Dr Araz Rawshani

The history of type 1 diabetes

Contents

Type 1 diabetes: A bittersweet story about sugar, environment and frustration

Few diseases are as mysterious as type 1 diabetes. Scientists all over the world have spent over 100 years finding the cause and cure for type 1 diabetes. Today we still have no explanation for why diseases occur and we have not succeeded in producing a cure. This is sad because type 1 diabetes is a common and extremely serious disease. Today, type 1 diabetes is the second most common chronic disease among children. However, type 1 diabetes also affects young people, adults and even the elderly. You can experience type 1 diabetes at any time during your life.

Although we have not yet been able to clarify the cause of the disease, nor have we found a cure, the story of type 1 diabetes is one of the most spectacular in medical science. Below is a brief historical look.

Type 1 diabetes in the early 20th century: a rare but fatal disease

In the early 20th century, type 1 diabetes was a very rare disease. The few affected by the disease died within a few days or weeks. All those affected were children and the disease was therefore considered a childhood disease (hence the name child diabetes). Today, about 120 years later, type 1 diabetes is the second most common chronic childhood disease and now affects adults and the elderly. Fortunately, very few people die in connection with being diagnosed with type 1 diabetes. The vast majority of people live a long life.

It was the first to describe diabetes by the Greek physician Arataeus (80—138 A.D.). He had met patients who were tired, lost weight and had sweet urine (he tasted the patients’ urine to determine it was sweeter than normal). However, it was only in 1776 that Matthew Dobson was able to confirm that people with diabetes actually had high concentrations of sugar in their urine.

In 1889, Oskar Minkowski and Joseph von Merring managed to pick out the pancreas from dogs, and then they noted that the dogs received diabetes. It began to suspect that the pancreas was important for blood sugar. In the 20th century, many and great progress was made. The researchers discovered that the primary fuel of the human body is sugar (glucose/glucose). It was possible to clarify how glucose is used in the body, how it is stored in the body and how it can be made in the body.

Insulin detected by Banting and Best

One of the greatest discoveries of medicine came in 1921, when Fredrick Banting and Charles Best discovered insulin. They discovered insulin by transferring parts of the pancreas from a healthy dog to a dog with diabetes. Then the diabetic dog got better. Banting and Best managed to figure out that there was a hormone in the pancreas that was important for blood sugar, and that hormone was insulin. Later, Banting and Best learned to take insulin from cattle and use it to treat diabetic people. From that day onwards, people with type 1 diabetes could survive.

A few decades later geneticists (scientists studying the genetic predisposition of man) managed to take the human insulin gene and paste it into bacteria, which caused bacteria to start producing human insulin. That way we could produce large amounts of insulin for those who lacked the hormone.

An autoimmune disease

In the 70’s, 80’s and 90’s, scientists began to understand that type 1 diabetes was an autoimmune disease. The word autoimmune means that the immune system is attacking the body. Type 1 diabetes is, therefore, a disease caused by the sudden onset of an attack on your own body by the immune system. The fact is that the immune system attacks precisely those cells of the pancreas that make insulin, and these cells are called beta cells.

The question is: what is it that triggers this erroneous reaction of the immune system?

The answer is still unknown to us.

More and more people get sick with type 1 diabetes

Type 1 diabetes was a very rare disease in the early 20th century. It was the American physician Elliot Joslin (1869—1962) who kept accurate statistics in his hometown of Boston. He was particularly interested in type 1 diabetes and therefore made a thorough survey of the people in Boston who had the disease. The fact that they were very few is explained by the fact that the vast majority of people died quickly and, in addition, few people suffered from the disease.

For some unclear reason, more and more children began to suffer from type 1 diabetes. From 1950, the onset of illness began to increase, which means that more and more children were affected. Every year, the number of new cases increases by as much as about 3%. When the researchers discovered this in the 1980s, they quickly started several international studies (e.g. DERI, DIAMOND and EURODIAB) and the purpose of these studies was to map the onset and circumstances of the illness.

Each year, therefore, 3% more than in the previous year and this increase has been most pronounced among children under 14 years of age. It has now been estimated that between 2005 and 2020, the incidence rate will increase by as much as 70%, which is an alarming figure. Unfortunately, we don’t know why. There are several hypotheses, but none of them is satisfactory.

An unknown environmental factor is likely the explanation

You might think that type 1 diabetes is a genetic disease, but that is not the case, although some genes increase the risk of having type 1 diabetes. However, our genes cannot be the whole explanation. The difference in the genes of different populations is extremely small, but the difference in the incidence (number of cases) is very large. See the picture below, which shows differences in the disease globally (number of people with type 1 diabetes is shown on the map). The picture shows that there are great variations around the world, but the fact is that genes do not differ significantly in these different locations.

In addition, the incidence of type 1 diabetes has increased very rapidly in recent decades, while our genes remain virtually unchanged. It also speaks against genes. That means there must be a factor in our environment that causes type 1 diabetes. This environmental factor has changed over time, so that more and more people are affected. It may be that a protective factor in the environment has gradually disappeared. Or a harmful factor in the environment has increased. Unfortunately, we don’t know.

In conclusion, today it is believed that there is something in our environment that starts the autoimmune process that leads to the body’s immune system attacking pancreatic beta cells. This environmental factor can be anything, from viruses to chemicals or eating habits.

The successes are many

The great successes in type 1 diabetes concern the treatment itself. Today we have become very skilled at treating type 1 diabetes. Today, patients can receive good treatment that they do themselves with modern medicines and technical means. With the help of modern insulin and blood sugar control capabilities, people with type 1 diabetes can keep their blood sugar in check.

One of the most important research studies in this context was the DCCT study, which showed that low blood sugar was favorable. Today we know that it is fundamental to try to keep blood sugar as low as possible, without causing inappropriate blood sugar drops (hypoglycemia). With modern devices, you can actually monitor your blood sugar constantly (without stinging yourself several times) and the insulin can also be delivered via a pump. It gets better and better every day.

In parallel with improvements in insulin therapy, we have also learned that it is beneficial to treat high blood pressure and high blood lipids. Today, these three — the treatment of blood sugar, blood pressure and blood lipids — are the cornerstone of treatment. Of course, diet and exercise are also essential.

In the future, treatment will be even better. Today already there are “artificial pancreas” that can take care of the measurement of blood sugar and insulin injections automatically. At the same time, scientists are working on both vaccines and cures. The future is therefore bright.

With insulin began to survive and then came cardiovascular disease

Before the insulin came, all those who had type 1 diabetes died. Thanks to insulin, the individuals managed to survive. Over the years, we got better at controlling blood sugar. Then these people could suddenly survive to adulthood and you noticed that instead it was cardiovascular disease and complications to type 1 diabetes that became the big problem. People with type 1 diabetes were shown to be at very high risk of heart attack, stroke, heart failure, kidney failure, nerve damage, eye damage. People with diabetes have many times an increased risk of these diseases. Fortunately, we have become much better at treating and preventing these complications.

At least 50,000 Swedes have type 1 diabetes

Today, about 50,000 Swedes live of type 1 diabetes. The vast majority of people have fallen ill as children, but you can actually suffer from type 1 diabetes throughout your life. The earlier you suffer from type 1 diabetes, the more genetic risk factors you have. So genes play a role. Genetic risk factors mean that those affected by type 1 diabetes usually have genes that make their immune system prone to attack the pancreas. Such genes are therefore unfavorable genes.

The following picture shows how many people (in Sweden) aged 0 to 34 years suffer from type 1 diabetes. It is clear that the disease is highest in the 10-14 age group.

Summary

What was once a rare and deadly disease has today become a common disease that can be lived with. Despite huge improvements, mortality and morbidity are still very high among people with type 1 diabetes.

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