly background rate to be programmed for the first time. With the development of H-Tronin 100 two years later, insulin became available specifically for pumps. Due to its greater stability, this insulin had improved flow properties and was thus less prone to damage.
The British Diabetic Association (now Diabetes UK) releases the first position statement on diet and diabetes.]]>nonono 1985International Diabetes InstituteThe International Diabetes Institute was formally opened in Australia. It was estimated that about 30 million people around the world had diabetes at that time. The IDI - no affiliation with the IDF - is focused on finding a cure or a means of diabetes prevention and its complications, and to helping meet the needs of people with diabetes and those at risk of developing it.
The first insulin pen, the NovoPen 1 manufactured by Novo Nordisk, was introduced in Germany. The pen had no dose pre-selection, however, and was only suitable for 1.5 mL ampoules, but it was very successfully marketed on the basis of its small size and its appearance.]]>nonono 1986Insulin Pen Insulin pen delivery system is introduced in the U.S. The first PIMS (Programmable Implantable Medication System) unit was surgically implanted in the abdomen of E. Jackson Piotrow, a professor at American University, on November 10 at The Johns Hopkins Hospital, Baltimore, Maryland.]]>nonono 1989Banting MuseumThe The Banting Museum and Education Centre, named after Dr. Frederick Banting, opens in London, Ontario. Queen Elizabeth lights the Flame of Hope.]]>nono/files/Timeline/images/Banting_House2006.jpg 1990Islet Cell TransplantThe first transplantation of human islet cells is performed at the Diabetes Research Institute in Miami, FL.]]>nonono 1993DCCT ReportThe Diabetes Control and Complications Trial (DCCT) report is published. The DCCT results clearly demonstrate that intensive therapy (more frequent doses and self-adjustment according to individual activity and eating patterns) delays the onset and progression of retinopathy, kidney disease, and nerve damage in individuals with type 1 diabetes.
Get more information on type 1 diabetes.
Instant glucose tablets are introduced.]]>nonono 1995New Type 2 MedsPrecose (acarbose) and Glucophage (metformin) are approved for use by type 2s.
Get more information on type 2 oral medications.]]>nonono 1996Just Like Human InsulinThe FDA approves the first recombinant DNA human insulin analogue, lispro (Humalog). By changing a single amino acid, a more rapid onset and a shorter duration of action was achieved compared to human insulin.]]>nonono 1998A UK StudyThe United Kingdom Prospective Diabetes Study (UKPDS) is published. UKPDS results clearly identify the importance of good glucose control and good blood pressure control in the delay and/or prevention of complications in type 2 diabetes.
Get more information on diabetes complications.]]>nonono 1999NovoLog NovoRapid (NovoLog in the US) is marketed as the first rapid-acting insulin analogue. It is manufactured by Novo Nordisk.
Insulin For Life (IFL), a tax-exempt, not-for-profit company, is established and registered in the state of Victoria, Australia. The organization collects and distributes insulin and other diabetes supplies to people in need that would otherwise be wasted.
See Insulin for Life on dLifeTV.]]>nono/files/Timeline/images/insulin4Life.jpg 2000GlargineThe first long-acting insulin analogue, glargine, became available.
Get the insulin action chart here. ]]>nonono 2001Help for Sight-Impaired Novo Nordisk Pharmaceuticals launches InnoLet. It is the first insulin delivery system specially designed to suit the needs of insulin users with poor eyesight and reduced dexterity.
Novo Nordisk establishes the World Diabetes Foundation with the purpose of improving diabetes care in developing countries.
InDuo is introduced as the world's first combined blood glucose monitor and insulin injection system.
According to the Eli Lilly Corporation, in 2001 95% of insulin users in most parts of the world take some form of human insulin.
FDA approves Cygnus' first-generation model of the GlucoWatch Biographer for use by adults - the first frequent, automatic and non-invasive glucose monitor.]]>nonono 2003New NamesThe names Insulin Dependent Diabetes Mellitus (IDDM) for type 1 and Non Insulin Dependent Diabetes Mellitus (NIDDM) for type 2 diabetes are formally dropped.]]>nonono 2004dLife Founded dLife is founded.
Levemir, a long-acting insulin analogue, is launched.
Medtronic introduces the worlds first "intelligent insulin pump and glucose monitoring system, a wireless system comprised of a Medtronic MiniMed Paradigm 512 Insulin Pump and Paradigm Link Blood Glucose Monitor, co-developed with BD.]]>nono/files/Timeline/images/logo.png 2005Insulet Omni-PodInsulet Corp. introduces a wireless insulin injector that is worn on the skin like an infusion set, eliminating the tube that attaches to the pump. The OmniPod integrates the infusion set, automated inserter, and insulin reservoir, and delivers insulin according to programmable instructions delivered wirelessly from a wireless controller called the Personal Diabetes Manager (PDM). The PDM features a built-in meter that uses Freestyle test strips.]]>nono/files/Timeline/images/2005omnipod.jpg 2006Creating Insulin Stem cells are transformed into insulin-producing cells for the first time.
Research shows that insulin itself is a key target in the autoimmune attack on pancreatic beta cells.
The first inhalable insulin, Exubera, from Pfizer was approved in the USA and Europe. According to the manufacturer, the substance is particularly suitable for people with type 2 diabetes, who require insulin at meals in addition to blood sugar-lowering medication. The rapidly-acting insulin powder is breathed in with the aid of an inhaler. Exubera is discontinued in 2007 due to weak sales.]]>nono/files/Timeline/images/exhubra.jpg 2007Nasal Insulin VaccineClinical trials to develop a nasal insulin vaccine, to protect those at most risk of developing type 1 diabetes, commence in Australia.]]>nonono TodayInfinity and Beyond!Researchers are working on an insulin patch and inhaled insulin.
Deaths due to diabetes complications like cardiovascular disease are declining.
Genetic engineering is being used to manipulate cells so they secrete insulin.
Improved approaches to managing diabetes in pregnant women increase the successful outcomes for mother and child.
A sensor-computer-pump system that mimics the insulin response of the normal pancreas is being developed to function as an "artificial pancreas".]]>nonono