One hundred years ago, in 1925, the landscape of diabetes care was fundamentally—and tragically—different. The year before, in 1924, the revolutionary treatment of insulin was just beginning to become widely available. Before this breakthrough, a diagnosis of Type 1 diabetes was almost a guaranteed death sentence, and the management of Type 2 diabetes was extremely difficult. Life with diabetes was a desperate struggle against metabolic collapse, relying on starvation diets and closely monitored routines.
Type 1 Diabetes: A Race Against Time (Pre-1921)
Before the discovery of insulin by Banting, Best, and Collip in 1921, there was no effective treatment for Type 1 diabetes (then known as “juvenile diabetes” or “insulin-dependent diabetes”).
The Starvation Diet: The Only Option
The primary, and most effective, medical treatment was the strict Allen Starvation Diet, developed by Dr. Frederick Madison Allen in the early 1910s. The theory behind the diet was to keep glucose levels low by dramatically reducing the body’s energy intake, thereby reducing the production of toxic ketones.
- Regimen: Patients were put on a regimen of near-starvation, often consuming as few as 400 to 500 calories per day, consisting primarily of fats and proteins with minimal carbohydrates.
- Outcome: This drastic measure successfully delayed the onset of diabetic ketoacidosis (DKA), the life-threatening condition caused by severe insulin deficiency. However, it came at a terrible cost: children with Type 1 diabetes were often emaciated, stunted in growth, and constantly weak. They essentially traded a quick death from DKA for a slow, wasting death from starvation.
- Lifespan: The average lifespan for a child diagnosed with Type 1 diabetes was only about one to two years. Many were too weak to play or attend school, their lives dominated by constant hunger.
Monitoring and Testing
Monitoring was primitive by modern standards.
- Urine Testing: Glucose was measured using simple chemical reactions in urine, such as the Benedict’s solution test, which would change color depending on the sugar concentration. This was a qualitative measure (high, medium, low) and lagged hours behind current blood sugar levels, offering little control.
- Dietary Precision: Since they couldn’t directly measure glucose accurately or frequently, doctors and caregivers meticulously weighed and measured every single item of food the patient ate to strictly enforce the starvation diet.
Type 2 Diabetes: A Struggle for Balance
Type 2 diabetes (then often referred to as “adult-onset diabetes”) was also difficult to manage, but less immediately fatal than Type 1 because the pancreas still produced some insulin.
Dietary Management
The cornerstone of Type 2 management was also dietary restriction, but less severe than the Allen diet.
- Carbohydrate Restriction: Doctors prescribed diets that drastically limited carbohydrates, pushing patients toward higher fat and protein intake. The focus was on avoiding the post-meal glucose spikes that accelerate complications.
- Weight Loss: Since the link between obesity, sedentary lifestyle, and Type 2 diabetes was recognized, significant weight loss was heavily emphasized as the primary therapeutic goal. Patients were encouraged to be as physically active as their low-calorie diets would allow.
Pharmaceutical Interventions (Limited)
Before the mid-1950s, modern oral medications for Type 2 diabetes simply did not exist.
- Herbal Remedies: Some doctors and patients used traditional or folk remedies, though with little proven efficacy.
- Metformin Precursor: The biguanides (the class of drugs that includes modern Metformin) were actually first synthesized and used in the 1920s, but were largely forgotten or set aside until the 1950s due to the focus on insulin. One hundred years ago, they were not a standard part of treatment.
The Game Changer: Insulin (1924 Onwards)
By 1925, insulin was beginning to transition from a laboratory marvel to a clinical reality. The impact was nothing short of miraculous.
Initial Challenges
Even with insulin available, the transition was challenging:
- Purity: Early insulin was derived from the pancreases of cows and pigs. It was impure, often causing painful local reactions, abscesses, and allergic responses.
- Administration: Syringes were crude, expensive, and had to be sterilized by boiling before each injection. Needles were thick and blunt, making injections painful.
- Variability: Patients had only a single, fast-acting type of insulin. They had to inject multiple times a day and carefully time their meals to prevent severe hypoglycemia (low blood sugar), an entirely new, life-threatening risk.
The development of purer, standardized forms of insulin and the creation of protamine insulin (which prolonged the action of insulin, allowing for fewer injections) in the late 1930s began to stabilize the lives of those with diabetes. However, 100 years ago, life with insulin still required tremendous discipline, strict scheduling, and constant vigilance, making it a far cry from the flexible management systems of today.
In short, 100 years ago, life with diabetes—especially Type 1—was defined by a stark trade-off: starvation to avoid DKA, or death from metabolic failure. The discovery of insulin was the hinge upon which the history of diabetes swung, moving it from a death sentence to a manageable, chronic condition.
