The history of the invention of insulin is surrounded by mystery and controversy.
Every once in a while we hype the appearance of a “miracle drug”, a medicine capable of stopping an incurable disease. Most are pure smoke, but there are a few (one or two in each generation) that really make it.
The first of them was insulin, a hormone that saved the lives of millions of diabetics. Among them Mollie Kyle, the Osage protagonist of The Moon KillersMartin Scorsese's latest film, which is competing for the 2024 Oscars with ten nominations, including best film of the year.
The invention of insulin: Without it, diabetes is a death sentence
Diabetes mellitus 1 is an autoimmune disease: the body itself attacks the pancreatic cells that produce insulin. Without insulin to metabolize sugar, the body draws energy from fat, causing a buildup of ketones in the bloodstream. Ultimately, the metabolization of fat leads to ketoacidosis, coma and death.
Before insulin was isolated in sufficient quantity for clinical use, the only treatment was a strict diet high enough in calories that the body did not need to resort to fat. But at the same time it had to be light enough not to cause hyperglycemia, which obstructs microcirculation and, as a consequence, causes blindness or peripheral neuropathy.
The downside was that this Spartan diet only managed to extend the life of diabetics a little. In the medium term, the pancreas stopped producing insulin and, sooner rather than later, they ended up dying. It was a very harsh treatment for a disease that manifests itself at an early age. Until insulin became clinically available, a diagnosis of type 1 diabetes was a death sentence, more or less quickly, usually within months and often within weeks or days.
Although diabetes was not a new or unknown disease, in 1920 hardly anything was known beyond its symptoms. Since one of the main symptoms was polyuria, thousands of children died misdiagnosed with kidney diseases. However, hundreds of scientists had already investigated pancreatic secretions in the treatment of diabetes and, although in some cases sugar levels had decreased, the research had been hampered by the appearance of serious side effects.
Leonard Thompson, first to receive an insulin injection
Between the summer of 1921 and the spring of 1922, a team from the University of Toronto led by the Canadian surgeon Frederick Grant Banting managed to isolate insulin, a milestone that earned him the Nobel Prize in Medicine and Physiology in 1923 in the company of his Scottish colleague John James Macleod.
On January 11, 1922, Leonard Thompson, a 14-year-old Canadian boy who weighed only 29 kilos, became the first person to receive an insulin injection. The Canadian researchers had only been working on purifying the extract for a month and it was noticeable. The impurities caused a terrible allergic reaction and the treatment was stopped.
Luckily, they did not give up: in twelve days they achieved sufficient purity. The injection on January 23 was a success. Leonard showed signs of improvement and lived for thirteen years before dying of pneumonia. Until then, we remember, a diagnosis of type 1 diabetes was a death sentence.
Diabetes became chronic
We know what began to happen after 1923 thanks to the well-documented clinical history of one of the first people to receive complete insulin treatment, Elizabeth, the daughter of Republican Charles Evans Hughes, secretary of state, presidential candidate and later president. of the Supreme Court of the United States.
Born in 1907, Elizabeth developed diabetes in 1918. At that time, the life expectancy of a type 1 diabetic was usually no more than a few months. The only known treatment, as we have already said, was the starvation diet. If followed religiously, a diabetic could expect to live a couple of years before, unprotected by her malnourished state, she succumbed to any infectious disease.
When diabetes appeared, Elizabeth was 1.51 meters tall and weighed 34 kilos. On diets of 800 calories per day, in August 1922 she only weighed twenty. The moment she heard about the Toronto doctors' pioneering treatment, her mother contacted Dr. Banting, who accepted her as a private patient. Elizabeth was going to receive the liquid that would grant her almost sixty more years of life.
Accompanied by her mother, the girl arrived in Toronto in August 1922 and began receiving insulin injections. She recovered quickly and three months later she was a healthy looking girl who had regained her weight. She returned to school in 1923 and graduated in 1929. A year later she married and had two daughters and a son. She died of a heart attack in April 1981, aged 73. With Elizabeth, diabetes had not been cured, but it had become chronic.
Elisabeth Gosset Hughes was not the first patient to receive the treatment, but her father's fame caused the success of insulin to make headlines throughout America and Europe. Those who could afford it rushed to purchase the treatment, which began to be distributed by couriers throughout North America. This is how he reached Oklahoma, where thanks to oil the Osages had one of the highest per capita incomes in the world.
An expensive treatment that only a few could afford, including the Osage
Mollie Burkhart, the Osage protagonist of The Moon Killers, the Martin Scorsese film, suffered from type 1 diabetes. She was born on December 1, 1886, and was diagnosed at an unknown date in her youth. We are only certain that she was (supposedly) receiving insulin treatment starting in 1925, when FBI agents opened the file on the deaths under strange circumstances of dozens of wealthy Osages.
In reality, Mollie's diabetes had provided a perverse way of delivering poison. The Shoun brothers, doctors from Fairfax, showed up at her Gray Horse home all the time to inject her with what was said to be a new miracle drug: insulin. But Mollie's condition, instead of improving, was getting worse.
At the end of 1925, the priest of Fairfax received a secret message from Mollie telling him that his life was in danger. Sometime in 1926, Mollie was transferred to a hospital, where, separated from her husband and the Shouns, she began receiving treatment with two daily injections of insulin.
He died in June 1937 of unknown causes after receiving almost 2,000 injections of real insulin.
Manuel Peinado Lorca, Professor Emeritus. Director of the Royal Botanical Garden of the University of Alcalá, University of Alcalá
This article was originally published on The Conversation. Read the original.