Insulin Past, Present, and Future: 100 Years from Leonard Thompson

Abstract

Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus pathophysiology, childhood diabetes or what we now call type 1 or autoimmune diabetes mellitus was almost universally fatal. In limited-resource countries (LRC) around the world, this remains sadly true because of the expense and unavailability of medical care, medical information, and/or medications. In 1889, Minkowski and Mering identified the pancreas as the likely source of the problem in pancreatectomized dog experiments, and Langerhans, working with Virchow, identified the islands of pancreatic tissue now named after Langerhans as the likely source of the problem. Prior to that, Cawley, Boucherdat, Zuelzer, Gley, de Meyer, Schafer, Scott, Kleiner, and Paulescu all worked on this problem with varying results until Banting, Best, MacLeod, and Collip in Toronto in 1921 successfully treated pancreatectomized dogs with an alcohol-based pancreatic extract and then were the first to do the same with children and adults with diabetes, starting with Leonard Thompson in early 1922. Urinary and blood glucose levels were reduced, and clinical symptoms decreased concurrently. The magnificent medical historical work by Professor Michael Bliss, also from Toronto, as well as an excellent US NPR Television documentary, describes the trials and tribulations of this event that culminated in the “fastest Nobel Prize” awarded. Progressive biopharmaceutical advances have modified insulin from pigs and cows and then genetically engineered insulin to work much faster and also much slower to provide more modernized ways of providing insulin. Insulin pens then replaced vial and syringe administration, and then insulin pumps coupled with continuous blood glucose sensors have made delivery more physiologic in addition to more attention paid to nutrition advice, education, and psychosocial support around the world. Programs to assist delivery of expensive insulin to LRC administered by Insulin for Life, Life for a Child (LFAC), Changing Diabetes in Children (CDIC) coupled with support by ISPAD (International Society for Pediatric and Adolescent Diabetes) have continued to make such advances available thorough wonderful philanthropy in insulin manufacturers and manufacturers of blood glucose monitoring equipment and insulin pump/sensor suppliers.

Continuous Glucose Monitoring in Transient Neonatal Diabetes Mellitus—2 Case Reports and Literature Review

“…All three can be used in infants, children, adolescents, adults, and the elderly without realizing that they are ideally administered about 15 min before meals to try and control the glycemic fluctuations of most foods and snacks and that they would need to be coupled with some form of basal/background insulin for glycemic control between meals. All fast-acting insulin analogs share the same potential benefits and have minimal differences in terms of clinical performance, reducing nocturnal and postmeal hypoglycemia, and improving coverage for postmeal glycemic excursions [ 11 ].…”

Las insulinas en pacientes con Diabetes Mellitus tipo 1 y 2. Revisión

“…Se encontró un total de 45 artículos, de los cuales se excluyeron 25, basándonos para esta investigación solo en 20 artículos de ellos. (10)…”

Insulin detection in diabetes mellitus: challenges and new prospects

“…Combinations of bolus and basal insulin analogues have enabled close mimicking of the physiological secretion of insulin, to achieve improved diabetes mellitus management 15 . Historically, a vial and syringe were the only insulin administration options 17 . Even today, subcutaneous insulin injection is the most widely used administration route and is carried out using insulin pens 18 and infusion pumps 19 .…”