As recently as the early twentieth century, all types of diabetes were often a death sentence; type 1 diabetes was always fatal. In his 1916 article, “The Treatment of Diabetes Mellitus,” early prominent diabetes specialist Elliott P. Joslin noted that most children with diabetes would enter a fatal DKA coma shortly after diagnosis and die within a few years. At the time, treatment wasn’t particularly promising either, with one widespread prescription being “starvation diets”—permanent and severe calorie restriction to avoid high blood sugar levels—that left patients with stunted growth, reduced resistance to infection, and emaciation. In another article decades later, Joslin reflected: “We literally starved the child and adult with the faint hope that something new in treatment would appear. . . . It was no fun to starve a child to let him live.”
The discovery and extraction of insulin between 1921 and 1922 by Canadian surgeon Frederick Banting and his team at the University of Toronto—then-medical student Charles Best, and biochemists James Collip and John Mcleod—changed everything. One of the earliest success stories of insulin treatment was Elizabeth Hughes, daughter of U.S. Secretary of State Charles Evans Hughes. In 1919, after a diabetes diagnosis at the age of eleven, a specialist put Elizabeth on a starvation diet that brought her weight down from sixty-five to fifty-two pounds. When her urine was determined to no longer contain glucose, her diet was relaxed and her weight rose slightly. But when her condition suddenly deteriorated in 1922—and her weight dropped to forty-five pounds—she was brought to Banting and his team to be included in an insulin treatment trial. Hughes not only regained her weight, she went on to live a long life, dying of pneumonia in 1981 at the age of seventy-three.
For many diabetics today, insulin replacement therapy—the measured intake of lab-extracted insulin, now produced by microbes—provides immediate relief to their painful suite of symptoms, and a relatively easy fix to a gruesome and debilitating physiological and psychological experience. But if a patient is so lucky as to be diagnosed with diabetes in time to prevent or ameliorate DKA, they are immediately faced with another disconcerting problem: accessing the treatment, which happens to be one of the most lucrative pharmaceutical products in human history.