2,500 years from 'honey urine' in ancient India to sensors that talk to insulin pumps.
For most of history the pancreas was a puzzle: a soft lump of 'all flesh' with no obvious job, while doctors in India, Greece and England noticed that some people passed sweet urine and wasted away. In the 1800s anatomists found its ducts and islands, and a dog experiment tied it to diabetes. Then in 1922 a teenager in Toronto was given insulin, and a death sentence became a condition people could live with.
First genetically engineered medicine approved (human insulin)
Genentech and Eli Lilly, USA
c. 1st millennium BCE (dates debated)Sweet urine and 'all flesh'
600 BCE – 1600
Sweet urine and 'all flesh'
Indian physicians describe madhumeha, 'honey urine', and Greek anatomists find and name the pancreas, though nobody yet links the two.
500 BCE
c. 1st millennium BCE (dates debated)
Madhumeha: 'honey urine'
Sushruta and Charaka (texts attributed to them)Ancient India
The Sanskrit medical texts known as the Sushruta Samhita and Charaka Samhita describe madhumeha, 'honey urine': urine so sweet that ants and flies gather round it. They link it to thirst and wasting, and note that it is more common in people who eat rich food and move little. The texts were compiled over centuries, so exact dates are uncertain.
Why it mattered. It is among the oldest known descriptions of diabetes, and of the link between lifestyle and one form of it.
Herophilus, one of the first scientists to dissect human bodies, described a gland lying along the start of the intestine. Aristotle had already used the word pancreas for something in animals, but Herophilus is usually credited with the first description.
Why it mattered. It put the pancreas on the anatomical map, though its jobs would stay a mystery for 2,000 years.
The Greek physician Rufus, in a book on naming the parts of the body, called the gland pan-kreas, 'all flesh', because it seemed to be soft flesh with no bone or cartilage. The name stuck.
Why it mattered. We still use his word, in almost every language.
The Greek doctor Aretaeus gave a vivid description of diabetes, from the Greek for 'passing through' like a siphon: great thirst, huge amounts of urine, and a body that wastes away. He did not know its cause.
Why it mattered. His words gave the disease its lasting name and picture.
Anatomists trace the pancreatic duct and its exit, chemists prove the sugar in diabetic urine, and a student spots mysterious islands of cells. A dog experiment finally ties the pancreas to diabetes.
1642
The main pancreatic duct is found
Johann Georg WirsungPadua, Italy
While dissecting a body in Padua, the German anatomist Wirsung found the main duct running the length of the pancreas and had it engraved on a copper plate. He did not know what it carried, and was murdered the next year.
Why it mattered. It showed the pancreas sends something into the gut, the first clue to its digestive job.
The English physician Thomas Willis wrote that the urine of people with diabetes was wonderfully sweet, like sugar or honey. He tasted it himself, as doctors then did, but did not guess that it held sugar.
Why it mattered. It rediscovered in Europe what Indian doctors had long known, and later gave diabetes 'mellitus', honeyed.
The German anatomist Abraham Vater described the small swelling where the bile duct and the pancreatic duct meet and open into the duodenum. It is still called the ampulla of Vater.
Why it mattered. This tiny opening explains why a gallstone can block the pancreas and cause pancreatitis.
Dobson boiled away the urine of a man with diabetes and was left with a white, sugary cake. He also found the man's blood serum tasted sweet, an early hint that the problem was sugar in the blood.
Why it mattered. It turned 'sweet urine' into chemistry: diabetes is about too much sugar.
The French physiologist Claude Bernard showed that pancreatic juice breaks down fats, and also starch and protein, far better than stomach juice. Soon after, he found that the liver stores sugar as glycogen and releases it into the blood.
Why it mattered. He proved the pancreas is the gut's main enzyme factory, and that the body controls its blood sugar.
In his thesis, 22-year-old medical student Paul Langerhans described small clusters of cells, scattered through the pancreas, that looked different from the rest. He honestly wrote that he did not know what they were for.
Why it mattered. These islets turned out to make insulin, and they still carry his name.
Oskar Minkowski and Joseph von MeringStrasbourg (then Germany, now France)
Studying digestion, Minkowski and von Mering removed a dog's pancreas. The dog soon passed large amounts of urine full of sugar: it had diabetes. A popular story says flies around the urine gave it away, but that detail may be legend.
Why it mattered. It proved that the pancreas controls blood sugar, and started the hunt for the substance it makes.
The first hormone is found in the gut, the islets are blamed for diabetes, and a team in Toronto extracts insulin and saves a dying boy.
1901
The islets are blamed
Eugene OpieBaltimore, USA
Examining the pancreases of people who had died with diabetes, the American pathologist Eugene Opie found the islets damaged, even when the rest of the gland looked normal.
Why it mattered. It pointed the search for the missing substance at the islets, not the juice-making cells.
William Bayliss and Ernest StarlingUniversity College London, England
Bayliss and Starling put acid into a dog's intestine after cutting its nerves, and the pancreas still poured out juice. A chemical from the gut lining, which they named secretin, was travelling in the blood. Starling later coined the word 'hormone'.
Why it mattered. It proved that organs talk to each other with chemical messages, the idea behind insulin too.
The Romanian physiologist Nicolae Paulescu made a pancreatic extract he called pancreine and showed in 1921 that it lowered blood sugar in diabetic dogs. Historians still debate how much credit he deserves for insulin.
Why it mattered. It shows that the race to find insulin had several runners.
Frederick Banting, Charles Best and J. J. R. MacleodUniversity of Toronto, Canada
The young surgeon Frederick Banting and student Charles Best, working in John Macleod's lab, made extracts of dog pancreas that lowered blood sugar in diabetic dogs. Late in 1921 the biochemist James Collip joined to purify the extract.
Why it mattered. For the first time, the missing substance was in a bottle.
Leonard Thompson, treated by the Toronto teamToronto General Hospital, Canada
Leonard Thompson, 14, was dying of diabetes. His first injection, on 11 January, was impure and did little. On 23 January he got Collip's purified extract, and his blood sugar fell towards normal. He lived another 13 years.
Why it mattered. Diabetes in children had been a death sentence. From then on, it was a condition people could live with.
Banting, Macleod, Best and CollipStockholm, Sweden, and Toronto, Canada
Banting and Macleod won the 1923 Nobel Prize in Physiology or Medicine, and shared their prize money with Best and Collip. The inventors sold their insulin patents to the University of Toronto for $1 each, so that no one could lock it up. Drug makers such as Eli Lilly began making it in bulk that same year.
Why it mattered. It was one of the fastest Nobel Prizes ever, and insulin quickly reached patients around the world.
Scientists split diabetes into types, read insulin's sequence and 3D shape, learn to measure it in blood, and finally make human insulin in bacteria.
1936
Two kinds of diabetes
Harold HimsworthUniversity College Hospital, London, England
Himsworth tested how people with diabetes responded to glucose and insulin together. Some were very sensitive to insulin; others were 'insulin-insensitive'. This split grew into what we now call type 1 and type 2 diabetes.
Why it mattered. It was the first big step towards understanding insulin resistance.
After about ten years of work, Frederick Sanger worked out the exact order of all 51 amino acids in insulin's two chains. It was the first protein ever sequenced, and it won him the 1958 Nobel Prize in Chemistry.
Why it mattered. It proved proteins have exact, readable sequences, which opened the way to making insulin from its gene.
Rosalyn Yalow and Solomon BersonBronx Veterans Administration Hospital, New York, USA
Yalow and Berson invented radioimmunoassay, a way to measure tiny amounts of insulin in blood. They found that many people with type 2 diabetes have plenty of insulin, not too little. Yalow won the 1977 Nobel Prize; Berson had died in 1972.
Why it mattered. It showed that type 2 diabetes is often about insulin not working well, and transformed hormone testing.
Studying haemoglobin in Tehran, the Iranian scientist Samuel Rahbar found an unusual form that was raised in people with diabetes. It was later named HbA1c: haemoglobin with glucose attached.
Why it mattered. HbA1c became the test that shows average blood sugar over about three months.
Dorothy Crowfoot HodgkinUniversity of Oxford, England
Using X-ray crystallography, Dorothy Hodgkin and her team solved the 3D structure of insulin, 34 years after her first X-ray photo of it. She had already won the 1964 Nobel Prize in Chemistry for other structures.
Why it mattered. Seeing insulin's shape helped explain how it works and how to design new versions.
Genentech and City of Hope scientists; Eli LillySouth San Francisco and Duarte, USA; Indianapolis, USA
In 1978 a team including David Goeddel, Arthur Riggs and Keiichi Itakura got bacteria to make human insulin from synthetic genes. Eli Lilly scaled it up, and in October 1982 the US approved Humulin, the first medicine made by genetic engineering.
Why it mattered. Insulin no longer had to come from the pancreases of cows and pigs, and biotech medicine was born.
Specialist diabetes care grows, including in India, sensors track glucose day and night, and huge surveys reveal how many people live with diabetes.
1971
1971 (hospital founded 1954)
A hospital just for diabetes in Chennai
Prof. M. ViswanathanRoyapuram, Chennai, India
Prof. M. Viswanathan, often called the father of diabetology in India, had set up a hospital in Chennai in 1954. In 1971 it became a hospital only for diabetes care, and a research centre followed in 1972.
Why it mattered. It helped make diabetes a specialty in India, decades before the scale of the problem was measured.
Dr V. Mohan, son of Prof. M. Viswanathan, and his wife Dr Rema Mohan, an eye specialist, founded the Madras Diabetes Research Foundation. It went on to run major studies of diabetes in India, including the national ICMR-INDIAB survey.
Why it mattered. It built the research base that finally measured diabetes across all of India.
The US approved the Dexcom STS, a small sensor under the skin that showed glucose every few minutes in real time. Earlier systems had only recorded data for a doctor to read later.
Why it mattered. Continuous glucose monitors changed daily life for many people with diabetes.
The MiniMed 670G became the first 'hybrid closed loop' system approved in the US: a glucose sensor and an insulin pump linked by software that adjusts background insulin automatically. People still had to tell it about meals.
Why it mattered. It was a first step towards an artificial pancreas.
ICMR-INDIAB study (R. M. Anjana, V. Mohan and colleagues)All of India's states and union territories
Starting in 2008, the ICMR-INDIAB study tested over 100,000 adults across India. Its 2023 national report estimated that 101 million people had diabetes in 2021, about 11.4% of adults, and another 136 million had prediabetes.
Why it mattered. It showed diabetes is one of India's biggest health challenges, far larger than earlier estimates.
Adults living with diabetes worldwide, by edition of the IDF Diabetes Atlas
Estimates for adults aged 20 to 79 from each edition of the International Diabetes Federation's Diabetes Atlas. Methods and data improved between editions, so part of the rise is better counting, but the growth is real.
2000 1st edition: 151 million
2003 2nd edition: 194 million
2006 3rd edition: 246 million
2009 4th edition: 285 million (for 2010)
2011 5th edition: 366 million
2013 6th edition: 382 million
2015 7th edition: 415 million
2017 8th edition: 425 million
2019 9th edition: 463 million
2021 10th edition: 537 million
2024 11th edition: 589 million (about 1 adult in 9)
Did you know?
'Pancreas' is Greek for 'all flesh', because the ancient Greeks found no bone or cartilage in it.
Banting, Best and Collip sold their insulin patents to the University of Toronto for $1 each, so that no company could control it.
Insulin was the first protein ever sequenced and the first human protein made as a medicine by genetically engineered bacteria.
All the blood in an adult holds only about 4 to 5 grams of glucose at a time, about a teaspoon.
Paul Langerhans was a 22-year-old student when he described the islets, and he never learned what they did.
The people
Who figured it out
PL
Paul Langerhans
1847 – 1888 · Pathologist · Germany
Found the islets as a 22-year-old student, without knowing what they did.
OM
Oskar Minkowski
1858 – 1931 · Physician · Lithuania (then Russian Empire), worked in Germany
With Joseph von Mering, showed that removing the pancreas causes diabetes.
FB
Frederick Banting
1891 – 1941 · Surgeon · Canada
Led the Toronto work that extracted insulin, and shared the 1923 Nobel Prize.
CB
Charles Best
1899 – 1978 · Physiologist · USA, worked in Canada
Banting's student partner in the insulin experiments of 1921.
JC
James Collip
1892 – 1965 · Biochemist · Canada
Purified the extract that worked for Leonard Thompson.
FS
Frederick Sanger
1918 – 2013 · Biochemist · England
Read insulin's sequence, the first for any protein, and won two Nobel Prizes.
RY
Rosalyn Yalow
1921 – 2011 · Medical physicist · USA
Co-invented radioimmunoassay to measure insulin in blood; Nobel Prize 1977.
DC
Dorothy Crowfoot Hodgkin
1910 – 1994 · Chemist · England
Solved insulin's 3D structure in 1969 after 34 years of trying.
SR
Samuel Rahbar
1929 – 2012 · Scientist · Iran, later worked in the USA