The Discovery of Insulin

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I’ve been thinking about diabetes more than usual recently.  Fortunately, it’s not because my blood sugars have been out of control, which is typically when diabetes takes up more of my mental space.  No, the reasons have been diverse and pretty interesting.

First, I just finished reading a book that sat on my Good Reads “To Read” list for many, many years.  The Discovery of Insulin was written by Canadian historian Michael Bliss back in the early 1980s, years before I was diagnosed with diabetes.  This book is a study of the nuanced and often conflicting stories of how insulin was discovered in Toronto in 1921.

The traditional story is that a young physician, Frederick Banting, and his medical student assistant, Charles Best, discovered insulin in the summer of 1921 after Banting had a sudden stroke of genius regarding the external and internal secretions of the pancreas.  They spent that steamy summer removing the pancreas from dozens of dogs in order to make them diabetic, deriving pancreas extract from other dogs (though a complicated process), and then injecting that extract into the diabetic dogs.  Their results were amazing.  The extract reliably lowered the blood sugar in the dogs.

The story that Bliss tells provides significant detail about the context in which Banting and Bliss made their discovery.  A number of researchers in Europe were also close to discovering this “anti-diabetic” extract in the early 1920s.  It was widely known that the high blood sugar of diabetics was caused by an inability to metabolize carbohydrates and researches had zeroed in on the pancreas (and liver) as the organs responsible for this metabolic function.

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There was a major controversy surrounding the discovery of insulin and it centered around who was awarded credit for the discovery.  Banting and Best were logical choices, but they received significant assistance from the head of their laboratory and internationally known expert in carbohydrate metabolism, J.J.R. Macleod as well as J.B. Collip, the biochemist who helped refined the extract.  When the Nobel Prize in Physiology was awarded to Banting and Macleod (who were not on speaking terms at the time), they shared their awards with Best and Collip, respectively.  Apparently, Banting lived for decades with a deep resentment toward Macleod because of his belief that his original idea was the catalyst for the discovery of insulin, and that Macleod was trying to steal the credit that was rightfully his.

As interesting as the history was to me, I found myself more deeply moved by the description of life for diabetics before the discovery of insulin.  Chronic hyperglycemia (high blood sugar) leads to ketosis (the burning of fat to fuel the body) which causes acidosis (excessive acidity in the blood) which quickly leads to death.  The best method for prolonging life in diabetics (before insulin) was a starvation diet.  Diabetics could actually live for 2 to 4 years by sticking to a strict, low carbohydrate and low calorie diet – often less than 500 calories per day.  If they chose to eat normally, they’d waste away more quickly and die from ketoacidosis within a matter of weeks.

Reading this history, I imagined and empathized with the pain and suffering of these individuals.  People who had the same disease I do but were unfortunate to live before this literally life-changing discovery.  What a weird feeling to know that my life depends on this extract that was discovered less than 100 years ago.

With this story very fresh in my mind, I met the parents of another young mother with Type 1 Diabetes.  At a mutual friend’s party, these parents sought me out when they learned that I had diabetes.  Dennis and I spent about an hour chatting with these knowledgeable and concerned parents.  The story they told was very different than my diagnosis.  Their daughter has struggled to accept her diabetes since she was diagnosed 15 years ago at the age of 17.

Talking about my experience and the way my parents handled my diabetes diagnosis made me very reflective.  Just a week before, my mom reminded me of something I asked her while still in the hospital upon diagnosis.  I looked at her and said, “God doesn’t give you more than you can handle, right Mom?”  My optimism helped me through those early days.  I also recalled that my dad encouraged me to see this disease as something that I had to overcome and that would, ultimately, make me stronger.  I don’t recall my parents treating me like a victim or feeling sorry for me (I’m sure they did, but they didn’t let me see it).

Several years ago, I had the realization that I never rebelled against my diabetes management (blood glucose tests, injections, etc.), in part because my care was always in my own hands.  It wasn’t like my parents managed my diabetes or enforced a strict diet on me.  From the beginning, it was mine to manage, for better or worse.  My control wasn’t very good in my teen years, but that independence and self-confidence helped me transition to adulthood without a dramatic rebellion against diabetes self-care.

In trying to describe my experience to parents who understand diabetes so intimately, I found myself feeling love and gratitude for my mom and dad.  I now appreciate, as a parent myself, how devastating and frightening my diabetes diagnosis was for them.

Finally, the timeline of diabetes seems to be moving along: from death sentence to chronic condition to a cure, as recent study results seem to point to a cure in my lifetime.  A friend of mine participated in one of the first human trials at a San Diego based company who announced promising study results today.  They were able to insert modified stem cells, encapsulated in a permeable pod, into patients.  After several months, they removed the pods and found that the cells had been producing insulin and other hormones that are missing in Type 1 diabetics. There’s still several years of study and refinement ahead, but it’s a very promising step.

It’s funny, living with this disease for over 22 years, it can often remain pretty much in the background of my daily life.  Eating a low carbohydrate diet, exercising regularly, wearing an insulin pump, and now taking this new medication, all contribute to fairly steady and predictable blood sugars.  I enjoyed reflecting on diabetes in a more conscious way through these recent experiences and have a newfound sense of gratitude for the ability to live well with diabetes.

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