Sweet Urine Disease

 “In ancient China people observed that ants would be attracted to some people’s urine, because it was sweet.”

Diabetes was one of the first diseases described with an Egyptian manuscript from c. 1500 BCE mentioning “too great emptying of the urine”. The first described cases are believed to be of Type 1 Diabetes.

The disease was also recognize by the ancient Greeks, Chinese, Egyptians, Indians and Persians.

The earliest surviving work with detailed reference to Diabetes is that of Aretus the Cappadocian, a Greek physician during the second century A.D.

He described patients who were passing too much water like a siphon and named the condition diabainein (διαβαίνειν). The intended meaning of the word was “excessive discharge of urine” which is composed of δια- (dia-), meaning “through” and βαίνειν (bainein), meaning “to go”.

Diabetes appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the Diabetes disease was incurable. However Aretaeus the Cappadocian did attempt to treat it but he could not give a good prognosis and he commented that life (with Diabetes) is short, disgusting and painful”.

He attributed the diabainein to the moisture and coldness, reflecting the beliefs of the “Pneumatic School”. He hypothesized a correlation of Diabetes with other diseases and he discussed differential diagnosis from the snakebite which also provokes excessive thirst.

His work remained unknown in the West until the middle of the 16th century when in 1552, the first Latin edition was published in Venice.

Type 1 and Type 2 Diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 CE with Type 1 Diabetes associated with youth and Type 2 Diabetes with being overweight. Furthermore they also identified the disease and classified it as Madhumeha or “honey urine”.

In medieval Persia, Avicenna (980–1037) provided a detailed account on Diabetes Mellitus in The Canon of Medicine, “describing the abnormal appetite and the collapse of sexual functions,” and he documented the sweet taste of diabetic urine. Like Aretaeus before him, Avicenna recognized a primary and secondary Diabetes.

He also described diabetic gangrene and treated Diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times.

Also in the ancient China people observed that ants would be attracted to some people’s urine, because it was sweet. The term “Sweet Urine Disease” (táng niǎo bìng (糖尿病)) was coined.

This name has also been borrowed into Korean and Japanese.

Later on around 1425, the word “diabainein” became “Diabetes” from the English adoption of the Medieval Latin Diabetes.

The word Diabetes comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs) which literally means “a passer through; a siphon”.

In 1675, the British Thomas Willis added “Mellitus” or “from honey” to the term, although it is commonly referred to simply as Diabetes.

Mel in Latin means “honey”; the urine and blood of people with Diabetes has excess glucose, and glucose is sweet like honey.

Adding the name “Mellitus” was an important step to separate the Diabetes Mellitus from the Diabetes Insipidus.

They both are referred as Diabetes because they are associated with increased thirst and frequent urination. However the two are entirely separated conditions with different mechanisms.

In an everyday term Diabetes Mellitus could literally mean “siphoning off sweet water”.

In 1776 Matthew Dobson confirmed that the sweet taste comes from an excess of a kind of sugar in the urine and blood.

Although Diabetes has been recognized since antiquity and treatments of various efficacy have been known in various regions since the Middle Ages, and in legend for much longer, pathogenesis of Diabetes has only been understood experimentally since about 1900.

Diabetes Mellitus is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth.

Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood – it is the principal source of fuel for our bodies. When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth.

However, glucose cannot enter our cells without insulin being present since insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.

A person with Diabetes has a condition in which the quantity of glucose in the blood is too elevated (Hyperglycemia). This is because the body either does not produce enough insulin, or produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces.

This results in too much glucose building up in the blood. Excess blood glucose eventually passes out of the body in the form of urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

It is incredible to state that Diabetes is one of the oldest documented disease and still, effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. This was followed by the development of the long-acting insulin NPH in the 1940s.

The distinction between what is now known as Type 1 Diabetes and Type 2 Diabetes was first clearly made by Sir Harold Percival (Harry) Himsworth, and published in January 1936. Which is just a lifetime ago.

As you can understand Diabetes is a serious, chronic disease with a lot of possible complications in many parts of the body linked to it and it can increase the overall risk of dying prematurely. Possible complications include heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled Diabetes increases the risk of fetal death and other complications.

Badly controlled Diabetes can cause: 

  • Eye complications – glaucoma, cataracts, diabetic retinopathy, and some others.
  • Neuropathy – diabetic neuropathy is a type of nerve damage which can lead to several different problems.
  • Foot complications – neuropathy, ulcers, and sometimes gangrene which may require that the foot be amputated.
  • Skin complications – people with Diabetes are more susceptible to skin infections and skin disorders.
  • Heart problems – such as ischemic heart disease, when the blood supply to the heart muscle is diminished.
  • Hypertension – common in people with Diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke.
  • Mental health – uncontrolled Diabetes raises the risk of suffering from depression, anxiety and some other mental disorders.
  • Hearing loss – Diabetes patients have a higher risk of developing hearing problems.
  • Gum disease – there is a much higher prevalence of gum disease among Diabetes patients.
  • Gastroparesis – the muscles of the stomach stop working properly.
  • Ketoacidosis – a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
  • HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) – blood glucose levels shoot up too high, and there are no ketones present in the blood or urine. It is an emergency condition.
  • Kidney disease – uncontrolled blood pressure can lead to kidney disease.
  • PAD (Peripheral Arterial Disease) – symptoms may include pain in the leg, tingling and sometimes problems walking properly.
  • Stroke – if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of stroke increases significantly.
  • Erectile dysfunction – male impotence.
  • Infections – people with badly controlled Diabetes are much more susceptible to infections.
  • Healing of wounds – cuts and lesions take much longer to heal.

When Diabetes is not well managed, complications develop that threaten health and endanger life. Acute complications can contribute to mortality, high medical costs and poor quality of life.

Abnormally high blood glucose can have a life-threatening impact if it triggers conditions such as Diabetic Ketoacidosis (DKA) in Type 1 Diabetes and Type 2 Diabetes, and Hyperosmolar coma in Type 2 Diabetes.

Abnormally low blood glucose can occur in all types of Diabetes and may result in seizures or loss of consciousness. It may happen after skipping a meal or exercising more than usual, or if the dosage of anti-diabetic medication is too high.

Over time Diabetes can damage the heart, blood vessels, eyes, kidneys and nerves, and increase the risk of heart disease and stroke.

Such damage can result in reduced blood flow, which – combined with nerve damage (neuropathy) in the feet – increases the chance of foot ulcers, infection and the eventual need for limb amputation.

Diabetic retinopathy is an important cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels in the retina.

Diabetes is among the leading causes of kidney failure.

Uncontrolled Diabetes in pregnancy can have a devastating effect on both mother and child, substantially increasing the risk of fetal loss, congenital malformations, stillbirth, perinatal death, obstetric complications, and maternal morbidity and mortality.

Gestational Diabetes increases the risk of some adverse outcomes for mother and offspring during pregnancy, childbirth and immediately after delivery (pre-eclampsia and eclampsia in the mother; large for gestational age and shoulder dystocia in the offspring). However, it is not known what proportion of obstructed births or maternal and perinatal deaths can be attributed to Hyperglycaemia.

The combination of increasing prevalence of Diabetes and increasing lifespans in many populations with Diabetes may be leading to a changing spectrum of the types of morbidity that accompany Diabetes.

In addition to the traditional complications described above, Diabetes has been associated with increased rates of specific cancers, and increased rates of physical and cognitive disability.

This diversification of complications and increased years of life spent with Diabetes indicates a need to better monitor the quality of life of people with Diabetes and assess the impact of interventions on quality of life.

It is a sad fact that the Diabetes prevalence has doubled since 1980. Therefore Diabetes is also an important public health problem, one of four priority NonCommunicable Diseases (NCDs) targeted for action by world leaders. Both the number of cases and the prevalence of Diabetes have been steadily increasing over the past few decades.

In the past three decades the prevalence 1 (age-standardized) of Diabetes has risen substantially in countries at all income levels, mirroring the global increase in the number of people who are overweight or obese.

The global prevalence of Diabetes has grown from 4.7% in 1980 to 8.5% in 2014, during which time prevalence has increased or at best remained unchanged in every country.

The World Health Organization also raised attention in 2016 to the fact that the Eastern Mediterranean Region has experienced the greatest rise in Diabetes prevalence.

Researched, collected and written by Zsolt Szemerszky

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