32
LIVING
lack of insulin, which we now know
acts as a key to open cells to receive
glucose, caused dangerous levels of
glucose to accumulate in the blood.
Finally, science was on the right
track, but it took an impoverished
Canadian doctor who had failed to
make a living as a surgeon to start
the revolution in diabetes treatment.
Frederick Banting's specialism
was orthopaedics but he also had an
interest in diabetes. Early attempts
to give fresh pancreatic extract
from animals to people with Type
1 diabetes had failed or created
toxic side effects, but, after reading
a medical paper, Banting believed
he could crack it. In spite of his
lack of research experience, he
persuaded John Macleod, a Scottish
professor of physiology at the
University of Toronto, to let him have
a go. Macleod gave him lab space
and an assistant, Charles Best, a
medical student.
Through the summer of 1921,
the men worked out how to remove
insulin from a dog's pancreas and
gave it to other dogs whose pancreas
had been removed. By November
they'd successfully kept a dog alive
for 70 days. In December, a new
team member, biochemist James
Collip, came on board. His task was
to purify the insulin so that it could
be given to humans. They developed
a purer form of insulin, this time
from the pancreases of cows. This
was the extract administered on 11
January 1922 to 14-year-old Leonard
Thompson, who was dangerously
ill with diabetes ketoacidosis (DKA),
which is what people with diabetes
died of back then, as it caused
fatal dehydration. By the time he
received his second injection on
23 January, Collip had purified the
insulin further, using alcohol. The
glucose and ketones in the boy's
blood subsided.
until February 1922. He patented
his method of manufacturing
pancreas extract and complained
about the Nobel Prize going to
the Canadian scientists. German
doctor Georg Zuelzer did the same,
having managed to bring a patient
with diabetes out of a coma with a
pancreatic extract in 1908. But, unlike
Banting, he was unable to resolve the
problem of toxic side effects.
The discovery of insulin paved the
way for care that emphasised living
with diabetes rather than rapidly
dying from it. An early pioneer was
Dr Elliott Joslin, the first doctor in
the US to specialise in treating the
condition and founder of the Joslin
Diabetes Centre. He started to give
his patients insulin and detected in
them a physical renewal he likened to
the Old Testament vision of Ezekiel,
who saw a valley of dry bones rise
up and once again be coated in
flesh. But he also warned that this
"resurrection" had to be managed,
and he pioneered the threepronged
approach of diet, exercise
and insulin.
Insulin was heralded as a cure,
and deaths from diabetic comas
plummeted from more than 60% at
the turn of the twentieth century to
just over 1% in the 1950s. As we know
now, it is actually a treatment, not a
cure - and back then, there was still
a long way to go.
It very quickly became clear that
too much insulin had the capacity
to cause potentially severe or even
deadly hypos. Little more than a
decade after people with Type 1
Canadian
teen Leonard
Thompson
became the first
human being to
receive a shot of
insulin
For the first time, there was proof
that insulin could prevent people
from dying of diabetes. In May 1922,
the pharmaceutical company Elli
Lily began mass producing insulin
from the pancreases of pigs and
cows, and shortly afterwards Novo
Nordisk started making it in Europe.
In 1923 Banting and Macleod received
the Nobel Prize in Physiology or
Medicine for their discovery. The
rivalries between the researchers
involved had always been - and
remained - fierce, but Banting shared
his prize money with Best, while
Macleod split his with Collip.
First past the post?
Not everyone felt that Banting and
his colleagues had got there first.
Romanian physiologist Nicolae
Paulescu had succeeded in 1916 in
stabilising blood sugar levels when
injecting an aqueous pancreatic
extract into a dog. But the First
World War interrupted his studies
when he was called up and he
didn't manage to trial it on humans
Diabetes was
first described
in ancient
Egyptian
manuscripts
dating to
around 1500 BC