The Disease of Sweet Urine

Here’s a slightly odd thing about me: I love diabetes.  I do not, of course, mean that I would enjoy experiencing the disease, or that I wouldn’t embrace a cure if an easily administered one appeared tomorrow.  But I have a strange fascination with it – whatever the type, however blameless or self-inflicted.  Both my grandfathers had diabetes.  One, diagnosed with type I at the stunning age of 35 by his eye doctor, used to fascinate me as a child.  The pineapple orange juice he always kept in his huge car, which he once shared when he came to pick us up at the airport; the daily injections, laboriously calculated.  My other grandfather I hardly knew.  Prey to heart disease when I was only 3, I know nothing about him that wasn’t told me by my father or his family.  But in the double genetics I’ve always felt there was something about this disease that was making itself heard.  Ensuring it had my special attention.

Partly there’s a fascinating history to diabetes.  Specifically it should be called Diabetes Mellitus.  Diabetes by itself indicates a condition of increased urination.  Mellitus means sweet.  This is the disease of sweet urine: diagnosable in the days before lab tests when urine observation was a critical skill in the physician’s training.  Diabetes Mellitus has been with us for some time.  It used to be nearly a death sentence, state of the art treatment until 1920 was near starvation.  Survivors were walking skeletons, and the prognosis was still less than a year.  It wasn’t until a few graduate students injected diabetic dogs with insulin that there was any hope.  Under insulin therapy the walking skeletons put on weight.  They came back to life.  It has been called the first miracle drug.   

And yet even as recently as the 1960’s being diagnosed with diabetes was a dramatic reduction in your life expectancy.  Kidney failure, blindness, heart disease, and neuropathy all lurked just around the corner.  Not to mention laborious medical regimens and high rates of infections.  As recently as 1965 we didn’t understand WHY.  Why did this disease destroy some places in the body, but not others, why did some succumb and others live well beyond expectations?   Although I had read some of the history of insulin discovery, and learned a few key points from a close diabetic friend in college, I longed to understand the connection between too much sugar and these horrifying end results. 

I was somewhat disappointed.  While we were taught key findings in diabetic diseases, shown images of kidneys, retinas, and blood vessels; the pathways were never fully drawn out for us.  I remained unable to explain to myself why A leads to E.  So it was I found myself doing the unthinkable – reading an article recommended by a lecturer, which was not required and far too detailed to be covered on the exam.  The article is here, if anyone’s as fascinated as I am, but it gets somewhat technical and biochemical.  It was worth it though, because I think I understand now.  And by understanding, I can remember.  And if my bizarre need to understand one specific disease is worth anything, it will be that maybe one day I can help someone else understand.  Maybe a patient (because I’ll surely have diabetic patients, we all will).  And maybe it will help them manage things a little better, help motivate them just a little more to watch their sugar levels.  I know it would motivate me.