I would wager that most people didn’t know diabetes is one of the top 10 killers worldwide. I would bet most didn’t realize that last year diabetes killed more people than breast cancer. I would also suspect that most think being diagnosed with diabetes means you just can’t eat sugary things, and perhaps you have to prick your finger occasionally and take some injections. Yet the World Health Organization estimated that diabetes killed some 4.6 million people last year. That’s one death every seven seconds. In 2009, diabetes killed more people than HIV/AIDS (1.8 million), malaria (781,000) and tuberculosis (1.3 million) combined.
More than all the rest, I’m quite sure that if asked what great achievements Canada has contributed to humanity, most would not respond with, “Canada discovered the world’s first miracle drug.” Yet Canadian scientists saved millions, if not billions, including me, from certain death with the development of a life-saving substance called insulin.
I am a Type 1 diabetic, which is to say I have Insulin Dependent Diabetes Mellitus. IDDM is an organ-specific autoimmune disorder. There is little sense of what triggers it, but when triggered my body’s immune system started attacking a tiny cluster of cells in the pancreas called the islet cells. As one of my doctors put it, “Your body stops recognizing parts of the self as self.” These cells are responsible for the production of insulin, a hormone that is needed to metabolize carbohydrates, fatty acids and amino acids — common properties found in most everything you eat. Without the ability to convert glucose into energy, my blood gets increasingly full of sugar while my cells begin to starve. This state is called hyperglycemia, and if left untreated is fatal.
Let me tell you the story of my life, as it would have unfolded before the discovery of insulin. I was diagnosed at the age of two, when I started losing weight rapidly and my formerly animated little self became overcome with exhaustion. At this point, my loving parents would have taken me to the best doctors they could find. These doctors would have put me on the most effective treatment plan they had for diabetes: starvation. As a toddler, I would have subsisted on some 400 calories a day in an attempt to lower the levels of glucose in my bloodstream. This would have prolonged my life by several months. I would have become skeletal until I was either consumed by a diabetic coma or died of starvation — all before I reached the age of three. Dr. Elliott Joslin, whose Boston clinic was and remains a renowned diabetes centre, recalled that before insulin, one of his dieting patients was “just about the weight of her bones and a human soul.”
In the book The Discovery of Insulin, Michael Bliss describes the painful wasting death of many people with diabetes before insulin:
Food and drink no longer mattered, often could not be taken. A restless drowsiness shaded into semi-consciousness. As the lungs heaved desperately to expel carbonic acid (as carbon dioxide), the dying diabetic took huge gasps of air to try to increase his capacity. “Air hunger” the doctors called it, and the whole process was sometimes described as “internal suffocation.” The gasping and sighing and sweet smell lingered on as the unconsciousness became a deep diabetic coma. At that point the family could make its arrangements with the undertaker, for within a few hours death would end the suffering.
But this was not my fate because something strange and miraculous happened.
Toward the end of 1920, a young surgeon named Frederick Banting, who had no previous experience in physiology or medical research, sold his practice against the advice of his girlfriend and moved to a tiny apartment in Toronto. After reading an article on pancreas secretions, Banting had an idea, and he approached an expert in carbohydrate metabolism at the University of Toronto, Dr. John Macleod. Motivated by some inexplicable confidence and the memory of watching his dear childhood friend, Jane, wither and die from diabetes, Banting badgered the thoroughly skeptical Dr. Macleod into temporarily loaning his lab space. Macleod provided Banting with keys to a sparsely equipped lab, 10 dogs and a medical student, Charles Best, then headed home to Scotland for the summer.
By the end of the summer, Banting and Best had managed to keep several diabetic dogs alive with injections of a substance they’d isolated — later named insulin. By January 1922, the first human received insulin. His name was Leonard Thompson, a 14-year-old Toronto boy dying of diabetes. By May, he was discharged from the hospital having gained back his weight and appetite. News of his recovery spread like wildfire, as emaciated diabetic children were rescued from death by the thousands.
Amidst the excitement, Dr. Joslin wrote, “I had witnessed so many near resurrections that I realized I was seeing enacted before my very eyes Ezekiel’s vision of the valley of dry bones.” The Bible passage Joslin was referencing reads as follows:
… and behold, there were very many upon the valley; and lo, they were very dry. And he said to me, “Son of man, can these bones live?”
And as I looked, there were sinews on them, and flesh had come upon them, and skin had covered them … and the breath came into them, and they lived, and stood upon their feet, an exceedingly great host.
Within the year, diabetes had been transmuted from a death sentence into a life-long struggle with a chronic illness. It was a medical miracle.
It is vital to remember, however, that while insulin is a medical breakthrough, it is not a cure. Diabetes is a harrowing disease with a cascade of accompanying complications: heart disease, kidney failure, stroke, amputation and blindness. It still kills millions every year. Despite having access to some of the best medical care in the world, I have already begun to lose my eyesight. While the life expectancy for most Canadian women is 80, as a Type 1 diabetic, my life expectancy is 65.
Diabetics also regularly experience low blood sugar, or hypoglycemia. Since I was two, on a weekly basis I have experienced symptoms as mild as shaking and disorientation to symptoms as severe as blacking out, vomiting and seizures. In some cruel irony, though severe hypoglycemia can kill you, low blood sugar levels are also a sign of better glucose control.
As I write this, I have a high blood sugar because I slept in and missed breakfast. In my head, I’m calculating how much sooner I’ll go blind, or die, because of this oversight. This is a haunting I can never escape. Not for one meal, not for one evening. At all times, I require a glucometer, test strips, insulin, a device for taking insulin and something in case I go low — whether out for the night or on a beach for vacation. Managing diabetes is ceaseless — a perpetual mathematical equation between what you are eating, your insulin dosages and all the other factors that affect your metabolism: sleep, stress, exercise, alcohol and even excitement. It requires a hyper-vigilance that is exhausting, that we often get wrong and that is often accompanied by intense judgment and misunderstanding by both medical professionals and well-meaning friends.
So, in this last week of November — which happens to be Diabetes Awareness Month — please proudly remember that Canadian scientists, Dr. Frederick Banting (a farm boy from Ontario) and then medical student Dr. Charles Best, in an essentially hijacked lab in Toronto, invented the first miracle drug, which continues to save millions of lives. Please also remember that the diabetics in your life have a severe disease. We are only kept alive by daily injections of infinitesimal amounts of insulin and constant blood sugar management. We daily undergo a kind of monotonous work and monotonous suffering that no one sees, and we have a sickness that never stops threatening our lives.
When I was seven, Her Majesty Queen Elizabeth, The Queen Mother kindled the Flame of Hope at Banting House National Historic Site — “The Birthplace of Insulin” — in London, Ontario, in memory of all those who have lost their lives to diabetes. As a symbol of hope, the flame will burn until extinguished by the team of researchers who are able to declare that there is, at last, a cure for diabetes.
I have been living with diabetes for 28 years. In my lifetime thus far, I have taken over 50,000 injections. I am profoundly grateful for every one of them.