Bec Johnson, Type 1 Diabetes Family Centre CEO
November 14, 2021
A century ago, Canadian research team Frederick Banting, Charles Best, James Collip, and John Macleod discovered a vital hormone. After testing it on diabetic dogs, they injected their miraculous solution, insulin, into human patients, averting the terrible, inevitable decline towards death that was the fate of every person diagnosed with type 1 diabetes prior to 1921. The efforts to purify insulin, prove its value, and then to produce it at scale form a remarkable story of deep dedication, astonishing scientific breakthroughs, powerful hope, and intense competition.
People living with diabetes the world over clamoured for the new discovery, knowing that for them, insulin was the key to life. However, historian Michael Bliss comments, “the prosaic reality was that… for all the diabetics to whom insulin became the staff of life itself, there were others who could not afford it … there were diabetics in the 1920s whose doctors had yet to learn about insulin or were too conservative to use it… [and] there were, and in parts of the world still are, diabetics who never knew they were diabetic, having access to no doctor at all.”[1]
As Bliss identifies, the discovery of insulin immediately raised compelling issues of access – to the medicine itself, to the tools with which to administer it, to healthcare, and to knowledge. While many notable advances have been made – insulins are now no longer extracted from the organs of animals but produced biosynthetically, they have been manipulated to give patients the option to take insulins that peak at different times, and the invention of insulin pens and pumps has made administering insulin faster, easier and more finely-tuned – the very same issues of access remain with us today, 100 years on.
Insulin was a truly miraculous discovery, but insulin did not solve the problem of type 1 diabetes. In fact, extending the lives of people with diabetes with insulin raised many more questions than answers; people rapidly learned that diabetes was a far more complicated disease than anyone realised before the early 1920s, and that patients needed a whole suite of further supports to live good lives. With insulin, Bliss says, “the stone was rolled away, and diabetes became a matter of the quality of life, not the speed of death.”[2]
Quality of life proved to be an elusive goal that brought diabetes care into focus during last 100 years. In the 1920s American doctor Elliot P. Joslin was a pioneer in diabetes care, and he was adamant in his position that good glucose control, achieved through a restricted carbohydrate diet, exercise, and frequent testing and insulin adjustment, would prevent diabetes complications.[3] His views on the importance of tight glucose control were widely disputed[4] during his lifetime, but vindicated 30 years after his death upon the publication of the DCCT (Diabetes Control and Complications Trial) in 1993, which showed clear relationships between glucose management and complication risks.
Joslin showed that for a person with diabetes, a quality life required much, much more than insulin. Access to quality care, information, know-how, technology, support and of course insulin itself has become central to the lives of people diagnosed with type 1. But even now, many of us, Australians included, do not have access to the vital tools we need to manage our condition.
[1]Bliss, M. The Discovery of Insulin. University of Toronto Press, Canada, 1982. [2] Bliss, M. (1982) p248 [3] Joslin, E. P. Diabetic Manual. Lea and Febiger, USA, 1924. [4] Feudtner, C. (1995). The Want of Control: Ideas, Innovations and Ideals in the Modern Management of Diabetes Mellitus. Bulletin of the History of Medicine: 69(1).