Frederick Banting

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James Collip
Figure 1 The discovery of insulin in 1922 is accredited to Frederick Banting and Charles Best (a medical student), seen above, supervised by JJR MacLeod and assisted by James Collip. The work was carried out at the University of Toronto
Frederick Banting Young
Figure 2 The same child as seen in Figure 2 in 1923 after insulin treatment became available following its discovery by the Toronto group. The effect of this new therapy was 'miraculous'
Frederick Banting Childhood
Figure 3 A 3-year-old child with type 1 diabetes mellitus, photographed in 1922 before insulin treatment was available. The only treatment then was a 'starvation' diet; patients rarely survived for more than 2 years

American Diabetes Association etiologic classification of diabetes mellitus

Starvation Diet Diabetes

Uncommon forms of insulin-mediated diabetes, e.g. 'stiff-man' syndrome, antiinsulin receptor antibodies

Infections, e.g. congenital rubella and cytomegalovirus

Gestational diabetes mellitus

Other specific types

Genetic defects of P-cell function, e.g. Chromosome 20, HNF-4a (MODY 1) Chromosome 7, glucokinase (MODY 2) Chromosome 12, HNF-la (MODY 3) Mitochondrial DNA

Genetic defects in insulin action, e.g Type A insulin resistance Leprechaunism

Rabson-Mendenhall syndrome Lipoatrophic diabetes

Diseases of the exocrine pancreas, e.g Pancreatitis

Trauma/pancreatectomy Neoplasia Cystic fibrosis Hemochromoatosis Fibrocalculous pancreatopathy

Endocrinopathies, e.g. acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hyperthyroidism and somatostatinoma

Drug- or chemical-induced diabetes, e.g. glucocorticoids, diazoxide, ^-adrenergic agonists and thiazides

Other genetic syndromes associated with diabetes, e.g. Down's, Klinefelter's, Turner's, Lawrence-Moon-Biedl and Prader-Willi syndromes, Friedreich's ataxia and myotonic dystrophy

Figure 6 The American Diabetes Association has proposed an etiologic classification of diabetes based on research findings over the past two decades. The nomenclature has changed from insulin-dependent diabetes to type 1 diabetes and from noninsulin diabetes mellitus to type 2 diabetes. All forms of diabetes are characterized according to their known etiologies, immunologic, genetic or otherwise. This opens up the concept of 'the diabetic syndrome'. HNF, hepatic nuclear factor; MODY, maturity-onset diabetes of the young

Diagnosis of diabetes mellitus positive if:

Diabetic Dermopathy

Figure 7 Although a definitive diagnosis of diabetes may be made using the glucose tolerance test, it is no longer recommended for routine clinical use. In the presence of diabetic symptoms, the diagnosis may be established by finding a random plasma glucose level of > 11.1 mmol/l (200mg/dl) or a fasting plasma glucose level of > 7.0mmol/l (126mg/dl) . Both impaired fasting glucose and impaired glucose tolerance are defined in the text

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