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2021 marks the 100th anniversary of insulin’s discovery – the first life-saving treatment for diabetes. In the century since its breakthrough, insulin has saved and improved the lives of millions of people with diabetes in Canada and worldwide.

In 1921, a Canadian team of researchers discovered a treatment for the (then fatal) disease of diabetes. Inside a laboratory at the University of Toronto, Dr. Frederick Banting, Dr. Charles Best, Dr. James J.R. Macleod, and Dr. J.B. Collip succeeded in producing extracts from a pancreas that contained an effective anti-diabetic agent. They successfully tested the extract on patients with diabetes at Toronto General Hospital, named it insulin, and presided over its development in treating innumerable patients, saving lives around the world.[1]

What’s in a name?

Insulin comes from the Latin word insula, meaning “island.” Specifically, it refers to the islets of Langerhans (clusters of specialized cells in the pancreas that secrete insulin and glucagon). Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. It is made by the beta cells of the pancreas and released into the blood when the glucose level goes up, such as after eating. Insulin helps glucose enter the body's cells, where it can be used for energy or stored for future use.

A stepping (mile)stone

The discovery of insulin has transformed diabetes from a death sentence to a chronic condition. Further related advances in technology and research will continue to improve diabetes management and, perhaps one day, cure diabetes.

“Finding a cure will depend on how much we understand whole body biology and physiology. Even though we are trying our best, I don’t think we understand our bodies all that well. Fundamental biology is key. If you cannot understand biology, you cannot understand disease,” said Dalhousie Medicine New Brunswick’s Dr. Thomas Pulinilkunnil in a 2019 Dal Med News article discussing heart health and diabetes.

The Diabetes Canada Scholar and associate professor in Dalhousie University’s Department of Biochemistry & Molecular Biology noted that simply increasing the dosage of insulin is not an appropriate method of dealing with the effects of the disease.

“Research over the past couple of years has shown that giving patients excess insulin is not advisable. We still have a lot to learn about how diabetes causes metabolic complications in multiple organs, and only then might we be closer to a cure.”

Keeping hormones in check

Dalhousie’s Department of Pediatrics Division of Endocrinology is home to a wide range of activities focusing on helping children with diabetes and other diseases relating to endocrinology. The clinical work is well supported by a professional and experienced endocrine and diabetes team made up of doctors, nurses, dietitians, a social worker, and administrative assistants who provide patients with comprehensive diagnoses, treatment, and education.

Nearly 50 per cent of the clinic’s patients are using insulin pumps. To help meet its goal of providing families with the tools they need to manage their own diabetes, the clinic offers comprehensive insulin pump services for children of all ages with Type 1 diabetes and provides group education workshops for its patients and families living with diabetes. The objective is to help better equip parents and youth with the skills they need to manage their diabetes well for lifelong health.  The clinic partners with the Nova Scotia Insulin Pump Program (NSIPP) to help families with the expense of insulin pumps.  NSIPP provides assistance to families who meet financial and medical eligibility to help them access this treatment option. This program provides financial support that depends on family income and size for people with type 1 diabetes up to their 26^th birthday.

Dr. Elizabeth Cummings, Division Head of Pediatric Endocrinology, is quick to point out that the insulin pump program is providing a necessary service, but it does not solve the difficulties of living life with diabetes.

“People think that a pump makes life easier, and it manages the diabetes for you,” says Dr. Cummings. “The bottom line is that it’s still a lot of work.”

The insulin pump program and education workshops help to equip youth with the tools and skills they need to live well with diabetes and to transition successfully to adult diabetes care. They collaborate with the clinic’s adult endocrinology colleagues and the Diabetes Care Program of Nova Scotia to provide diabetes transition services and clinics (or virtual programs during COVID).

When Frederick Banting et al first discovered insulin and subsequently sold the patent to the University of Toronto for only $1, it was their way of giving back to the world. “In the spirit of that philosophy, we need to be supporting families of those living with diabetes every day so they can have the best possible care,” says Dr. Cummings. “That was their gift to humanity.”

Dr. Cummings feels the NSIPP is an important step in the direction of living up to that altruistic ethos. However, there are still important gaps is support for type 1 diabetes management for those over age 26 and for newer technologies like continuous glucose monitoring systems.

Prior to COVID-19, small groups of families would come to the clinic to receive important information about what an insulin pump does, how to safely use it, and the work required to maintain it. Thanks to the pandemic, these education sessions are now offered virtually, allowing more families to participate without the hassle of traveling long distances.

Celebrating a Century

Over the past century, Canadian scientists have made game-changing advancements in biomedical sciences, human health, and health care. The discovery of insulin not only resulted in the 1923 Nobel Prize in Medicine, but it also provided a boost to medical research in Canada, as patent royalties from insulin funded new facilities and research programs.[2]

Insulin is decidedly one of Canada’s greatest contributions to medical research. The discovery made one hundred years ago in a lab housed on Canadian soil is internationally renowned for saving the lives of millions of people living with diabetes and positively impacting people’s lives on a global scale.

Footnotes:

[1] “Discovery of Insulin,” Government of Canada online, March 24, 2021, https://www.pc.gc.ca/en/culture/clmhc-hsmbc/res/information-backgrounder/decouverte-insuline-insulin-discovery.

[2] “Discovery of Insulin,” Government of Canada online, March 24, 2021, https://www.pc.gc.ca/en/culture/clmhc-hsmbc/res/information-backgrounder/decouverte-insuline-insulin-discovery.