Imagine a hospital ward full of quasi-comatose, emaciated children wasting away of ketoacidosis….and watching them slowly come back to life one by one. That is what happened 100 years ago, after the discovery of insulin. Today is World Diabetes Day, and this year we celebrate 100 years since the discovery of insulin. Before injected insulin was available, Type 1 diabetes was a death sentence. Death could be delayed for at the very most 2 years, with a very strict starvation diet. The discovery of insulin is one of the most significant events in the field of medicine.
Sir Frederick Banting graduated as a surgeon from the University of Toronto in 1916 and immediately left for England with the Canadian Army Medical Corp. Returning from the war with a shrapnel injury to the right arm and a case of PTSD, he did a 1 year surgical internship at the Hospital for Sick Children (aka Sick Kids) in Toronto, and then set up a private practice in London Ontario. He was seeing few patients, and took a side job as an instructor at Western University Medical School to make ends meet.
On October 20, 1920, he was preparing for a lecture on the pancreas by reading an article which concluded that a hormone secreted into the blood by the islets of Langerhans controlled glucose metabolism. Banting saw the potential for isolating an extract related to diabetes from the pancreas and wrote it in his notebook October 30, 1920. He was put in touch with Professor John Macleod, an expert on carbohydrate metabolism. Despite the fact that 400 previous attempts to treat diabetes in animals with pancreatic extract had failed when tried on humans, Dr Macleod agreed to supervise him. In May 1921, Banting went to Toronto to begin his research, joined by an undergraduate summer student assistant, Charles Best. Best had the necessary lab skills for the project, since most of Banting’s experience was as a battlefield surgeon.
In August 1921, their extract ‘isletin’ (later called insulin) decreased glucose and improved the overall condition of Marjorie, a dog with diabetes. Macleod provided additional labs resources so the results could be reproduced. In December, James Collip, a biochemist with an interest in hormones, was recruited to help purify the pancreatic extract. He came up with an extraction process that made it pure enough to try on humans.
On January 11, 2022 13 year old Leonard Thompson was the first human injected with the insulin extracted from pig pancreas. It caused an abscess and an allergic reaction. 11 days later he was injected again, with the extract further purified by Collip and it worked! Leonard Thompson lived 14 more years with insulin, and died of pneumonia at age 27. Watch this amazing ‘Canadian Heritage Minute’ video:
March 1922, there was a 3 month shortage of insulin, as supply was not able to keep up with demand. June 1922, in an effort to mass produce insulin in a cost effective way, the University of Toronto partnered with Eli Lilly. Lilly was able to ship their pork insulin, called Iletin to Toronto by July, allowing Dr Banting and team to take on more patients. In November 1922 Danish company Novo Nordisk also began to produce insulin known as Toronto.
Most ‘newsworthy’ of Banting’s early insulin patients was Elizabeth Hughes, daughter of the US Secretary of State. She followed the ‘starvation diet’ strictly for 3 years and was taken to Toronto at age 14. In 1996, a collection of letters she wrote to her mother from August to November 1922 was donated to the University of Toronto. Elizabeth wrote to her mother about injecting 5cc of insulin ‘We only have a 2cc syringe. After the first 2cc, the nurse unscrews the syringe from the needle, which is left sticking into me, fills it again and injects 2cc more, then the same again with the final cc. The process takes about 20 minutes, my hip feels as if it would burst, my leg is numb, then in an hour I would hardly know anything had been given.’* She went on to graduate from University, got married, had 3 children and lived a very full life!**
I had the opportunity to attend a wonderful lecture by the late Michael Bliss during a Diabetes Canada conference in Toronto October 2011 for the 90th anniversary of insulin. He was a historian and author of the book ‘The Discovery of Insulin’. In 1979, while writing the book, Dr Bliss contacted Elizabeth’s husband to find out when his wife had died and find out about her later life. She wrote back to him herself saying she was alive and in good health 58 years after first receiving insulin!
October 25, 1925, the Nobel Prize for Medicine and Physiology was awarded to Banting and Macleod for the discovery of insulin. Banting shared his prize with Best and Macleod with Collip. Frederick Banting remains the youngest recipient and the only Canadian to receive a Nobel Prize in this category.*** Since insulin is a life-sustaining treatment and they wanted it to be accessible to anyone who needed it, Banting, Best and Collip sold the patent for $1 each. Banting claimed that insulin belonged to the world, not to him. I do not think they would be too impressed to know that in 2021, there are parts of the world that do not have access to insulin, and for many it is not affordable!
This post may seem rather ‘off topic’ for my blog. Those of you who only know me virtually may not know that in my ‘day job’ I am a pediatric diabetes educator, so posting this today was important for me. Huge advances in insulin manufacturing and delivery have been made in the last 100 years, and although insulin is a life-sustaining treatment, and still the only treatment for Type 1 diabetes, it is not a cure. Hopefully in the not so distant future, this century’s Frederick Banting will finally discover a cure!
Happy World Diabetes Day, Cristina
*Bliss, Michael The Discovery of Insulin. Toronto: McClelland and Stewart Limited, 1982.
**FYI – glass syringes had to be sterilized. Needles were reused multiple times and required sharpening. This was the standard for over 30 years. In 1954 a disposable glass syringe was designed for the Polio vaccine and it was used for insulin delivery as well. Disposable 1cc syringes finally became available in 1969
***Frederick Banting received a lifetime endowment to continue medical research, and also was a well respected landscape painter. His paintings are on display at Banting House in London, Ontario. He died in Feb 1941 at age 50 in a plane crash while serving in WW2.
‘Glory enough for all’ Canadian TV Docudrama
Photos from Library Archives Canada and Banting House National Historic Site
Stamp-Canada Post April 2021