Innovations in insulin: past breakthroughs and new research

Since the first injection of insulin in 1922, the outlook for type 1 diabetes has been transformed. Considered one of the greatest breakthroughs in science, the discovery of insulin continues to save the lives of millions of people around the world every day.

Now, more than 100 years since the initial discovery, promising research is underway into newer types of insulin that work faster and are more responsive. As we face this brighter future, we take a look back at the development of insulin and the lessons we can learn from the past.

The breakthrough that changed the world

Before the 1920s, there weren’t any treatments for type 1 diabetes, leading to lower life expectancy and life-limiting complications. The only thing doctors could do was put people with type 1 on restrictive low carb diets.

Canadian surgeon Sir Frederick Banting, his assistant Charles Best and physiology professor John MacLeod were the first to take pancreatic islet cells (where we now know insulin-making cells are) and use them to stabilise blood glucose levels in dogs.

In 1921, the team began working with the biochemist James Collip to develop this into a treatment for people with type 1 using insulin developed from the pancreas of cattle.

Treating people with type 1

In January 1922, 14-year-old Leonard Thompson from Canada became the first person to receive insulin. The injection reduced his blood glucose levels, but he still had high levels of ketones and developed swelling at the site of the injection. After Collip purified the insulin, a second injection lowered Leonard’s blood glucose levels with no side effects.

The team’s breakthrough transformed the outlook for people with type 1 and insulin therapy remains the standard treatment for type 1 diabetes to this day.

The introduction of human insulin

In the 1980s, scientists engineered insulin in a laboratory by growing insulin proteins within bacteria. This synthetic insulin could be produced in large quantities at a lower cost. It was also absorbed more rapidly with fewer skin reactions, so animal insulin started to be phased out.

However, the introduction of human insulin wasn’t accompanied by sufficient information or research about the differences between animal and human insulin. There was a reported increase in hypo unawareness, especially at night, meaning people couldn’t tell when their blood glucose was low. This caused shock and fear in the type 1 community.

“Pig and cow insulin was all there was when I was diagnosed. It caused skin reactions, and soreness under the skin. At that time, my hypo symptoms were always obvious. When I switched to human insulin, I thought it was closer to what our bodies would produce naturally, with fewer adverse reactions. There wasn’t blood testing available, so all you could rely on to detect a hypo was your own symptoms.”

– Victoria Roberts, diagnosed with type 1 in 1979.

Supporting the type 1 community

There is some evidence that animal insulins increase levels of adrenaline more than human insulins, resulting in more hypo symptoms and making low blood glucose levels more noticeable. Human insulins also might not cause the same sharp drop in glucose that triggers glucagon, the hormone that works in opposition to insulin to raise blood glucose levels. This means the body’s natural defence against hypos may not kick in.

People with type 1 were swapped to human insulin without being given the choice to stay on their current treatment. During this time, JDRF campaigned for a choice of insulins and supported people with their concerns. We also funded innovative research projects to accelerate breakthroughs to help people manage their type 1 more easily, like developing better forms of insulin and hybrid closed loop technology.

Breakthroughs in insulin treatment

Now, insulin therapy is more advanced than ever. Fast-acting insulins minimise the rise in blood glucose after eating or drinking, and slow-acting insulins provide steady insulin throughout the day.

From large needles and painful injections, insulin can now be administered more gently through pens and pumps. Technology like hybrid closed loop systems and continuous glucose monitors are reducing the burden of type 1.

The next generation of insulins

We’re funding research across the world to explore new types of insulins, often referred to as novel insulins. This includes fast-acting insulins, glucose-responsive ‘smart’ insulins and different delivery methods, such as weekly insulins and insulin pills.

In 2016, we supported Arecor, a biotechnology company, to accelerate the development of a stable, rapid-acting, ultra-concentrated insulin. This novel insulin was designed to help people with high insulin needs and enable the development of smaller, more user-friendly insulin pumps. Arecor are currently testing two forms of novel insulin in clinical trials: one is ultra-rapid acting, while the other is ultra-concentrated as well as ultra-rapid acting.

Scientists in the Type 1 Diabetes Grand Challenge, our £50 million partnership with the Steve Morgan Foundation and Diabetes UK, are developing ultra-rapid insulins that reach the bloodstream even quicker to lower glucose levels. This would enable fully closed loop systems that don’t require people to warn it if they’re planning to eat or exercise. Other Grand Challenge researchers are at an early stage of designing glucose-responsive insulins, where the insulin only becomes active when needed, stabilising blood glucose before lying dormant again. This could free people from the relentless burden of glucose monitoring.

As novel insulins emerge, we need to learn from past mistakes. It’s crucial that people with type 1 always have a choice in how they manage their condition and receive the information and support they need before using new treatments. Whatever breakthroughs in insulin therapy, JDRF will support the type 1 community every step of the way.