100 Years of Insulin

Volume 4, Issue 5

The idea for insulin came to Frederick Banting, Canadian medical scientist, in the early hours of the morning of October 31, 1920. Waking from a restless sleep, Mr Banting scribbled down a 25-word hypothesis that would eventually lead to one of the most significant medical breakthroughs in the history of modern medicine. Without the proper lab space and research acumen, Mr Banting approached his colleague at the University of Toronto, John James Rickard Macleod, an international expert in diabetes—Mr Macleod agreed to assist with developing this novel compound. 

Their work would immediately save lives, and it would go on to transform diabetes from a virtual death sentence into a chronic condition. In this week’s issue of Talking Therapeutics, we pay homage to the marvel that is insulin, and focus on current issues that reduce access to this life-saving treatment. 

Point 1: Insulin Is a Medical Marvel 

On January 23, 1922, Leonard Thompson, a 14-year-old Toronto boy, was drifting in and out of consciousness at Toronto General Hospital. He soon became the first person to receive purified extract of what would eventually be called “insulin.” Bill Bigelow, University of Toronto surgeon, witnessed the early insulin trials. According to the University of Toronto, Dr Bigelow recalled seeing comatose patients “awakened dramatically, snatched from death’s door.” Insulin's effect on Leonard Thompson and others was nothing short of miraculous. 

Based on these early successes, the University of Toronto collaborated with Eli Lily to start mass production of insulin. Mrs Banting and Macleod later earned a Nobel Prize in Medicine for their discovery. 

Initially, insulin products were extracted from cows and pigs that left issues with antigenicity, which went unresolved until 1978 when the first synthetic “human” insulin was produced using E coli bacteria and recombinant DNA technology. While this novel technology made insulin products safer, it unfortunately also comes with a higher monetary cost, which is often still passed on to the consumer. This leads to our second point…

Point 2: Insulin Is Too Expensive

The annual cost of insulin for people with Type 1 diabetes in the Unite States nearly doubled from $2900 in 2012 to $5700 in 2016, according to the most recent data available from the Health Care Cost Institute. Patients who are uninsured or underinsured often shoulder a significant percentage of this out-of-pocket cost—leading many patients to ration their insulin along with the required testing supplies. Starting this week, Walmart will sell an exclusive private-label version of analog insulin, ReliOn NovoLog, to patients who have a prescription. The insulin will cost about $73 for a vial, or about $86 for a package of prefilled insulin pens. This ultimately works out to a price difference with branded competitors at $101 per vial of insulin or up to $251 per pack of prefilled insulin pens. 

While interventions like the Walmart product are great steps, clearly much more needs to be done—likely at the level of the federal government—in order to ensure that all persons with diabetes are able to access this lifesaving medication.

Dr Jennings is currently an Associate Professor of Pharmacy at Long Island University and the clinical pharmacist for the Heart Transplant and LVAD teams at New York- Presbyterian Hospital Columbia University Irving Medical Center.  He is an active researcher in his field, and he has published over 120 peer-reviewed abstracts and manuscripts, primarily focusing on the pharmacotherapy of patients under mechanical circulatory support. As a recognized expert in this area, he has been invited to speak at numerous national and international venues, including meetings in France, Saudia Arabia, and India. Finally, Dr Jennings has been active in professional organizations throughout his career. He is a fellow of the American College of Clinical Pharmacy, the American College of Cardiology, the Heart Failure Society of America, and the American Heart Association.  

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of the Population Health Learning Network or HMP Global, their employees, and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, or anyone or anything.