How insulin changed the way type 1 diabetes was treated in children

Contemporary Pediatrics® :

Hello, and thank you for joining us. I'm Joshua Fitch editor for Contemporary Pediatrics®. Today I'm here with Dr. Andrew Lam, author of "The Masters of Medicine: Our Greatest Triumphs in the Race to Cure Humanity's Deadliest Diseases," set to be released April 18. Dr. Lam, thank you so much for joining us. Can you give our audience just a little bit more about you?

Andrew Lam, MD:

Sure. Thanks a lot for inviting me, Joshua. I'm a retinal surgeon practicing in Western Massachusetts. I'm an assistant professor at the University of Massachusetts Medical School.

Contemporary Pediatrics® :

Dr. Lam, can you talk about how type 1 diabetes in children went from, essentially a starvation diet treatment to insulin and kind of the story behind it? And why you deemed it necessary to go into your book?

Lam:

Yeah, there's an entire chapter on diabetes in the book. And I think you have to remember that, as you alluded to, before, the discovery of insulin type 1 diabetes was a death sentence, you know, can you imagine being a parent and being told that food would literally kill your child? You know, you and I might need 2000, 2,100 calories a day. But the only treatment they had was to basically starve these kids and give them as little food as possible to keep them alive and so these kids would have maybe a calorie diet of like 300 calories, what would that look like? That's like an egg for breakfast, maybe five olives, and a couple spoonfuls of Brussel, sprouts for lunch, an egg for dinner, and maybe a couple of spoonfuls of spinach. That's it, that's what we're talking about. And by doing this, you, it'd be horrible. And you'd basically maybe extended allies for maybe a year, you know, so it's hard to imagine a more tragic illness than type 1 diabetes. Now, the story of insulin's discovery is truly one of the greatest stories in the history of humanity. You know, it centers on this Canadian surgeon named Frederick Banting. And he was kind of a failure. You know, he had a practice in Ontario, but he wasn't very successful. He had basically very few patients. And he tried to make ends meet by giving lectures at a medical school. And he would do this for like 2 bucks an hour. I mean, it was very modest. And so he was assigned one day to give a lecture on carbohydrate metabolism, not something he had, like, kept up on. So he decided to read about it. And one night, he was up late kind of reading articles, and he came across an article from an American pathologist who had identified a patient who had a pancreatic duct stone that have blocked the flow of digestive enzymes. And what was interesting about this report, was that the acinar cells of the pancreas, which are the ones that produce all the digestive enzymes, had atrophied away, leaving only the islets of Langerhans. Now, at the time, doctors kind of suspected the pancreas had something to do with diabetes, but it didn't know how, and they had could see the islets of Langerhans cells, but they didn't know what they did or what they produced. And they thought that the reason why they couldn't isolate the product of the cells is because whatever was being made, was being overwhelmed and destroyed by all the digestive enzymes. So if Banting had this epiphany, he said, well, I'm a surgeon, what if I ligated or tied off the pancreatic duct in some dogs, we did like seven or eight weeks, so that the acinar cells that are just enzymes would go away, and then only leaving the islet cells and whatever they made, then I could take these pancreases out, squash them up, get some extract, and inject those into some dogs who had diabetes and see what happened. So you can imagine him doing this, these dogs are like lying on the ground dying of diabetes listless, he injects his extract in and suddenly they're jumping up and down, frantic, frisky, licking him on the face. I mean, it was literally a miraculous. And the story is far more in depth than this. But basically, this was the beginning of something that has made diabetes from a death sentence to a chronic manageable illness. And of course, the story really only starts there because as I alluded to the tension animosity, jealousy, envy between the co-discoverers was a true saga. You know, there were actual physical altercations a great deal of, of contention about who did what, when. So it's truly one of those great stories. It's saga full of failings, but also triumph. And it's one of the most incredible stories that one could tell.

Contemporary Pediatrics® :

Thank you, Dr. Lam, and can you kind of just further touch on how once this process this treatment process with insulin became streamlined that immediate benefit, especially for the pediatric group kind of came about?

Lam:

I mean, it was miraculous. I mean, there's so there were certain well known cases that Banting treated early on one of them was a little girl named Elizabeth Hughes, whose father was Charles Evans Hughes, who was basically the Secretary of State of the United States at the time. This is kind of one of the one of the more famous examples and she had been sent to a sanitarium in New Jersey, where, you know, if you're going to keep someone on 300, 400, 500 calories a day, you've got to lock up the food. You've got to mete out the food very carefully. You got to measure everything they're doing got to check how much exercise they're doing. I mean, she had survived in this place. I mean, we're talking about weight, well below 100 lbs, like 60 lbs, you know, 55 lbs. So she was one of Banting's first patients, and she immediately once she started getting insulin injections started eating. And she, you know, her diet, her letters are full of letters of stories, her mom saying I've had the first of a certain kind of food or fruit I've had in three years, you know, can you imagine that? It's incredible. And so she actually lived a very long life. And her life was basically standing at the very last moment by insulin. And so there's lots of photos as well of children who looked skeletal and then a year later, they're really full, fully bodied and put on a ton of weight, even chubby, and it's incredible. The transformation, the resurrections that occurred. Elizabeth Hughes' doctor from New Jersey, came to visit her in Toronto and didn't even recognize her, even though she had lived in his Institute for years. It's amazing.

For more information on Lam's book, click here.