Monday, January 12, 2004

"The Bittersweet Science" by Austin Bunn. New York Times Magazine, March 16, 2003.

Had this one lying around for a while, but ran across it recently while tidying. The story still fascinates.

While diabetes, in the sense of its symptoms (sugar in the urine, excessive thirst, weight loss, and eventual death) had been recognized since classical Greek times, doctors were helpless in the face of it. For one thing, they did not understand the difference between Type 1 diabetes (failure of the pancreas to secrete insulin) and Type 2 diabetes (failure of the body's tissues to respond appropriately to insulin). During an 1871 siege of Paris by the German army, a doctor Apollinaire Bouchardat noticed that while hundreds were starving to death, his diabetic patients actually improved.

In 1919, 11-year old Elizabeth Hughes was diagnosed with diabetes and given a life expectancy of no more than three years. In order to keep her alive, Dr. Frederick Allen of the Morristown, New Jersey, Psychiatric Institute began to starve her--the only known palliative treatment at the time.

When she came to the converted mansion to begin treatment, she weighed 75 pounds and was nearly 5 feet tall. The doctor put on her on a fast for a week, and then on a diet of 400-600 calories a day. Carbohydrates were forbidden. The intent of the severe diet was to eliminate sugar from the urine. Dr. Allen took his patients to the edge of death, keeping them on a knife-edge between death from diabetes and death from starvation. His clinic was filled with rows of emaciated children unable to leave their beds. By April 1921, Elizabeth was 13 years old and had endured two years of treatment. She weighed only 52 pounds, and averaged 405 calories/day. But she rarely showed sugar in her urine, and was just strong enough to read and sew.

In the summer of 1922, two Toronto doctors, Frederick Banting and Charles Best, experimented with removing the pancreases from dogs, and so causing the dogs to contract diabetes. They then treated the dogs with injections of a filtered solution of macerated pancreas, and the dogs' blood glucose levels returned to normal. This was the discovery of insulin.

Elizabeth's parents took her to Toronto where she was seen by Dr. Banting three days before her 15th birthday. She weighed 45 pounds. By the end of the first week on insulin treatment, she was up to 1,220 calories per day--with no sugar in her urine. Soon she was able to take in 2,200 calories per day--including foods like bread and potatoes, which she hadn't tasted in three and a half years. By January 1923, she was up to 105 pounds; later that year, Dr. Banting won the Nobel Prize.

Elizabeth went on to attend Barnard college, marry, raise three children, and lived to die of a heart attack in 1981 (more than 43,000 injections of insulin later).

The history of the transformation of diabetes from an acutely terminal illness to one that could be managed over the life of the patient is the subject of Dr. Chris Feudner's book, Bittersweet: Diabetes, Insulin and the Transformation of Illness.