What was life like for those with severe diabetes before insulin? The answer isn’t pleasant. People with type 1 diabetes, more commonly known as juvenile diabetes, lost weight rapidly. They complained of hunger, thirst, and other problems, and gradually slipped into diabetic coma. Once the coma began you alerted the undertaker. There was nothing more you could do for them.
Doctors tried hard to treat diabetes. In earlier times, some thought that children who were passing sugar in their urine (a key indicator of diabetes) needed more sugar to make up for what they were losing. This was a disastrous therapy.
By the early twentieth century, the most that doctors could offer people with diabetes was a special diet. If someone could not burn (metabolize) normal amounts of food, perhaps they should eat only as much food as they could burn up — as much food as they could handle without spilling a high amount of sugar in their urine or blood.
Diets are still a first resort for those with type 2 diabetes. However, in those days the diets had to be so strict that children could not maintain their weight. They were called starvation diets. In fact, anyone who did stay on the diet would eventually die from starvation. What an awful choice – quick and painful death from diabetes, or an extra year or two of life gradually wasting away.
It was a horrible disease. Children with diabetes who followed their diets looked like the victims of World War II concentration camps. Most just gave up and surrendered to the disease. A very few children managed to stay alive, gradually becoming reduced to skin and bones. Their parents were told that perhaps some new treatment might emerge before they died. You could always hope.
That hope finally appeared in 1922. A team of researchers at the University of Toronto announced that they had at last discovered the substance in the pancreas that enabled the body to burn food. The hormone called insulin could be extracted from the pancreases of animals, purified and injected into humans. It would not cure diabetes (and there was confusion on that point), but it restored the ability to process food. Regular injections of insulin reduced symptoms, allowing something close to a normal life.
For years, the true story of the discovery of insulin was hidden in a fog of romance, myth, and controversy. It seemed to be all about the brilliance of two untrained researchers, Doctor Fred Banting and his helper, Charles Best, the famous Banting and Best whose names are known to every Canadian school child.
We now know that the research was much more complicated. Other senior scientists helped Banting and Best convert their crude extracts of pancreas into a substance that actually worked on people. The formal supervisor of the research, professor of physiology James J. R. Macleod, played an important role from beginning to end. James B. Collip, a biochemist in Toronto on leave from the University of Alberta, also made a key contribution when he figured out how to purify Banting and Best’s substance.
Collip made the insulin that worked on the first human patient, 14-year old Leonard Thompson. A charity case, Thompson weighed only 65 pounds and was near death in January 1922 when injections of insulin brought him back to life. For the first time in the history of the world, doctors could treat severe diabetes.
The members of the insulin research team, working under intense pressure, had a tendency to behave like Canadian hockey players. At times of crisis they would drop their gloves. On the night of the first successful test on Leonard Thompson, Banting and Collip had a fight in their lab. Best had to separate them.
The 1923 Nobel Prize in medicine was awarded to Banting and Macleod for the discovery of insulin. Banting shared his prize money with Best, while Macleod shared his with Collip. At the University of Toronto’s dinner to celebrate the Nobel award, a wise physician commented, “In insulin there is glory enough for all.” Now, we honour all four discovers of insulin — not just Banting and Best.
Leonard Thompson and the other patients who first got insulin did not care whether the discoverers were friends or enemies. The discovery was all that mattered. Insulin made the difference between life and death.
In the early months, the real problem was that there was not enough insulin to treat those who needed it. It was difficult and sometimes impossible to produce. For a time the Toronto group lost the knack of making any effective insulin. Desperate patients were flocking to Toronto, but there was no insulin that worked. The team finally took an offer of help from an American drug firm, Eli Lilly and Company. A close partnership between Lilly and the University of Toronto gradually yielded good results with insulin production. Later in 1922, a Danish scientist visiting Toronto was taught to make insulin. He went home to found the company that became Novo Nordisk. Today’s two biggest insulin producers have their roots back in Canada in 1922.
The most exciting stories that year came from Leonard Thompson and others whose lives were saved by insulin. In October, the teenaged Elsie Needham was admitted to Toronto’s Hospital for Sick Children in a diabetic coma. When she received an injection of insulin and returned to consciousness, it was as if she had risen from the dead. Everyone marvelled.
A little American boy, five-year old Ted Ryder, was accepted for treatment in Toronto. He weighed only 27 pounds, and was within weeks of death from starvation. Within a year he had fattened up on insulin.
Fifteen-year old Elizabeth was the daughter of the United States Secretary of State, Charles Evans Hughes. She had been on a starvation diet for three years. At first Elizabeth was denied treatment because of the insulin shortage. When she was finally accepted in August 1922, Banting noted in her file:
Patient extremely emaciated, slight edema of ankles, skin dry & scaly, hair brittle & thin, abdomen prommt (prominent), shoulders drooped, muscles extremely wasted, subcutaneous tissues almost completely absorbed ... scarcely able to walk on account of weakness. Height 5ft. wt 45 lbs.
Elizabeth responded beautifully to insulin. In autumn of 1922, she wrote letters to her mother that are a wonderful record of the power of insulin.
I am simply bursting to see you and can hardly wait for you to actually see with your own eyes what I'm eating nowadays, for if you didn't I declare you'd think it was a fairy tale. I know you will hardly know me as your weak, thin daughter, for I look entirely different everybody says, and I can even see it myself ... you see I am getting now what a normal girl of my age should and am of course gaining every hour it seems to me in weight and strength.…
The best part of all my diet now is that I am eating absolutely anything, including candy. Now don't be shocked by that statement, for it is only on reactions when I have that privilege, but you see it gets my blood sugar up to normal again as quickly as anything will, so Dr. Banting thought that as long as I was out a great deal candy would be much easier to carry and to take also. So now my pockets are full of these little molasses kisses, you know, and when I have a reaction I take just one and I recover immediately....
I could use up pages just in numerating all the dishes I have nowadays and it seems to me that I eat something every day that I haven't tasted for over three years, and you don't know how good it seems and how I appreciate every morsel I eat. I can't express my gratitude for the chance I am having, in being up here to take advantage of this wonderful discovery, for it is truly miraculous...
Even today, insulin users today can find their injections bothersome. It was much worse for a pioneer like Elizabeth. She told her mother what it was like.
Imagine, I have to take 5cc at a time. Isn't that awful? ... but it seems they have had no extract for the last few days and I suppose we were lucky to have even that poor stuff. We only have a two cc. syringe you know and so nurse Blanche fills that and gives it to me and then unscrews it from the needle which is left sticking in to me (I feel like a pincushion) fills it again, and gives me that (am left a pincushion once more), and then have the fifth cc. It really is quite a process, and altogether takes about twenty minutes for the whole performance. My hip feels as if it would burst too, but it doesn't, although my whole leg is numb until I walk on it a bit, then it recovers rapidly and within an hour I would hardly know anything had been given.
Elizabeth's hips, the fleshiest part of her body, were nothing more than a mass of swollen lumps from insulin injections. She always added that she could endure anything for the sake of her new diet and what it was doing for her.
I want if you can possibly find them, the links that were taken out of my little silver watch and my gold bracelet. My arm is fattening out so much you will be glad to hear that my watch is really becoming quite uncomfortable, so I need another link put in and I saved them just for this special emergency, although I must say I didn't ever expect it to come ...
Elizabeth Hughes lived for 59 more years with her diabetes and insulin. She had a full and busy life. I met her when I researched the discovery of insulin. She had no side effects from her diabetes (and I had to wait to see her until she got back from visiting China). She gave me the letters to her mother for our archives in Toronto.
In 1983 I discovered Ted Ryder living quietly in Hartford, Connecticut. He was the last survivor of Toronto’s first group of insulin patients. He died in 1993, in his seventy-first year of using insulin.
Today, some patients have been taking insulin for more than eighty-five years. Millions of people with diabetes around the world owe their lives to the Canadian research. Diabetes has not been cured, and having to take insulin every day is not exactly pleasant. Still, those with diabetes can have real lives. The power of medical research allowed Canadians to tame diabetes ninety years ago. Insulin is still the finest achievement of Canadian medical research.
Dr. Elliott Joslin, a great diabetes doctor, provided the best description of what happened to his patients with insulin. He wrote that by Christmas of 1922:
I had witnessed so many near resurrections that I realized I was seeing enacted before my very eyes Ezekial's vision of the valley of dry bones:
‘…and behold, there were very many in the open valley; and, lo, they were very dry.
And he said unto me, Son of Man, can these bones live?
And ... lo, the sinews and the flesh came upon them and the skin covered them above: but there was no breath in them.
Then said He unto me, "Prophesy unto the wind, prophesy, Son of Man, and say to the wind, Thus saith the Lord God: "Come from the four winds, O breath, and breathe upon these slain, that they may live."
So I prophesied as he commanded me, and the breath came into them, and they lived, and stood up upon their feet, an exceeding great army.’