Experiences of First Insulin-Treated Patients (1922–1923)

Abstract

Background: Historical description of first insulin trials just after its discovery. Areas of Uncertainty: The review includes first initiatives of insulin treatment. The probability of other trials, not reported to the Insulin Committee of the University of Toronto and conducted in the years 1922 and 1923, is quite low. Data Sources: (1) Archival Collections, University of Toronto: Insulin Discovery and Early Developments of Insulin (University of Toronto Libraries digital special collection, with a particular section entitled “From a Patient's Point of View” containing letters, patient charts, newspaper clippings, and photographs). (2) Thomas Fisher Rare Book Library: Academy of Medicine Collection, F. G. Banting Papers, C. H. Best Papers, J. B.Collip Papers, W. R. Feasby Papers, E. Hugues Papers, J. J. R. Macleod Papers. (3) National Library of Medicine: PubMed search for the topic of history of insulin, History of Medicine-on syllabus archive. (4) Selected Journals for History of Medicine: Bulletin of the History of Medicine, Journal of the History of Medicine and Allied Sciences, Medical History. (5) Selected books: The Discovery of Insulin (M. Bliss); Diabetes, Its Medical and Cultural History (D. von Engelhardt); H. C. Hagedorn and Danish Insulin (T.Deckert), Continuing Quest (W. A. Tomkins). Therapeutic Advances: This historical review shows the quick progress from impure pancreatic extract to the selective isoelectric precipitation of the hormone, which made possible the introduction of insulin in the clinic. Conclusions: The coordination between the Departments of Physiology (Connaught Laboratories) and Medicine (Toronto General Hospital) was essential for the discovery and implementation of insulin therapy. The Insulin Committee was decisive for the negotiation with the pharmaceutical industry, the purification, grand-scale production, patents' achievement, and provision of licenses to expert clinicians and prestigious health centers. At the end of the year 1923, insulin treatment was already extended to Europe (mainly Scandinavia, Great Britain, and Spain). Insulin discovery and treatment changed the clinical spectrum of diabetes.

A Century of Insulin

“…By summer of 1922, Banting began treating patients with diabetes in a private clinic in Toronto [18]. The first US patent application for insulin was filed under the names Collip and Best in June 1922 [19].…”

100 years on: the impact of the discovery of insulin on clinical outcomes

“…There were few effective treatments beyond dietary restrictions and extended periods of bed rest. 6 7 Patients with T1D were often kept in hospital for weeks or months at a time, while their calorie intake and glucose excretion were meticulously recorded. 8 The majority of physicians relied either on starvation treatments that combined low-calorie diets with periods of fasting, as promoted by Allen and Joslin, or low-carbohydrate, ketogenic diets to treat children with diabetes ( figure 1 ).…”

“… 8 The majority of physicians relied either on starvation treatments that combined low-calorie diets with periods of fasting, as promoted by Allen and Joslin, or low-carbohydrate, ketogenic diets to treat children with diabetes ( figure 1 ). 6 7 The aim of the severe calorie restriction was to reduce glycosuria, dehydration and the development of diabetic ketoacidosis, which was a frequent cause of death in children with diabetes. However, the extent of the calorie restriction had to be carefully monitored owing to the negative effect on growth and the ability of the patient to resist and respond to infections.…”

“…The discovery and successful extraction of insulin by Frederick Banting, Charles Best, John Macleod and James Collip, which has been extensively reviewed, including a comprehensive account by the Canadian historian Michael Bliss, was literally life-saving and was described as one of the miracles of modern medicine. 6 8 Insulin therapy was the first treatment that helped patients return to a healthy weight and to restore their levels of energy, while reversing and preventing diabetic ketoacidosis. Moreover, the decision of the researchers to license insulin for just one Canadian dollar and to make it freely available worldwide enabled many companies to begin extracting and purifying insulin, speeding up supply to those most in need.…”

“…To mitigate concerns, many patients were initially treated with small doses to prevent hypoglycemia and to produce an average weight gain of 1 lb in 15 days. 6 Outside of the main teaching hospitals, the lack of experience meant that care could often be quite variable from patient to patient and that patient education was often not provided in a consistent manner. 15 Many physicians were initially skeptical that insulin could or should be administered by patients.…”