An Injection of Hope – the Legacy of Insulin
Throughout recent history, the world of science has evolved exponentially with each passing decade and, as a result, so too has the world of medicine. With fundamental advances in technology, we have been able to gain a better understanding of the human body, including the all-important treatment of illnesses, diseases and conditions.
For proof of such medical evolution, look no further than the COVID-19 pandemic that brought the entire world to a standstill in March 2020. In less than a year, scientists were able to develop not one but several safe and effective vaccines capable of protecting us from this previously unknown virus, which were subsequently rolled out across the world.
However, such revolutionary medical breakthroughs are by no means a new trend that is exclusive to the twenty-first century, nor is it a phenomenon that has only emerged as a result of the technology of the last fifty years. In fact, one of the most important innovations in medical history occurred an entire century ago, that being the discovery of insulin by Sir Frederick Banting, John Macleod, James Collip and Charles Best.
Before the insulin innovation of 1921 and the subsequent introduction of insulin treatment for diabetes thereafter, the only form of treatment available for people with diabetes was a primitive ‘starvation diet’ of low carbohydrate/low-sugar meals. Extreme diets such as this included as little as just 450 calories a day. To put that into context, one large milkshake from a well-known, global fast-food chain equates to 468 calories, which would exceed the stated calorie quota without even ingesting solid food. Add to this that – according to the British Nutrition Foundation – the current GDA for an adult male is 2,500 calories and for a female is 2,000, a diet of 450 calories a day is incredibly low and would have undoubtedly impacted the patient’s quality of life not to mention the effect it would have had on cognitive function, muscular development and general nutrition.
Even with such radical treatment, the implementation of this unenviable diet-led treatment was largely ineffective and the life expectancy of a person living with diabetes was commonly limited to just one year following diagnosis. Worse still, the state of being in such a prolonged calorie deficit was also known to actually contribute to fatalities, with many recorded examples of this drastic diet causing patients to die of starvation as a result.
With no known cure or safely sustainable treatment available at the time, prior to 1921 anyone unfortunate enough to be diagnosed with the condition was essentially living on borrowed time. As such, Banting’s discovery couldn’t have come soon enough.
Through comprehensive experimentation on canine test subjects, Banting et al. were able to intentionally ligate the pancreatic ducts of these subjects and isolate islet cells for insulin extraction. The result proved to be an earth-shattering medical discovery that quite literally changed the world of medicine and with it provided a lifeline to people living with diabetes all over the world.
From there, the insulin process was refined further for human trials and the world’s first effective treatment for diabetes was born. A purer form of insulin was subsequently developed using the pancreatic extracts of cattle and on January 1922, 14-year-old Leonard Thompson became the first human to receive the injection. Within 24 hours, his blood glucose had dropped to near-normal levels.
With the trials a success and insulin a proven marvel of medicine, large-scale production of the drug soon began, with medical firm Eli Lilly at the helm of this production. As technology continued to progress, so too did the development and refinement of insulin and a slow-acting insulin was introduced in 1936 by Novo Nordisk Pharmaceuticals Inc.
Nevertheless, even with such medical advancements, animal insulin remained the primary form of insulin that was used for decades after the initial discovery, chiefly extracted from cattle and pigs. However, whilst it had been proven effective, it wasn’t without its flaws. Many patients had suffered allergic reactions as a result of this animal insulin, highlighting the need for a viable, safer alternative to be found.
That alternative wasn’t discovered until 1978, when the first synthetic form of insulin was produced. Created using E. coli bacteria, the genetically engineered insulin was commercially available to the public from 1982, once again a product of the Eli Lilly company.
Five decades on, the world of insulin experimentation has advanced even further, following the evolutionary trend of the twentieth century. Today, there are a number of synthetic insulin variations available, capable of treating a variety of diabetic needs – from long-acting insulin and rapid-onset insulin to near-perfect replicates of the human form.
Whilst insulin has typically been delivered via a standard needle or insulin pen for generations, there is also a third method – the insulin pump – that allows for automatic insulin delivery. The pump consists of a computerised device that controls the delivery of insulin into the body on a regular basis, which is attached to a tube and administered via a cannula – much like a hospital drip. This method can also be used for manual insulin delivery as well, which can be useful when the timing of the insulin dose is influenced by the food you eat.
In addition to these methods, modern innovations in medicine have also paved the way for the development of an additional non-invasive method of taking insulin via an inhalation pump. Commonly known by its brand name, Afrezza, the rapid-acting inhalation powder can be administered much like an asthma pump, with loadable cartridges that deploy the insulin upon inhalation.
These variations in insulin delivery allow people living with diabetes an additional level of freedom and the ability to live normal lives, free from the constraints of this biological condition. Better still, such variations also allow doctors to prescribe a medication that best suits their patients’ lifestyles.
With continuous progress in the world of science and medicine, the future of diabetes treatment is looking more promising than ever. Who knows what innovations there may be by the time the discovery of insulin reaches its bicentenary in 2121.