<p>Today is Insulin Appreciation Day, a time to reflect upon the discovery of insulin that revolutionised diabetes management 94 years ago. <br /><br /></p>.<p>Until the early 20th century, there was no medicine available to manage diabetes. The only treatment available was to reduce caloric intake bringing it down almost to starvation levels in the hope that this would extend the patient’s life.<br /><br />While the precursor for insulin, pancrein, a pancreatic extract from dogs was discovered in the early 1990s by the Romanian Physiologist, Nicolas C Paulescu, it was only in 1921 that Frederick Banting and Charles Best started their experiments with dogs at the University of Toronto to extract insulin for human use.<br /><br />In 1922 in Toronto, a 14-year-old boy, Leonard Thompson, was chosen as the first person with diabetes to receive insulin. Leonard, who was nearly on his death bed, after receiving insulin rapidly regained strength and appetite and went on to live for another 13 years, before dying of pneumonia.<br /><br />As research advanced over the years, insulin extraction has evolved from animal insulin to human insulin and today to synthesis of insulin analogs. Type 1 diabetes is a form of diabetes that appears mostly in childhood when the child’s immune system attacks and destroys the insulin producing cells in the pancreas, which are called beta cells.<br /><br />Insulin is a hormone that helps convert the glucose from our food and makes it available to the cells in our body to produce the energy we need for day-to-day functioning. When the pancreas stops producing insulin at such an early age, there is virtually no way to get it back to normal functioning. So, children with Type 1 diabetes start using insulin as a treatment early and continue it for the rest of their lives.<br /><br />Type 1 diabetes mellitus can be both emotionally and physically challenging for children and their families. Undergoing blood tests, taking insulin injections regularly, managing the diet and engaging in regular exercise are arduous tasks for a child. Doctors need to counsel children and their families that without insulin the child’s life is under threat and that insulin should be considered a boon and not a burden.<br /><br />Unfortunately, not every child is diagnosed at an early stage. Awareness about Type 1 diabetes is not as high as they should be because it is commonly assumed that diabetes affects adults and not children. <br /><br />In fact, 11 out of every 1 lakh children born in India are afflicted with Type1 diabetes. There is a definite need to address the problem of early diagnosis, regular monitoring and timely treatment of the disease because one lakh out of five lakh children affected by Type1 diabetes in the world are in India.<br /><br />High incidence in India<br /><br />India also accounts for the highest incidence of Type 1 diabetes in South-East Asia. According to the sixth edition of the International Diabetes Federation Atlas, India has three new cases of Type 1 diabetes per one lakh children in the age group 0-14 years. <br /><br />The prevalence of diabetes in India differs from region to region. For example, data from Karnataka has reported an incidence of 3.7/1,00,000 in boys and 4.0/1,00,000 for Type 1 diabetes, while in Chennai and Karnal (Haryana), on an average, three and 10 out of a lakh children, respectively, suffer from it.<br /><br />Along with the regular use of insulin comes another challenge for the child: daily blood monitoring of blood sugar levels. With technological advancements, there are various options available to children to aid in the regular monitoring of blood sugar levels and insulin delivery. This helps them in leading a flexible lifestyle and doctors can recommend such forms of treatment for the patients. The bionic pancreas development is underway and may be a major breakthrough in the treatment of diabetes in future.<br /><br />Effective management of Type-1 diabetes is possible. With proper care, children can lead a healthy life and it can also reduce the probability of developing complications affecting the eye, kidneys, nerves and vessels and related diseases in future. Children must be encouraged to deal with diabetes in the right spirit and should be helped to overcome any obstacle that comes in their way.<br /><br />(The writer is Consultant Endocrinologist, M S Ramaiah Memorial Hospital, Bengaluru)</p>
<p>Today is Insulin Appreciation Day, a time to reflect upon the discovery of insulin that revolutionised diabetes management 94 years ago. <br /><br /></p>.<p>Until the early 20th century, there was no medicine available to manage diabetes. The only treatment available was to reduce caloric intake bringing it down almost to starvation levels in the hope that this would extend the patient’s life.<br /><br />While the precursor for insulin, pancrein, a pancreatic extract from dogs was discovered in the early 1990s by the Romanian Physiologist, Nicolas C Paulescu, it was only in 1921 that Frederick Banting and Charles Best started their experiments with dogs at the University of Toronto to extract insulin for human use.<br /><br />In 1922 in Toronto, a 14-year-old boy, Leonard Thompson, was chosen as the first person with diabetes to receive insulin. Leonard, who was nearly on his death bed, after receiving insulin rapidly regained strength and appetite and went on to live for another 13 years, before dying of pneumonia.<br /><br />As research advanced over the years, insulin extraction has evolved from animal insulin to human insulin and today to synthesis of insulin analogs. Type 1 diabetes is a form of diabetes that appears mostly in childhood when the child’s immune system attacks and destroys the insulin producing cells in the pancreas, which are called beta cells.<br /><br />Insulin is a hormone that helps convert the glucose from our food and makes it available to the cells in our body to produce the energy we need for day-to-day functioning. When the pancreas stops producing insulin at such an early age, there is virtually no way to get it back to normal functioning. So, children with Type 1 diabetes start using insulin as a treatment early and continue it for the rest of their lives.<br /><br />Type 1 diabetes mellitus can be both emotionally and physically challenging for children and their families. Undergoing blood tests, taking insulin injections regularly, managing the diet and engaging in regular exercise are arduous tasks for a child. Doctors need to counsel children and their families that without insulin the child’s life is under threat and that insulin should be considered a boon and not a burden.<br /><br />Unfortunately, not every child is diagnosed at an early stage. Awareness about Type 1 diabetes is not as high as they should be because it is commonly assumed that diabetes affects adults and not children. <br /><br />In fact, 11 out of every 1 lakh children born in India are afflicted with Type1 diabetes. There is a definite need to address the problem of early diagnosis, regular monitoring and timely treatment of the disease because one lakh out of five lakh children affected by Type1 diabetes in the world are in India.<br /><br />High incidence in India<br /><br />India also accounts for the highest incidence of Type 1 diabetes in South-East Asia. According to the sixth edition of the International Diabetes Federation Atlas, India has three new cases of Type 1 diabetes per one lakh children in the age group 0-14 years. <br /><br />The prevalence of diabetes in India differs from region to region. For example, data from Karnataka has reported an incidence of 3.7/1,00,000 in boys and 4.0/1,00,000 for Type 1 diabetes, while in Chennai and Karnal (Haryana), on an average, three and 10 out of a lakh children, respectively, suffer from it.<br /><br />Along with the regular use of insulin comes another challenge for the child: daily blood monitoring of blood sugar levels. With technological advancements, there are various options available to children to aid in the regular monitoring of blood sugar levels and insulin delivery. This helps them in leading a flexible lifestyle and doctors can recommend such forms of treatment for the patients. The bionic pancreas development is underway and may be a major breakthrough in the treatment of diabetes in future.<br /><br />Effective management of Type-1 diabetes is possible. With proper care, children can lead a healthy life and it can also reduce the probability of developing complications affecting the eye, kidneys, nerves and vessels and related diseases in future. Children must be encouraged to deal with diabetes in the right spirit and should be helped to overcome any obstacle that comes in their way.<br /><br />(The writer is Consultant Endocrinologist, M S Ramaiah Memorial Hospital, Bengaluru)</p>
