Light microscopy and electron microscopy are universal tools of pathologists. They are essential tools for the clinical practice of medicine of the living and of even greater importance in that of the deceased. Due to the dearth and almost total absence of autopsy experience and/or exposure, (with the exception of coroner investigations) physicians and research investigators in The United States of America have been deprived, through no fault of their own, of the opportunity for knowledge of the anatomic pathology of diabetes.
Magnetic Resonance Imaging and other diagnostic modalities yet to be, are not substitutes for the autopsy, which remains the pillar of medicine. My research provides the very earliest laboratory diagnosis of type1 and type 2 diabetes by insulin assays with normal glucose tolerance. The very earliest diagnosis provides the greatest opportunity for treatment and cure. My research unveiled the diabetes phenomena: people with normal blood sugars can be diabetic.
The anatomic pathology of diabetes mellitus is vascular. This includes all arteries and capillaries. The distribution of capillaries throughout the body accounts for a potential of clinical pathology manifestation in every organ. The earliest identification of the anatomic pathology of diabetes persists even today as an enigma and persistent challenge to international clinical medicine.
William Osler, M.D., in his classic text, The Principles and Practices of Medicine (1892) was unable to identify a beginning of diabetes other than hyperglycemia. However, he noted age differences. Diabetes beginning in children, all of whom had a short survival and diabetes beginning in adulthood, had much in common. There were no cures and no ultimate survival. In adult diabetes, Osler noted frequent urination as an early sign of diabetes. The urine did not always contain sugar. Occasionally, diabetes insipidus was identified. Unknown at that time was that arteriosclerosis of the kidneys could elevate the renal threshold for sugar thereby resulting in negative urines.
During Osler’s time, arteriosclerosis was treated as an independent affection of the vascular system being an involution process accompanying old age as an expression of the natural wear and tear of the vessels. Longevity according to Osler was a vascular question. He so well expressed this in the axiom – “a man is only as old as his arteries.” To a majority of men, death came primarily or secondarily through this portal just as it does today. When arteriosclerosis occurred in the young, he attributes it to an inherited event. Osler noted that – “a man of twenty-eight or twenty-nine may have {the} arteries of sixty {years old} and a man of forty may present vessels as much degenerated as should be at eighty.” (See Chapter 14. Pathology of Type 1 Diabetes.) This concept expressed by Osler that arteriosclerosis, heart failure and diabetes are simply an aging event prevails today. Unfortunately, this remains the cornerstone of the “silent” diabetes epidemic.
Doctor Osler, a distinguished Professor of Medicine, Johns Hopkins University, was fully aware that the autopsy was the pillar of medicine. He personally performed many autopsies. His pathology dissertations were extensive, especially on arteriosclerosis equal to that of today. Dr. Osler was a physician, a clinician and a truly great clinical pathologist.
A light microscopy examination by Dr. Paul H. Kimmelstiel and Dr. Clifford Wilson in 1936 revealed a lesion definitive for diabetes: intercapillary glomerulosclerosis of the kidney. They described their findings as a clinical entity occurring in type 2 diabetes of long duration. With the exception of the specific pathology of intercapillary glomerulosclerosis of the kidney, diabetes mellitus is not an autopsy diagnosis. This is due to the failure of academia to acknowledge that atheroma- atherosclerosis is the primary pathology of diabetes mellitus.
In 1972, Dr. Marvin Siperstein and associates reported electron microscopy findings of basement membrane hypertrophy of the endothelium of renal glomeruli in 50 of their 51 diabetes patients. They had noted this histopathology finding of diabetes microangiopathy preceded the hyperglycemia manifestation of diabetes by months or years. Even more remarkable was their findings of basement membrane hypertrophy in prediabetes prior to the onset of detectable carbohydrate abnormalities. This discovery also preceded the clinical hyperglycemia manifestation of diabetes by months or years. Worldwide medicine at the time of Dr. Siperstein and even today is still harnessed to the identification of diabetes and prediabetes mainly by fasting blood glucose.
In 1974 and 1975, the oral glucose tolerance with insulin assays demonstrated that hyperinsulinemia is type 2 diabetes. This was concurred over and over again in my subsequent 14,384 examinations. The oral glucose tolerance with insulin assays is an empirical laboratory procedure. This procedure is multiple biochemical biopsies that are dynamic. Results are one of five dynamic glucose/insulin patterns: Pattern I identifies euinsulinemia (normal, nondiabetic); patterns II, III and IV diagnose hyperinsulinemia, type 2 diabetes; pattern V identifies hypoinsulinemia, type I diabetes potential. These five dynamic patterns are reproducible. The 14,384 oral glucose tolerances with insulin assays with ages ranging from 3-91+ years have substantiated the very earliest laboratory diagnosis of diabetes.
Analytical analysis with deductive reasoning will affirm the very earliest laboratory diagnosis of diabetes. The very earliest laboratory diagnosis with treatment will abort the worldwide diabetes epidemic. Independently, light microscopy and electron microscopy and the oral glucose tolerance with insulin assays diagnose diabetes.
Magnetic Resonance Imaging and other diagnostic modalities yet to be, are not substitutes for the autopsy, which remains the pillar of medicine. My research provides the very earliest laboratory diagnosis of type1 and type 2 diabetes by insulin assays with normal glucose tolerance. The very earliest diagnosis provides the greatest opportunity for treatment and cure. My research unveiled the diabetes phenomena: people with normal blood sugars can be diabetic.
The anatomic pathology of diabetes mellitus is vascular. This includes all arteries and capillaries. The distribution of capillaries throughout the body accounts for a potential of clinical pathology manifestation in every organ. The earliest identification of the anatomic pathology of diabetes persists even today as an enigma and persistent challenge to international clinical medicine.
William Osler, M.D., in his classic text, The Principles and Practices of Medicine (1892) was unable to identify a beginning of diabetes other than hyperglycemia. However, he noted age differences. Diabetes beginning in children, all of whom had a short survival and diabetes beginning in adulthood, had much in common. There were no cures and no ultimate survival. In adult diabetes, Osler noted frequent urination as an early sign of diabetes. The urine did not always contain sugar. Occasionally, diabetes insipidus was identified. Unknown at that time was that arteriosclerosis of the kidneys could elevate the renal threshold for sugar thereby resulting in negative urines.
During Osler’s time, arteriosclerosis was treated as an independent affection of the vascular system being an involution process accompanying old age as an expression of the natural wear and tear of the vessels. Longevity according to Osler was a vascular question. He so well expressed this in the axiom – “a man is only as old as his arteries.” To a majority of men, death came primarily or secondarily through this portal just as it does today. When arteriosclerosis occurred in the young, he attributes it to an inherited event. Osler noted that – “a man of twenty-eight or twenty-nine may have {the} arteries of sixty {years old} and a man of forty may present vessels as much degenerated as should be at eighty.” (See Chapter 14. Pathology of Type 1 Diabetes.) This concept expressed by Osler that arteriosclerosis, heart failure and diabetes are simply an aging event prevails today. Unfortunately, this remains the cornerstone of the “silent” diabetes epidemic.
Doctor Osler, a distinguished Professor of Medicine, Johns Hopkins University, was fully aware that the autopsy was the pillar of medicine. He personally performed many autopsies. His pathology dissertations were extensive, especially on arteriosclerosis equal to that of today. Dr. Osler was a physician, a clinician and a truly great clinical pathologist.
A light microscopy examination by Dr. Paul H. Kimmelstiel and Dr. Clifford Wilson in 1936 revealed a lesion definitive for diabetes: intercapillary glomerulosclerosis of the kidney. They described their findings as a clinical entity occurring in type 2 diabetes of long duration. With the exception of the specific pathology of intercapillary glomerulosclerosis of the kidney, diabetes mellitus is not an autopsy diagnosis. This is due to the failure of academia to acknowledge that atheroma- atherosclerosis is the primary pathology of diabetes mellitus.
In 1972, Dr. Marvin Siperstein and associates reported electron microscopy findings of basement membrane hypertrophy of the endothelium of renal glomeruli in 50 of their 51 diabetes patients. They had noted this histopathology finding of diabetes microangiopathy preceded the hyperglycemia manifestation of diabetes by months or years. Even more remarkable was their findings of basement membrane hypertrophy in prediabetes prior to the onset of detectable carbohydrate abnormalities. This discovery also preceded the clinical hyperglycemia manifestation of diabetes by months or years. Worldwide medicine at the time of Dr. Siperstein and even today is still harnessed to the identification of diabetes and prediabetes mainly by fasting blood glucose.
In 1974 and 1975, the oral glucose tolerance with insulin assays demonstrated that hyperinsulinemia is type 2 diabetes. This was concurred over and over again in my subsequent 14,384 examinations. The oral glucose tolerance with insulin assays is an empirical laboratory procedure. This procedure is multiple biochemical biopsies that are dynamic. Results are one of five dynamic glucose/insulin patterns: Pattern I identifies euinsulinemia (normal, nondiabetic); patterns II, III and IV diagnose hyperinsulinemia, type 2 diabetes; pattern V identifies hypoinsulinemia, type I diabetes potential. These five dynamic patterns are reproducible. The 14,384 oral glucose tolerances with insulin assays with ages ranging from 3-91+ years have substantiated the very earliest laboratory diagnosis of diabetes.
Analytical analysis with deductive reasoning will affirm the very earliest laboratory diagnosis of diabetes. The very earliest laboratory diagnosis with treatment will abort the worldwide diabetes epidemic. Independently, light microscopy and electron microscopy and the oral glucose tolerance with insulin assays diagnose diabetes.
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