Page 412 - Handbook of Biomechatronics

The Artificial Pancreas 407

At around the same time, ancient Hindu writings noted that ants were
attracted to the urine of people suffering from a mysterious emaciating disease,
but it was only in about 500 BCE that the first references to sugar in the urine
of obese people were made (Swidorski, 2014).
Both Galen and Hippocrates refer to periods of study at the temple of
Imhotep in Memphis but neither mentions any symptoms consistent with
diabetes in their subsequent writings. In fact, the first-known clear reference
to the disease was by Aretaeus of Cappadocia (AD 129–199), a Greek phy-
sician who introduced the term “diabetes” from the Greek word for
“syphon” as he noted that it caused a constant flow of urine. The reason
for this increased flow is due to the kidneys trying to flush excess glucose
from the blood. It is worth quoting Aretaeus in full as his observations accu-
rately reflect the full horror of the disease if left untreated.
Diabetes is a wonderful affliction, not very frequent among men being a melting
down of the flesh and limbs into urine. The patients never stop making water, but
the flow is incessant, as if the opening of aqueducts. Life is too short, disgusting,
and painful, thirst unquenchable, excessive drinking, which, however, is dispropor-
tionate to the large quantity of urine, for more urine is passed; and one cannot stop
them either from drinking or making water, or, if for a time they abstain from drink-
ing, their mouth becomes parched and their body dry, the viscera seems as if
scorched up; they are affected with nausea, restlessness and burning thirst, and
in no distant term they expire
(Adams, 1856).

For the next two millennia, diagnosis of diabetes was most often made by
“water tasters” who drank the urine of those suspected of having diabetes
to determine whether it tasted sweet. Mellitus, the Latin word for honey,
was later added to the term “diabetes” for this reason. This diagnostic
method was formalized by Matthew Dobson in 1776 when he found a sub-
stance like sugar in appearance and taste when diabetic urine evaporated. He
also noted a sweetish taste of sugar in the blood of diabetics and that diabetes
could be fatal in <5weeks in some cases while in others it was a chronic
condition. This was the first time that a distinction is made between type
1 and type 2 diabetes (Macfarlane, 2014).
In 1848, Claude Bernard discovered that glycogen was formed in the liver
by identifying different concentrations of the substance in the portal and
hepatic veins. He speculated that it was the same sugar that was found in
the urine of diabetics. This was the first time that glycogen metabolism was
identified and linked to diabetes (Tattersall, 2009). Bernard also explored
the significance of the pancreas in diabetes and noted that ligature of the pan-
creatic ducts was not associated with diabetes (Leiva-Hidalgo et al., 2011).