The Future of Diabetes Part One

for a while. I've I've been suggesting it for kind of ever because I keep I keep running into all of these new research articles about amazing things that have been done in the in the treatment and diagnosis of diabetes, and and it's a really big issue. I mean, this isn't a thing that, like, you know, seven people are are dealing with. This is this is a little bit

larger than that. Not not at things that only seven people are dealing with are not worth looking into me for those seven people, it could be it could be huge, But no, that is exactly the point that why we wanted to tackle this. Diabetes is something that affects millions of people, It's going to affect millions more in the future. Obviously, It's one of those topics that we should look at and say, what's the forward thinking approach to dealing with

managing uh, diagnosing, perhaps in some distant future, curing diabetes. Yeah, I would say with diabetes, it's not exactly like all other diseases, not not just because it affects so many, but because it is one where I would say, at least from from where i'm you know, I'm no expert, but just in what I read the end does sort of seem to be in sight with diabetes more so than with many other chronic diseases. At the very least, the facility with which we can manage diabetes today has

has increased exponentially over the last several decades. And there's just a lot of research progress. Yes, their entire organizations that have been UH in in existence for since like the nineteen forties, that have been dedicated to researching and treating and diagnosing diabetes. So ah, yeah, and before we got into this research, I didn't realize how long ago people knew about this. Wow. Yeah, we've got a timeline

to go through. Yeah, I went a little crazy, y'all when I was researching the history of diabetes and our understanding of it, and uh, we should all know better than to put a history section in there. I kept thinking I should skip some stuff, but I kept finding things that were so fascinating. But first, let's let's talk about some numbers about why this is such a big deal. Yeah. Yeah, because he said millions of people. So I mean, so, so what's what's what's millions of people? We've got like

like trillions of people on the planet. Not quite trillions yet, but sometimes it feels that way when you're on a crowded Marta train. But according to Center for Disease Control report in UH two thousand fourteen, there are twenty nine point one million people in the United States who have diabetes, and eight point one million of those people are undiagnosed. So there's only like three hundred and something million people

in the United States. That's like significant percentage, nine point three percent of the population in two thousand fourteen, so not almost ten percent of the population having diabetes, and out of that group, twenty seven point eight percent of them don't have it as a diagnosed condition. They may be aware that something is wrong, especially if they're suffering some of the more severe symptoms of diabetes, but they

haven't been formally diagnosed with the disease. Um percentage wise, the group that has the highest incidents rate of diabetes is the sixty five and older group. That's twenty five point nine percent of the population, more than a quarter of all people over the age of sixty five the United States have diabetes. As with many diseases, this is

a disease where risk factor tends to increase with age. Yes, yes, and then uh, the actual largest as far as sheer numbers go, Like the largest number of people that would be in the forty five to sixty four year old age range with the thirteen point four million diabetics, but that only accounts for sixteen point two percent of people in that age range, So percentage wise it's fewer, but in sheer numbers it's the largest population. So uh, one of those fun things that you start to think about

when you start, you know, grouping people into percentages. Uh. More men than women are diabetic in the United States. They're fifteen and a half million men with diabetes versus thirteen point four million women, and that same CDC report estimated that the total cost of diabetes in the United States in two thousand twelve was two hundred forty five billion with a B dollars two d forty five almost two hundred fifty billion dollars. Uh. So that includes both

direct and indirect costs. So if you look at just the direct costs of diabetes, this being the diagnosis and treatment and management of the disease, that's seventy six billion. So still I mean enormous number uh, indirect costs in case you're wondering, well, what what the heck is that entail? According to the CDC, they were lumping in things like disability, loss of productivity due to the fact that people are

missing work uh, and premature death as contributors to indirect costs. Globally, it's been estimated that about twelve percent of all health expenditure is going to diabetes treatment. So yeah, this is where the word trillion can be the start can start to get thrown around, because when you're looking on a global scale, uh, it is it is an enormous issue, both financially and obviously as a quality of life and and just health and survivability issues around the world, which

is why we're really tackling it. It doesn't look like things are getting particularly better right now. The diabetes UH prognosis is that it's going to be on the increase over the next few years. Yeah, despite the optimistic news that we're going to have it lit like like like kind of the warning signs are out there. Researchers are

sort of going like, hey guys. Yeah, According to one paper I was reading, by twenty thirty, there's an expectation that there will be five hundred fifty two million people with diabetes worldwide. And and it's difficult to make global estimates about this kind of thing because some researchers think

that many more cases go undiagnosed and underestimated. Even in those undiagnosed cases in other parts of the world, the number of cases right now could be of what we currently think there are a k A about five hundred and twenty million cases worldwide, which would mean that you would guess that number for would be even higher because that was based upon sort of what we are pretty sure or what we know so far. Right right in the US alone, rates and expenses of diabetes are expected

to very nearly double during that time period. Yeah, that's something else we'll be chatting about quite a bit. In fact, let's go ahead and kind of transition into that. There's been a lot of news over the past several years about increases in the price of insulin, and we're going to talk more about diabetes and what insulin you know,

what factor insulin plays in diabetes management. But the important thing to remember here is insulin dosages are are something that that people with type one or type two diabetes, uh, that's usually part of their diabetes management. People with type one, you need it. People of type two, you might not need it, but you should certainly have access to it. Yes, yes, So there are a lot of different types of insulin, uh, not just in how it interacts the body, but how

it's produced. And that makes this conversation a little more complicated. It it's not like we have a single that that says insulin and you just draw off as much as you need and you're good to go. There's actually lots of different types. There's long acting, there's short acting, there's instant acting. There's all different types of ways to derive insulin. So it gets pretty complicated. But The thing you need to remember is that the pharmaceutical game is a for

profit deal. So as that it means, you know, the companies are trying to make a profit selling insulin no matter what the type. Maybe there's not as much competition as it sounds based upon the fact there's so many

different types of insulin. There are actually a few major companies that are They provide the vast majority of insulin, and at least in the United States um and there are a lot of other factors that are playing a role here, including drug wholesalers, pharmacies, insurance companies, all of these things of act the price of insulin, and part of the price also depends upon something that is completely independent of diabetes and the demand for insulin, and that

is that the overall drug sales have been on on a decrease like they would they've been decreasing over time. So that sounds like that's pretty good except for pharmaceutical companies that want to make a profit. One way you can offset your losses in one area is to increase the prices of another drug that's still in demand in another area. And while that's not the only cause, or even necessarily the primary cause for insulin prices on the increase.

It is a factor. It is a contributing factor. Um. In fact, pharmaceutical companies said as much in a two thousand eleven Reuters Health summit. They admitted to the fact that part of the reason the insulin prices were on the increases because other drugs were not selling as much. So you cover your losses in one area by increasing the price on another. It's frustrating, but that's kind of

how capitalism tends to work. So um. Anyway, the drug companies are are really seeing a benefit to the strategy, as you would imagine. I mean, you've got a growing market, more people being diagnosed with diabetes who need access to these medications. You can increase the price of those medications, so more people buying stuff for more money means yea for companies that make the stuff right. So um, And I don't want to demonize anybody in this. It's not

I certainly have very strong opinions. Might not want to No, no, I I I absolutely understand their their strategy behind this. But when you when you hear stories about parents of children with type one diabetes who are paying as much as their mortgage every month to to get an insulin supply. It's like, oh, that's not that's not chill. Yeah. There. I do have a lot of strong opinions, but they also range on the political scale, which is why I'm

trying trying to be as objective as possible. Absolutely that that was that was an emotional aside from me, and I completely agree with it for the record. But another issue that we have here is that the United States doesn't regulate the price of prescription drugs. So this this really plays into that. Right, we don't have a regulatory body that says you can't do that. We're we're seeing stuff play out right now in the United States that

is sort of related to this issue. You know, we had the Congress calling up the CEO of the company that makes EpiPens to really talk about the increase in EpiPen costs over the last you know, five or six years, and so we're starting to see that kind of take

a turn here in the US. But as of right now, there is no official body that says, hey, you can't charge that much because people real people are dying or suffering or or there they're taking extreme measures to stretch their supply as much as possible in order to be able to afford to live, and so there's there's a

lot of that going on right now. Also, you might remember we did an episode about biologics, and insulin falls into that category, meaning that there they aren't as easy to replicate in the lab as small molecule drugs that you would you would create a generic for. Right It's it's a relatively uncomplicated biologic, but it's still much more

complicated than for example, UH aspirin. Yeah, so you know, and patents can expire on the process for creating uh biologically um derived drugs, But that doesn't necessarily mean that someone's going to come along and create a cheaper, faster, uh more efficient method of manufacturing it and thus lower the cost and pass the savings onto you. That's not

necessarily going to be the case. In fact, there's only so much cost you can cut from the manufacture RNG side on the on biologics, So, uh, that doesn't necessarily mean someone couldn't come in and sell the stuff for less. But why would you when you can be making all of this lovely money. But she can make a beautiful hat. Yeah, yeah, you can. You can sit there and uh and and

light your your your giant stogie with your hundred dollar bills. Um, I'm sure they're using it for for drug development and paying many of their hard workers as well, not just for money, hats but but but exactly, I mean getting into numbers, it's hard. Another thing that it's difficult to estimate is is the actual cost of a drug here in the United States because the process of obtaining obsurance, insurance,

and then obtaining drugs either through that or through another program. Um. It it means that we don't have like a solid price sheet for a lot of stuff. But you looked into one of the estimates, Yeah, this is okay, So this is This again illustrates how complicated things are here in the US and then other parts of the world

to UH. You could have two people in line to buy the exact same drug, and one person is going to pay one price and another person is going to pay a dramatically different price, and it could all depend upon the way that they are paying for that drug, whether it's out of pocket through insurance, through programs like medicaid. UH. These all have an impact, and it's all because of

the different relationships that are going on. Behind the scenes to set prices, and it gets kind of crazy because like we're used to the idea of you go to a store and if if Lauren wants to buy like, uh, some some chocolate milk, and I want to buy some chocolate milk, We're not charge different prices for that chocolate milk. I mean it might be it might be like twenty cents more expensive at like your favorite big box store, us my favorite, but if we're going to the same store, yeah,

I mean, I mean, okay, let's be fair. Some stores they have a picture of me and they say, charge an extra dollar for chocolate milk. He is a chocolate milk fiend and he doesn't pay attuch the price tags. But in a fair world that doesn't happen. But in the drug world, that's it's totally different. So there was a research fellow, Dr Jing Lao, who was worked in the division of pharmacoepa, demiology and pharmaco economics. Wow, I didn't think I was going to get through either of

those at Brigham and Women's Hospital in Boston. It wrote an article in two thousand and fifteen for JAMMA in Internal Medicine. I always like to go Jamma for this, you know, getting jam out. So he found that between two thousand and fourteen, medicaid costs per unit of insulin increased between six dollars and eighty six per unit to fifteen dollars and thirty eight cents per unit, depending upon the type of insulin. Now this was just through Medicaid,

but but the same is true across the board. And he said, no matter how he cut or analyzed the data, there was always a price increase. It didn't matter how he was, like, you couldn't massage the data so that there wasn't a price hike, right to clarify, Yeah, like like like increasing by six dollars and eighty six cents was the lowest of the price increases that occurred. And and it went all the way up to that fifteen per unit per unit, and and that was and again

it depended upon the type of insulin. Like we mentioned earlier, there were tons of different types of insulin um and some types of insulin, like long acting insulin, were affected more than others, largely because fewer diabetic patients were using long acting insulin and companies still had to produce it. There's still a demand for it, but to offset that

manufacturing costs of producing something. When you know, if you're a company and you're producing insulin and no one is using this particular type, you could shut that production down, switch that those resources to something else and make more money. But if there's still a demand for it, but it's not as big a demand as it used to be, then the way you cover those losses again as you hike the price UH. And this sends up being a burden on people who are dependent upon that specific type

of insulin. UH. This is a huge problem for a growing number of people, So it's it's even more more concerned than if it were just a huge problem to start with. It's a huge problem and the number of people effects is increasing. So diabetes is an illness that disproportionately affects people in lower socioeconomic classes, largely because they may not have access to UH a good healthy diet, and or they may not have the opportunity to do

any sort of exercise routines or anything. Things that have been shown to, if not prevent diabetes, often either decrease its effects or or put off when it would actually set in for a person. So sure Sure also recent studies have shown and we'll talk about this a little bit later, that stuffit like a like stress and even air quality can can be increasing risks can can increase

your risks of developing type two diabetes. And not only that, but you have people in these same socioeconomic classes who will go to extreme measures to skip or ration medications to reduce that financial impact they have for purchasing medications.

That can also lead to patients attempting to manage diabetes primarily through diet, like in other words, trying their best to eat a healthy diet and not have to take insulin because insulin is so expensive, which certainly helps um and can in some cases lead to effective management of the disease, but in many cases it cannot. Right there, it cannot help in type one. I mean it will not, it will not magically have you produce insulin if you have type one diabetes. Will talk more about that in

a second. If you have type two diabetes and it's not severe, it might be that through managing your diet and exercising more, that's all you need and you don't have to take any insulin shots or or have any other method of having insulin doses. But for some people that's just it's just not enough. It's physically not enough. It's not that they are bad people. Is not that they aren't working hard enough. It is not that they're

not eating healthy enough. They literally aren't producing enough insulin. So I want to make that clear. I don't want any sort of blaming going on here for people who actually are suffering through this. I mean, if you can, if you can get a direct facts to that, to those people's like pancreas, pancreases, pancrea, um, then maybe you can blame the pancreas. Yeah, but as far as we know, the pancreas is not one of the more sentient organs

and therefore hasn't made any you know, actual decisions. It never responds to my snapchats. Yeah, weird. I wrote a song about it. Yeah, yeah, he wrote a song about the pancreas. I don't remember that. I just remember that. There is one. That's all I wait, no, are you thinking of part of like a surgeon? No? No, no, that is that that song I could do from beginning to end right now, because he finally made it through med school somehow he made it through. But no, the

there is to a karaoke episode. Sometimes oh man, she knows not what she asks for. So at any rate, we need to remember that these effects aren't just devastating for the people who can no longer afford or or have are having difficulty affording insulin. It affects all of us, right, because whether it's affecting us through insurance rates or other types of economic factors, even if you have no emotional

connection with somebody who's going through this, there is an impact. Yeah, that the loss of productivity in a workplace, the the overall right, the rates of insurance, the the the rates of hospital availability due to those resources being taken up by by people who have unfortunately encountered side effects with that kind of disease. Um. I mean, you know, what I'm saying is is that you don't have to be a crazy socialist in order to get to want to

help solve this problem. Now, this this problem is something that everyone, regardless of your economic philosophy, should want solved because no matter what, it does have an impact, right you know. So uh and so yeah, so, what what is diabetes? We've been talking about it for like for like trillions of well, you know, like like I wanted to. I wanted to do that thing where we go like like, hey, there's this problem, you've maybe heard of it, and then

we describe what it is. It might have been better to do it. This is great, all right, Yeah, diabetes, Let's let's talk about diabetes. Yeah, so diabetes. Hey, and I'm gonna take laughter wherever we can find it in these episodes, because this is something that I feel very strongly about. In the interest of full disclosure, one of my parents is type two diabetic, so this I I and I also obviously I am concerned. I'm I don't know if you guys know this, Lauren, you do because

you bring it up all the time. I'm getting up there in years, so I am concerned about this sort of stuff. I think that if you go back through the record, did Joe and I have equal mocking Yeah, but you are also my co host on text for two years, so I don't think I've ever mocked your age. Usually you're the one who brings it up, That's true. I I am probably the most guilty of the three of us. So. Diabetes, also known as diabetes militis, is a disease in which the body suffers due to blood

sugar levels that are too high. So glucose levels in the blood are above healthy levels. And glucose, to be fair, is important stuff. I mean, it is what our cells use as a fuel source. But to get the glucose where you need it, your body produces a hormone called insulin, and diabetes is a disease really kind of a family of diseases that impact insulin production leading to increased blood sugar levels. So you mainly have type one and type

two diabetes. There are other ones as well, but those are the two big broad categories, right, and so the common distinction that is made is the type one diabetes is the diabetes that is experienced from early onset diabetes, and type two diabetes is adult onset diabetes. Yeah, that's why it used to be known as In fact, that was the official term for type two diabetes until relatively recently, when when I guess you realize you didn't have to

be an adult. Yeah no. But but as as we've said earlier in this episode, in type one, your body does not produce insulin at all, um, and that is because type one diabetes is actually an autoimmune disorder. The bodies over zealous immune system is targeting and killing the cells in the in the pancreas that make your insulin for you. Yeah, those are called beta cells or some sometimes in in there. You go, yeah, yeah, no, wonder I couldn't just say that. That's very strange. I looked

it up. But the yeah, the beta cells in this case are attacked by T cells immune system white blood cells right right that in the fact, there's ongoing research about why the T cells attack the beta cells and UH, and discovering the cause of this is one way that we might be able to help discover ways of curing diabetes in the future. But there is some research on that that we will get to either later in this episode or probably in the next one, actually, I think

in the second episode. Yeah, And then we've got type two diabetes, right where the body might produce insulin, but it doesn't do it very well. It's not very effective at it, so glucose tends to stay in the blood stream and accumulate and get to dangerous levels. It's the It is much much more common than type one diabetes. Yeah, in the United States, about of diabetes cases are type two and UH. And what happens in type two specifically, is that for a number of reasons um that the

body becomes resistant to insulin. It no longer insulin no longer prompts your body's cells to take gluc to take glucose out of the blood stream um. So, so you're glucose levels in the blood remain high, which prompts your pancreas to keep making more and more insulin um. Eventually, this leads to an overload situation where the pancreases beta cells start dying off because they just haven't had a break.

And then there are other types of a big one being gestational diabetes that occurs in about seven percent of all pregnant women in the United States, has the same symptoms as type two diabetes, and generally happens the first time a woman is pregnant. It often will go away after the woman gives birth, but it can increase the risk of the woman later developing type two diabetes. So, and like we said, there are other ones as well.

There's one that's actually linked to steroid usage in fact, But but but the primary ones are are really type two and then type one. Uh so, what's the big deal? What? Why are we worried? About glucose in the bloodstream. Well, in and of itself, it's not terrible, but it leads to some deterioration of different things in the body. Yeah, like your kidneys and your eyes are often to u two types of tissue that are are first affected by this.

So you can suffer impairment, vision impairment, you can go blind, Actually, you can suffer really bad kidney damage. You can also cause nerve damage. It could contribute to heart disease or strokes, as well as some other related issues. It can also

necessitate amputation in some cases. And the reason for that is that you could suffer nerve damage in your extremities, mostly your feet, most frequently your feet, and then not notice when you when you develop things like sores or other injuries on those on your feet, which can then get worse and worse to the point where they necessitate

an amputation. Um. And so actually that's one of the things that that doctors will tell you if they diagnose you with diabetes is to frequently inspect your feet because you may have uh sores or wounds or something along those lines that you weren't aware of because you couldn't it due to the nerve damage. But if you're able to take care of your feet, then you can you

can avoid the necessity of an amputation further down the road. Um, and all of this is part of why it's so important that that people have access to insulin who need it,

because that helps that helps mitigate that kind of damage. Yes, uh yeah, so this is life or death was really what we're talking about, you know, it's and and to really bring home how big a problem this is and how long it's been around, we now have Jonathan's epic timeline of diabetes, not my personal one as far as I know, I'm if I do have diabetes, I am I'm currently undiagnosed. Uh, but it really is an epic

timeline though, oh yeah, no, it's crazy. So the first timeline I consulted really started in nineteen ten, and it was going it was going into like the formal, academic,

real deep study of diabetes. But if you want to look at how long have people been aware that something along these lines was going on and sort of the path of discovery to figuring out what was actually happening, you gotta go way back to fifteen fifty two b C. And this is by the way just the earliest known record, so it could predate like like our our knowledge of

something related to diabetes could predate this. But heasy Ra, a physician, noted the symptom of frequent urination for an as yet unnamed disease at that time, which is later by by experts been identified as diabetes um In b C, there are Hindu writings that make reference to an emaciating disease that has an odd symptoms, which is that ants are attracted to the urine of people who have the disease. I imagine that's because we discovered later that the kidneys

are trying to purge glucose from the body through the urine. Yes, so there's elevated levels of glucose or sugar in the urine and ants like like sugar. So uh five that are BC were the first descriptions of sugar being present in the urine of people with the disease. The disease specifically obese people. Two BC. Apollonius of Memphis coins the term diabetes, so we get the terms that's crazy, that's it.

We got diabetes two BC. So the word means to go through or to siphon and it's referencing the symptom of a patient draining more fluid than they could consume,

so that frequent urination. So that was the defining feature of the disease for a very long time because that was you know, obviously, early physicians had to have very limited um means to base their observations, right, They couldn't look into the human body without usually killing somebody, So that kind of made it difficult to pursue any kind of harder yes, challenging first century c e. The Greeks described diabetes as a disease that results in quote a

melting down of the flesh and limbs into urine end quote. I love ideas that people have. Yeah, if you skip ahead about a hundred sixty three years to one sixty four in the Common era, Galen of Pergamum, a Greek physician diagnoses diabetes as a kidney disease. Uh, this would not be the only time people were slightly off track, you know, they you can understand mostly urine kidneys equal urine just working backward. Just turned out that they were not quite on the right track there. Then we get

into the dark ages. Physicians would diagnosed diabetes with water tasters, which is exactly what you think it is. I'm guessing making water, tasting the water that you make exactly. The physicians would take a sip of the patient's urine and if they tasted sugar, if the urine had any sweetness to it, they would know that the patient had diabetes. Wow, jors really went the extra mile in the dark ages. Uh. That's also when they added the word militis to diabetes.

Militis is Latin for honey, so sweetness. So you've got to siphon from diabetes and then you have honey with the militis siphoning sweetness from your body. Yeah. Yeah, So sixteenth century we get a poetic go ahead, Paracelsus, who is a Swiss German philosopher, physician, and occultist. Uh so he said that diabetes is a serious general disorder. Getting away from that specific kidney diagnosis from earlier. Uh, now we're gonna skip over to seventeen seventy six. Lot of

stuff was going on that year. Don't know if you guys are familiar with it, but you know there's a whole musical about it. So I will bore you here

just to say sit down, John um. An English physician by the name of Matthew Dobson made notes about diabetes and noticed that some people die in less than five weeks, while others can live with a chronic condition, and the pending upon the severity, could survive for several years, which is really the earliest record of someone making note that there seems to be two different pathways for this disease, not to the point where any kind of formal description

was made of either type, but rather just a general observation. Then we get to a Scottish military surgeon named John Rollo experimented with patients by putting them on a high fat and protein diet after noticing that the sugar content in their urine would increase if they ate starchy foods. The idea was get them off the starchy foods, put them on high fat and protein diet foods, and the following year he published a work saying that there was elevated level of sugar in the blood as well as

the urins. This is the first time we actually see someone say maybe there's more to this. One of these other humors could possibly be involved. Yeah, it's not not that people were still using the idea of humor. Were they They were not. People are still using it today, all right, some people misuse humor, and I call those the satire sites that don't know. Never mind, that's totally different to how sorry, I just got completely distracted. Uh

skipping ahead of eighteen forty eight. By the way, there's tons of other stuff that I could have included. I finally got some self control. It began to not include every little interesting fact that was coming across. But in eighteen forty eight, a French physician Clothe Barnard we we, I'm so bad at French. I casey, where's Casey? My

French is terrible. My French is terrible. So but anyway, Bernard learns that glycogen is formed by the liver and the knee hypothesizes that the same type of sugars found in the urine of diabetics um. In eighteen sixty nine, a German medical student Paul longer Hans, which is going to sound familiar to anyone who's heard of the islets of longer Hans, identified two different types of cells in the pancreas. Now one type of cell. He said, all right,

I understand this. This is the stuff that secretes the pancreatic fluids that we've kind of observed in previous medical exploratory surgeries things like that would be another one of the bile let's just call it bile. But the second type of cells, which would be what we end up calling the islets of longer hans, also known as the beta cells that we've mentioned earlier, they produced something else

that was kind of a mystery to him. He wasn't sure what it was that would turn out to be the hormone insulin um and so, but this was the beginning of that realm of exploration. In the eighteen seventies, you had a French pharmacist named a Pollinaire Bouchard that who made note that diabetic patients have less sugar in their urine. During a time of food rationing in Paris when the Franco Prussian War was taking place, so people

were having less access to food. He noticed that his diabetic patient ended up having less sugar in their urine, and it began to give them the idea that perhaps there could be individualized diets for people who have this disease and that that could improve their condition. Um thanks Franco Prussian War yeah. Sometimes sometimes some interesting developments come out during times of conflict, and they aren't necessarily directly

related to the conflict. It's just out of necessity we learned things like that, So kind of fortuitous in a weird way. Fortuitous for diabetic patients, not so much for people who were fighting in the Franco Prussian War. In eighteen eighty nine, researchers at the University of Strasbourg and France remove the pancreas of a dog to see how it would affect the dog's digestion, and they observed that

the dog developed diabetes. So they said, okay, so the pancreas seems to play some role in this disease that we've been studying for for centuries now but had very little actual understanding about it. By nineteen away we get German physicist George Ludwig Zuelzer who experiments by injecting a quote pancreatic substance in the quote into diabetic patients. It seems to work a little bit. It actually does decrease the level of glucose in their blood. Yes, severe side effects.

It is not a purified method of insulin dosage um. It ends up being uh, it's not an effective treatment because the side effects are so severe. In the nineteen hundreds, you have a couple of different things happening. Dr Elliott Joscelyn, By the way, this is where my notes originally started. Dr Elliott Jocelyn wrote the first edition of the Treatment

of Diabetes militis in nineteen sixteen. In nineteen Sir Edward Albert Sharpie Schaffer, which is possibly the best name I have ever read, can't his name is my name too, published a study on the pancreas. Sir Edward discovered that the pancreas produces a substance that non diabetics would produce, and that would be insulin. So this builds on that that islets of Longer Hans research that was done decades before.

Uh So, the name actually comes from insula, which means island, and it's called that because the islets of Longer Hans were the source of the hormone. So they just continue to use the island's motif. Um. So we've got siphoning, we've got honey, and we've got islands all all wrapped up here in this disease. Your islands aren't working. You will siphon honey yes in doctors Frederick Banting and Charles Best would experiment with dogs that had had their pancreases removed.

They inject dog insulin into the experiment animals and they see that the glucose levels go down. UH. They would actually eventually get awarded the Nobel Prize for that. In fact, technically Banting was awarded it and shared it with Best. James call Up developed a means of purifying insulence so that it could be used on humans, and then by three just two years later, you get the first commercial production of insulin from Eli Lilly and Company, which is

still a major producer of insulind. Over the next several years, companies would develop different approaches to producing insulin, including slow acting insulins, fast acting insulin's. You know, all these sorts of different approaches depending upon UH what you were specifically

trying to manage UM. One of the things that that people who have severe diabetes wrestle with is the fact that going to bed is terrifying because you want to make sure that you take the right insulin dosage to manage your glucose levels without going hypoglycemic, meaning your glucose levels fall too low. Because that can lead to a very dangerous episode, and if you're asleep, there's no you

don't have any warning signs before it happens. So the different types of insulin are absolutely necessary to to deal with UH diabetes at different stages. By ninety six, you get Sir Harold Himsworth who publishes a paper distinguishing the two types of diabetes according to insulin sensitivity. But it wouldn't be until nineteen fifty nine that these two types are formally defined in medical literature as type one and

type two UH. The American Diabetes Association would form in nineteen forty in response to increase rates of diabetes and heart disease in the United States. By nineteen forty four,

you get the insulin syringe. It's a standardized syringe used for insulin dosages and it actually UH It revolutionizes diabetes management at that point, so the insulin was obviously the first major development, but this syringe made it far easier to administer the insulin and UH dramatically improve the quality of life of millions of people who were suffering from diabetes. Nineteen sixty four you get the first strips to test blood glucose levels up to that point, you were testing

urine not blood, which was less accurate. Also, the earliest tests were incredibly elaborate, like you had to boil stuff, and yeah, you know it was it was a very long process in order you just to get that initial read out of how much glucose was in your system. Right, And this is frequently the kind of thing that you need to be on top of in a kind of

immediate sense for best best response. Yeah, yeah, if you're because if you're looking at it and you're like, well, here, these are what my glucose levels were an hour ago, it may not be the case at that point, and you know, or maybe that you've already suffered some terrible episode because of it. Uh. The first blood glucose meter would be developed in nineteen seventy, which was meant for clinical use, not home use. It was like a five dollar device in nineteen seventy and was meant, you know,

that was just at the doctor's office. You weren't going to buy one and take it to your home. But nineteen seventy also saw the development of a very useful piece of technology, the insulin pump, which as of evolved quite a bit since its first invention, but an insulin

pump helps remove the need to do regular insulin shots. Essentially, it's a device is a pump that can pump insulin into you and you can typically set the pump so that it puts injects a specific amount of insulin into your system and UH it was a huge help for people trying to manage diabetes. It's standard issue for anyone who has type one diabetes UH and is more frequently being used by people who have type two diabetes. It's not as common, but more type two are seeking out

the possibility of using a pump um. So this is the way it works is that you typically have a little spring loaded device that has the tube through which insulin will be delivered into your body, and it's got a little needle at the end of it to puncture you and and insert a catheter under your skin. So you would typically find someplace around your abdomen. You would place the spring loaded device onto that site after you've

already prepped it obviously activate it. It would then essentially inject and then place the catheter into into the place in your abdomen. You would remove the device. You would then remove the needle and then you're left with a catheter that leads into your body and the pump can pump inslin directly into your system that way, um, and it's designed at a point now where people can self

administer this. Actually watched a video of a young boy, I mean maybe like twelve or thirteen years old doing this. Hard to watch for somebody like me, who one I feel a lot of empathy toward the kid, who, by the way, was like, this is so much better than having to give myself five or six in slun shots to day. But also just the idea of like you've got to do this and every and you can't just set it and forget it. You've got to replace it. Like,

you can't leave it in place indefinitely. After after like maybe up to three days, you would have to move. You have to remove it and prepare a new site and inject again. So it's a constant thing. It's one of the things where you know, you're aware that this is going to be part of your routine from that point moving forward. It's one of the other things about this disease that I think is easy to forget if

you have never had to deal with it. It's that you know, the treatment for it and and even just the monitoring of it can be painful. And it's something that that diabetics deal with. I mean, it's much better to deal with that than the symptoms of diabetes. Sure, but you know, like just a prick is kind of an argument that you could you could conjure up in your head, but I don't know. Just to prick several times a day every day for the rest of your

entire life is certainly certainly a thing. It's it could be discourage. It can discourage people into even checking to see if they should be diagnosed, because we have this weird thing as humans we're not knowing is almost like not having it. And if we don't admit it, then we don't have to go through that that pain and that frustration and that inconvenience. But the truth of the matter is it's much better than the alternative. It's just hard to imagine that when you aren't dealing with it yet.

Right moving on through the timeline, were almost done, uh in the nineteen eighties. This is when researchers start to develop the technique to synthesize insulin using bacteria, which really simplified the manufacturing process allowed you to create much greater yields of insulin um and it's still a complicated process, but less so than it used to be. It also means that there's less likelihood of having like a shortage

because you can more easily manufacture it. However, as we mentioned at the top of this episode, it does not necessarily mean it brings the price down, or at least that doesn't. It's not a big enough factor for that to be, you know, to to actually decrease the price. So what was it like living with diabetes in the past. Probably not very good. A lot of medical care in the past. Yeah, Well, to be fair, if you had type one diabetes, there wasn't really any living with it

at all. Anyway. You would typically have a life expectancy of about five weeks because your body wasn't producing insulin. No one knew about insulin, there was no it was. It was pretty much a death sentence. If you had type two diabetes, you might live a long life if it's not a severe case and you're not over indulging and you know, just just through happenstance um, but it

would also be a life riddled with complications. But for centuries, no one knew how to treat diabetes, so your quality of life would be poor to nonexistent, depending upon the type you had. By the average life expectancy for a ten year old child diagnosed with diabetes was one year, so to eleven and that's it. If you were thirty and you then developed diabetes, doctors will give you four more years, And if you were fifty, the expected expectancy

was eight more years. So actually the older you were, the longer you would survive after being diagnosed with diabetes. But still, I mean you, you didn't have any reliable treatments that could give you a better quality of life. Doctor Rolo, who I mentioned earlier, wasn't the only physician to attempt to treat diabetes with changes in diet, and

not all those attempts were successful. According to the Defeat Diabetes Foundation, there was a French physician in the eighteen fifties who treated diabetics by feeding them lots of sugar. Well that makes a stupid kind of sense. If you see the body is losing lots of sugar through urine, then maybe you need to replace it. I don't know.

It didn't work, uh, and it was not a treatment that was UM pursued for very long but and it's not the only time people were wildly incorrect with how they should treat diabetes, but it was one of those notable ones. And I should also mention that while this did appear on their website, I did some preliminary research to try and find like some corroboration, couldn't find anything.

But that doesn't mean it it's not true. It just means that while I like I was giving myself very limited time for each of these items because I didn't wanna, I didn't wanna spend too much time on this one thing and then say like it's absolutely not true or it really is true, and I didn't contribute anything else. UM survival rates among infants born to mothers with diabetes were really low. Initially, the fatality rate was greater than

fifty percent. Dr Priscilla White, who founded the Jocelyn Pregnancy Clinic in nineteen dedicated much of her career to fighting just aational diabetes, and by nineteen seventy four, Dr White had reached a nine percent survival rate among babies born to her patients, so an incredible turnaround of that that rate so uh, I felt that was absolutely needed to mention that Dr White played a great part in this. Go twentieth century and go go go that, and go

that nice woman's research here. Yeah. Absolutely. By the nineteen twenties, commercial production of insulin had really transformed diabetes management. In fact, it became possible to manage diabetes beyond just trying to change your diet. That was further boosted in the nineteen fouries with the development of that syringe I talked about, and by two thousand four, life expectancy for people with diabetes was much longer, but still fifteen years lower than

that for the general population. So transitioning now into some of the modern technology about how we diagnose and manage diabetes today, Well, first of all, we've got a ton of different gluecoast meters out there that are much more accurate.

They typically require you to to prick your finger and put blood on a strip of paper and then analyze that that blood using some sort of meter device, But they tend to be very very accurate, which give people a good idea of what type of insulin, how much insulin they need to administer in order to manage their diabetes. We have a lot better understanding of the effects of

different foods. So sometimes diabetics want to eat something that is going to you know, raise their glucose levels, and so they'll they'll sometimes at the rent fest and you're like, well, there's going to be a deep fried Snickers bar. Yeah, and so you might you might take that into account and you adjust your your insulin dose dosage for that

day so that you can experience that. Like, it doesn't necessarily mean forgoing all types of foods that you might really like and then just eating things that are of that aren't starching, like avoiding carbohydrates and highly uh. There's also some improvements to technology so that insulin pump I mentioned earlier. There are now wireless pumps that are in various stages of development and deployment. And these wireless pumps, first of all, when you're wireless pump, you might think like, well,

is this an internal thing? How is it wireless? It's wireless in the sense that you can have a wireless connection between the pump and a glucose meter, so that you still have a pump that you have to wear on your body somehow. Usually there's some sort of yep, but still got a tube from the pump to going underneath your skin. Uh. It clips on typically to a piece of clothing or something along those lines, but it

can connect wirelessly to a glucose meter. So what you would do is you would go to test your your glucose your blood glucose level, and you'd prick your finger and do all that, and then the meter would make the measurement and then send that data to the wireless pump, which would then administer the proper amount of insulin in order to manage your eucost levels or even stop uh administering insulin to make sure you don't go hypoglycemic. Right.

So what that means is is that if you're if you're, say, out to dinner and and you know that you need to you've either just finished something or you're about to eat, you know that you need to adjust your insulin levels, you don't need to uh take your pump off at the dinner table and manually punch in the button and do a whole thing and then like stick it back in your body, or you know, go to go to a restroom and do that kind of thing. You can you can do it more more discreetly right right, Yeah,

so you don't. Yeah, it really means you don't have to fuss with the pump at all, and that that like that is again another quality of life issue beyond the the pain of dealing with diabetes just to manage it properly, there's also it's not so much a social stigma. But you know, you don't want to have to this embarrassing you have to take out a medical device and you're sitting around dinner with You don't want to make anyone feel self conscious. You don't want to draw attention

to it. You know, you just want to be able to enjoy your time without that added frustration. Um. So yeah, that those definitely have a a big advantage over the traditional insulin pumps um and they're still in different stages of development. We'll talk more about that in our next episode. One of the things I saw I thought was really interesting is that another implementation of this approach is using smartphones and smart watches as your your way of of

getting an indication about your glucose levels. So there's this one company that's offering a product that would pair with Apple's iPhone and their their watch as well, and the way it works is that you have an app, you download it to your watch and your phone, and you use a little sensor that this company provides and it has a thin wire they say, it's about the thickness of a hair, and you stick that under the skin, uh,

and secure the sensor to your body. It monitors your glucose levels, sends that information to a secondary device which then takes the data, sends it to the cloud where it gets analyzed so that you get the actual proper blood glucose level. That data is sent to your iPhone,

which they could be sent to your watch. There's a lot of different stops along this this route, like a lot of points here, but the point being that you can look at your watch and get a very quick accurate reading of what your blood gluecose levels are and

then respond if necessary. UM. So kind of interesting to see, Like I wouldn't have necessarily thought of like the smartphone or smart watches being a device that you could convert into like a medical device in this way, but it absolutely is something that could do that and allow you to keep a really close look on that and that could be very that could be life saving and right circumstances, UM and and this is kind of wrapping up our

our initial episode about diabetes, and we've we've covered yeah, all that all that good juicy history stuff. Where we are now, um, you know, in the a lot of a lot of really interesting things are coming in in the future. We're going to talk about them next time. Yes, so we'll we'll focus on a lot of research and a lot of thought that has gone into ways to manage and treat and possibly cure diabetes. And how far

off are these things? Um, how realistic are they? We're going to take a look at some of those questions in our next episode. If you guys have suggestions for future episodes Beforeward Thinking, write to us. Let us know our email addresses f W Thinking at how Stuff Works dot com, or you can drop us a line on Twitter or Facebook. We are FW thinking on Twitter. If you go to Facebook and search fw thinking, our profile will pop up. You can leave us a message there

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