Diabetes Management in the 1930s-1970s
In the old days, when glucometers and the concept of self monitoring blood glucose (SMBG) was non-existent, diabetes management involved testing urine for glucose (glycosuria) <1>. The test, more commonly known as "Fehling's test" or "Benedicts test" was very inconvenient. Look below to view a Youtube video of how the test might have been performed. Urine samples were collected throughout the day and was boiled in solutions containing copper sulfate (i.e. Fehling's solution) <1>. If there was no presence of glycosuria, the solution would remain blue. However, if there were presence of glycosuria, the solution changed colour in accordance to the concentration of glycosuria <1>.
- Small amount of glycosuria, the solution would turn "green."
- Moderate amounts of glycosuria, the solutions would turn "yellow"
- Significant amounts of glycosuria, the solution would turn "orange"
Image from:http://edusanjalbiochemist.blogspot.ca/2013/01/urinalysis-chemical-examination.html
Accessed video from: http://www.youtube.com/watch?v=0PBjqW93rco
"Rainbow Coverage" and the Origin of Insulin Sliding Scale
The original insulin sliding scale was known as "Rainbow Coverage <2>." The idea stemming from the concept of "chasing the rainbow." Specific amounts of "regular insulin" was administered depending on the colour of the urine (from performing "Fehling's test" or "Benedicts test" as described above) <1>. Picture on the left is a 1934 insulin sliding scale created by Elliot Joslin. Back in 1934, "regular insulin" was the only form of insulin available<1>. Basically, "regular insulin" was administered based on retrospective amounts of glycosuria.
Reference:
1. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
2. Golightly LK, Jones MA, Hamamura DH,et al. Management of diabetes in hospitalized patients: Efficacy and effectivess of sliding-scale insulin therapy.Pharmacotherapy 2006;26(10):1421-1432
1. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
2. Golightly LK, Jones MA, Hamamura DH,et al. Management of diabetes in hospitalized patients: Efficacy and effectivess of sliding-scale insulin therapy.Pharmacotherapy 2006;26(10):1421-1432