What was it like to have type 1 diabetes in the early 20th century?

Question

Someone in my family died in 1924 of type 1 diabetes at the age of 26. What would life have been like for her? Would she have been in the hospital frequently? What was the average life-expectancy for someone with type 1 diabetes back then?

Answer 1

As a 21st Century Internist, I will add that the biggest distinction will be that most Type 1 Diabetics, as you have pointed out, will die earlier than we have see in modern medicine. They will also have more complications from diabetes compared to modern day diabetics because they were completely uncontrolled. Macrovascular disease would have likely been the reason most died (heart attacks and strokes), but the microvascular diseases would have also been problematic -- to include cataracts, blindness, neuropathy (putting them at risk for infections like osteomyelitis), and gastroparesis. The best way to search for this on the internet is to use the terms 'natural history' of disease and diabetes. I found this article that talks about the history of insulin from the American Diabetes Association that has some nice information.

Before insulin was discovered in 1921, people with diabetes didn’t live for long; there wasn’t much doctors could do for them. The most effective treatment was to put patients with diabetes on very strict diets with minimal carbohydrate intake. This could buy patients a few extra years but couldn’t save them. Harsh diets (some prescribed as little as 450 calories a day!) sometimes even caused patients to die of starvation.

They also discuss the distribution issue mentioned by @jwenting above. However, they make it seem like it happened soon after the discovery of insulin in 1921.

In January 1922, Leonard Thompson, a 14-year-old boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin. Within 24 hours, Leonard’s dangerously high blood glucose levels dropped to near-normal levels. The news about insulin spread around the world like wildfire. In 1923, Banting and Macleod received the Nobel Prize in Medicine, which they shared with Best and Collip. Thank you, diabetes researchers! Soon after, the medical firm Eli Lilly started large-scale production of insulin. It wasn’t long before there was enough insulin to supply the entire North American continent. In the decades to follow, manufacturers developed a variety of slower-acting insulins, the first introduced by Novo Nordisk Pharmaceuticals, Inc., in 1936.

Reference: History of Insulin

Answer 2

Life for someone with diabetes in the early 20th century would be the same as someone with diabetes now if it was left untreated. The consequences of not treating diabetes include:

• Heart Disease and Stroke
• Blindness
• Kidney Failure
• Diabetic Neuropathy

The discovery of insulin as a treatment for diabetes occurred in the 1920s, so either this family member was already suffering severe consequences of diabetes or she did not obtain sufficient treatment in time. Any treatments available before the discovery of insulin were only experimental.

On a related note, I found an article in the Diabetes journal that confirms msh210's comment that testing was done by tasting the urine.