The centenary of insulin

Last update: 16/03/2021

The centenary of the development of therapeutic insulin in 1921 by Frederick G. Banting and Charles H. Best, under the supervision of John J. R. Macleod and with the collaboration of James B. Collip is a milestone of considerable significance for many in the global diabetes community and a landmark breakthrough in the history of medicine.

In May 1921, the experiments that would culminate in the synthesis of commercially available insulin first began in Toronto, Canada. Frederick Banting and Charles Best experimented on a number of diabetes-induced dogs with limited success. A breakthrough came when one of the dogs, named Marjorie by the Toronto team, survived for 70 days with injections of the pancreatic extract, or ‘Isletin’ as the team were calling it. On January 23rd of the following year, the first successful injection of insulin was administered to a person living with diabetes.

There are other key milestone events in the timeline of the discovery of insulin, taking us from the initial idea that led to the research, through to mass production and the wider distribution of insulin beyond North America. Of course, the work in Toronto in late 1920 and early 1921 did not happen in a vacuum. The International Diabetes Federation will take the opportunity to mark many relevant dates and themes in the history of diabetes, including pioneering work that took place prior to the discovery and the subsequent developments that have transformed diabetes care over the past 100 years.

While these historic events have saved and improved the lives of millions living with diabetes, it is important to remind ourselves that insulin and other diabetes medicines and care still remain beyond the reach of many who need it.

Securing universal access to insulin for all who require it remains a global challenge. The barriers to access and affordability are myriad and complex, reflecting the multiple steps involved in the production, distribution and pricing, as well as the infrastructure required to ensure the appropriate and safe use of insulin.

United, the global diabetes community has the numbers, the influence and the determination to bring about meaningful change. We need to take on the challenge. We owe it to the millions of families affected by diabetes and we owe it to the legacy of Banting and Best. Collectively, we must address the burning question on the lips of many who may not be able to ask it for themselves: “how much longer?”

Insulin at 100: A life-saving discovery but more remains to be done

  • The journey to a medical miracle

    • October 1920 - Fredrick G Banting has idea for insulin research
    • November 1920 - Banting meets John JR Macleod
    • May 1921 - Banting begins experiments, assisted by Charles H Best
    • August 1921 - Banting and Best first use extracted insulin to regulate the blood glucose of dogs with severe diabetes
    • December 1921 - James B Collip joins the research team to help purify the crude insulin extract
    • January 1922 - The first successful insulin injection is administered to Leonard Thompson on January 23
    • October 1923 - Banting and Macleod are awarded the Nobel prize for the discovery of insulin

Insulin at 100 perspectives

Over the past 100 years, millions of people with diabetes have survived and thrived thanks to the research conducted in Toronto in 1921 and the subsequent innovations in diabetes care.

People living with diabetes from across the world share their personal perspectives on living with the condition and what the centenary of insulin means to them.

  • Mariana Gómez (Mexico)

    Mariana Gómez lives with type 1 diabetes. She is member of the IDF Blue Circle Voices network

    How were you diagnosed?

    I was diagnosed with type 1 diabetes over 30 years ago in Mexico City. I was seven years old. I had been feeling very unwell for about a month. I was losing weight, drinking a lot of water, my vision was blurry, I lacked energy and didn’t want to play. As I had always been extremely active and alert, my parents knew immediately that something was wrong. They took me to my paediatrician and then to different hospitals, where I was prescribed treatments. But I did not get better.

    My health deteriorated until, one morning, I felt strong abdominal pain and could not raise my head nor open my eyes. I was taken back to hospital, where no one knew what was wrong with me. One of the doctors noticed a fruity odour on my breath. He asked my parents for permission to run a blood glucose test. I remember being out on an IV drip. I felt tired and confused. I fell asleep.

    Five days later, I woke up. My grandfather was sitting at my bedside. My mother soon joined him. As soon as I saw her, I started to feel safe. She always made things better. A few weeks later, I was able to go back home, but my life had changed.

    How did your diagnosis affect your family?

    My diagnosis came as a complete surprise to my parents. There was no history of type 1 diabetes in the family and they knew nothing about the condition. The cost of the equipment and supplies that I would require to ensure a good quality of life was a shock for them. I had no health insurance and my family could not get insurance coverage for me. This was the start of a long, difficult period for our family, without sufficient resources to manage my condition. However, my parents adapted. They learned whatever they could. Soon, they became my diabetes educators. My father is a scientist and his colleagues from all over the world sent him magazines with the latest information on diabetes.

    What are the three most important things that have supported your diabetes care?

    Diabetes education has been key. Reading and studying about my condition has empowered me to help not just myself, but others as well. My family has also been a huge support, along with the diabetes community that is always there to provide help and advice.

    What has been your lowest point with diabetes?

    My lowest point was when my husband and I had to decide whether to buy blood glucose test strips or food. Despite the difficulties, I see myself as privileged since I can survive and have options. This is not the case for everyone with diabetes in my country. For some families, affording diabetes care is just not an option. This stark reality is what motivates me to advocate for myself and all people with diabetes.

    Have you ever had issues accessing insulin?

    In Mexico, all people with diabetes have had issues accessing insulin at some point. Insulin is perhaps cheaper than in other countries, but only around one in three Mexicans with diabetes earn enough to afford everything required to manage their condition. Those of us who can afford our treatment cannot simply stand by and do nothing. We know what is needed and have tried for many years to influence decision-makers to allocate the required resources. However, we also acknowledge that we require training to strengthen our advocacy efforts.

    How would your life change if you could not access the diabetes care you need?

    Insulin is not optional when you live with type 1 diabetes. If I could not access it, I would die. Many do not have ready access which is why we must work , harder and stronger together to bring about change. Living with diabetes is hard enough in itself, but beyond the day-to-day management of my diabetes I also have had to become the best diabetes advocate I can be to ensure my voice is heard and I get the care I need to stay alive.

    If you could change something about your diabetes care, what would it be?

    I would like to change the fact that I constantly feel like I am swimming against the tide. I did not choose to have type 1 diabetes. I believe I have the right to health and firmly believe that this, just like other important human rights such as freedom, security and education, should not be negotiable. People with diabetes need medicines, devices, supplies, appropriate care and education on how best to manage their condition.

    What do you think needs to change to improve the future of people living with diabetes in your country?

    Many things need to happen in Mexico. We need to guarantee appropriate care, treatment and education for all people living with diabetes. We need to help people with diabetes thrive, not simply survive. We need to guarantee that our right to access health care is respected and supported.

    What would you like to see change in diabetes over the next 100 years?

    Hoping for a cure might be too ambitious. I would like to see every person affected by diabetes able to access the care they need. No person with diabetes should die because of lack of care and no one should ever feel alone. We need to work harder as a community so that we all feel included and supported.

    What does the centenary of insulin mean to you?

    Without the discovery, I would not be giving this testimonial. The centenary means there was a group of people with a shared vision who collaborated to save lives. We need the scientific community and people with diabetes to work together to bring health and happiness to everyone affected by the condition.

    If you could go back and talk to yourself when you were diagnosed, what would you say?

    If I could back in time, I would say, “Hold on tight little girl. This is going to be a tough journey.”

  • Riva Greenberg (USA)

    Riva Greenberg has been living with type 1 diabetes for 48 years. She is an advocate, author, public speaker and a member of the IDF Blue Circle Voices network.

    How were you diagnosed with diabetes?

    I was diagnosed when I was 18. I came home from college for an unexpected winter break. I had been having the typical symptoms of diabetes for about three months: peeing a lot, thirsty, losing weight without trying. I also had cramps in my legs that were very painful. One night, I woke up screaming in pain from the leg cramps. My parents took me to the doctor, who measured my blood glucose. It was very high. I was admitted to hospital and spent four days there. They brought down my blood glucose and taught me how to inject insulin by practicing on oranges. I vividly remember thinking that my life was beginning and ending at the same time. I could barely comprehend that I had a condition that required injections for the rest of my life. I went back to college with piles of insulin and syringes.

    How did your diagnosis affect your family?

    My family understood my diagnosis, but could only relate to type 2 diabetes. This ran in both their families. My mother was very concerned. She would always ask me about my diabetes whenever I came home from college. Being diagnosed at 18 can be harder than when you are a child or older adult. You often live away from home and therefore can’t rely on family support. I was on my own for quite a long time, until I met other people with diabetes.

    What are the three most important things that have supported your diabetes care?

    Besides insulin, first is my own discipline and dedication to taking care of myself. I eat healthy and walk every day, I know the importance of getting good sleep, not being stressed and not being too hard on myself. I can't “control diabetes,” but I do my best and that’s what’s important. Second is the support that I receive from my husband, which has been amazing. Third is staying abreast of all the new developments in diabetes so that I can be well informed of what could be helpful to me.

    What has been your lowest point with diabetes?

    My lowest point happened almost 20 years ago, when I experienced my worst episode of low blood glucose. My husband and I were in London, staying at a friend’s house. One night, I woke up in bed and found my way to the bathroom. I stood in front of the medicine cabinet mirror, looking at my reflection and wondering what I was doing there. I had the presence of mind to think, “Oh my god, I think my blood glucose is low.” I walked back to the bedroom to get my blood glucose meter, and then returned to the bathroom where I sat on the black and white tiled floor, which I remember well. I checked my blood glucose and it was 29 mg/dl. I thought to myself, “Okay, I need to eat some glucose tablets.” I did and laid on the floor for 15-20 minutes. I began to feel a little better and snuck my way back to bed. It is an episode I will never forget.

    Have you ever experienced any issues accessing insulin?

    I am very fortunate that insulin is readily available to me. I am aware that it is not available and affordable to many people across the world, including in wealthy nations like the USA. A few years ago, I was fortunate to do some volunteer work at a diabetes clinic for the underserved in Bangalore, India. Every first Sunday of the month, the clinic would invite all the families of children with diabetes in the city to come and receive a vial of insulin, along with 30 test strips so that the children could check their blood glucose once a day. I experienced something I will never forget when the diabetes educator showed the children how to inject their insulin. “As you inject,” she said, “smile because we are so happy to have this medicine.” I found that enormously touching and a wonderful thing to be able to have gratitude for insulin and all that we have. I am fortunate that I can readily access insulin and always keep in mind that it is a lifeline. People with type 1 diabetes need to be able to get it when they need it.

    What changes have you seen over your nearly 50 years living with diabetes?

    Living with diabetes for 48 years gives me something I call historical gratitude. When I was diagnosed, blood glucose meters were still ten years away from being available. I would have to go to a lab twice a year to find out what my blood glucose was. Now we have Continuous Glucose Monitors (CGMs) and I can see my blood glucose level every five minutes. Insulin delivery has also advanced significantly, making diabetes management easier. Syringe needles have gotten shorter and thinner and we have insulin pens. Information about diabetes is also much more accessible than it used to be. Decades ago, you basically only got information from your doctor. Now, thanks to the internet, social media, books and magazines, there is an enormous amount of information available. This is fantastic because, as they say, knowledge is power.

    Have you experienced low awareness or misconceptions around diabetes?

    I have experienced many misconceptions and I actually wrote a book on the topic - 50 diabetes myths. A big one is that you can get diabetes by eating sugar. There is also a general public perception that people with type 2 diabetes bring the condition on themselves by being lazy and overweight. Type 1 diabetes, on the other hand, is not understood at all by many people. They have no idea of what is involved and how complex it can be to manage the condition on a daily basis.

    If you could go back and talk to yourself when you were diagnosed, what would you tell yourself?

    I would tell myself, “It's okay, you’re going to get through this. Not only are you going to get through this, but you’re going to be all the stronger for it.” I really believe I am healthier because I have type 1 diabetes. I pay much more attention to eating healthy and getting regular exercise. I therefore expect to live as long a life, if not longer, than many of my contemporaries who do not have diabetes. When I was diagnosed, people with type 1 diabetes were pretty much told that the condition would cut twenty years off our life spans. No more! We now know that we can live long and healthy lives if we take good care of our diabetes.

    What’s your message to people with diabetes who have just started their journey with the condition?

    My message to people with diabetes today completely lets them off the hook: “You cannot control blood glucose. You cannot control diabetes.” Everybody tells us to control our diabetes, but it is unpredictable and there are too many variables in play. We can influence, navigate and respond to our condition with the right behaviours. This should be considered as success.

    What would you like to see change in diabetes over the next 100 years?

    I will not be around for that long so I will shorten the timeframe to the next ten years. I would like to see diabetes cured. Although, having lived two thirds of my life with the condition, it is almost impossible for me to know what it would be like to live without it. I do not necessarily think we will find a cure in the next ten years, so it would be amazing to see management made so simple that you do not even have to think about it. We are moving rapidly in that direction with the artificial pancreas, which manages blood glucose and insulin delivery automatically.

    What does the centenary of insulin mean to you?

    The centenary of insulin is quite amazing for different reasons. Firstly, that we can celebrate a discovery that keeps me alive. Secondly, that access and affordability remain issues for a medicine that was made available so long ago.

  • Sabine Hančl (Germany)

    When insulin was discovered and used to treat people living with type 1 diabetes, it was extracted from the pancreases of cows and pigs. Animal insulin remained the only treatment option for type 1 diabetes until the 1980s when synthetic human insulins were developed. Since then, the use of animal insulin has declined significantly but many people with type 1 diabetes still rely on it.

    Sabine Hančl from Germany is one of them. Diagnosed with type 1 diabetes in 1963, Sabine has a life-threatening allergy to synthetic human insulin and therefore depends on animal insulin for her treatment.

    How were you diagnosed with type 1 diabetes?

    I was diagnosed with type 1 diabetes in May 1963. I was nine years old. My parents took me to the Children’s hospital on a Sunday afternoon. I had been feeling unwell for some time. I had been drinking lots of water, losing weight, feeling increasingly tired and not eating much. They measured my blood glucose at the hospital and it was very high. Type 1 diabetes was a very rare condition in children at that time and so the hospital was unfamiliar with the appropriate therapy. They consulted with the distant University of Düsseldorf and immediately treated me with insulin.

    For the first few days following my diagnosis, I was given salted water gruel and soup to eat and lots of mineral water and tea to drink. A laboratory assistant came to my bed several times a day to measure my blood glucose, carrying all the required accessories on a tray. I was always particularly curious about the rounds, during which doctors patiently explained to me why I would always require insulin injections. Before I was discharged, my mother learned how to boil and assemble the glass syringe, inject me with insulin and calculate my diet. At that time, people with type 1 diabetes were treated with one daily fixed dose of long-acting insulin.

    I eventually learnt to inject insulin and calculate my diet on my own, which gave me more freedom. I was particularly proud at being able to assemble the syringe, draw up the insulin and inject myself. We only received five needles per quarter in those days and so I sometimes had to file down parts of a needle that did not feel smooth.

    What has been most important for your diabetes care?

    Blood glucose self-monitoring – first with test strips, later with monitoring devices and now with sensors – has been very important for me. This has given me more freedom and allowed me to manage my diet more flexibly and intensify my insulin treatment to achieve blood glucose values close to the norm. However, most important of all is that animal insulin remains available as I have a life-threatening allergy to synthetic human insulin.

    What has been your lowest point with diabetes?

    In 2001, my life-threatening allergy to human insulin was ignored and I was mistakenly given two units of human insulin in a clinic. I went into severe anaphylactic shock with respiratory arrest. Since that day, I have a large tattoo on my right forearm with the allergy notice, which has proved very helpful.

    Have you ever had issues accessing insulin or other diabetes care?

    Animal insulin is no longer available in Germany so it has become increasingly difficult for me to access it. I source animal insulin from the UK and recently experienced issues as a result of the UK’s withdrawal from the European Union. Thankfully, in January 2021 animal insulin was exempted from the list of medicines banned for export to the EU from the UK.

    What changes have you seen in your diabetes care since you were diagnosed?

    Diabetes therapy has become much more person-centric, with a greater emphasis on education and self-care. In my early years with the condition, my physician was the only person who determined my therapy and checked my blood glucose. Since then, independent diabetes management has become increasingly possible.

    What does the centenary of insulin mean to you?

    The centenary has a very special meaning for me since Banting and Best used animal insulin to treat people with type 1 diabetes. For many years, it was the only insulin treatment option available. For me it will always remain the only option.

  • Heather Koga (Zimbabwe)

    Heather Koga has been living with type 2 diabetes since 2013. She is a member of the IDF Blue Circle Voices network.

    Did your diagnosis come as a surprise to you?

    It did not really come as a surprise. I had been diagnosed with gestational diabetes the previous year, when I was pregnant with my son. At that time, I was told that I was at risk for type 2 diabetes. Therefore, it was not a surprise, but it happened much sooner than I expected.

    What are the three most important things that have supported your diabetes care?

    The first has been the support that I get from other people with diabetes. The second is insulin, which helped stabilise my condition after a period of very high blood glucose levels. Third is the support I receive from health professionals – my physician, nurses, dieticians and other specialists.

    What is most important in your diabetes self-care?

    Information and knowledge. They say knowledge is power; once you have the necessary knowledge, you can find your way and know how to react in any situation. When it comes to managing my diabetes, it's all about the information I get from my diabetes association, other organisations, people living with diabetes, and what I find through my own research.

    What has been your lowest point with diabetes?

    My lowest point occurred during my first two years with type 2 diabetes. I experienced difficulties managing my blood glucose levels, resulting in several complications. I tried hard to manage them but it was very difficult. Things improved when I started using insulin. It comes with its own complications, but my situation is now much better than when I was only taking oral medicines.

    When did you start requiring insulin to manage your diabetes and how did that make you feel?

    I started requiring insulin about two years after my diagnosis. It was hard to accept. I resisted at first because I felt I had failed to manage my condition with oral medicines, diet and exercise. I told my doctors that I did not want to use insulin, believing that I could get the desired results without it.

    Do you have any challenges accessing the insulin you need?

    I have not personally had any challenges accessing insulin since I have health insurance. For other people in Zimbabwe it is really a challenge. Insulin is generally very expensive and therefore very difficult to afford for people without health insurance. Some people have to go without their insulin or ration their dosages.

    How would your life change if you could not access insulin?

    It would change for the worse since insulin has really helped me manage my diabetes. If I could not access it, my condition would deteriorate as it did before I started using insulin.

    If you could change something about your diabetes care, what would that be?

    I would really like to be able to follow the advice I am given on medication, diet and physical activity.

    What do you think needs to change to improve the future of people living with diabetes in your country?

    If I could change anything about diabetes in Zimbabwe, I would ensure that there is more awareness and education around the condition. Many people know little about diabetes and there are many misconceptions. Diabetes is considered a condition that only affects older people. There is a general understanding that you get diabetes by eating too many sweets. Diabetes is also thought to be a product of witchcraft, and therefore does not require seeing a doctor. Lastly, many people think that you can’t get diabetes if you have a healthy weight.

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