in medical history, with diagnosis no longer sounding the death knell for patients. According to local expert Herbert Hope-Gill, before insulin was discovered, thousands of diabetics withered away without anyone knowing why.

It was not until Frederick Banting, an orthopaedic surgeon, made the connection that any progress was made in the area. "Diabetes is a condition characterised by an elevated blood sugar due to a deficiency of insulin,'' he explained. "It is therefore interesting and inspiring to recall the circumstances of the discovery of that hormone and its role in diabetes.'' A specialist in internal medicine and a sub specialist in endocrinology, metabolism and diabetes, Dr. Hope-Gill actually spent four years at the University of Toronto, where insulin was discovered by Dr. Banting and his assistant, Charles Best. It was there that he became very involved in the treatment of diabetes, going on to serve as Chief of Clinical Diabetes at the University of South Florida. He has also written several research papers on the disease which were subsequently presented throughout Europe, Australia, Canada and the United States. "Until insulin was discovered, thousands upon thousands of diabetics withered away to their deaths with high blood sugars without anyone knowing why they were dying,'' he said. "These patients ultimately lined the long wards, awaiting their imminent deaths. In the 1920's there was some evidence that the condition was related to failure of production of some substance from the pancreas, a large gland in the back of the abdomen, since people with destruction of this digestive organ become diabetic. It was Charles Banting, an orthopaedic surgeon, of all things, who became immersed in the conundrum of what role the pancreas was playing in this condition.'' Dr. Banting agonised over the question, becoming quite frustrated until the answer came to him in a dream one night, said Dr. Hope-Gill. "To tie the pancreatic duct, a tube that drained the pancreatic digestive juices into the bowel. In effect, this caused the pancreas to digest itself into a mush.'' Dr. Banting managed to obtain a laboratory room to carry out his work, and with the help of medical student, Charles Best, set to work. It was by using various primitive separation techniques on the self-digested pancreatic tissue, that the two managed to find a portion of the solution that contained a substance which, when subsequently injected into a cat, rendered it unconscious with a low blood sugar. "Tremendously excited, they then injected the solution into a medical student volunteer,'' said Dr. Hope-Gill, "They were downcast when he failed to show the least effect and they all went home, crestfallen and defeated. "On the way home, the medical student, by now sweating and his heart pounding, began to become confused. He managed to knock on a door of a house and was given orange juice and a sandwich for what was, in fact, the first insulin-induced hypoglycemic reaction of all time. Imagine the thrill Banting and Best must have felt when they heard of the student's experience. Imagine their joy when the first insulin was given to dying diabetics lining the wards, allowing them to arise and go home. From there, it was a matter of purifying the extract further and arranging for the production of large quantities of insulin from beef pancreases, as developed in concert with Lilly Pharmaceuticals.'' Dr. Hope-Gill said the two ultimately learned that insulin was produced from little islands of cells stationed throughout the pancreas, the Islets of Langerhans. These islands were resistant to digestion by the surrounding cells that produced the digestive juices that could break down other cells. These Islets were therefore separable from the surrounding digested tissue and their concentration led to the extraction of a high concentration of insulin. "Since the insulin was extracted from these `Islets', they named the new hormone from the Latin for island, calling it insulin. For his efforts, Banting was awarded the Nobel prize. His little laboratory, smaller than an average bedroom, still sits there today at his alma mater, the University of Toronto, a monument to a man's ingenuity and tenacity. But the discovery of insulin was only the first shot in a war against a disease that still disables and kills many people.'' Many advances have been made since that discovery, said Dr. Hope-Gill, including the purification of animal insulin. "Since there were many problems with the body's rejection of this animal insulin, this was followed by the incredible development of a method of producing human insulin using synthesised human genes which are incorporated into bacteria. These genes can miraculously piece together the correct sequence of building blocks -- amino acids -- from a soup containing the genetically-programmed bacteria and all of the necessary amino acids. The bacteria then release the newly-synthesised insulin back into this soup and it is then extracted and purified for injection. '' A large problem, the specialist explained, was that insulin had to be taken by injection since stomach acid destroys it. A major advance was the development in the 1950's of oral agents, called sulfonylureas, that lowered blood sugar. These medications were not like insulin but rather increased insulin release and increased the ability of insulin to lower blood sugar. In the 1970's, a newer type of agent, Cure lies in the future weight loss.

"A number of new developments are in the offing. Primitive insulin pumps that continuously deliver insulin are available, but the development of such a pump that responds to the minute-to-minute changes in blood sugars still seems a way off. Pending further developments, pancreatic transplants have proved unfeasible in virtually every case.

"In view of the role of viruses, vaccines might one day prevent many cases of Type I Diabetes. Newer types of oral agents that lower blood sugar in other ways are being developed and there are a number of new medications that aid weight loss which are near to acceptance. The ultimate cure probably lies in correction of one's genetic structure, with normalisation of insulin secretion and correction of resistance to the effects of insulin but this awaits developments a distance in the future.'' Dr. Herbert Hope-Gill HEALTH HTH