“Man may be the captain of his fate, but he is also the victim of his blood sugar.” —Wilfrid Oakley, MB BChir, an early pioneer in diabetes care
Perusing the list of the most notable medical achievements in the 20th century, a reader may conclude that the discovery of insulin should rank in a category by itself. Consider some of its competitors: penicillin, discovered by Sir Alexander Fleming, MBBS, a brilliant Scottish bacteriologist noted for his original thinking and technical ingenuity throughout his illustrious career; the polio vaccine developed by Jonas Salk, MD, who had long studied viral diseases and focused his career on this particular virus for several years before his groundbreaking discovery; or the DNA double-helix structure discovered by a gifted, varied group of investigators working at Cambridge University in England, including James Watson, PhD (zoologist), Francis Crick, PhD (biologist), and Rosalind Franklin, PhD (chemist).
In stark contrast, consider the two people whose names are inextricably linked with the discovery of insulin: Frederick Banting, MD, was a struggling orthopedic surgeon who, for financial reasons, abandoned a fledgling private practice in London, Ontario, Canada, to pursue research in diabetes despite his lack of any formal training in the topic, and Charles Best, a 22-year-old medical student at the University of Toronto, Ontario, who was vying with a classmate to work on this project and succeeded by winning a determining coin toss.1 (Interestingly, decades later, the losing student, E. Clark Noble, MD, had a second brush with fame, when he was mailed a bag of leaves from a Jamaican plant by a patient who was visiting the island and had heard about their medicinal effects on diabetes. Dr. Clark Noble passed them along to his brother, Robert Noble, MD, who directed a research lab at the University of Western Ontario in London. The leaf extracts showed little effect on blood glucose levels, but significantly suppressed bone marrow tissue. Subsequent work identified the primary ingredient as the vinca alkaloid, vinblastine, which remains a mainstay in cancer chemotherapy.)
Dr. Banting and Mr. Best were hardly the first investigators to try to extract the hormone responsible for glucose regulation from the pancreas. Prior efforts to inject subjects with crude pancreatic extracts were abject failures that led to abscess formation and fatal infections. These concoctions were loaded with the digestive enzymes, amylase and lipase that masked the tiny volume of secretions from the islets of Langerhans. Scientists were certain that these secretions contained the elusive glucose-regulating hormone, but were stymied by how to isolate it from the pancreatic slurry.