Insulin at 25

In pre-insulin days, diabetics had two alternatives: eat well and die tomorrow, or live on a starvation diet and die by inches. Then one day in 1920 Frederick Banting, a young research M.D. at the University of Toronto, wrote in his notebook: "Tie off pancreatic duct of dogs. Wait six to eight weeks. . . . Remove residue and extract." Months later, Banting and Charles Best, a medical student assisting him, announced the isolation of insulin, the sugar-controlling hormone of the pancreas that gives diabetics--people whose bodies cannot use up their sugar intake--a new lease on life.

This week 1,000 members of the American Diabetes Association met at Toronto to strike a quarter-century balance sheet on insulin. (Among those present: Charles Best. Absent: Sir Frederick Banting, killed in a plane crash while on a secret wartime mission to England.) Diabeticians found the gains many, but the war against diabetes still far from won.

Some of the gains:

P: Diabetic coma, the result of hyperglycemia (excessive sugar in the blood) and once the cause of most diabetic deaths, is now "an inexcusable complication, except when the coma is precipitated by infection or some other illness."

P: Formerly, 45% of diabetic mothers died in childbirth; now a diabetic mother has the same chance of surviving as a normal mother.

P: New, slow-acting insulin solutions, developed by Denmark's Dr. H. C. Hagedorn, allow diabetics to get along on less frequent injections (often only one a day). A.D.A. President Joseph Barach summed up: with insulin plus careful (but ample) diet, "the diabetic patient can now expect to live an almost normal life."

Curbed, not Cured. But diabetes, though controllable, is still neither preventable nor curable, and the tendency to diabetes has been found to be hereditary. No sure way is known to halt deterioration of a diabetic's blood vessels, often eventual hardening of his arteries. Sometimes the smallest scratch may still mean gangrene. Though insulin has sent the younger (under 40) diabetic's life expectancy soaring, the overall death rate has actually increased during the insulin era: diabetes in 1920 caused 1.4% of all U.S. deaths, now causes 2.5%.* Most diabeticians still feel much as Banting did when he was invited by a U.S. university to deliver a two-hour talk on the disease: "Hell," said he, "for all I know about diabetes, 15 minutes would be enough."

* Partly a statistical illusion, because 1 ) the average age has increased, and diabetes is largely a disease of middle age; 2) deaths formerly attributed to heart disease, arteriosclerosis, etc. are now correctly diagnosed as caused primarily by diabetes. The U.S. diabetes death rate hit its peak in 1940, dropped off slightly during wartime when overeating was less prevalent.

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