The great diabetes idea, 100 years on

A young Dr. Frederick Banting, discoverer of insulin to treat diabetes.

You’d be hard pressed to invent a more unlikely medical hero than the man who was Dr. Frederick Banting in 1920.

He was only a few years out of medical school and was moonlighting as an instructor of orthopedics and physiology as a stopgap until his medical practice got off the ground. He had zero experience in researching diabetes. In fact, he couldn’t even spell the word.

Yet 100 years ago, at 2 a.m. on Oct. 31, his scribbled note to extract insulin from a dog’s pancreas to treat ‘Diabetus’ put in motion a discovery that would save millions of lives.

“He set off a chain reaction that became one of the greatest medical discoveries of our time,” said Dr. Rob Hegele, a leading international endocrinologist and distinguished university professor of medicine and biochemistry at Schulich School of Medicine & Dentistry and director of the London Regional Genomics Centre at Robarts Research Institute.

Hegele and Grant Maltman, curator of the Banting House National Historical Site of Canada, are co-authors of a paper, newly published in The Lancet Diabetes & Endocrinology, that firmly positions London as the birthplace of insulin a century ago, on Oct. 31, 1920.

But if the idea was hatched in Banting’s yellow-brick home on Adelaide Street, it was at least incubated at Western.

The former war surgeon’s fledgling medical practice was going poorly, averaging just two patients a month, Hegele said. “There was this idea of ‘build the practice and they will come,’ but nobody came in. So, he decided to do what would now be called a side hustle, or moonlighting, to make a living.”

Banting landed a part-time teaching position at Western’s medical school. “He would be assigned a subject and would cram on it over the weekend prior to teaching a course to medical students,” Hegele said.

On that particular weekend, Banting went to the medical school library and researched journal articles on the pancreas, the organ that (when it functions as it should) helps with digestion and regulates blood sugar.

That night, sleepless, he scrawled: “Diabetus. Ligate pancreatic ducts of dog. Keep dogs alive till acini degenerate leaving islets. Try to isolate the internal secretion of these and relieve glycosurea.”

Insulin note written by Dr. Frederick Banting

Thomas Fisher Rare Book Library, University of Toronto. Image used with permissionIn the middle of a sleepless night on Oct. 31, 1920, Dr. Frederick Banting scribbled this note – an idea that was the genesis of treating diabetes patients with insulin.

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Ten days later, he cold-called John James Rickard Macleod and persuaded the University of Toronto physiologist to take him on as a researcher into isolating insulin to treat people with diabetes. Three years after that, the pair shared a Nobel Prize in Medicine (which they in turn shared with fellow researchers Charles Best and James Collip, who would later become Western’s dean of medicine).

Hegele said the team’s advances represented a continuum of important discoveries and milestones also worth celebrating: extracting insulin from the pancreases of dogs, purifying it, testing it and injecting it into a teenaged boy in 1922 to save his life.

“But there was really that one event that set everything in motion,” Hegele said. “It’s almost a mythological story.”

Added Maltman, “This is serendipity, this is an act of divine intervention, the Moon and Mars and Venus, all wrapped into one. This is one man with one idea that changed the world.

“All because of a guy who didn’t have two nickels to rub together, and there happened to be a teaching position open at Western.”

At Banting House on Adelaide Street in London, that eureka moment continues to be commemorated – even the bedroom where he scribbled his idea is re-recreated, including the original flowered wallpaper and his bed – and diabetics the world over continue to pay homage. The site’s flame of hope will continue to burn until a cure is found.

Sir Frederick Banting's bedroom

Banting House National Historical SiteThis is the bedroom – with original bed and wallpaper – where young Dr. Frederick Banting jotted a 2 a.m. note that would ultimately lead to insulin as a diabetes treatment.

Hegele is in the forefront of that global push to find a cure – or cures – for his 6,000 patients and for millions more around the world.  For all the advances in research, diabetes kills more than 1.6 million people each year.

“Even before we get to a cure, there have been modest developments in medicine that dramatically improve the lives of our patients,” Hegele said. “Right now, we think of diabetes as two types: type 1 and type 2. I think in 10 years there will be more sub-divisions that will allow clinicians and patients to target treatments.”

From advances in mapping the genetic markers to finding biomarkers and serological markers of diabetes, and to new frontiers in genome editing, the possibilities are tantalizingly close at hand, he said.

But the pace of Banting’s achievements – from idea to effective use in patients in three years – is unlikely to be replicated, Hegele said. “For me, the only thing that’s comparable in terms of rapid advances is with COVID-19, Operation Warp Speed (the US aim to discover, test, produce and distribute 300 million COVID-19 vaccines by January 2021) .”