Medical research; Diabetes, part 1

The following program is produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the first programme on the subject on diabetes from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. The people you will hear today are Dr. F. D.W. Lukens of the University of Pennsylvania. Dr. Garfield Duncan of the Pennsylvania Hospital in Philadelphia and Dr. Randall Sprague of the Mayo Clinic in Rochester Minnesota. And my name is Glenn Philips. One of the illnesses that has plagued mankind is diabetes a disease that is familiar to all but the lack of understanding of this malady is overwhelming. The word diabetes is so commonplace in our language that we often overlook the fact that it is still one of our most disturbing medical problems. Research on the problem and the measures of control. I was advanced but the total cure is not yet hours

for a description of this disease and for answers to some of the most often asked questions. We have consulted with three of the leading authorities on diabetes in the nation. First I ask if there were different forms or kinds of diabetes. Dr F D W Lukens of the University of Pennsylvania answered. We will receive different answers to this question depending on whom you ask. As far as I am concerned there is only one kind of diabetes. This is due to insulin insufficiency insulin insufficiency may be an absolute that is a lack of insulin produced by the pancreas. It may be relative in the sense that a reasonable supply of insulin is still not enough because of fever and the crème disease or some other condition. But the only cause of diabetes as far as I'm concerned is insulin insufficiency produced in some manner.

Dr. Randall Spragg of the Mayo Clinic answered to the same question in this manner. Yes there are different. Kinds of diabetes it's. The. Common form of diabetes that physicians. Most frequently deal with. Is due to a lack of insulin. The pancreas particularly the eyelet tissue of the pancreas is. Unable to produce insulin in normal amounts. And this leads to difficulties in the. Utilization of sugars in the body. Some physicians believe that. Even the common type of diabetes may be subdivided into. More than one group. For example of the diabetes so young

people children adolescents and young adults is quite different in its behavior. From the. Milder Diaby to us that commonly afflicts older people. And on this basis it has been thought that they might be. Fundamentally different diseases. However. All the evidence available to date indicates that. These types of diabetes are basically the same and are due to a lack of insulin production by the pancreas. There are unusual forms of Beatrice. Which physicians rarely see. For example diabetes can be result from overactivity of the. Cortex of the adrenal glands and occasionally. Diaby does occurs in association with. Tumors of the central portion or model of the adrenal glands a

condition which is commonly associated with high blood pressure. Another rare form of diabetes is that which is associated with tumors of the central portion or Madala of the adrenal glands. This type of diabetes disappears when the tumor is removed surgically. Another uncommon type of diabetes occurs in association with. Tumors of the pituitary gland which. Produce abnormal amounts of growth hormone and produce the picture of acromegaly in the patient. But by far the greatest number of cases of diabetes are due to. Simply a lack of production of insulin by the eyelet tissue of the pancreas without any associated disease of the pancreas or other and occurring lines.

Does diabetes tend to hit individuals during a certain age group. Dr Sprague said it's been estimated that there are perhaps a million. People in the United States who are known to have diabetes and probably somewhat over a million who have diabetes but do not know it. And perhaps there are another three million individuals who. Are potentially diabetic. That is who might develop diabetes before they live out their lifespan at the various age groups. Diabetes is relatively rare in the younger ages for example. From ages 1 to 20 It's been estimated that only about one person in twenty five hundred has a dose or as the more advanced ages such as from 60 to 70. It's been estimated that approximately one person in 50 has diabetes. There are many diabetics who have achieved world as well as national state or local

stature. Dr. Spragg discussed this aspect for a brief moment. There are some. Individuals with diabetes in this country. Who are rather well known for their achievements in athletics and other. Types of activity. For example there are two. Star tennis players in this country who have had beat us ever since childhood they are Billy tell bricked. Former Davis Cup player and captain of the Davis Cup team. Has severe diabetes and has had it for. Many years. Another is Hamilton Richardson. Who also has severe diabetes dating back to his childhood. In the field of politics there are many of course but one who has. Let it be generally known that he has diabetes

is Senator Clinton PM and are some of the New Mexico. Who was secretary of Agriculture under President Truman. Another Mrs. Clare the writer is employment director of the J.C. Penney company an exceptionally capable woman who has had severe diabetes for many years and many others could be mentioned in various callings. Like all diseases diabetes presents its own special problems that require the education of the patient. The family and the community. Dr. Sprague commented. I feel that education is of extreme importance to. Diabetic patients. I have always told my diabetic patients that the ones who get along best with their condition are the ones who know the most about it and learn it early in the

course of their diabetes so that they can apply it to their care over the years. If patients are to be educated in the care of their diabetes it is of course necessary that. The medical profession be educated. There is a continuing need for a program of professional education and Iapetus. And this is one of the major activities of the American Diabetes Association. Also it is important that there be a sound educational program relative to diabetes in medical school for the training of future doctors. Public education and is also important because it is only by becoming familiar with. The importance of diabetes and some of the problems associated with it that the public will be

inclined to give its support to research and Beatrice and. I might say also to give their understanding and their understanding to the individual with diabetes. Goes without saying that nurses who participate in the care of diabetic patients need to know a great deal about the condition. You mentioned the police force. This is perhaps not the most important aspect of education and beat us but. Diabetics who take insulin are sometimes subject to insulin reactions and the police sometimes mistake insulin reactions for drunkenness and there have been some rather serious. Instances of mishandling of diabetic patients by the. Police when they were mistakenly thought to be under the influence of alcohol.

I wonder what the prospects for employment of the diabetic were. Dr Sprague set the American Diabetes Association for some years and has had a committee on the employment of diabetics which has made rather careful studies of the problem and has investigated the basis for some of the prejudices against the employment of diabetics in industry. And one of the conclusions of this committee is that the. Well controlled well cared for diabetic is capable of. Handling almost any type of employment for which he is. Educationally fitted. In other words the presence of diabetes is rarely an

obstacle to the satisfactory performance of duties and most forms of employment. There are of course certain restrictions necessary. A diabetic taking insulin. Should not be piloting an airplane or operating heavy or rapidly moving machinery which might injure himself or others. I have recently. Been reading the report of a study of diabetics in the petroleum industry. And the study reports that out of 20000 workers one point three percent had diabetes. It's interesting that 80 percent of these had no symptoms whatever at the time their diabetes was discovered during the course of their employment. The diabetics were able to handle a wide variety of job

assignments and in general I did well with them. I think every effort should be made to overcome unwarranted prejudice about the employment of diabetics in the industry because by and large they are capable of doing their jobs very well. I read a T does play a part in diabetes. Doctor look at least discussed this problem. Diabetes is very rightly and then phatic Lee called an hereditary disease. When one uses the word hereditary about human beings it is hereditary as of who whose heredity is always a little uncertain. One must modify it. We should perhaps say that diabetes may be genetic. It is really inherited or it may be developmental. Some developmental defect in

embryonic life. Or some faulty development of growth in early life may be the background of diabetes. But if we use the words broadly hereditary or developmental. Then diabetes is certainly one of those diseases and diabetes being an hereditary or developmental disease nevertheless develops late in life in most people. There are other conditions in medicine where this is true. The public is best acquainted with varicose veins which I thought to be a developmental defect events and yet most people don't get trouble from them until they are middle aged. The question perhaps that most concerns us all. Can diabetes be prevented. Dr Sprague said yes there are some. Methods for the prevention of diabetes yes. One

method that is commonly mentioned is the avoidance of intermarriage of individuals with diabetes in their families because of the hereditary factor. Such marriages are. Somewhat likely to lead to the development of diabetes in the offspring. I would hasten to add that. It is very unlikely that the Beatles could ever be bred out of the human race by avoidance of such marriages because there are so many non diabetic individuals who are carriers of the diabetic trait and capable of transmitting it to their offspring that it is simply not practical to. Avoid. New cases of diabetes by any genetic method. But then a far more important method of prevention is the.

Void and so of obesity. For example it's known that 80 out of 100 individuals with diabetes were overweight at some time in their life and it's. Well established that excess weight leads to the development of diabetes in many instances. Let Debbie this is most likely to occur in individuals over 40 years of age and so avoidance of obesity is particularly important. Over the age of 40. And love women are more likely to develop diabetes than men. And this makes these precautionary measures about avoidance of overweight particularly important in the case of women. The question of married by two diabetics is often discussed. I wondered if it would be possible if the only precedent for or

indeed a need for control over such marriages. Dr. Garfield Duncan said I would hardly think that that would be practicable on less any individual or individuals can sign came from diabetic families. I think it would be an excellent procedure. To reassure the other party that there is no detectable Evan Z even under this stress of this special tests. No evidence of diabetes I should think that would be very reassuring. But to have this is a general population. Test for that. Population in general I don't think that would be practicable if one thinks of it the same as having a Wasserman test for selfless I don't think so. Still discussing the possibility of marriage control the following few moments is part of the

original interview with Dr looking. I doubt if any laws regulating the marriage of human beings will be practical as far as diabetes goes. I think most physicians take the point of view that when a diabetic. Wishes to marry. He should be encouraged not to marry another diabetic. And I'm not sure that we have solid proof even for that recommendation. For the originally. Claimed men Delian inheritance which you have suggested that would where they would be 100 percent diabetic children if two diabetics marry. This is not completely established in that diabetes may be a somewhat irregularly inherited trait and it might be very ill advised to put up prohibitions on human beings and anybody who has dealt with young people getting married knows that you can't

stop them anyway and you might as well be practical. The really important thing on which all physicians would agree is that these young people should be told the facts. And should be warned to be on the alert for the development of diabetes in their relatives or children will be very very practical I guess for just a few moments. If the chances are that you may develop diabetes to the next in years to come because you know your parents have been diabetic where there is a history of diabetes in your family or you are about to have children and you know that there is a good chance they may develop it. Are there any safeguards which you may take upon yourself or assume you will help us. Yes there are two safeguards. First reasonably frequent health examinations. Certainly once or twice a year. Will warn of the disease early enough so

that extra precautions can be taken and the principle of precaution that will be taken whenever it will be to avoid becoming overweight. Avoided like the plague. And in the case of a young woman she would be tested during a pregnancy. For both for diagnosis and for special treatment for protection during pregnancy if that seemed to be needed. And any diabetic should be tested and a relative of a diabetic should be tested during an acute infection with a fever. What are the chances of developing diabetes in offspring to parents to people. Will they themselves do not have diabetes and have not developed it as yet. However there their parents or grandparents may have had it. Well the official the official figure is one quarter of their offspring. The men daily in recess a figure when two people with a trait a

recess of trade marry and have offspring. It would be very difficult to document that figure accurately in human beings where heredity is such a mixed thing. I asked Dr Duncan if the human carried the diabetes with him all of his life or if it was contracted at some point in his life. If the former is true that is the carrying of the illness through one's life. What caused the manifestation of the disease. He answered. Now you are asking what time cause I me. Well of course there's a draw of a strong hereditary influence genetically related to EDL etiology. The vast majority of diabetic patients have blood relatives who have diabetes. And if true

diabetics matter. We can predict with reasonable certainty that all of their children will have diabetes if they live long enough and if a diabetic maze into a diabetic family. Their one of their children statistically should have diabetes one out of four at least. So this question heredity is is very important. Now while the diabetes you might ask. Well now the precipitating cause precipitating cause in the young diabetic. He usually is some specter of growth or development. Where they grow rapidly where they probably have an increase in the production of the growth hormone or the girl when she has her first month season at

puberty. There are times where we have a little peak in the increase number of juvenile diabetics. Now in the patient to as adult acquired diabetes the perceptive cause usually is overweight obesity. Now in either of these groups the diabetes may be brought to the surface. By other complications diabetes may be recognized for the first time during pregnancy the pregnancy has increased the burden on the bank. Yes and I've been he's comes to the. Creeps onto the stage and I say for the patient whose disease of the thyroid gland where there's excess metabolism that may make the diabetes manifest or the patient with an acute infection that may bring to the surface a. I diabetes

these are. Heart features which make the diabetes worse and where they've been below the surface. Up until this point. These often bring them through where they detect. But in the overall I would say the causes really are due to the head register a predisposition number one and obesity number two these other features that I mentioned could be considered as accidental influences with Dr. Duncan's answer in mind. Is it possible then to detect the illness of the individual who is in a pre-diabetic state. He commented Yes there are several ways in which if we're fortunate we can pick up the patient in the pre-diabetic state. Of course much more would have been known about that as we collect

great number of cases that have been picked up in this manner and one of the most reliable is their woman who has a baby weighing more than 10 pounds. At least 70 percent of such women and especially if they have a family history of diabetes. We have developed diabetes later on though at this time there may be no evidence of diabetes detectable. Then there are other. Changes changes in the nervous system involving the feet numbness of the feet or tingling in the feet or bending of the feet. That's very common with other disorders. Bought in a family with a history of diabetes. This may. Give and suggest that this patient

may. Have diabetes or. Will I have diabetes. Now we have a special test so that it can cause tolerance test is one that has been used a great deal where we suspect the possibility of diabetes. We give these patients 100 grams of Lugo's glass or two of water and take a series of tests after them and they are they in accordance with a type of courage obtained we and we find indications as to whether this patient has a mild diabetes or not. Now Dr. Carr on his group at the University of Michigan that survey and also Dr. West later have pointed out that we may be able to pick up pre-diabetics.

Even more frequently if a small or two small doses of cortisone is given a matter of hours before this due course tolerance test is done and if an abnormal curve results they look upon that as a possible pre-diabetic indication so that this test of giving quite a song and followed by glucose tolerance test may particularly in patients or individuals who come from families that have diabetes scattered through it. This may be a real I have great reading value to them because if you can detect diabetes at this stage. If the patient is 20 pounds overweight you get him to reduce his weight on the Barras taking his

food and those indications of the diabetes will probably push so far into the background that they may never become of importance. So early detection particularly in the. Overweight patient. We have a real agent to prevent the appearance of technical diabetes and that does not forget that this represents about 80 percent of the diabetic population. Next week you will hear doctors look at Duncan and Spragg as they discuss some of the current basic research on diabetes. On the next programme from the series human behavior social and medical research consultant for this program was Dr. Jerome Kahn of the University of Michigan Medical School and Philip speaking asking that you join us next week and thanking you for being with us at this time.

This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the end i.e. Radio Network.