WEBVTT
00:00:58.879 --> 00:01:05.599
Imagine being fourteen years old and being told that eating is part of the problem.
00:01:06.159 --> 00:01:17.359
You're desperately thin, you're hungry, weak, your body's wasting away, and the treatment keeping you alive is essentially controlled starvation.
00:01:18.319 --> 00:01:24.560
That was the reality of severe type one diabetes before insulin therapy.
00:01:24.959 --> 00:01:33.840
In nineteen twenty two, a Canadian teenager named Leonard Thompson was hospitalized at Toronto General Hospital.
00:01:34.079 --> 00:01:35.599
He had diabetes.
00:01:36.159 --> 00:01:41.919
And at that time, the diagnosis could be devastating.
00:01:42.879 --> 00:01:50.719
Doctors had learned that restricting carbohydrates and calories could sometimes prolong life.
00:01:51.039 --> 00:01:56.400
Some patients were placed on extraordinarily restrictive diets.
00:01:57.439 --> 00:01:59.680
But think about what that meant.
00:02:00.079 --> 00:02:12.560
The child was already losing weight because his body couldn't properly use or store fuels, and medicine's best option was often to restrict the fuel coming in.
00:02:13.360 --> 00:02:18.240
It might buy time it couldn't replace what was missing.
00:02:18.719 --> 00:02:21.039
Leonard was extremely ill.
00:02:21.360 --> 00:02:36.399
Then on january eleventh, nineteen twenty two, he received an injection of pancreatic extract developed through the work of Frederick Banting, Charles Best, and their colleagues.
00:02:36.719 --> 00:02:42.240
And it wasn't the miracle moment we sometimes hear in the simplified version of the story.
00:02:42.719 --> 00:02:45.360
That first extraction was impure.
00:02:45.759 --> 00:02:51.120
The response wasn't good enough, and Leonard developed a local reaction.
00:02:51.519 --> 00:02:57.519
A biochemist named James Collip worked on improving the purification.
00:02:58.079 --> 00:03:01.039
They tried again later that month.
00:03:01.360 --> 00:03:04.719
This time Leonard's glucose fell substantially.
00:03:04.959 --> 00:03:13.599
His glycosuria, which is basically glucose in urine, it's never supposed to be in urine, but that's something that's common when you have diabetes.
00:03:13.840 --> 00:03:21.199
Anyway, this number improved and the treatment did not produce the same severe local reaction.
00:03:21.520 --> 00:03:29.439
Suddenly, medicine had something it had never had before, a way to replace the missing signal.
00:03:29.599 --> 00:03:32.000
And I want you to notice something important.
00:03:32.479 --> 00:03:35.439
Insulin didn't magically remove diabetes.
00:03:35.680 --> 00:03:39.280
Lena's beta cells hadn't suddenly returned.
00:03:39.680 --> 00:03:49.840
What changed was that physicians could now provide from outside the body something his body could no longer provide adequately for itself.
00:03:50.719 --> 00:04:01.520
That distinction matters because even today you'll hear type 1 diabetes discussed as though insulin is simply a medicine that lowers blood sugar.
00:04:01.759 --> 00:04:03.840
It is more profound than that.
00:04:15.039 --> 00:04:24.399
Fat metabolism changes, protein metabolism changes, ketone production changes, and electrolytes as well as water balance change too.
00:04:24.639 --> 00:04:28.480
The entire metabolic state begins shifting.
00:04:28.800 --> 00:04:42.960
Eventually, we're going to go inside the physiology and understand why a person can have an enormous amount of glucose in the bloodstream, and yet metabolically parts of the body are behaving as though they're starving.
00:04:43.199 --> 00:04:46.560
It's one of the great paradoxes of diabetes.
00:04:46.800 --> 00:04:50.720
But Leonard's story gives us something else, perspective.
00:04:51.199 --> 00:05:06.560
Today we have insulin pens, pumps, continuous glucose monitors, rapid acting insulin analogs, long acting analogs, algorithms that can communicate with pumps, and we're going to understand all of them.
00:05:06.800 --> 00:05:13.360
But none of that makes sense until we understand how extraordinarily the original discovery was.
00:05:14.000 --> 00:05:23.360
Because barely more than a century ago, type 1 diabetes could turn food into an enemy and starvation into treatment.
00:05:23.680 --> 00:05:26.399
Then insulin changed the story.
00:05:26.800 --> 00:05:29.120
But there's another mystery here.
00:05:29.439 --> 00:05:36.959
Banting and best didn't simply wake up one morning and decide the pancreas must contain a diabetes hormone.
00:05:37.199 --> 00:05:48.879
People had been following clues for decades, and one of the strangest clues was sitting somewhere nobody expected to find the answer in the urine.
00:00:58.879 --> 00:01:05.599
Imagine being fourteen years old and being told that eating is part of the problem.
00:01:06.159 --> 00:01:17.359
You're desperately thin, you're hungry, weak, your body's wasting away, and the treatment keeping you alive is essentially controlled starvation.
00:01:18.319 --> 00:01:24.560
That was the reality of severe type one diabetes before insulin therapy.
00:01:24.959 --> 00:01:33.840
In nineteen twenty two, a Canadian teenager named Leonard Thompson was hospitalized at Toronto General Hospital.
00:01:34.079 --> 00:01:35.599
He had diabetes.
00:01:36.159 --> 00:01:41.919
And at that time, the diagnosis could be devastating.
00:01:42.879 --> 00:01:50.719
Doctors had learned that restricting carbohydrates and calories could sometimes prolong life.
00:01:51.039 --> 00:01:56.400
Some patients were placed on extraordinarily restrictive diets.
00:01:57.439 --> 00:01:59.680
But think about what that meant.
00:02:00.079 --> 00:02:12.560
The child was already losing weight because his body couldn't properly use or store fuels, and medicine's best option was often to restrict the fuel coming in.
00:02:13.360 --> 00:02:18.240
It might buy time it couldn't replace what was missing.
00:02:18.719 --> 00:02:21.039
Leonard was extremely ill.
00:02:21.360 --> 00:02:36.399
Then on january eleventh, nineteen twenty two, he received an injection of pancreatic extract developed through the work of Frederick Banting, Charles Best, and their colleagues.
00:02:36.719 --> 00:02:42.240
And it wasn't the miracle moment we sometimes hear in the simplified version of the story.
00:02:42.719 --> 00:02:45.360
That first extraction was impure.
00:02:45.759 --> 00:02:51.120
The response wasn't good enough, and Leonard developed a local reaction.
00:02:51.519 --> 00:02:57.519
A biochemist named James Collip worked on improving the purification.
00:02:58.079 --> 00:03:01.039
They tried again later that month.
00:03:01.360 --> 00:03:04.719
This time Leonard's glucose fell substantially.
00:03:04.959 --> 00:03:13.599
His glycosuria, which is basically glucose in urine, it's never supposed to be in urine, but that's something that's common when you have diabetes.
00:03:13.840 --> 00:03:21.199
Anyway, this number improved and the treatment did not produce the same severe local reaction.
00:03:21.520 --> 00:03:29.439
Suddenly, medicine had something it had never had before, a way to replace the missing signal.
00:03:29.599 --> 00:03:32.000
And I want you to notice something important.
00:03:32.479 --> 00:03:35.439
Insulin didn't magically remove diabetes.
00:03:35.680 --> 00:03:39.280
Lena's beta cells hadn't suddenly returned.
00:03:39.680 --> 00:03:49.840
What changed was that physicians could now provide from outside the body something his body could no longer provide adequately for itself.
00:03:50.719 --> 00:04:01.520
That distinction matters because even today you'll hear type 1 diabetes discussed as though insulin is simply a medicine that lowers blood sugar.
00:04:01.759 --> 00:04:03.840
It is more profound than that.
00:04:15.039 --> 00:04:24.399
Fat metabolism changes, protein metabolism changes, ketone production changes, and electrolytes as well as water balance change too.
00:04:24.639 --> 00:04:28.480
The entire metabolic state begins shifting.
00:04:28.800 --> 00:04:42.960
Eventually, we're going to go inside the physiology and understand why a person can have an enormous amount of glucose in the bloodstream, and yet metabolically parts of the body are behaving as though they're starving.
00:04:43.199 --> 00:04:46.560
It's one of the great paradoxes of diabetes.
00:04:46.800 --> 00:04:50.720
But Leonard's story gives us something else, perspective.
00:04:51.199 --> 00:05:06.560
Today we have insulin pens, pumps, continuous glucose monitors, rapid acting insulin analogs, long acting analogs, algorithms that can communicate with pumps, and we're going to understand all of them.
00:05:06.800 --> 00:05:13.360
But none of that makes sense until we understand how extraordinarily the original discovery was.
00:05:14.000 --> 00:05:23.360
Because barely more than a century ago, type 1 diabetes could turn food into an enemy and starvation into treatment.
00:05:23.680 --> 00:05:26.399
Then insulin changed the story.
00:05:26.800 --> 00:05:29.120
But there's another mystery here.
00:05:29.439 --> 00:05:36.959
Banting and best didn't simply wake up one morning and decide the pancreas must contain a diabetes hormone.
00:05:37.199 --> 00:05:48.879
People had been following clues for decades, and one of the strangest clues was sitting somewhere nobody expected to find the answer in the urine.
