This book describes the people behind the innovations and the struggles they overcame to advance the treatment of diabetes. It weaves these stories together with stories of patients who battled diabetes and inspired the innovations. The book will appeal to both readers of popular science books and those who are interested in diabetes.
The book is in draft form, but I’ve published it on tacomed.com, since I have no idea when I’ll have time to complete it.
A brief synopsis of the story:
Chapter 1. George Minot grows up privileged in Boston. He’s a graduate of Harvard College and Harvard Medical School. In 1921, the 35 year old physician is named the Chief of Medical Service at one of Boston’s best hospitals. A few weeks later, he is diagnosed with diabetes. He expects to live no more than a year or two.
Chapter 2. Fred Banting, six years younger than George Minot, grows up on a farm in Ontario. None of his family has more than an eighth grade education. Fred finishes high school, but fails out of university. Instead, he enrolls in medical school, which at the time was more like a trade school. He serves in World War I as a surgeon, then opens a medical office in a small town in Ontario as a general practitioner.
Chapter 3. Prelude to a discovery. In 1889, Oskar Minkowski removed the pancreas of a dog simply to demonstrate that it was possible. He discovered that removing the pancreas causes diabetes.
Chapter 4. Measuring blood glucose levels in 1920. At the time, measuring blood glucose levels required mixing blood with dangerous chemicals and judging how red the resulting solutions was.
Chapter 5. Discovery in the summer of 1921. Fred Banting, small town physician, writes a letter to a University of Toronto professor about an idea on how to cure diabetes. The professor is skeptical, but invites Fred to give it a try. Over the summer 1921, Fred moves to Toronto and figures out how to isolate insulin from pancreases. Within a year, insulin brings people out of diabetic comas, rescuing them from death and restoring them to almost normal health.
Chapter 6. Eli Lilly. After the discovery of insulin, a crisis develops. Fred Banting and University of Toronto cannot produce enough insulin for all the patients who need it, including George Minot. They turn to the pharmaceutical company Eli Lilly. Engineers at Eli Lilly discover the principle of isoelectric precipitation, which allows them to produce enough insulin for all.
Chapter 7. Standardization. As the industrial production of insulin begins, standardization becomes important. Injecting too much insulin causes hypoglycemia, which can lead to death. How can a patient judge the potency of insulin? The unit of insulin is defined.
Chapter 8. Nobel Prizes. Fred Banting becomes the first non-European to win the Nobel Prize for Medicine in 1923. Banting pursues medical research from 1923 to 1941. He joins the war effort, then dies in a plane crash while trying to travel to England across the North Atlantic in the winter. George Minot manages his diabetes with careful control of his diet and injections of insulin. He eventually shares the Nobel Prize for Medicine in 1934 for finding a cure for pernicious anemia. George Minot dies in 1950 from complications of diabetes.
Chapter 9. Proteins. A description of the structure and function of proteins, particularly insulin.
Chapter 10. Complications from diabetes. Insulin allows patients with diabetes to live longer, but they develop a characteristic set of complications: nerve damage and restricted blood flow. George Minot, like many diabetes patients, has foot problems due to his diabetes.
Chapter 11. The control controversy. Different forms of insulin are engineered to produce longer lasting effects. A debate rages in the medical community about the importance of controlling blood glucose levels tightly.
Chapter 12. Recombinant DNA production of insulin. A new crisis develops. By the 1970’s, projections indicate that the demand for insulin will exceed the supply within a decade. The supply is constrained by the number of cattle and pigs slaughtered each year, since the only way to get insulin is to purify it from animal tissue. Eli Lilly develops a process to induce bacteria to synthesize human insulin, thereby producing human insulin in unlimited quantities. Developing bacteria with human genes leads to ethical questions and regulations that slow down research.
Chapter 13. Modern Glucose Measurements. A plant scientist studying molds in the 1930’s discovers glucose oxidase, a key component of modern digital blood glucose meters. Another scientist studying sickle cell anemia develops the hemoglobin a1c test, an important measure of glucose control.
Chapter 14. Autoimmune disease. The immune system and cause of diabetes. Other autoimmune diseases exist; they are similar to diabetes in cause, but not effect. The rise of Type 2 diabetes.
Chapter 15. Insulin Pumps. Alfred Mann hears of the problems diabetes patients have with control. He develops an implantable pump to provide better control.
Here’s some reviews.