Diabetes has been affecting humanity through thousands of years of recorded history. Yet, it has only been in the last one hundred years that the true causes of diabetes—and insulin—were discovered. But the innovations in treating diabetes over the past century did not stop at insulin; new understandings about the disease have been reached. New medicines have been developed, which do not only target blood-sugar levels but also deal with the complications relating to the heart, ultimately lowering the mortality rate among diabetes patients.
 
When diabetes is mentioned, the first thing that springs to mind for most people nowadays is the oral medication. But did you know that the humble insulin shot was the first diabetes medication ever to successfully prolong the lives of diabetes patients? The very latest advances in diabetes medication have insulin to thank for the luxury of time in their development.

Insulin is a hormone secreted by the pancreas. It is instrumental in converting sugar into energy for the body to use. Different types of insulin-related disorders cause different types of diabetes:

1. Diabetes type 1, commonly found in children, occurs when the body cannot produce its own insulin.
2. Diabetes type 2, commonly found in overweight adults, occurs when the body is not able to use insulin well.
3. Gestational diabetes occurs in pregnant women whose insulin levels are affected by the placental hormone to such a degree that the body cannot use insulin effectively.

All types of diabetes can cause complications leading to hepatic steatosis (fatty liver), kidney disease (high blood-sugar putting strain on the kidneys’ filtration process), or even heart disease (high blood-sugar resulting in damage to the arteries).

The discovery of insulin and its role in diabetes was a medical breakthrough of such a magnitude that it won the Nobel Prize for many teams of scientists. In their research, Oskar Minkowski and Joseph von Mering found that dogs which have had their pancreas removed became diabetic. That study was elaborated on by Frederick Banting and Charles Best, who kept diabetic dogs alive by giving them pancreas extracts in a saline solution. Finally, James Collip and John Macleod put the finishing touches on the medical breakthrough by perfecting the method of purifying insulin extracted from the pancreas of calves, making it suitable for use by humans.

In January of 1922, the perseverance of these scientists manifested as a miracle for the life of 14-year-old Leonard Thompson, who suffered from a severe case of diabetes and was in a critical condition. Within just 24 hours of receiving his first dose of purified insulin, his blood-sugar levels—sky high at 520 milligrams/deciliter—plummeted to just 120 milligrams/deciliter. His condition improved visibly, he continued to receive insulin, and he lived. Leonard Thompson’s rescue from death’s door by insulin became the first ray of hope for all diabetes patients worldwide.

From 1982 onwards, insulin production no longer relied on extraction from animals. Advances in the genetic engineering have allowed human insulin to be produced from bacteria. In 1985 the insulin pen was invented, immeasurably improving the practicality, convenience, and ultimate quality of life for diabetes patients. The invention of insulin analogs, a form of human insulin modified for slow or quick release, came about in 1997. This further improved the quality of life for diabetes patients and their families by allowing them to tailor their insulin intake to suit their own daily schedules and activities. Indeed, insulin has come a long way in its 100-year journey thus far.

But there is another medical breakthrough that may carry the torch for diabetes patients even further on than insulin; diabetes medication that can be taken orally. This new generation of diabetes medication includes various types with the following effects:

• Reduce the amount of sugar released into the bloodstream by the liver
• Increase the body’s sensitivity to insulin
• Stimulate insulin production
• Prolong the effectiveness of insulin in the body
• Reduce glucose reabsorption in the kidneys

These oral anti-diabetic drugs are far more convenient to store, transport, and administer than insulin. Adoption has been quick and widespread, especially among patients with relatively mild forms of diabetes. 

Yet, the dangers of diabetes do not only show up in the form of high blood-sugar levels. Kidney disease, liver disease, and heart disease are constant threats from diabetes. Thus, the development of diabetes medication today no longer focuses on dealing only with blood-sugar levels. Instead, they are addressing a whole host other systemic health issues for diabetes patients, to the point that this new approach has been made become compulsory by the regulatory authorities’ drug approval process. The latest generation of medication have proven their effectiveness, not only in their much-reduced side effects, but by the undeniable yardstick of fewer and shorter hospital admissions and fewer mortalities from diabetes-related heart disease.

What stands out in the 100-year history of insulin is the unrelenting determination and skill brought to bear in the fight against diabetes by some of the greatest minds in science and medicine. Bumrungrad International Hospital is immensely proud to be part of the continuing effort to improve the quality of life for diabetes patients. We do this by continually striving to bring the very latest developments in treatment to our patients, thereby continuing to bear the century-old flame first lit by giving insulin to that young boy with diabetes.