Insulin restored life to those on the verge of death

Lilly’s production of insulin was saving lives.  On November 16, 1923 a thirty four year old woman, MI, was brought to the Hospital of the University of Pennsylvania [Jonas, Leon. A REPORT OF SIXTY-FOUR CASES OF DIABETES MELLITUS TREATED WITH INSULIN. Philadelphia: American Periodicals Series II, 1923. ].  She was in a coma.  Her medical history showed that starting two years before she had to urinate frequently and began to gradually lose weight, down to 94 pounds.  She never saw a physician until the week before being admitted to the hospital.  When she did see a physician on November 12th of that year, she was immediately diagnosed with diabetes and placed on a restricted diet.

The 34 year old woman was entering the end stages of diabetes. She had trouble breathing two days later.  The next day she exhibited mental problems: delirium and stupor.  These symptoms escalated to a coma from which she could not be roused on Nov 16th, when her family brought her to the hospital.  Typically, a person in her condition would be dead within a day or two.

She was treated at the hospital by Dr. Leon Jonas, who had a limited amount of insulin. Dr Jonas initially had measured her blood sugar at 411 mg/dL.  He injected her with 20 units of insulin, within two hours she began rising from the coma.  Over the course of 6 weeks she was given 32 units of insulin most days.  (She received half a dose, 16 units for two days when supplies were low.) Glucose levels in her blood and urine dropped and stabilized.

She was discharged from the hospital after 14 days, in much better health than when she was admitted.  Dr Jonas had her on 8 units of insulin before each meal, and recommended a diet that strictly controlled her carbohydrate intake.  In July 1924, when Dr Jonas wrote up her case for publication, she was following the diet.  She was taking 10 units of insulin before breakfast and an equal amount before her dinner.  She was healthy, functioning as a normal house wife of her era.

While solving the production problem, Lilly and the Toronto group struggled with a second problem: standardization.  Collip had developed an assay to measure the effectiveness of insulin in his fractions, while trying to perfect the purification of insulin.  Collip’s assay, inject the insulin into a rabbit and measure a drop in blood glucose, became the basis of the first standard.