I’ve written recently about growth hormone and its important role in the body. For certain, severe growth hormone deficiency has major health impacts that go beyond extreme short stature. However, insulin is a hormone infinitely more important to health and longevity than growth hormone. Insulin treatment for type 1 diabetes accounts for roughly half of the children cared for by pediatric endocrinologists.

Insulin achieved a significant milestone this year. Ninety years have passed since insulin was first successfully purified and used to treat children with type 1 diabetes. It’s hard to imagine the terrible life-ending news that the diagnosis of diabetes once was or the horror for a child and family of the diagnosis of diabetes before the discovery of insulin treatment. An excerpt from the book, The Discovery of Insulin paints a grim picture of the diagnosis of diabetes.

“Food and drink no longer mattered, often could not be taken. A restless drowsiness shaded into semi-consciousness. As the lungs heaved desperately to expel carbonic acid (as carbon dioxide), the dying diabetic took huge gasps of air to try to increase his capacity. ‘Air hunger’ the doctors called it, and the whole process was sometimes described as ‘internal suffocation.’ The gasping and sighing and sweet smell lingered on as the unconsciousness became a deep diabetic coma. At that point the family could make its arrangements with the undertaker, for within a few hours death would end the suffering.”

An inkling of insulin’s action and its location in the pancreas was discovered in 1888, but it would take thirty more years to finally achieve the medical breakthrough that changed the diagnosis of type 1 diabetes from ending in certain death to a living with a chronic condition.

A group of four physicians – Frederick Banting, Charles Best, John Macleod and Bertram Collip – at the University of Toronto made the Nobel prizing winning discovery. By 1922, the team perfected the process over a startlingly rapid two years. A teenager, Leonard Thompson, was chosen as the first person to test the newly purified insulin extract. The initial extract was partly successful but impurities led to an allergic reaction that required weeks of additional work. Thanks to the work of Collip, a purer insulin extract was developed and was successful in lowering Leonard’s blood sugar and restoring his health and energy.   

Scarcity of supply plagued the early months of insulin use as many desperate families sought insulin treatment for their dying child. A source had to be located to produce enough insulin, and slaughterhouses provided the answer to the problem. Insulin was extracted from pancreases of cows destined for food. Pharmaceutical companies began work to mass purify the new insulin and expand its availability beyond Toronto.

Thompson will forever be remembered in history as the first to receive insulin. However, the story of one of the first Americans treated with insulin, Elizabeth Evans Hughes, offers a compelling story of the diagnosis of type 1 diabetes prior to insulin treatment. The 14 year old had been diagnosed three years before and had been placed on the only treatment available at the time – a starvation diet.

Those on the diet faced severe restriction of calories. Every morsel of food was measured and some days food was not allowed. The diet only prolonged life for a few years after diagnosis. Starvation prevented blood sugars from rising into deadly levels and kept symptoms of diabetes in check temporarily. Elizabeth’s family watched as she weakened daily and wasted away to 45 pounds. In desperation, they were able to bring her to Toronto to join the growing group of children receiving the scarce supply of insulin.

The story of Elizabeth was incorporated into mini-series from the 1980s chronicling insulin’s discovery. This 10 minute you tube video clip includes a portion of Elizabeth’s story that shows the desperation of her family and Elizabeth’s phenomenal response. The clip also highlights friction between the different physicians that endured beyond insulin’s discovery.

Like Leonard Thompson, Elizabeth was pulled from near death to a new life on daily injections of insulin. She went on to live a phenomenally long life, dying at age 74, for someone diagnosed in the early years of insulin treatment. Elizabeth attended college, married, and had three children. She is remembered for her philanthropic work.

The progress of insulin treatment still remains a slow one since 1922. Insulin must still be given by injection. Processes to chemically modify insulin were invented in the coming decades which helped reduce the number of injections required and give more stability to blood sugar levels. In the past 20 years, synthetic human insulin has replaced the beef and pork insulin formerly used. Recombinant DNA technology has also allowed creation of new, novel insulins that further improve diabetes care.

Medical progress continues to improve the lives of those with type 1 diabetes, but progress is slow. Two major breakthroughs – blood glucose monitoring and insulin pump therapy occurred on in the past 30 years.  Insulin treatment sustains the lives of those with type 1 diabetes while they, their families, and the medical community wait for the cure or the next big breakthrough.

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He loves to write, and he is a regular contributor to the Physician Perspective  page on the Cook Children’s Web site.

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