6. DIABETES

Fifteen hundred years ago the Greeks found a name for it: diabetes, which literally means "passing enormous quantities of urine." But the recorded history of the disease goes as far back as 1500 B.C. when reference to the symptoms of the disease we know as diabetes was made in ancient Egyptian writings.

However, the first important medical literature about the disease comes from Aretaeus of Cappadocia, a Greek who is thought to have lived between 120 and 200 A.D.

He described diabetes as "... a melting down of the flesh and limbs into urine. Its cause is of a cold and humid nature as in dropsy."

He suggested that remedies for "the stoppage of the melt­ing" were the same remedies that he prescribed for dropsy.

Today—some 1800 years later—we still do not know the true cause of diabetes, but we have learned enough about the disease to be able to treat it effectively and the control of diabetes is one of the very bright lights in the history of medicine.

Shortly after the turn of the century, George Hammond, a middle-aged businessman in a small community, sat listlessly at his desk. He had dropped his pen and now stared irritably across the office at his partner, John Gallway. Abruptly he got up and went to a water cooler and drank several glasses of water.

Gallway watched his partner with a worried frown.

"George, are you ill?" he finally asked.

Hammond drank another glass of water before he an­swered. For a few seconds his face reflected impatience and almost anger at the question, but he seemed to get control of his irritation and he nodded, almost curtly, and went back to his desk.

"I don't know what's wrong with me," he admitted. "It seems that I'm always thirsty and hungry. I can't get enough to drink."

"It seems to be going right through you, too," John ob­served. "At least, you're making quite a few trips to the room out back."

George smiled wryly. "Well, there's certainly enough of that. It seems I have to urinate every time I turn around. The worst of it is that it's several times a night. Marj says I'm worse than the youngsters."

"And you're always hungry?"

"Starved. I eat enough for two or three men, Marj thinks."

"But you're not gaining weight, are you?" Gallway asked.

"No." Hammond opened his coat and pulled out his trouser band. "I've actually lost ten pounds in the last couple of weeks, I think. Seems that way. Look at these pants. Two inches too big."

His partner nodded. "I thought you were losing weight." He looked closely at his partner, noting again the dryness of George's skin, the flabbiness, the skin eruptions. George Hammond looked ill. He looked old. It seemed as if he was aging about twice as fast as he should.

"I think you'd better see Dr. Carbright," he said.

"Maybe so. Probably need a tonic."

"Well, do it today. Don't put it off."

"Too busy. You know that. I'll wait until next week. This isn't serious. I'm sure of that."

Hammond did not see the doctor the next week, nor the next. He knew that he should. He certainly was feeling worse. Even his eyes were beginning to bother him, and he was so tired all the time; so tired that his legs cramped at night.

He supposed he'd better see the doctor, though. The thirst was getting worse all the time, and the constant necessity to urinate so much—something must be wrong. Besides, Marj had cried several times because he had been so irritable, and then wanted to be left alone.

"Something's wrong," she had insisted. "You look so—so sick, George. It's like you're getting old, and you're really not. You just look that way. And you're so short with the children

and me. You eat a great deal, yet it doesn't show on you and —George, I'm so worried about you. Please see Dr. Car-bright."

"All right!" he had snapped. "It's nothing. But I'll see him. Before I get too old to hobble down there."

"George—I didn't mean that. You know I didn't. It's just that—well, your skin is so dry . . . you look so . . ."

"I look so old."

Marj Hammond tried to hold back tears as she turned away. Suddenly she was frightened. This certainly wasn't the man she had married. Something terrible had changed him, and the knowledge frightened her more than anything ever had.

George kept his word and visited Dr. Carbright the follow­ing day. The examination was quick, the questions were sig­nificant and positive, and when the doctor was finished he was very grave as he told his patient to put on his coat.

"My news isn't very encouraging," he said frankly. "You have diabetes."

"Diabetes! But how did I get that?"

"I can't tell you what causes it, George. And I don't know how much I can help you. We have no cure for it."

"But you can do something!"

"We're quite certain there's a relationship between diabetes and the sugar in your blood. At least, we know that some persons are helped when they limit to a minimum the amount of sugar they consume. There are some diets we've been trying. We'll start at once."

George looked into his doctor's eyes, searchingly, seeking the answer to a question he dreaded to ask. The doctor seemed to understand.

"Are you trying to ask me what the prognosis is, George?"

"Yes. I'd rather know."

"Not good. We'll put you on a strict diet at once. Do every­thing we can. Maybe—but only time will tell. I'll be frank with you. Your condition is serious."

George Hammond's condition was too serious to be saved by the tardy attempt for treatment through a diet, which, at best, might have been inadequate for his condition.

Within weeks after Hammond's visit to the doctor's office, he began to lose his sharp appetite and complained of ab­dominal cramps and nausea. His thirst increased. He said that his head ached and he had other pains over his body.

One evening he became very ill. He complained to Marj of difficulty in getting his breath. His lips and his tongue became dry and parched, and when she felt for his pulse she dis­covered that it was rapid.

She sent for Dr. Carbright, but before the doctor ar­rived, George Hammond had gone into a diabetic coma from which he never recovered. His death was typical of thousands that could be attributed to diabetes. This had been the common history of death from diabetes over the ages.

The small-town Dr. Carbright, even in those days, was fairly knowledgeable about the disease, but it was not until some twenty years later that the effort to control diabetes was to be successful.

Although we are not certain of the true cause of diabetes, we can much more scientifically define diabetes than could Aretaeus.

Actually, two disorders are generally known as diabetes, diabetes mellitus and diabetes insipidus. Today, when speaking of diabetes, almost everyone means diabetes mellitus.

To properly understand diabetes, we must realize that every living person must have sugar in his blood if he is to live. These sugars are obtained or absorbed from the food we eat. The sole substance of sugar is carbohydrate, the principal constituent of starchy foods such as potatoes, bread, and fruits.

In the digestive processes the sugars are broken into a simple form called glucose. The glucose is stored in the liver, muscles, and other tissues of the body, as glycogen.

When the total amount of sugar in the blood drops below normal, the stored-up glycogen converts into glucose and goes into the blood stream. The conversion normally is such that the blood glucose is maintained at an average value in the body.

This blood-sugar feeds various tissues and organs in the body with necessary energy and heat. In the average person the amount of blood-sugar in the blood ranges from 70 to 100 milligrams per 100 centimeters throughout the 24-hour periods.

Obviously, some body processes are necessary to accom­plish all this. When something goes wrong with these proc­esses, we are in trouble. Sometimes the body may lose its ability to metabolize sugar, or it may make too much sugar.

The result is diabetes. As Anthony M. Sindoni, Jr., M.D., explains in The Diabetic's Handbook: "It is a condition in which the body has partially lost the power to 'burn' the sugars obtained or absorbed from foods. As a result, the sugars which escape burning accumulate above the normal amount in the blood."

In more detailed explanation, something has prevented the storage of glucose in the cells of the liver. Consequently, blood and tissues are flooded with glucose—more than the cells can use. For some reason the burning of the sugar by the cells is not being promoted correctly. Although the cells have a surplus of glucose, they cannot make correct use of it. Consequently, fat becomes the body's main fuel, and from this is left acid remains that are poisonous when present in excess.

The surplus of glucose is passed out through the kidneys, requiring an increased amount of water for excretion. This, in turn, awakens an almost constant thirst. These two conditions —excessive urination and thirst—are two of the first symp­toms of diabetes. And, of course, the appearance of sugar in the urine, and a too-high blood-sugar range, are well-known symptoms.

But why does this happen? What goes wrong?

For some reason, as yet undiscovered, the condition results when there is an insufficient amount of a substance called insulin in the body.

Insulin is a fluid substance that is discharged into the blood stream from the pancreas. It is produced by the "islets of Langerhans," which are nests of cells in the pancreas, an organ that is five to seven inches in length, transversely located across the upper back part of the abdominal cavity. The Langerhans islets were named for the German medical student, Paul Langerhans, who first took note of them in 1869.

The pancreas consists chiefly of two portions, one larger than the other. They also differ in structure and purpose. The larger portion secretes a digestive fluid into the small intestine. The smaller part of the organ is made up of the islets of Langerhans, which, in turn, consist of two groups: the beta cells, which secrete the hormone insulin, and the alpha cells which secrete a substance called glucagon. The precise be­havior or action of glucagon still is a mystery, but it may suppress the action of insulin.

Between one and two million islets of Langerhans in the average person produce enough insulin to "burn"—metabolize —the sugar, fat, and protein. When a person has insufficient insulin, or if the insulin is prevented from functioning prop­erly, the ability to burn and store sugar properly is lost, and diabetes results.

Discovery of insulin is one of the great medical discoveries of the early years in the twentieth century. It culminated, to a large degree, as a result of other discoveries of note over the years.

Thomas Willis, an English physician, observed that the urine of diabetics "was wonderfully sweet as if it were im­bued with honey or sugar." Matthew Dobson proved that such urine did contain sugar by evaporating the liquid. Dr. John Rollo prescribed dietary treatment for diabetes in 1796.

Researchers Minkowski and von Mering produced dia­betes in dogs when the pancreas was removed, establishing the relationship between the pancreas and the disease.

Around 1900, lesions of the islets of Langerhan were ob­served in fatal diabetes. Shortly before that the British physi­ologist, Edward Sharpey-Schafer, suspected changes in the islets in relation to the disease.

Then came the important "breakthrough."

A young Canadian surgeon, Frederick Banting, who had served overseas with the Canadian army, settled in London, Ontario to practice. He obtained a post as demonstrator of physiology in the University of Western Ontario where he became interested in the study of diabetes. Later he went to the University of Toronto and worked on the baffling problem there with the assistance of a young medical student, Charles H. Best. Their research was conducted in the laboratory of Professor J. J. R. Macleod, who aided somewhat with the work, as did Dr. J. B. Collip.

In this laboratory, Banting, aged 30, and Best, 23, discov­ered insulin in 1921. For their vastly important contribution to mankind, they were awarded the Nobel Prize. Their names will go down in medical history.

From this date the story of diabetes takes a new and almost startling turn. It was discovered that although insulin could not be produced artificially, it could be obtained from the pancreas of cattle or pigs. Consequently it became possible to inject insulin into the bodies of diabetics and thus establish a control of diabetes.

As a result of the discovery of insulin—directly, or in­directly—almost any diabetic who has proper care can now live almost as long as a person without the disease. Nor must he restrict his activity.

In the United States alone there are about 1,600,000 diag­nosed diabetics. It is believed that there may be another 1,300,000 who are undetected and not getting treatment.

Altogether it is estimated that about 3,750,000 persons living today are potential diabetics, and probably will develop the disease sometime during their lives. Some 65,000 new cases are diagnosed yearly.

Although insulin is not a cure for diabetes, it is the first treatment that can control the disease and allow victims to live virtually normal lives. Recently, new discoveries add to the hope that even greater victories over diabetes are in the making.

After considering this brief resume of progress in the fight against diabetes, it is obvious that in the lore of folk medicine virtually all "remedies" pertaining to diabetes are, in fact, only concerned with the symptoms of the disease.

Until the discovery of insulin and the knowledge of insulin's function, our understanding of the disease was woe­fully incomplete, except for symptoms, the course of the disease, and the tragic end.

For instance, the Aztecs prescribed that "one who lacks saliva and is inordinately thirsty" (symptoms of the disease) should swallow some liquid made of various herbs and animal matter. Some of the liquid should also be held in the mouth. The juice of ground herbs was to be poured over the victim's head.

Aretaeus, who gave the disease its name, said that: "Medi­cines which cure thirst are required . . . we must, then by all means strengthen the stomach, which is the fountain of thirst." He recommended a purge, the use of nard, mastich, dates and raw quinces; the juice of these with nard and oil for lotions and that water be boiled with autumn fruit. He also suggested a diet of milk and cereals, starch, groats of spelt, and astringent wine.

It is interesting to note, however, that by 1889 there was a definite attempt upon the part of some doctors to recognize the role that sugar might be taking in the disease.

In 1889, George H. Napheys, A.M., M.D., said in his Handbook of Popular Medicine: "The treatment of this affec­tion (diabetes) is yet, to a degree, a matter of uncertainty. It is believed that the absolute prohibition of sugar in the diet, or of particles prone to form sugar, will aid greatly in check­ing this disease.

"Perhaps the best results obtained have followed the 'skim-milk treatment.' The patient is restricted to the milk, carefully skimmed, for a month at least, and then allowed, in. addition, two to four pints of a curd made by the use of rennets, gradu­ally; as improvement occurs, lean meat and green vegetables are given."

English herbalists have recommended periwinkle and sweet cicely for diabetes. Of the latter, it is quoted in Culpeper's English Physician and Complete Herbal, 1947: "It (sweet cicely) has an action on the pancreas and is a useful herb for sufferers from diabetes."

The efficacy of any folk remedy for treatment of diabetes is, of course, probably without any foundation of fact. The true and exciting story of the disease is in the modern day, and the future. It is a story written in scientific laboratories, by researchers who daily probe with knowledge far beyond even the imagination of our forefathers.

In the fall of 1960, another businessman, Carl Long, who was about as old as George Hammond was at his death, sat in his doctor's office after his annual physical checkup.

He was a rather husky man, dynamic in appearance, and well groomed. He had a wife and two daughters. He was successful in his business. Now he adjusted his horn-rimmed glasses and smiled confidently at Dr. Thomas Briney.

"Okay?" he asked.

"Yes and no," the doctor answered. He was a contem­porary of Long's. As a matter of fact, they had attended high school together in this city where they had stayed to make their homes.

"Yes and no!" exclaimed Long. "That's no answer, Tom. Something wrong? Heart? High blood pressure?"

"As a matter of fact your blood pressure is a little high. But it's not that. It's those lab tests I had you stop by for yesterday. I have the results. And maybe a slight shock for you, Carl."

Long continued to smile, but a little nervously now.

"What is it?"

"Excessive sugar in the urine and in the blood. It looks as if we have a little diabetes to cope with."

Carl sat back in his chair, took a deep breath and let it out slowly. He nodded.

"My father was a diabetic," he said. "He died of a heart attack, but he'd been a diabetic since 1930 or so."

"On insulin?"

"Yes."

"Then you know something about it. And, incidentally, statistics show that a lot of diabetes can be traced to heredity. Some 30 to 65 per cent."

"Then we should keep a close watch on the kids."

"Yes. If it shows up we want to catch it fast. It's usually more severe with kids."

"Physical exams?"

"Of course. There are some simple home tests, too. You'll be on them, anyhow, so you might as well make it a family habit. They're simple tests for sugar in the urine. Anyone can make them."

"So I've heard. Analysis papers that you simply moisten with urine? Things like that?"

"That's right. We'll discuss them later. Right now, we have to discuss you."

"Aren't there some new treatments besides insulin?"

"Yes. But I'm not certain if we can use them. We have some testing and experimenting to do. If we catch it early enough, and if it's mild enough, maybe we can do it with diet alone. With one out of three we can. Maybe one of the pills—-oral medication—will do the job."

"There still isn't a cure, is there, Tom?" Long asked, a little hopefully. "None of these new pills?"

"No. I wish we had one, Carl. But we haven't. However, this isn't going to bother you too much, nor cut down on your activities."

"How about my golf?"

Dr. Briney smiled. "You've heard about Ham Richardson and Bill Talbert? Tennis stars? Well, they're diabetics. H. G. Wells was. So were Mayor Fiorello La Guardia and Thomas Edison."

Carl nodded. "Sure. I know, Tom. We don't have to go out of town. Barney O'Brien is. Sam Howland, over at our com­petitor's, is on insulin. I guess I know half a dozen. It's just that—"

"Sure. I know. You don't like to suddenly find yourself with the stuff. I know exactly how you feel about it."

"I suppose you do, Tom. You probably see enough of it. I guess you can understand what—"

"More than that," Dr. Briney smiled at his friend. "I'm one, myself. I've been a diabetic for five years!"

"Well, I'll be damned!" breathed Carl Long in surprise.

"Nope. You'll be saved, my friend," the doctor grinned. "Let's get at it!"

Within a few weeks Carl Long was taking one of the new "diabetes pills" which seemed to sufficiently help control the extent of Long's illness.

His case is little different from hundreds that are recorded every month in doctors' offices across the land.

Unfortunately, many other cases are not discovered until the disease has made dangerous inroads into the victims' health, or before they have been claimed by death.

Diabetes is an insidious disease in some unique ways. It does not give pain or fever. It is not contagious. As a result, patients may neglect treatment and become victims of the dangerous effects of the disease.

Not only may a patient become unconscious in diabetic coma, but such a person runs most dangerous risks from gangrene, especially from infection around the feet. Gangrene is always an especial danger for diabetics. Before proper treatment aided people in better controlling the disease, am­putations of toes, feet, and limbs as a result of gangrene were all too frequent among diabetics.

Even in this day of control, the diabetic must be most careful about infections, especially of the feet.

Public education about diabetes is of paramount importance. The advisability of a yearly medical examination is obvious, since tests for possible diabetes almost always are included in this examination.

Once the patient has been diagnosed as being a diabetic, he should then be fully informed and instructed about his disease. The instruction usually extends to his family, too.

In Long's case, the fact that his father had suffered from the disease made Carl somewhat familiar with it. Despite this knowledge, new treatment developments had taken place since his father's death. Carl, as have probably millions of others, had read or heard about the new oral treatments.

What are these "pills"? How do they work? Are they cures? Do they substitute completely for the older insulin injecment treatment? And what about insulin? Have there been changes in its use?

Here is a brief review of treatments:

INSULIN—Insulin is given by injection, usually self-admin­istered by the patient in the normal course of treatment. There are two types in use: the regular insulin and the crystalline zinc insulin. The regular was the first discovered and still is commonly used in treatment. The second is in a purer form, being prepared in a chemically pure state from zinc insulin crystals. It is usually called protamine zinc insulin. Both have the same basic effect upon the blood sugar, and are obtained from a pharmacist with a doctor's prescription which states the type, strength, and amount.

Insulin, of course, does not cure diabetes. In prescribing insulin, the doctor also will give the patient instructions about diet, as there must be control over the food and sugar intake into the body. The insulin is adjusted to the patient's condi­tion, diet, and the findings of laboratory examinations of the blood and urine.

Insulin Shock may come as a result of an overdose of insulin, too frequent injections, too long an interval between the time of injection and food intake, a hypersensitivity to insulin, increased exercise or muscular activity, or sudden reduction of blood sugar when it is very high.

It occurs, of course, when the blood sugar has dropped too low, usually below 70 mg per cent. It may result only in a sense of uneasiness or it can bring unconsciousness, depending upon the extent and rate of the fall of blood sugar. In more pronounced cases, the patient may be restless, weak, nervous, trembling, pale, and it is not uncommon for him to act some­what like a drunken person.

Frequently the patient, himself, is aware of a ringing in the ears, double or blurred vision, a mental confusion, trouble with talking, a rapid pulse, and sweating.

Unfortunately the appearance of drunkenness that sometimes occurs with insulin shock has resulted in very ill persons being arrested and jailed for drunkenness.

Diabetics under insulin treatment are well informed about the dangers of shock and how to identify its approach. The remedy is to raise the blood sugar by drinking orange juice, ginger ale, or eating sugar in any form.

As a protection, many diabetics carry a small identification card with pertinent information printed on it. These often are furnished by drug firms. One such card, distributed free by Rexall, reads, in part:

IF FOUND IN A COMA

call nearest physician or emergency hospital immediately. I suffer from DIABETES and must use INSULIN. My coma or weakened condition is the result of insulin reaction. In the meantime, if I can be aroused sufficiently to swallow, give me a lump or two of sugar or one small glass of orange juice . . .

The card has space for the patient's name and pertinent information concerning his doctor and other medical facts.

Such a card may prevent incidents such as that which recently involved Les Jones, a hard-working, sober service department manager of a car dealership in a West Coast city.

Late on a Saturday afternoon, he called his wife to tell her that he would be late. He had an overload of work that he wanted to get out.

"What about eating?" she asked, automatically, thinking of her husband's diabetes, the insulin, and his diet.

"Haven't thought about it yet. Too busy," he said. "I'll see you later, honey. Maybe about ten o'clock."

He hung up and his wife went about preparing dinner for herself and the three children.

At ten o'clock, her husband failed to come home. At eleven o'clock she called the garage, but no one answered. Finally, at midnight, she called the manager of the dealership and expressed her fears.

"I don't know, Martha," the manager said. "At about seven I was there and he said he was going to eat, but when I came back at nine, he was still there and he hadn't gone out to eat."

"But he should," she said, worry suddenly strong in her voice. "He always takes his insulin before he eats."

"Would that make a difference?"

"Yes. If he didn't eat pretty soon, he could go into insulin shock. And you know how he is. He always drives to get a job done, and he forgets time and everything else."

"Look, Martha—I'm going down to the garage. I'll see if he's there."

The manager failed to find his employee in the garage. He went out and spotted an all-night cafe where some of the employees frequently ate. He went in. They had not seen the service manager, at least, no one answering his description.

"You didn't see anyone who looked sort of sick, did you?"

The counter waitress shook her head. "Nothing like that. But there was some drunk out in front. He was sure sick. Fall­ing all over himself in the gutter."

"Did you see him?"

"Me? I should go out to look at a passed-out drunk. Nope! But if you want a look at him, you might try the drunk tank down at the jail."

The car dealer played a hunch and drove to the city jail. He found his employee there in the drunk tank, apparently unconscious.

A doctor was called immediately and the ill man was re­vived from the insulin shock he suffered.

Unfortunately, he had changed clothing before leaving the garage and had forgotten to take his wallet out of his work trousers. Consequently, he carried no identification or the diabetic warning card he had in his wallet.

Constant research has continued with insulin. Results in­clude globin insulin with zinc, which takes a little longer to act than plain insulin, and lasts longer; NPH which may have a slightly more prolonged action than globin insulin; and Lente insulin which has a comparable prolonged action without the addition of foreign substances such as globin, histone, or protamine.

Despite recent discoveries in oral medication, insulin re­mains the "stand-by" for the treatment of diabetes, although some of the "pills" are effective in certain cases. Dr. Charles H. Best, who helped the late Dr. Frederick Banting discover insulin, believes that an orally effective insulin eventually will be developed.

Oral Medications For Diabetes—At present, there are three kinds of oral medication in considerable use in treating dia­betes. Others are being tested. The three kinds of tablets now being prescribed are: Orinase, Diabinese, and DBI. Each is taken by mouth. In selected patients, one or the other of them may be very effective in helping control diabetes.

Orinase and Diabinese are related to the sulfa drugs. DBI belongs to a chemical family called biguanides.

Orinase And Diabinese—Both of these "diabetes pills" come from the sulpha family. Both apparently are most suc­cessful with patients over 40 years of age, and those with mild cases. Neither is generally recommended for juveniles, who are generally treated with insulin. Laboratory and clin­ical findings indicate that these two oral pills are effective only when the patient's pancreas still is producing at least a little insulin.

In theory, the pills stimulate the pancreas to release additional natural insulin, or they serve to inhibit the work of an enzyme called insulinase that breaks down insulin.

Consequently, the pills can be very useful in controlling the diabetes of older persons who still produce some of their own insulin, or, occasionally, by enabling patients to reduce the amount of insulin.

They are not advisable for most juvenile diabetics, nor problem cases, nor—or course—cases where the body is pro­ducing no insulin.

Orinase, also known as Tolbutamide, is said by some ex­perts to be not quite as potent as Diabinese.

DBI—DBI, which is also known as Phenformin, unlike Orinase and Diabinese, works independently of insulin. It will lower blood-sugar when the pancreas is not functioning, and has lowered it in some patients who have had the pan­creas removed.

DBI can be used by all kinds of patients, young and old. Dr. William Pearlman, Wilkes-Barre, Pennsylvania, reports: "It is evident that DBI is an effective agent in 80 per cent of all diabetic patients, particularly the young ones."

This success among younger patients is of especial signifi­cance, since most juveniles usually have had to resort to strict diets and insulin.

Take the case of Bob Walton, 15. For more than four years he had been on a very limited diabetic diet and had faced the routine of daily insulin shots. The diabetes was under control, but now his mother sat in Dr. Klemmer's office talking about another problem now unexpectedly con­fronting her son.

"He's withdrawing into himself completely," she told the doctor. "He's dropped all his friends at school. He wants to quit school, and simply refuses to study. He has no interest in anything. He—well, I don't know what to do, Doctor. We're almost frantic with worry."

"And you say it seems to revolve around the diabetes?"

"Yes. He says he can't go to the hamburger places with the others. Or parties. He can't eat as they do. He has to watch his diet so closely. He hates the insulin shots. He won't date any girls because of it. He—he just isn't Bob any more. I'm frightened."

The doctor nodded his understanding. "It happens," he told her. "But maybe we can do something for Bob. In his case, I think DBI and diet may work."

He explained the new tablets to her and suggested that they wait until Bob came in for his regular checkup the following week.

After the checkup, Dr. Klemmer told the boy that they were going to try the new oral medication. Bob immediately became interested and was eager to make the change.

"Those shots of insulin every day get me down," he con­fessed. "This is more like it. Do you think they'll work?"

"In your case I think there's a good chance that they will."

The DBI treatment was successful with Bob and within a few months he was active in school affairs, was doing ex­tremely well with his studies, and was about as happy and well adjusted as anyone could wish.

Reports on the use of DBI from medical schools and cen­ters across the country indicate good results from use of the drug in controlling the disease.

In Boston, Dr. Leo P. Krall has treated hundreds of cases with oral on in recent years. For many he selected the DBI treatment and reports good results for most of them.

"Oral drugs are the most striking advance in the manage­ment of diabetes since the discovery of insulin," Dr. Krall has stated.

Dr. Sindoni, Jr. sums up the present situation in relation to insulin and oral treatments with the comment that: "Within the next few years we hope to have better insulin preparations and perhaps some oral substitute that will simulate the action of insulin. When they prove successful your doctor will advise you (the diabetic patient). The day will come when research workers will discover the cause of diabetes, because they are constantly working toward that aim.

Other Aids—In addition to the above, some other drugs that may be taken orally seem to have some effect upon diabetes control.

Aspirin is known to lower blood-sugar and once was used quite extensively in the treatment of diabetes.

Other drugs that dilate the arteries may be helpful, as well as large doses of estrogen, and some antihistamines.

Detection Of Diabetes—The American Diabetes Associa­tion has been active in educating the public to the advisa­bility of tests for diabetes and yearly a week-long Diabetes Detection Drive, conducted by the American Diabetes Drive Association, has been effective.

Testing is simplified through use of simple self-testing kits that almost anyone can use.

Recently "pre-diabetes" tests have been receiving attention and experimentation. These tests are directed toward fore­telling whether a person will become a diabetic.

The use of cortisone for one of these tests apparently is fairly reliable. The injection of a small amount of cortisone in the person being tested raises the blood-sugar content in the circulation. The amount of the increase enables the testing doctor to foretell whether or not the tested person may eventually be a diabetes victim.

Orinase also may foretell diabetes. In experiments that use an injectable form of Orinase, indications are that the injection lowers blood-sugar of non-diabetics in 30 minutes. If the suspect is diabetic, the lowering time takes more than one hour.

Catching the disease as early as possible can be very im­portant to the patient and emphasizes the importance of good detection methods.

Dr. Riley Thomas of Howard University Medical School, Washington, D. C, has been testing an oral anti-diabetic drug for some three years. He recently reported that a six-week treatment will protect a person for about 18 months if the diabetic tendency is caught early enough.

Thus, while there still is no cure for diabetes, improve­ments in detection and treatment become medical news each year. The next important discovery may come in treatment, prevention—or even in a cure.

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