Friday, December 31, 2010

History of Insulin - Part 2

After the group of Toronto doctors were able to isolate insulin, treat humans and refine the extract with the help of Eli Lilly; there was still a huge problem.  Supply & distribution.  This area of the exhibit was much smaller than the areas devoted to the discovery of insulin or the advancement of how it was utilized by patients; but had my MBA dork side really excited.

Before a synthetic compound like Novolog or Humalog was created insulin needed to be extracted from the pancreas of a pig.  The below picture shows the number of big pancreases necessary for 1 liter of insulin:
Since everyone loves Wilbur, that was obviously going to cause some supply chain issues!

John Rockefeller then got involved in the process and promised the Eli Lilly corporation $150,000 for the refinement and further development of insulin extracts.  The financing and partnership provided the capital necessary to develop the drug for wide-scale human use and allowed for further partnerships with manufacturing and shipping companies.  Without the wheels of business the discovery of insulin would have impacted the lives of far fewer people.

This part of the exhibit really spoke to me directly.  My professional life has turned towards creating partnerships that allow a product, which I believe will help people lead healthier lives, reach more people.  Until I grasped that I probably would not be alive today if it wasn't for the funding by people like Rockefeller or partnerships between Eli Lilly and Toronto University I don't know that I fully appreciated the necessity of such partnerships.  One can't function without the other and while the discovery of insulin won a Noble prize its reach, scope and impact would have been far less dramatic with the wrong supply and distribution strategy.  This quote from J.K. Lilly to Elliott Joslin kind of sums it up:

"The great and refreshing discovery through this experience
was that the really great men in any line of endeavor are the
most approachable, simple, and direct in their reasoning and contacts.
Both in letter and in spirit, we have endeavored to indicate to you
how precious our relations have been with you and your associates."

Wednesday, December 29, 2010

History of Insulin - Part 1

I had the pleasure of visiting the NY Historical Society's exhibit on the history of insulin with my sister on December 21st.  After some holiday cheer I finally had the time to upload the pictures from the exhibit to my computer so over my next several posts I hope to walk you through how amazing the exhibit was.  The exhibit brought to light how incredible of a breakthrough the discovery of insulin was but also illuminated how the breakthrough would have saved far fewer lives had it not been for the potential profitability of the drug.  From a personal, medical and business perspective I was in awe as I walked through the exhibit.

Part 1 - The Breakthrough

In 1921 a group of University of Toronto researchers were able to isolate the peptide insulin from islet cells in the pancreas.  This would lead to the first partnership between a research university and a corporation, Eli Lilly.  The path to discovering insulin not surprisingly was met with in-fighting, and egos.  Tensions were no doubt raised due to the near death-sentence a diagnosis of type 1 diabetes had been met with to that point.

While the Toronto researchers were successfully isolating insulin in the pancreas Frederick Allen and Elliott Joslin were treating diabetic patients through a near starvation diet.  The idea was to restrict a diabetic to a critically low level of calories so that the body would be forced to accept the calories with a minimal insulin spike.  The diet prolonged the life of some diabetics but did not address lifestyle conditions and was not sustainable.  Essentially the diet bought time as the real treatment was being developed.

Dr. Banting in 1920 was reviewing an 1889 study of Dr. Minkowski and jotted the following note to himself "Ligate pancreatic ducts of the dog. Keep dogs alive till acini degenerate leaving islets. Try to isolate internal secretion of these and relieve glycosurea."  Over that summer Banting and team performed several experiments on dogs and were able to keep Alpha alive for the entire summer with no pancreas.  In subsequent months further tests were performed on dogs using insulin extracted from a fetal calf pancreas with positive results.  This led to the first human test on Leonard Thompson in 1922.  The first experiments proved costly as the insulin was too impure and caused severe allergic reactions in the test subjects.  With the help of Eli Lilly the research team was able to better purify the insulin extract which led to one of the most heart wrenching exhibits:

In 1922, 5-year-old Teddy Ryder was treated with insulin.  The first picture shows how dire his medical condition was prior to receiving insulin; the photograph on the right is Teddy after insulin a cherubic faced  healthy boy.  That moment more than any other during the exhibit struck me as how fortunate we all are that the Toronto based team was able to isolate insulin.  This team is the reason why any of us can function normally in society let alone run triathlons, compete in the NBA, NFL or accomplish whatever we set our minds to.

Teddy's note expresses in its simplest form the impact this discovery has had on anyone who has been diagnosed with diabetes:

"Dear Dr. Banting, I wish you could come to see me.  
I am a fat boy now and I feel fine.  
I can climb a tree.  
Margaret would like to see you.  Lots of love from Teddy Ryder."

Tuesday, December 7, 2010

Exhausted of Explaining

Something odd happened on Friday night when I was out for Korean BBQ with around 15 people, some of whom I knew and some of whom I was meeting for the first time.  Before the food arrived I excused myself to the rest room, tested my blood sugar and pumped off before returning to the table.  One thing I have never done is felt the need to hide my diabetes; I wouldn't help out Triabetes or blog if that was the case.  Rather dating new people, working in a new place and meeting new people has caused me to explain how I compete in triathlon, how I developed type 1 at 27, describe the difference between type 1 and type 2 and explain that juvenile diabetes is the same as type 1 and that it doesn't go away just because you grow up so many times over the past month and 1/2 I just couldn't do it one more time.

Explanation fatigue; I'm sure this is a universal trend for anyone who deals with something that is a bit different than the person sitting next to you.  There comes a point where you just don't feel like talking about "it," whatever "it," may be anymore.  As understandable as it is that I wanted a night where I didn't have to have "the conversation," my decision to test and bolus away from the table really surprised me.  I guess sometimes everyone just needs a vacation from the things they are forced to focus on daily.

Wednesday, December 1, 2010

High fat foods

It has been far too long since I wrote about how various food compositions affect my blood sugar so I thought I'd get back on the d-blogging wagon and talk about something relevant.  Armed with my trust Dexcom again I've been able to analyze how all sorts of foods impact my blood sugar levels.  The really cool thing about a CGM is that you can see the time series trend of how the glycemic index of a food will impact the amount of time your blood sugar spends "out of range."

Normally for lunch I have a turkey sandwich on sprouted grain bread or a salad, I know exciting.  Today I was beyond hungry when lunch rolled around so I opted for lamb shwarma and falafel.  Not the epitome of health but my diet has been super rigid lately so I felt the need to splurge a bit and get in some fats.  The shwarma was covered in hummus and babaganoush while the 6 falafel balls were gigantic.  Since this wasn't a very carb dense meal (although high fat) I assumed there were about 90 grams of carbohydrates.  I took in the approriate amount of insulin and 20 minutes after eating began to see my blood sugar climb.  My blood sugar plateaud at about 290 and remained there for about 3 hours before it precipitously came down to range.

This got me to thinking about the relationship of different nutrition compositions and diabetes.  It is alot easier to understand what a high carbohydrate/ high sugar food is versus a high glycemic food.  Ice cream for example has much fewer carbohydrates than you would first assume but the high fat content of ice cream makes it incredible difficult to manage with artificial insulin.  Understanding the glycemic index takes time and its not the most widely discussed nutrition metric but probably should be.  Counting carbohydrates is important to determine the appropriate amount of insulin but understanding how the nutritional composition is what can really lead to an awesome a1c. 

Oh and since I didn't post last week, Happy Thanksgiving everyone!