In the meantime, the outlook for diabetes patients was bleak. Before insulin, about half of all people diagnosed with diabetes would be dead within two years and 90% would be dead within six years. Through careful experimentation and observation with diet, incremental advances had increased survival times. The primary advances had been through manipulation of the diet. Unfortunately, the only diet that seemed to extend the lifespan was no essentially no diet, or starvation.
When George Minot was first diagnosed with diabetes by Dr. Elliot Joslin in October 1921 his blood sugar was at 430 mg/dL blood, about four times the normal level. Minot was a thin man, even by the standards of the time. He stood six feet one and a half inches tall, but only weighed 135 pounds. Although he may have lost some weight due to diabetes it wasn’t much. A year before, he had weighed 142 pounds.
Joslin’s message to George Minot was the same as Minot had heard Joslin instruct medical students years earlier,
When they have understood the principles of the burning of sugar in the body, when they have learned to control themselves and to follow the diet without cheating, and when they have kept a daily record of food intake and sugar excretions to serve as a guide to treatment, they have come out all right. [inqu physician, p 122.]
Joslin was one of the leading diabetes physicians of the time. (The leading doctor in the US was probably Fredrick Allen, the originator of the “starvation diet”.)
Dr. Joslin immediately put George on a starvation diet. His initial recommendation was the following: 189 grams of carbohydrates, 89 grams of protein and 15 grams of fat per day. This was about 1250 calories, less than a man of his size and activity needed to maintain his weight. The goal of this starvation diet was to reduce the amount of sugar in the blood. Joslin knew that elevated sugar levels eventually lead to ketoacidosis, coma, and ultimately death.
A week later, Minot’s blood sugar levels were still high. Joslin cut his diet in half in response. Minot was now only allowed to eat 525 calories per day! After two weeks, Minot’s blood sugar had been cut to 190 mg/dL, but he also only weighed 128 pounds. Joslin kept him on this diet for another two weeks.
Minot had regular visits with Joslin. Through constant modifications of his diet, his blood sugar remained under control. However he was slowly dying of starvation. By February 1922, Minot’s weight had fallen to only 122 pounds, but his blood sugar was only slightly high at 150 mg/dcL. In George’s case, the starvation diet managed to keep the blood sugar low, but it was at a serious cost of his weight. It wasn’t clear how much longer this could go on.
George was on a strict diet, and maintaining the diet required rigor. Whenever he ate, at home or on the go, he brought along a spring kitchen scale made by John Chatillon and Sons. The scale was used to measure everything he ate, to the gram. The weights of the food he consumed were meticulously recorded by his wife. Later in his life, he became very good at estimating the weight of food and wasn’t completely bound to his scale. However, he continued to record everything he ate for the rest of his life.