DIABETES

Evening Post, Volume CVII, Issue 85, 9 April 1924, Page 9

DIABETES

ITS MODERN TREATMENT

VALUE OF INSULIN

ADDRESS BY DR. D. M. WILSON.

Under the anspices of tEe Red Cross Scitiety, Dr. D. Macdonald Wilson, Medical Superintendent of the Wellington Hospital, delivered an address last evening on the subject of diabetes and its modern treatment with insulin. Dr. Wilson began by stating that the earliest medical records we have of diabetes were published in Roman and Mohammedan .writings from the first to the tenth century. During the Dark Ages, when all arts and sciences received a setback, auy knowledge of it was more or less lost. The next real description we have of the disease was in the seventeenth century, given by an English doctor, Thomas Willis. However, for another 150 years it was not differentiated from similar diseases, and was merely considered a disease of the kidneys. Early iv the 19th century, when.chemistry and physiology had advanced, the test for sugar in urine was 'discovered, and thus for the first time it was differentiated from other disease. It was first put! on a scientific basis by the eminent French physiologist Bernard, who lived from 1313 to. 1878. He was the first to show that the sugar absorbed into the body through our foods was stored in the liver. That raised the question of whether it was a liver disease or a kidney disease. And further work on the digestive processes by other investigators during the following years showed that it was the1 secretion "from the pancreas which transformed the starches of food into sugar. Further experiments on dogs, by removing the pancreas, showed that a state of diabetes could be produced in the dog, thus tending to prove that it was the pancreas and not the liver or the kidneys which were at fault. THE PANCREAS. ! The next step in progress was that I an examination of the pancreas under the microscope showed that there were special areas, which were named islands of Langerhaus, after the discoverer. Further examination of the pancreas of patients who had died o£ diabetes showed ■ that these islands were always diseased or degenerated. Thus -we reached the stage of knowledge where investigators theorised that the main glands of the pancreas produce the secretion which form the sugars in the body, but that these islands produce an internal secretion which enable the body to absorb the sugar. In a diabetic patient sugar was formed, but owing to the want of ; "some unknown secretion the sugar could 'not be utilised by the body. Thus investigators came to the conclusion that there must be some secretion from these islands, but no one succeeded in isolating it. Some years ago, Professor Schafer, 'of Edinburgh, suggested the name insulin ■' for this theoretical secretion, which had not yet been found—the name being taken from the Latin word for island., EPOCH-MAKING DISCOVERY. : This was the state of our knowledge until Dr. Banting, of Toronto, made his epoch-making discovery. In diabetes, apart from ordinary symptoms which are "well-known, pi thirst, wasting, in.creased, secretion, from the' kidneys containing sugar, the patient is also liable to at any. time become unconscious, go j into deep coma, and die. "This is due to the formation of waste products in the blood, owing to the different foods of the body not being utilised. In the normal individual the three different types ■of food —protein, fat, and carbohydrates —are utilised in a more or less definite ratio." If this ratio becomes unbalanced, waste products are produced, with dangerous consequences. Coma is apt to de-'' yelop iv diabetes because there -is no store of proper sugar to burn up the proteins and fat properly. Regarding the treatment of diabetes, Until recently diabetes was treated less scientifically, and the one idea was to reduce the amount of starch or carbohydrate iin the food, because this was known to increase the sugar in the blood. This reduction' of carbohydrate I was done at a risk to the patient, be- j pause .sufficient might not be absorbed to burn up the fat and protein, and prevent the waste substances from forming in the blood which produce coma. SCIENTIFIC DEETTNG PLUS "INSULIN. The modern treatment of diabetes is by scientific dieting, plus insulin. The object of dieting is to give the patient a diet on which he can live comfortably, and without any risk of coma. Diet by itself cannot cure tb.9 diabetes, because the cells of the island of Langerhaus once destroyed do not regenerate. In dieting Ihe patient tb-day the patient is commenced on what ws call a basal diet. I This is arrived at by taking the patient's weight and height, and working out his body area. By the experiments made by various isvestigators it is known that a person of a given -weight or body area requires just a sufficient diet when at rest to supply sufficient energy so that the patient will neither gain nor lose weight. The diet is expressed in calories, a measurement of ■the heat value. Therefore to:day, when treating a patient, we put the patient to bed, and put him on his basal diet, keeping him on that for about a week! Usually we. find that that is sufficient, to keep the blood and urine free of excess ol sugar.' However, this is not sufficient to allow a patient to be up and about and to earn his living by light work. Therefore we increase his diet up to what we consider is sufficient to allow him to work. In the .past, without insulin, this has been more or less impossible, as such a diet will nearly always increase the amount of sugar in the blood and urine. The great boon that insulin has given us is that this excess of sugar, which reveals that the pancreas is not acting properly, can be utilised by the use of insulin. The amount of sugar that a patient passes per diem when he is on this diet is measured, and we know that by givin^ so much insulin for every ounce of sugar passed, the blood can be kept sugar-free. Thus a patient on insulin can be kept free of sugar. So long as sugar is in the urine, the pancreas is being irritated, and further degeneration occurs By the use of insulin to clear the blood and urine of sugar, this irritation ceases, and so the progress of the disease is arrested. Also, as previously stated, coma is the resultl of there not being sufficient natural insulin in the body to burn up waste products; and by giving artificial insulin these products are burnt up, and so coma is prevented. COMA CASES NOW SAVED. Until the discovery of insulin, the outlook for a patient once in coma was practically in all cases hopeless. Treatment never brought the patient round. Ac-day,, by giving insulin, the majority 31 these cases are being saved. People may wonder why it is not possible to sat an ordinary diet, and then take quantities of insulin to counteract the sugar in the blood and urine. This would

mean giving enormous doses of insulin, which could not be injected with comfort, and the cost would be excessive. Also, there are grave clangers in taking large doses of insulin. In addition ta the dangers to the patient when the blood or urine is overloaded with sugar, there is a danger if the percentage of sugar in the blood is reduced below normal.- If huge doses of insulin were given, thp. percentage of the.sugar in the blood would probably be' reduced below normal, and a fatal coma develop m the patient from a condition just the reverse of the actual diabetes. This is one of the dangers which must always be guarded against in giving insulin. METHOD OF GIVING INSULIN. The method of giving insulin is to inject it under the skin or into the veins. Unfortunately, giving it by the mouth has no effect. Treatment with insulin and dieting demands intelligence of the patient, for to carry it on at home the patient must be prepared to inject the insulin himself, using aseptic precautions to prevent any. infection getting into the .skin. Then unless the patient is able to intelligently diet . himself, to weigh his food and carry out other medical instructions, he will never make any real progress even with the use of insulin. PRICE OF INSULIN REDUCED. It is interesting to note ■ that during .the last week or two the price of insulin has gone down to about one-third what it was a few months ago. It is a recognised fact that Jews are more liable to the disease than other people, and that the Japanese are little subjectto it. The proportion of deaths from diabetes is about 9.3.per 10,000 of the population. A SUMMARY.' _ From the foregoing it will be seen that insulin is not a cure for diabetes. Diabetes is a result of the lack of internal secretion from the pancreas. This lack is due to degenerated cells, which are not restored. Insulin merely supplies a deficiency. If a patient adheres strictly to the dietary regime suitable to himself, and takes insulin in the quantity sufficient for his case, the prospects are that his life may be prolonged to practically the ordinary span. The hope of the future is that by people undergoing a yearly examination, unsuspected and early cases of diabetes may be discovered; and by the use of insulin the progress of the disease may be .arrested, and perhaps the pancreas be regenerated to almost normal. In the present day too many cases are seen at an advanced stage, and insulin has not a fair chance ot, showing its value and power. If people would only learn what it means to have, say,, a yearly overhaul, so that Ihe disease could, be detected at its earliest stages, these- advanced cases of diabetes would probably never occur A vote of thanks to Dr. Wilson for his excellent lecture was moved by Mr J W loplis and heartily endorsed.