Type 2 Diabetes

Recent studies of the dietetics of diabetes have clearly demonstrated the great danger involved in the use of an exclusive meat diet. The rapid tissue disintegration taking place in severe cases of diabetes results in flooding the system with waste matters, which are, of course, toxic in character. When to these are added the toxic substances contained in the flesh of animals under the best conditions, together with the ptomains resulting from the decomposition which always takes place to a greater or less extent in flesh food before it is eaten, and still further by the urea and other excrementitious products resulting from the excess of nitrogenous material contained in the system when meat is largely used, it becomes apparent that the diabetic who makes use of an exclusive meat diet or a diet consisting largely of flesh foods, is in a state of chronic auto-intoxication. Such a person is constantly on the verge of diabetic coma; if he escapes, it is simply because his liver and kidneys are still able to do a sufficient amount of work in the destruction and elimination of poisons to save his life ; but sooner or later he will certainly reach a point at which a failure of these important organs to do the excessive amount of work demanded of them will result in the accumulation of toxic substances to such a degree as to produce the universal poisoning which is so graphically pictured in diabetic eoma.

- Case #8: 

Dr. Joslin's Mother 

The first was 73 years old and was Dr. Joslin's mother. The second was 16 years old and the youngest daughter of Dr. James Jackson Putnam, who had been Dr. Joslin's principal mentor in the first year of his practice and his teacher in the medical school. Dr. Putnam was the austere, brilliant and path-finding neurologist whose name is now inscribed on the chair in Neurology at the Harvard Medical School. 

It is said that Dr. Joslin specialized in diabetes to help his mother with her disease. While this is not correct, he certainly remained highly interested in her progress as well as in her type of diabetes, hee proudly noted in his later writing that a remission or two occurred in her diabetes when she carefully followed the restraints of a good meal plan. In the first edition of his textbook on diabetes, published in 1916, EPJ described his mother's case, thinly disguised under the topic "Is the tendency of the diabetic glycosuria to increase?" 

A woman showed the first symptoms of diabetes in the spring of 1899 at 60 years of age and 5% of sugar was found in June. She had gradually lost during the preceding fifteen years, twenty pounds and weighed 165 pounds when the diagnosis was made. Under rigid diet, the urine promptly became sugar-free, the tolerance rose to 130 grams and safe for very brief intervals and remained so for nine years until 1908. In 1909, a carbuncle appeared. With prompt surgical care, vaccines, the restriction of carbohydrates and the temporary utilization of an oatmeal diet, the sugar disappeared and the carbuncle healed promptly, but the urine did not remain permanently sugar-free, although only about 30 grams of sugar was excreted. Residence in the hospital for a few days in September of 1912, in order to have a few teeth removed, lowered the sugar to 0.8%. 

Except for brief periods of illness due to the carbuncle and pneumonia, the patient remained well during all these years and was unusually strong and vigorous for a woman of 73 until she finally succumbed to a lingering illness subsequent to a hemiplegia and death finally occurred due to a terminal pneumonia in 1913. 

With his mother's case. Dr. Joslin described the most common presentation of diabetes. When she was diagnosed with diabetes, she was overweight and probably inactive. Had she been born a decade later, Mrs. Joslin might have enjoyed a life lengthened by the use of insulin in the 1920s and antibiotics in the 1930s. 

As an aside: Dr. Joslin's inheritance from his mother, Sara Proctor Joslin, left Dr. Joslin a millionaire several times over by today's standards. Sara Proctor, her sisters and one brother were the heirs to a very large fortune derived from their father Abel's leather tanning trade. Sara Proctor became the second wife of Dr. Joslin's father Allen, who was a shoe manufacturer in the town of Oxford. This connection with the Proctor leather tanning business guaranteed the success of the Joslin shoe factory. EPJ was fond of noting that he was a direct descendant of John Proctor of Salem, who had been hanged for defending his principles in the witch trials of 1692.

EPJ's lifestyle, in line with his upbringing and religion, always understated his affluence. However, it afforded him the means to aid family and associates with education and travel, as well as the ability to acquire the property needed to gradually expand his clinic. He underwrote Priscilla White's training in 1928 at the leading pediatric center in Vienna, a typical act of generosity to his co-workers.

Event Rich Text

American pathologist Eugene Opie of John Hopkins University in Baltimore establishes a connection between the failure of the islets of Langerhans in the pancreas and the occurrence of diabetes.

Frederick Allen—one of the first to appreciate that diabetes involves total metabolism rather than carbohydrate metabolism alone—developed this model to show that complete removal of the organ resulted in uncontrolled diabetes and death, whereas dogs who retained more than 20% of their pancreas never developed diabetes. The fate of those with 80–90% pancreatectomy depended upon what they ate. ‘On an Eskimo diet they may be found to live in health’, said Allen, but ‘on a Hindu diet they soon go down to fatal diabetes’ [8]. Carbohydrate loading produced progressive glycosuria and hydropic degeneration of the islets, leading Allen to conclude that the as yet unknown pancreatic factor that prevented diabetes had been exhausted. Glucose toxicity had found its first advocate. Physiology also has its cycles, and investigators discovered in 1988 that glucose infusion precipitated pancreatic islet failure in dogs with subtotal pancreatectomy, little suspecting that they had reproduced one of the classic experiments in diabetes 75 years later [9].

Allen concluded that people with diabetes should be given just enough food to keep body and soul together, with as little carbohydrate as possible, and the starvation regimen was born [8]. The physician in charge of this diet has been described as a yachtsman sailing as close as possible to the wind [10]. Too many calories, and symptomatic hyperglycaemia would result; too few, and the patient would die of starvation (as some did). Naunyn had taught that ‘fat burns in the fire of the carbohydrates’, and carbohydrate was needed for the proper combustion of dietary fat, which might otherwise precipitate ketoacidosis. One risk having thus been balanced against another, a man weighing 60 kg and able to tolerate 100 g of carbohydrate might end up on 60 g of protein, 130 g of fat and 25 g of carbohydrate. His daily ration of the latter might consist of 7 oz (198 g) of thrice boiled cabbage, or 5 oz (142 g) of similarly treated spinach or two and a half bran biscuits [10]. The bran was needed to counteract the constipation induced by the rest of the diet.

Adults did relatively well on this regimen, but children hovered miserably between death from diabetes and death from starvation. One 12-year-old boy, already blind from diabetes, was reduced to eating toothpaste mixed with birdseed stolen from his pet canary. ‘These facts were obtained by confession after long and plausible denials’, remarked the pitiless Allen. The unfortunate child died of starvation. A few physicians hailed the treatment as a means of prolonging life, but Carl von Noorden shuddered and turned away when Joslin showed him one of his cases. The controversy concerning the value of extra months or years purchased at the cost of so much misery was very bitter, and Allen was banned from the diabetic clinic at the Rockefeller Institute in 1918 [11].