A recent article in the Toronto Star, Miracle on Bloor Street, reminded me that insulin therapy's 90th birthday will be arriving this week. Leonard Thompson, a 14-year-old teenager who had lost weight to 65 pounds, received his first injection in Toronto, Canada on January 11, 1922. He dramatically improved, and went on to live thirteen more years, dying at age 27 of pneumonia contracted after a motorcycle accident. (I have been unable to identify if the accident was in any way associated with hypoglycemia or other diabetes issues.)

Another success story from the early days of insulin therapy involves a young woman, Elizabeth Hughes. Elizabeth, like Leonard, was dying of diabetes before getting her first insulin injections in 1922. After a long and fulfilling life, she died in 1981 at age 73. It's been estimated that she received 42,000 insulin injections over her lifetime.

There are many more such stories from the early days, and many are summarized in a book which I strongly recommend that the interested reader locate and read: The Discovery of Insulin by Michael Bliss. (An excerpt from the book is available to peruse at Amazon.com.) Dr. Bliss, a Canadian historian who has written on several medical topics, wrote The Discovery of Insulin in 1982, and has lectured on the subject of the discovery of insulin many times. I have read and reread his book several times, and heard his presentation three times, and it's heartwarming to hear it every time.

The story of the discovery of insulin is also a story about scientific trial and error, and about scientific politics: the principal codevelopers of insulin included four men (Frederick Grant Banting, Charles Herbert Best, James Bertram Collip, and John James Rickard Macleod), of which two shared the 1923 Nobel Prize for Medicine: the prize was awarded to Banting and  Macleod "for the discovery of insulin". In many people's minds, Banting deserved recognition as well, and the choice of Macleod as co-winner was controversial. Banting decided to share the prize and gave half his prize money to Best. Macleod, in turn, split his half with Collip.

It's fascinating to read from Banting's Nobel Lecture (his acceptance speech) what the first patients went through as part of the clinical trial:

"In general the routine followed in all these clinics was as follows.

"After a careful history had been taken, the patient was given a complete physical examination... [Lab tests included] daily routine urinalysis [which] included the volume of the twenty-four hour specimen, the specific gravity, the reaction, and tests for albumen...acetone bodies... [and] sugar determinations... In addition to the above, the blood sugars were estimated...

"At first the patient continued on the same diet as that previous to his admission to hospital in order to obtain some idea of the severity of his case, and to avoid complications from sudden change of diet... On the second or third day he was placed upon a diet, the caloric value of which was calculated on his basal requirement... The patient remained on this basal requirement diet at least a week. During this time, blood sugar was estimated before, and three hours after, breakfast, in order to determine the fasting level and the effect of food. The quantity of sugar excreted was estimated daily...