This blog is about how much various aspects of diabetes cost (and why, these costs, are, quite frankly, outrageous), but this post is an introduction to one of the main costs of diabetes, which I plan to discuss further in my next post, insulin.
In people who do not have diabetes, insulin helps to regulate blood sugar levels and store excess glucose for energy. After you eat, the carbohydrates in your food break down into glucose, which your body uses for energy, and this glucose enters the bloodstream. In response to this increase in blood sugar (the concentration of glucose in the blood, usually measured in mg/dL), your pancreas produces insulin, allowing the glucose to enter your cells to provide energy.
At this point, your insulin levels are high, and excess glucose is stored in your liver as glycogen (a polysaccharide that produces glucose through hydrolysis). When your insulin levels are low— like between meals— your liver releases glycogen into the bloodstream in the form of glucose to keep your blood sugar in range (about 80-120 mg/dL).
People with diabetes, however, don’t have enough insulin to move the glucose into their body’s cells, so their blood glucose levels continue to rise after eating. People with type 1 diabetes (what this blog focuses on) produce little to no insulin, so insulin injections aim to replace what their body can’t produce. There are also different kinds of insulin (long, ultralong, intermediate, rapid, short, etc. acting) and different delivery options (shots/pens, insulin pump, and inhaled insulin), but we’re not going into that much detail here, but I highly recommend looking into it if you’re interested!
Though this blog really focuses on type 1 diabetes (in which the body is unable to make insulin and it needs to be injected, etc.) there are other types as well. This includes type 2 and gestational diabetes (these are the main ones, though there are other, rarer, forms). In type 2 diabetes, the body is unable to efficiently use the insulin the pancreas produces; in other words, insulin is being made and it can usually be treated with diet and exercise changes. Gestational diabetes (GDM) is when a mother has high blood sugar during pregnancy, and it’s associated with complications to both the mother and her child. It usually goes away after birth, but the mother and her child are at an increased risk of developing type 2 diabetes later in life.
Now we’re going to go into more of a history of insulin to take a look at how it’s made.
In part of the early 20th century, insulin wasn’t available, so physicians recommended fasting and decreased sugar intakes for people with diabetes. There was some improvement with this method, but it was far from ideal.
In 1922, insulin was discovered. Before this it had been hypothesized that a pancreatic secretion could control carbohydrate metabolism, and, after experiments involving a depancreatized dog, Frederick Banting, John Macleod, and Charles Best created isletin, a pancreatic extract that, when injected intravenously, lowered the dog’s blood glucose.
These experiments started in May of 1921, and later that year, biochemist J.B. Collip joined the group to help purify isletin for human use. Trials were done in humans, and in 1923, Banting and Macleod won the Nobel Prize in Physiology or Medicine for their discovery, which they shared with Best and Collip.
Not long after this discovery, Eli Lilly— a medical firm— began large-scale production of insulin, and in later decades, manufacturers would develop slower-acting insulins.
The insulin used at this time was actually from cattle and pigs, and while it saved millions of lives, it had some problems, such as causing allergic reactions in many patients. It wasn’t until 1978 when the first genetically engineered, synthetic “human” insulin was produced using Escherichia coli (E. coli), and it was first commercially sold by Eli Lilly in 1982 under the brand name Humulin.
I also want to highlight Frederick Sanger (the same scientist that developed Sanger Sequencing), who won the Nobel prize in Chemistry in 1958 “for his work on the structure of proteins, especially that of insulin.”
Now, insulin comes in a variety of forms, including insulin identical to what the body produces and ultra-long acting insulins, so people with diabetes can choose from many formulas for one that fits their needs. But we need to remember that insulin is not a cure for diabetes, it just treats the symptoms, and insulin injections are required many times a day, and without them, people will die.
I know this post is information-heavy (if you’re not a science person, I apologize), but I think it’s helpful to have a background on what insulin is and why it’s important to the people who need it to be able to more comprehensively understand why the cost of diabetes is such a problem.
Sources: Mayo Clinic, History of Insulin (NCBI), American Diabetes Association, NobelPrize,org, International Diabetes Federation
Thanks for the background info! I would love to know in future posts what the economic factors are to the high prices or about how our healthcare system is failing people with diabetes. Good work!
I really like your blog! Your blog is comprehensive, and I think diabetes is an important topic to discuss just because so many people are affected by it. It’s unfortunate that there is no cure for this disease so far. Even though I already knew a lot about this topic, I still learned something new from this blog. Great job! I am looking forward to your future post!
One of my best friends from home has diabetes and whenever she explains it to me I usually get somewhat confused. This helped me understand it a lot more! I think there should be more awareness of this disease due to how many people it effects and also the costs of the items needed to (in simple terms) keep you alive. I can’t wait to see what else you write about!
This is a great introduction to insulin and diabetes, I was really interested to learn about the different types of diabetes and the history of insulin production. I’m looking forward to reading about the civic/systemic issues behind this!
Very interesting blog post! A bunch of my family member have diabetes so it was really interesting seeing the science behind what happens. I also found it very interesting that insulin is derived from E. coli since I’m pretty sure that is some bacteria that causes food poisoning.