Before the discovery of insulin, people diagnosed with diabetes were often treated with severely restricted diets for months until they eventually died from the condition. But in 1920, something incredible happened that would change the lives of thousands of suffering people, and millions more over time.
On a 3rd Dynasty Egyptian papyrus, physician Hesy-Ra mentioned frequent urination as a symptom of an unknown ailment. This was the earliest known record of diabetes.
Apollonius of Memphis coined the term "diabetes" to refer to a disease that drained people of more fluid than they could consume.
Paul Langerhans, a medical student from Berlin, discovered islets of cells in the pancreas, but was unable to determine their function.
French scientists Apollinaire Bouchardat and Etienne Lancereaux observed that diabetes had two distinct clinical types: diabetes gras (obese) and diabetes maigre (lean).
Jean De Mayer coined the term "insuline" — derived from the Latin word "insula," meaning "island" — to refer to the peptide hormone secreted by Langerhans' islets of pancreatic cells.
After reading a paper on the relationship of the islets of Langerhans to diabetes, general surgeon Frederick Banting realized that the key to treating diabetes may be to extract insulin from pancreatic islet cells, writing "Try to isolate the internal secretion of [the preserved islets] to relieve glycosuria."
At the University of Toronto, physiology department chair Professor John James Rickard Macleod provided Banting and his assistant Charles Best with space to conduct a series of experiments to improve methods of extracting insulin from cow and pig pancreases, as a prospective treatment for diabetes in humans.
Banting presented his work publicly at the American Physiology Society.
In attendance was George Clowes of Eli Lilly and Company, who proposed a collaboration to produce insulin for the commercial market for the first time. His offer was declined, as the treatment was not yet ready.
Later, as the purification process for insulin continues, Banting and Best conducted the first human tests successfully.
On January 11, 14-year-old Leonard Thompson became the first patient to receive Banting and Best's pancreatic extract — which lowered his blood glucose and urine glucose, but not ketones.
Though Thompson's condition was much improved, he had an allergic reaction to impurities in the extract. In the following weeks, James Bertram Collip developed an improved process that removed contaminants from Banting and Best's extract.
In late May, the University of Toronto and Lilly signed a licensing agreement for the production of insulin in the U.S., Mexico, Cuba, and Central and South America.
The parties agreed that Lilly would share any manufacturing improvements with the University of Toronto to ensure that future licensees produced insulin of the highest quality, and that all licensees must pay royalties to the university for the sale of insulin.
Throughout the rest of 1922, Lilly's chief chemist George Walden developed a method to optimize quantity and purity of insulin.
In January, an American patent was awarded to Banting, Best and Collip, who sold the rights to insulin back to the University of Toronto.
The University of Toronto and Lilly developed a non-exclusive contract, allowing Lilly to use the trade name "Iletin" for insulin in the U.S., while paying royalties to the university for the sale of insulin.
On October 15 — almost two years after Banting's first notes on insulin — Lilly began shipping the first commercial supply of insulin.
In November, the not-for-profit Nordisk Insulin Laboratory, using Lilly's manufacturing notes, began producing insulin outside of North America — bringing insulin to a global audience
For their discovery and extraction of insulin as a treatment for diabetes, Banting and Macleod received the Nobel Prize in Medicine.
A total of 217 million insulin units were distributed by Lilly, 13 million of which were exported outside of the U.S.
Insulin treatments were administered by large, reusable glass syringes and needles.
Lilly began producing PZI insulin after researchers from Connaught Laboratories discovered protamine, a protein in found river trout that prolongs the effects of insulin.
Novo Nordisk developed an intermediate-acting insulin by forming crystals of protamine and insulin. This was marketed as NPH insulin, and could be mixed with a fast-onset insulin to complement its long-lasting action. These solutions became known as “premixed” insulin. Lilly began marketing NPH animal-sourced insulin in 1950.
Novo Nordisk introduced lente insulins (semilente, lente and ultralente), which were longer-lasting insulin suspensions that allowed doctors to prescribe dosage regimens suited to individuals' needs. Lilly began marketing lente insulin in 1954, and semilente and ultralente insulins in 1957.
Dr. Frederick Sanger and colleagues at Cambridge University clarified the primary structure of insulin, showing that insulin comprises a 21-amino acid A chain and a 30-amino acid B chain interconnected by two disulfide bonds.
Arnold Kadish devised the first insulin pump.
Chromatographic processes allowed for the production of highly purified animal insulins, which Novo Nordisk named "monocomponent" insulins and Lilly named "single peak" insulins.
Lilly began providing silver medals and congratulatory letters to patients who had been kept alive with the help of insulin for at least 50 years. This tradition continues today with 10-, 25-, 50- and 75-year medals.
David V. Goeddel and his Genentech associates, Arthur Riggs and Keiichi Itakura, worked with Lilly research scientists to demonstrate the use of recombinant DNA methods for making human insulin.
Genentech produced the first recombinant human insulin by combining A and B chains of insulin expressed in Escherichia coli from chemically-prepared genes. Lilly immediately licensed recombinant insulin and began development.
The first doses of recombinant human insulin were administered to volunteers without diabetes in London, England, which marked the start of clinical testing. Later, a Kansas woman with diabetes became the first person in the U.S. to receive recombinant human insulin.
Cardiac Pacemakers, a Lilly subsidiary, introduced the first microprocessor-controlled insulin infusion pump.
Lilly introduced the first human insulin of rDNA origin produced by recombinant DNA technology. Lilly also introduced a Neutral Protamine Hagedorn human insulin, manufactured by recombinant DNA technology.
Novo Nordisk introduced the first insulin pen.
Lilly received approval for a fixed-ratio premix recombinant human insulin.
Lilly began marketing insulin lispro, which was approved as the first rapid-acting insulin analog.
Lilly launched the first Lilly-designed pre-filled, disposable insulin pen. The design was updated in 2005.
Aventis (now Sanofi) received approval for the first long-acting basal insulin analog, insulin glargine.
Lilly began collaborating with the International Diabetes Federation to support Life for a Child, a program that provides insulin and supplies. Lilly employees donated to provide diabetes education and care for nearly 200 children in developing nations.
Lilly began the Lilly Camp Care Package program, one of the largest support initiatives for diabetes summer camps in the U.S.
The FDA approved a form of rapid-acting inhalable insulin developed by Pfizer. Another inhalable insulin entered the market in 2014.
Lilly launched an insulin pen designed to meet the needs of pediatric patients, allowing for half-unit dosing.
Lilly introduced Diabetes Conversations, a patient-focused program that provides educational resources.
Lilly launched the first multiple-dose electronic memory insulin pen and a compact and disposable low injection force pre-filled insulin pen.
Lilly partnered with The Walt Disney Company to create educational resources for families with children with type 1 diabetes. This was a major corporate responsibility initiative addressing the global health crisis of non-communicable diseases like diabetes.
The Lilly NCD Partnership was also announced this year.
Insulin glargine, the first insulin follow-on biologic, is made available to people with type 1 and type 2 diabetes.
Lilly launched the Lilly Diabetes Solution Center, a first-of-its-kind call center designed to help people with insulin affordability.
Novo Nordisk introduced faster insulin aspart.
Lilly introduced ultra rapid insulin lispro.
Lilly and Life for a Child commit to expanding access to care (including insulins, pens, blood glucose monitoring, education and A1C testing) to 150,000 young people in 65 countries over the next decade.
After a century of care, there's still so much work to be done.
As we celebrate the tens of millions of lives saved and improved by 100 years of insulin, Lilly remains committed to future treatment innovations and ensuring access to insulin for all.