Diabetes – History of Insulin

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Diabetes

By: Sharon R. Vining, RN, BSN, OCN

Email: Sharon@thethinkering.com ►

Diabetes is caused by the pancreas inability to produce insulin.  Before the development of insulin, diabetes was a death sentence.  Prior to the 1920’s, someone with Type I diabetes survival rate was months. 

It all started with a medical student in Berlin, Paul Langerhans.  In 1869, Langerhans discovered distinct collection cells in the pancreas.  Today these cells are called the Islets of Langerhans.  The term insulin originates from the Latin word insula meaning island.

In 1889, Oscar Minkowski and Joseph Von Mering while studying the effects of digestion removed a pancreas from a dog.  They found sugar in the dog’s urine after observing flies feeding of the urine.

Eugene Opie, in 1901, discovered insulin was produced by the Islets of Langerhans and that destruction of these cells resulted in diabetes.

In 1916, Romanian Professor Nicolae Paulescu developed an extract which he found lowered blood sugar in diabetic dogs.  Due to World War I, Paulescu was unable to publish his results until 1921.

In 1921, Canadians Dr. Banting and medical student Charles Best removed a pancreas from a dog and the dog developed sign of diabetes. Dr. Banting had studied Minkowski’s work and concluded the digestive secretions were breaking down the islet secretions.  Banting then grounded the pancreas and made an injectable extract and gave it back to the dog.  The signs of diabetes then went away.  Given their success with the dog, they then went on to make extract from the pancreases of cows.  With the help of biochemist Bertram Collip, they purified the insulin.  Banting and Best, confident of their insulin, were the first humans to test the insulin.  After injecting themselves with insulin, both became weak and dizzy (signs of hypoglycemia).

Their first actual patient was a 14 year old boy with type I diabetes, Leonard Thompson. Prior to this time, a Type I diabetic was put on a starvation diet and would live only a few months.  Leonard Thompson went on to live another 13 years before dying of pneumonia in 1935.

Children dying from diabetic ketoacidosis were kept in large wards, often with 50 or more patients in a ward, mostly comatose. Grieving family members were often in attendance, awaiting the (until then, inevitable) death.

In one of medicine's more dramatic moments, Banting, Best, and Collip went from bed to bed, injecting an entire ward with the new purified extract. Before they had reached the last dying child, the first few were awakening from their coma, to the joyous exclamations of their families.

The first American patient was Elizabeth Hughes Gossett, the daughter of the governor of New York.

With this success, Banting and Best went on to improve their techniques for producing insulin and Eil Lilly became the first manufacturer of insulin.  In 1923, Banting would then the Nobel Prize and shared the prize money with Best and Collip.

Insulin was further developed by Hans Christian Hagedorn, who in 1936 discovered by adding protamine prolonged the action of insulin.

Frederieck Sanger, in 1955, sequenced the protein insulin and went on to win the Nobel Prize in Chemistry for his work.

The 1960’s saw insulin become chemically synthesis.  Synthetic insulin, now known as “human insulin” was manufactured by Eli Lilly in the 1980s.  Human insulin has the advantage over animal insulin because it is less like to produce allergic reactions.

In 1996, Eli Lilly was the first to market analogue insulin, Lispro.  Analogue insulin has been genetically modified and has been altered to change how the insulin is absorbed, distributed, metabolized and excreted.

The latest insulin to be developed is from a Germany company, Sanofi-Aventis.  Lantus is a long-acting basal insulin analogue, which is given once daily. It consists of microcrystals which slowly releases insulin with a duration time of action of 18 to 26 hours.

 Today, we now have short acting, medium acting, long acting insulin, insulin pumps and most recently insulin pens.  Today, people with diabetes, with a proper health care regimen can expect to live to old age.

Insulin currently cannot be taken orally because, it’s a protein and once introduced into the gastrointestinal tract; it is reduced to fragments, whereupon all activity is lost. There has been some research into ways to protect insulin from the digestive tract, so that it can be administered orally or sub-lingually.

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