Diabetes mellitus, a condition characterized by high blood sugar, was a virtual death sentence for many before 1921, particularly for those with Type 1 diabetes. This form of the disease, often striking children and young adults, results from the body’s inability to produce the hormone insulin. Without insulin, the body cannot process glucose for energy, leading to a metabolic crisis. For centuries leading up to the medical breakthrough of the 1920s, physicians and patients relied on desperate, severe methods to prolong life, often for only a short time.
Identifying the Disease and Early Treatments
The presence of diabetes was recognized thousands of years ago, with ancient observers noting the characteristic symptom of “sweet urine,” or glycosuria. The term mellitus was added to diabetes in the 17th century, derived from the Latin word for “honey,” to distinguish it from other conditions causing excessive urination. Understanding the cause remained vague until the late 19th century, when research established the pancreas’s role in regulating blood sugar.
Prior to this understanding, treatments were largely ineffective and sometimes harmful. Physicians experimented with opium, bloodletting, and various diets, including high-fat/low-carbohydrate or, misguidedly, high-sugar regimens. These early attempts failed to halt metabolic deterioration, and for those with Type 1 diabetes, the prognosis remained terminal. The lack of a successful therapy left doctors without a true solution to the relentless progression of the disease.
Survival Through Severe Dietary Restriction
The only method offering a measurable extension of life was the deliberate restriction of food intake, formalized by physician Dr. Frederick Madison Allen in the early 20th century. Allen’s regimen, often called the “starvation diet,” limited the supply of glucose to the body to slow the fatal onset of diabetic ketoacidosis. By drastically reducing carbohydrate and caloric intake, the body produced less sugar, easing the strain on the failing metabolic system.
The core treatment involved an initial period of complete fasting until glucose disappeared from the patient’s urine, signaling temporary metabolic control. Patients were then placed on a severely restricted diet, often providing only 400 to 800 calories daily, with carbohydrates virtually eliminated. This minimal caloric intake was barely enough to sustain life, requiring patients to constantly monitor their urine for any reappearance of sugar.
The diet was a calculated measure to keep the patient just above the metabolic point of collapse. If glucose reappeared, the patient was immediately subjected to another fasting period. Although physically grueling, this extreme dietary control was the most effective way to delay the inevitable progression toward coma and death in patients with severe diabetes.
The Grim Reality of Pre-Insulin Life
The survival offered by the starvation regimen came at an immense human cost, forcing patients into a perpetual state of hunger and severe physical weakness. For children diagnosed with Type 1 diabetes, life expectancy was extremely short, often measured in months or, at most, one to three years following diagnosis. The strict dieting only slightly extended this timeline, turning the final years into a prolonged period of deliberate undernourishment.
Patients on this diet became severely emaciated, losing muscle mass and experiencing chronic fatigue due to the minimal caloric intake. They were constantly cold and starved. Even while adhering strictly to the regimen, these individuals remained highly susceptible to fatal complications, with infection or the eventual development of ketoacidosis remaining an ever-present danger.
The End of the Starvation Regimen
The discovery and availability of an effective pancreatic extract in the early 1920s brought an end to the era of starvation treatment. Once this extract, later purified as insulin, could be administered, the need for extreme dietary restriction vanished. Patients who had been reduced to skeletal figures on the starvation diet rapidly began to gain weight and regain their strength. The prognosis for Type 1 diabetes shifted instantly from a terminal diagnosis to a manageable, chronic condition.