Diabetes: The Epidemic of Our Time

What is Diabetes?

Diabetes mellitus is a group of metabolic disorders characterized by chronic high blood sugar (hyperglycemia) resulting from defects in insulin production, insulin action, or both. Insulin, produced by beta cells in the pancreas, is the hormone that allows glucose to enter cells for energy. Without proper insulin function, glucose accumulates in the blood, leading to widespread damage over time.

The Discovery of Insulin

Before 1921, a Type 1 diabetes diagnosis was a death sentence. Patients wasted away over months, with no treatment except starvation diets that merely delayed the inevitable.

That changed when Frederick Banting, a young Canadian surgeon, along with medical student Charles Best, successfully extracted insulin from dog pancreases at the University of Toronto.[3] In January 1922, 14-year-old Leonard Thompson became the first human to receive insulin injections. His blood sugar dropped, and he lived another 13 years.

Banting and lab director J.J.R. Macleod received the 1923 Nobel Prize in Physiology or Medicine, just 18 months after the discovery. Banting, believing Best deserved recognition, shared his prize money with him.

"Insulin is not a cure for diabetes; it is a treatment. It enables the diabetic to burn sufficient carbohydrates so that he can live."

The Type 2 Epidemic

While Type 1 diabetes is autoimmune and largely unpreventable, Type 2 diabetes has exploded into a global epidemic driven by obesity, sedentary lifestyles, and processed food. The numbers are staggering:

• Global prevalence has nearly quadrupled since 1980
• Over 537 million adults now live with diabetes[1]
• By 2045, this is projected to reach 783 million
• Nearly half of cases remain undiagnosed

Type 2 diabetes disproportionately affects low- and middle-income countries, where healthcare systems are least equipped to manage chronic disease. It's also increasingly affecting children and adolescents, once almost unheard of.

Complications

Chronically elevated blood sugar damages blood vessels and nerves throughout the body, leading to devastating complications:

Modern Management

Treatment has advanced dramatically from crude animal insulin and urine testing.[2] Today's toolkit includes:

Medications

• Insulin analogs: Rapid-acting, long-acting, and ultra-long formulations
• Metformin: First-line oral medication; decreases liver glucose production
• SGLT2 inhibitors: Block glucose reabsorption in kidneys; protect heart and kidneys
• GLP-1 receptor agonists: Enhance insulin release, suppress appetite (including semaglutide/Ozempic)

Technology

• Continuous glucose monitors (CGMs): Real-time glucose readings every 5 minutes
• Insulin pumps: Continuous subcutaneous insulin delivery
• Hybrid closed-loop systems: "Artificial pancreas" that automatically adjusts insulin

Prevention

Type 2 diabetes is largely preventable. Landmark trials have shown that lifestyle intervention (modest weight loss, 150 minutes weekly of moderate exercise, and dietary changes) can reduce diabetes risk by 58%, outperforming medication.[4]

Yet prevention remains underfunded compared to treatment. Addressing the diabetes epidemic requires tackling the "obesogenic environment": food systems, urban design, and policies that make unhealthy choices the default.

The Future

Research offers hope for transformative therapies:

• Beta cell replacement: Stem cell-derived insulin-producing cells
• Immunotherapy: Preserving beta cells in early Type 1 diabetes
• Smart insulins: Glucose-responsive formulations that self-regulate
• Gene therapy: Restoring insulin production

Until cures arrive, the focus remains on early diagnosis, tight control, and preventing complications. With proper management, people with diabetes can live long, healthy lives, a far cry from the pre-insulin era.