ASHORT HISTORY OF DIABETES (2)




By the turn of the twentieth century, prominent American physicians Frederick Madison Allen (1879–1964) and Elliott Joslin (1869–1962) became strong proponents of intensive dietary management for diabetes, given the lack of other useful treatments.
Dr. Allen envisioned diabetes as a disease in which the overstrained pancreas could no longer keep up with the demands of an excessive diet.
 To give the pancreas a rest, he
prescribed the “Allen starvation treatment,” which was very low in calories (1000 calories
per day) and very restricted in carbohydrates (<10g per day). Patients were admitted to hospital and given only whiskey and black coffee every two hours from 7 a.m. to 7 p.m.
This regime continued daily until the sugar disappeared from the urine. Why was whiskey included? It was not essential, but was administered simply because it “keeps the patient comfortable while he is being starved.”

The response of some patients was unlike anything seen previously. They improved instantly and almost miraculously. Others, however, starved to death, which was euphemistically called inanition.

A lack of understanding of the difference between type 1 and type 2 diabetes severely hampered the usefulness of Allen’s treatment. Type 1 diabetic patients were usually dramatically underweight children, whereas type 2 diabetic patients were mostly overweight adults. This ultra-low calorie diet could be deadly for the very malnourished type 1 diabetic (more on the differences between these two types of diabetes below and in chapter 2).
Given the otherwise fatal prognosis of untreated type 1 diabetes, this was not the tragedy it may at first have appeared to be. Allen’s detractors pejoratively called his treatments starvation diets, but they were widely considered the best therapy, dietary or otherwise, until the discovery of insulin in 1921.

Dr. Elliott P. Joslin opened his practice in 1898 in Boston after receiving his medical degree from Harvard Medical School, becoming the first American doctor to specialize in diabetes. Harvard University’s eponymous Joslin Diabetes Center is still considered one of the foremost diabetes institutes in the world, and the textbook Joslin wrote, The Treatment of Diabetes Mellitus, is considered the bible of diabetes care. Joslin himself is likely the most famous diabetologist in history.

Although Dr. Joslin had lost many patients to diabetes, he had also saved many by applying Dr. Allen’s treatments. In 1916, he wrote: “That temporary periods of undernutrition are helpful in the treatment of diabetes will probably be acknowledged by all after these two years of experience with fasting.”
 He felt the improvements were so obvious to everybody involved that studies would not even be necessary to prove the point.
ASHORT HISTORY OF DIABETES (2) ASHORT HISTORY OF DIABETES (2) Reviewed by Leembo on March 02, 2019 Rating: 5

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