Life Without Insulin - Murielle Müller

Insulin keeps me alive. It does keep us all alive, but I have to manually inject it because my insulin producing cells in the pancreas were destroyed in an autoimmune reaction. The result is called type 1 diabetes and it’s a pain in the ass. Sure, it teaches you resilience, taking care of yourself, but as a chronic condition, it is also a constant threat to your life. A little more than a hundred years ago, it did indeed kill you. If it wasn’t for the discovery of insulin, I’d be dead by now, and I would have died a very slow and painful death.

Back then, when people were diagnosed with type 1 diabetes, they often already looked like skeletons and doctors couldn’t really help them. One of the most common symptoms of untreated type 1 diabetes, caused by the body’s inability due to lack of insulin to process sugar/carbohydrates, is rapid weight loss. The unprocessed sugar remains in the blood and does not get into the cells (since you would need insulin to do that), so the body begins to take energy from fat deposits in the body. In order to process the surplus sugar, the kidneys try to get involved, immense thirst and subsequently frequent urination are the result of this, also typical symptoms of type 1. You see, it’s complicated to even understand what’s happening when you get such a diagnosis. Other indicators for type 1 diabetes are dizziness, fatigue, weakness, blurred vision and a number of variable symptoms. A hundred years ago, the only way to keep people with diabetes alive was to put them on a strict diet and restrict carbohydrate intake. But that prolonged patients’ life by maximum one or two years, and many patients ended up comatose from diabetic ketoacidosis. It was starving alive more than anything else.

Then, Frederick Banting came along. He didn’t really have success with his practice in London, Ontario and was frustrated, so one night, when he was lying awake and thinking, he had a eureka moment. Scientists such as Oskar Minkowski, Joseph von Mering, Paul Langerhans, and Sir Edward Albert Sharpey-Shafer conducted research which preceded Banting’s experiments but that was also necessary to understand what was going on in the body of a person with type 1 diabetes. These scientists never get enough credit, so bear with me as I explain what they did: Minkowski and von Mering found out that dogs showed signs of diabetes and eventually died when they removed their pancreas, so that was step 1 in narrowing down what was going on. Langerhans found out that it was all located in some cell clusters – he called them islets- and Sharpey-Shafer finally suggested that one hormone was missing from the metabolism in people with type 1. He was the one to call it “insulin”, from “insula” (island).

Well, back to Banting, lying awake in his bed at night. He concluded that these islets needed to be isolated to extract the secretion (insulin). Banting wasn’t really a specialist in metabolism, so when he asked for a laboratory space at the University of Toronto from Professor JJ. MacLeod, MacLeod wasn’t very eager to give it to him. But Banting insisted, and the professor gave in. The duo Banting and Best started their research experiments in May 1921. Why Banting was so ambitious to find a treatment for diabetes isn’t really clear, but it’s been said that he knew someone as a kid who died from type 1.

B& B duct-tied dog’s pancreases together to extract the insulin and injected it into other dogs. A female dog named Marjorie was the first being with diabetes to be kept alive by insulin treatment. She died the next morning of an infection, but her blood sugar was alright.

Banting is now known as the discoverer of insulin, although quite a number of scientists had to do work before him and after him to make insulin the clear liquid that I now inject every day. The first insulin was described as a “thick brown muck”, but with it, they were able to keep another dog alive. When they first injected insulin in a child, 14-year-old Leonard Thompson, the “thick brown muck” caused an allergic reaction and they had to stop the treatment. The next few days, James Collip worked on purifying the “thick brown muck”. He succeeded and 12 days after his first dose of insulin, Leonard got his second one, with no side effects, and successfully lowered blood sugar.

That is the glamorous story of the discovery of insulin that is often told, and it’s a nice one (except for the gruesome experiments with dogs...)! However, today, insulin is the sixth most expensive liquid in the world, just after Chanel No.5. Frederick Banting didn’t want to add his name to the insulin patent because he did not want to profit from a discovery that saved lives. He said something along the lines “insulin belongs to the world,” and thus, Collip and Best sold the insulin patent for a symbolic $1 to the University of Toronto. A hundred years later, this noble idea has been ransacked and insulin prices have reached astronomic levels in some countries, even though the production of one vial insulin costs between $3.69 and $6.16. Since the beginning of this century until 2015, the price of insulin has increased by more than 585 percent! In the US, the list price for a pack of insulin pens is about $530 at the moment and people have to engage in illegal trade with others, or cross borders to Canada or Mexico (where prices are a lot cheaper) to stay alive. It goes as far as people rationing insulin. You remember the horrendous way in which people starved alive before insulin was discovered? That’s what is happening there. When you ration insulin, your body does not get what it needs. The sad truth is that insulin no longer belongs to all, maybe it never has, and in the US, it belongs to Big Pharma corporations.

Access to insulin is always at risk in many parts of the world for a variety of reasons. I am utterly privileged to live in Germany, a country where insulin is affordable and accessible, where I have other devices to make my diabetes more manageable. But that is far from the standard around the world.

The house in which Banting lived is a museum now, and in front of it burns the ‘Flame of Hope’, which Queen Elizabeth ignited 1989. It’s supposed to burn until a cure for diabetes is found. All the while, it’s flickering, as people still die from lack of access to insulin.

(If you want to learn more about this and find out how to help, check out www.t1international.com or search #insulinforall)

Sources:

https://www.mysugr.com/en/blog/9-fun-facts-about-frederick-banting-you-need-to-know/

https://www.diabetes.org/blog/history-wonderful-thing-we-call-insulin

https://www.diabetes.org.uk/about_us/news_landing_page/first-use-of-insulin-in-treatment-of-diabetes-88-years-ago-today

https://www.t1international.com/usainsulin4allaction/

https://www.medicalnewstoday.com/articles/323774#development

http://blogs.britannica.com/2011/07/discovered-insulin/