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Using the ADA's celebration of the 100-year anniversary of the discovery of insulin as a backdrop, resident Advisory Board member Adam Sturts, DO, reflects on the history, present, and future of insulin from the perspective of a provider and a patient with type 1 diabetes.
Early on October 31, 1920, the Canadian orthopedic surgeon Sir Frederick Banting, MD, awoke suddenly with an idea that transformed type 1 diabetes mellitus from a certain death sentence to a treatable chronic medical condition. He penned the idea in his journal: “Diabetus. Ligate pancreatic ducts of dog. Keep dogs alive till acini degenerate leaving islets. Try to isolate the internal secretion of these to relieve glycosurea.”
Thanks to the efforts of Banting and his research team, John Macleod, Charles Best and James Collip among others, insulin was first isolated in 1921.
Prior to the discovery of insulin, there was no effective treatment for type 1 diabetes. Patients were prescribed starvation diets in a futile attempt to prolong their short, agonizing lives. Most died months after diagnosis.
Leonard Thompson, a 14-year-old type 1 diabetic, was the first to directly benefit from the discovery of insulin. He was severely malnourished, dehydrated and critically ill with diabetic ketoacidosis when he presented to Toronto General Hospital. After starting insulin injections in 1922, his condition improved and he lived for an additional 10 years. Dr. Banting and Macleod won the Nobel Prize in Physiology or Medicine in 1923 for their discovery and this is still the fastest time from discovery to Nobel Prize award. Millions of diabetic lives have been saved by insulin in the 100 years since discovery, including my own.
I vividly remember the day I was diagnosed with diabetes on August 5th, 1998, my 5th birthday, and the first insulin injection that I received. My initial insulin regimen included pork insulin and NPH. The injections and finger sticks for blood glucose monitoring were painful, but I tolerated them because I knew that without them I would be unwell. My family supported me through these early years. My friends affectionately nicknamed me “Juice Box.” Support systems through JDRF and Camp Nejeda, a camp for diabetic children, were essential to my family’s and my own psychological wellbeing. Eventually, I transitioned to insulin lispro and glargine then insulin aspart and glargine.
In 2006, I got my first insulin pump the Medtronic MiniMed Paradigm 511. The pump was truly a paradigm shift in the management of my diabetes because it allowed me to live more freely. I continued insulin pump therapy throughout undergraduate, physical therapy school and added a Dexcom G4 Platinum CGM in medical school with improvements in glycemic control and glycemic understanding. Preparation for medical residency not only included studying medicine and clinical rotations but also anticipating the impact of long hours, high stress and constantly changing schedule on my glycemic control.
I transitioned to the t:slim X2 insulin pump with Control-IQ hybrid closed loop technology coupled with Dexcom G6 CGM based on the efficacy and safety of this system demonstrated in the Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. The hybrid closed loop system has features, including automatic insulin adjustments, correction boluses and activity settings, that have been absolute game changers for me. I can sleep more comfortably knowing that the Control-IQ algorithm will decrease my basal rate and alert me if I am trending towards hypoglycemia. When rounding in the hospital I can glance at my pump and instantly see my blood glucose, alleviating the stress of not knowing and allowing me to focus on the care of my patients rather than worrying about my own blood glucose.
I am grateful for all of the therapeutic and technological advances since the discovery of insulin. We have come so far since 1921 but we still have many challenges to overcome moving forward.
Banting ultimately sold his patent for insulin for $1 because “Insulin does not belong to me; it belongs to the world.”
Unfortunately, the cost of insulin has increased substantially in recent years—the average price of insulin has nearly tripled since 2002, according to the ADA. Patients’ out of pocket costs are typically based on list price so our expenses have risen substantially. The factors responsible for this price increase are unclear. I am fortunate that I have had the financial means of affording insulin and diabetes supplies. Other diabetics are not so fortunate and pay the price with their lives.
Fortunately, the American Diabetes Association, the Endocrine Society, JDRF, and others continue to advocate for patients with diabetes to create reform to reduce costs and improve the affordability and accessibility of insulin and diabetes supplies. Resources such as insulinhelp.org and getinsulin.org can help patients find affordable insulin and I encourage physicians to share this information with diabetic patients.
My experience at the ADA 81st scientific sessions leave me optimistic that near term therapeutic advances involving “smart” insulins, advanced insulin delivery systems, closed-loop systems, and artificial pancreases will improve the lives of diabetic patients. My hope is that by 2121 we will be celebrating the anniversary of the cure for type 1 diabetes.
This piece represents the views and opinions of the author and do not reflect the views of the publication, MJH Life Sciences, or any other organizations.