The development of an effective treatment

 

Treatment of Diabetes in the early 1920s

 

As it had been for the past fifty years, treatment of diabetes was centered on starvation. For example in 1914 Frederick Allen, the leading American diabetologist, introduced his ‘Starvation Diet’.  Possibly influenced by the work of Bouchardat and believing that since the diabetic's body could not use food, perhaps limiting the amount of food allowed would reduce the strain. Patients were starved until the sugar disappeared from their urine and then put on a diet of about 1,000 calories per day. Diabetic coma was avoided, but patients were unfit for ordinary life activities. In the absence of anything better, however, the Starvation Diet was widely used as a treatment.

 

In retrospect, it is easy to see why outcomes were good in patients with what we now call type II diabetes, but for those with type I, death from "inanition" (starvation) was not uncommon. Fortunately, Allen's treatment did allow a number of young people to survive to become the first insulin users.


The isolation and first use of insulin

 

Frederick Banting was a 30-year-old surgeon from London , Ontario.  After reading a routine article in a medical journal, he had the idea of making an extract from the islets of Langerhans.  He recorded it in his diary at 2 a.m. on Oct. 31, 1920:

"Diabetus(sic) -  Ligate pancreatic ducts of dogs. Keep dogs alive till acini (enzyme producing cells) degenerate leaving Islets. Try to isolate the internal secretion of these to relieve glycosurea(sic) ."
He received support for his proposed research at the University of Toronto, where he began work on 17 May 1921 under the direction of John Macleod (a Scottish physiologist who was an expert in the field of carbohydrate metabolism) and assisted by Charles Best a 22-year-old medical student.
Their method was to tie off a dog's pancreatic ducts; the rest of the pancreas would atrophy after several weeks, but the islets of Langerhans would remain intact. An extract could then be made from the cells and injected into a diabetic dog (one whose pancreas had been removed). If Banting's idea was right, such an extract would relieve the symptoms of diabetes.  Following the initial experiments most of which resulted in failure,
Banting and Best finally managed to keep several dogs alive and healthy enough to attempt the extraction and use of the products of the internal secretion. Once they had found an extract that reduced the blood glucose levels of the dogs that had undergone pancreactomy, Banting and Best reported their findings to Professor MacLeod. With guidance from MacLeod, and the chemical expertise of James Collip, the group managed to produce extracts suitable for clinical trials.

 

Banting and Best with Marjorie
They went on to isolate the hormone insulin from bovine pancreases.  This led to the availability of an effective treatment — insulin injections — and the first clinical patient was treated in 1922. For this, Banting and Macleod received the Nobel Prize in Physiology or Medicine in 1923. They made the patent available and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of their decision.

 

The following will give you a fuller picture of this work and its context:

The Discovery of Insulin(1982) by Michael Bliss  

LINKS:

Greatest Canadian

Contributions of the American Journal of Physiology to the discovery of insulin Ira D. Goldfine and Jack F. Youngren

Unsung Heroes in the Battle Against Diabetes Stephen W. Barthold

2002 presidential address: A Tide in the Affairs of Medicine. (Presidential Address).(62nd Annual American Diabetes Association meeting, 14-18 June 2002)

 

Controversy about the discovery of Insulin.

Controversy began from the start.  There are several issues:

- disagreements between the researchers,
- the methods used,
-the use of animals.