Diabetes has been affecting lives for thousands of years. An ailment suspected to be diabetes, ‘excessive urination’, was recognized by the Egyptians in manuscripts dating to 1550 BCE. Treatment described in the manuscript suggests downing ‘a measuring glass filled with water from the bird pond, elderberry, fibres of the asit plant, fresh milk, beer-swill, flower of the cucumber, and green dates.’
In 1776 the distinction between Type 1 and Type 2 diabetes was made for the first time; for some people the condition was fatal in less than five weeks while for others it was a chronic condition.
The first significant dietary approach to treating diabetes was applied by Rollo in 1797. He successfully treated a patient using a high fat and protein diet after observing that sugar in the urine increases after eating starchy food.
In 1897, the average life expectancy for a 10-year-old child with diabetes was about 1 year. Diagnosis at age 30 carries a life expectancy of about 4 years. A newly diagnosed 50-year-old might live 8 more years.
Between 1900-1915 diabetes treatment includes: the “oat-cure”, this was a daily allowance of approximately eight ounces of oatmeal mixed with eight ounces of butter, eaten every two hours. Other remedies included the milk diet, “potato therapy” and overfeeding to compensate for the loss of fluids and weight.
In 1916, Frederick Allen promotes a strict diet regimen, which was soon widely adopted. Patients were admitted to the hospital and given only whiskey mixed with black coffee every two hours from 7 am to 7 pm. This regimen was followed until there is no sign of sugar in the urine – usually 5 days or less. A strict diet followed. Unfortunately, those patients with Type 1 commonly died during the treatment, likely from starvation.
Insulin is discovered.
It took over 50 years to discover which cells produce insulin, to understand that the absence of insulin producing cells leads to Type 1 diabetes and to find a way to produce insulin, safe for the use in those living with diabetes.
Insulin was first produced in 1922, it was a quick and short acting ‘soluble’ or ‘regular’ insulin which had to be injected at least twice daily. These insulins were crude and impure and early patients had to endure painful intramuscular injections. These insulins were taken from animals, commonly pigs and cows; many are still available today.
More than 2 tons of pig parts to produce 225 ml of purified insulin. These were the only insulins available until 1982.
In 1936 protamine and zinc were added to insulin to slow down its absorption to make a longer acting insulin and twice daily subcutaneous injections became the norm. It wasn’t until the 1980s that a basal bolus regime started to be used regularly.
Sequencing and synthesis of insulin – Many Firsts
As the science of genetic engineering advanced, insulin was the first:
- protein to be fully sequenced, accomplished by Frederick Sanger.
- human protein to be chemically synthesised.
- human protein to be manufactured through biotechnology, using bacteria to grow the insulin protein.
Synthetic insulin is ‘human insulin’ as it is not derived from animals, it is less likely to cause allergic reactions than animal insulin. These became widely available through the 1980s.
Analogue insulin is a genetically modified form of insulin, whereby the amino acid sequence is altered to change how the insulin is absorbed, distributed, metabolised and excreted. These are used to improve the effect of insulin and work
The future of insulin and treatments for Type 1.
Insulin remains the main way of managing Type 1 diabetes. However the mechanism of action and the technology used to deliver insulin is becoming ever more advanced in bioengineering. This has seen the development of insulin pumps, blood glucose monitors, continuous glucose monitoring systems and a range of insulin pens.
New treatments in the pipeline
Insulins of different strengths to help overcome night time hypos or a significant resistance to insulin are under development. Insulin is still delivered predominantly through subcutaneous injection, however this is not ideal for everyone and so oral or inhaled delivery of insulin is being researched. The most all-encompassing treatment for Type 1 diabetes is the development of an artificial pancreas. To find out more information on what stage of development the artificial pancreas is see here: https://diabetes-appg.co.uk/2016/05/10/the-technology-jigsaw-for-the-artificial-pancreas/