White Poison

Diabetes may seem like a common everyday illness today almost everyone knows someone battling it. But there was a time when it invoked the same fear and dread that cancer provokes in people today. Back then discovering that this condition stems from a lack of or absence of insulin was an immensely challenging feat. The story of the doctors who pursued this discovery is a testament to the power of tireless effort determination and courage proving that sheer willpower can overcome even the most daunting of obstacles.

Someone once said it well: when thoughts begin to wander, they can take you anywhere. Especially when you are waiting for someone and the wait grows longer and longer, your mind seems to drift even more freely. It feels as if, with nothing particular to do or focus on, your thoughts run unchecked. The mind turns into an open field where horses of thought race from one end to the other without reins. That was exactly my state. As the minutes of waiting stretched on, the discomfort of anticipation slowly changed into outright anguish. It was in that moment of unease that my thoughts were carried back to a poetry collection I had read years ago Ubaidullah Aleem’s “Moon face, starry eyes”. Almost spontaneously, a couplet I had first come across some twenty-odd years ago surfaced in my memory. I cannot recall it perfectly — time has a way of softening the edges, but it was a verse that had struck me deeply back then, and somehow it is still tucked away in some corner of my mind.

The sun is not pleasant by day, nor the moon by night;
What kind of feasts are these passing over us?

If there is any mistake in the couplet, please kindly forgive it, knowing that over twenty years have passed and time’s dust has settled on it. If this apology does not satisfy you, then we recall a few verses from a poem by Mustafa Zaidi, in which you surely will find no errors.

Meet me one last time, so that a burning heart
Turns to ashes, needing nothing more

Let the torn hem not be mended, nor the wounds of desire healed
May the breath remain steady, and the flame of the candle not flicker

Let the words be just enough for moments to count them
If a glance raises any hope, let the eyes be taken away

There was no mention this time of a meeting that would lead to yet another encounter. The poem spoke of a final meeting, but for us, it was certainly not the last. However, an important meeting with Mr. Saleem was indeed scheduled—one that seemed to become increasingly unlikely as the moments passed.

After a long wait of three hours, it began to feel as though this meeting might not happen at all. Just as our patience was wearing thin, the doorbell rang. Moments later, a child came to inform us that Mr. Saleem had arrived. He immediately sank onto the sofa. Though we were frustrated from the long wait, seeing his condition made us fall silent. His face was flushed and he looked utterly exhausted. Before we could ask about his health, he spoke up himself. “Friend, I’m feeling really unwell today. The weakness is so overwhelming I didn’t even want to get out of bed. But since I had promised, I had to come.” Hearing this, my mind instantly drifted back to a few years ago when Mr. Saleem was in robust health — tall, with a clear complexion and a well-built body. Suddenly, it seemed as if he had begun to wither away, as if someone had squeezed the life out of him. Just as I was reflecting on the past, he said, “I’m terribly thirsty. It feels like my tongue has turned into a piece of leather. Please get me some water quickly.” After two glasses of water, he cleaned his glasses and continued, “I also need to go to the restroom.” I accompanied him to the restroom and, while returning, reflected on how diseases can drastically change a once healthy person’s life. You might have guessed by now symptoms like weakness, intense thirst, poor eyesight, and frequent urination all point to a disease that has become as common as high blood pressure these days: diabetes.

In the last century, if a doctor told a patient they had diabetes (commonly known as sugar), it was considered more terrifying than a death sentence. Recovery seemed possible only through a miracle. However, in today’s world, diabetes has become a manageable condition, and after the discovery of effective treatments, it is no longer a life-defining curse. In the United States, two tennis players—Hamilton Richardson and William Talbert—both suffered from diabetes. Yet, through disciplined diet and insulin therapy, they managed to keep themselves fit and competitive.

Types of Diabetes

There are two main types of diabetes found in patients:

1. Diabetes Insipidus
This is a rare form of diabetes and is often described as “tasteless.” It is characterized by extreme thirst. The hallmark symptom of this condition is an unquenchable thirst.

2. Diabetes Mellitus
This is the more common form of diabetes, known for the “sweet” taste of the urine due to excess sugar. Until the 1920s, there was little distinction between these two types, but later chemical analyses clarified the difference.

The word “Diabetes” originates from Greek, meaning “to flow,” as patients with this condition pass urine in large quantities. However, frequent urination does not necessarily mean a person has diabetes; there can be other reasons for this symptom as well.

Symptoms of Diabetes

1. Polyuria: The patient urinates excessively, passing nearly 17 pints of urine in 24 hours. This urine contains approximately two pounds of sugar. Due to this, the bladder becomes affected and loses control, causing urine to slowly leak out. As a result, clothes often become wet and stiff, and white stains may appear on shoes.

2. Increased Thirst: Excess loss of water leads to persistent and intense thirst.

3. Increased Hunger: Due to the large amount of sugar lost through urine, the patient experiences excessive hunger. The sugar excreted in urine is known as glycosuria.

A diabetic patient’s tongue often becomes dry, red, and glossy. Gums may swell, and saliva production increases. If left untreated, the patient’s hunger will increase, but fatigue will also set in. As the disease progresses, itching and restlessness develop. If ignored for a prolonged period, the patient may slip into a coma, which can be fatal without immediate treatment. This severe state occurs when the level of ketones in the blood rises significantly.

Before falling into a coma, the patient’s voice becomes heavy, severe headaches occur, and limbs become numb. Gradually, the patient loses consciousness.

Diabetes Testing

Take a few drops of urine in a test tube and add half a teaspoon of Benedict’s Solution. Mix the contents thoroughly. Now, place the test tube in boiling water for about five minutes.

• If the liquid remains blue, it indicates no sugar in the urine.
• If the color changes to green, it signifies a small amount of sugar.
• A yellow color suggests a moderate level of sugar.
• If the solution turns orange or red, it means there is a high concentration of sugar present.

This simple test provides a quick insight into sugar levels in the urine, helping to identify potential diabetes cases.

The History of Diabetes

Diabetes is not a new disease, but it has spread rapidly over the past 50 years. Ancient Hindu and Roman civilizations were aware of this condition. Paracelsus, a pioneer in medicine, observed that patients’ urine contained nearly four ounces of a substance resembling salt. At that time, people were unfamiliar with white sugar, and the sugary substance in the urine appeared similar to salt crystals. Wales, a scholar teaching at Oxford, was the first to analyze the blood and urine of diabetic patients. His experiments revealed that their urine was surprisingly sweet—almost like honey. In 1775, Matthew Dobson conducted fermentation tests on urine and confirmed that the sweetness was due to sugar. Twenty-one years later, John Rollo introduced dietary treatment for diabetes by recommending patients consume meat and low-carbohydrate vegetables. Today, we understand that diabetes results from dysfunction in certain glands. Although the existence of these glands was known in ancient times, their functions remained a mystery. In 1945, Bouchardet became the first researcher to link the pancreas to diabetes, marking a major milestone in the understanding of this complex disease.

In 1886, Johan Conrad Brunner revealed that the pancreas plays a crucial role in helping the body utilize fats and sugars effectively.

In 1889, Oscar Minkowski and Joseph demonstrated this through experiments on dogs. They anesthetized several dogs and surgically removed their pancreases. Although all the dogs survived the operation, within four to six hours they began showing symptoms of diabetes producing large amounts of urine that contained sugar. Remarkably, one dog excreted nearly two ounces of sugar in a single day. During this period, the blood sugar levels in the dogs rose significantly.

Experiments on Dogs

The duct from the pancreas that connects to the small intestine was surgically sealed. Despite this, the dogs remained healthy. This indicated that besides the pancreatic juice entering the small intestine through this duct, there must be some other factor responsible for the utilization of sugar.

Minkowski’s Experiments

Minkowski removed the pancreas from a dog but soon after implanted pieces of it under the dog’s skin. Remarkably, the dog continued to live a normal life and did not develop diabetes, even though no enzymes from the pancreas reached the small intestine. This experiment revealed that the pancreas produces something that enters the bloodstream directly. After conducting experiments on various animals, researchers identified a hormone, which was named insulin.

The term “hormones” was first used in 1905. These substances are produced by the endocrine glands and enter directly into the bloodstream.

During his experiments, the Islands of Langerhans revealed that the pancreas contains two types of cells. One type resembles clusters of grapes, while the other appears as small islands or islets with distinct shapes. In 1893, it was proposed that the latter type of cells plays a role in controlling blood sugar. Because of this theory, these clusters were named the “Islets of Langerhans.” Further research showed that in patients with longstanding diabetes, these islets either diminish or become deformed.

In the past, physicians followed the practice of feeding patients the healthy organs of animals corresponding to their ailment. For instance, someone suffering from liver disease would be given the liver of a cow or goat to eat. In a similar vein, Minkowski fed the pancreas of healthy animals to dogs afflicted with diabetes. However, this approach did not yield any significant improvement in their condition.

Functions of the Pancreas

The pancreas performs two vital functions:

1. It secretes important digestive juices that aid in breaking down food.

2. It produces insulin, which enters the bloodstream and helps the body utilize the sugar present in food.

The Gratitude Owed to Banting

Frederick Grant Banting worked at a hospital in Canada. When he decided to pursue his FRCS qualification, his research focus was the pancreas, as it was closely linked to diabetes. He had studied extensively on the subject. He also came across the work of Zueler, who in 1908 had treated six diabetic patients using pancreatic extract. While the treatment showed some improvement, the patients suffered severe chills and fever. October 30, 1920, marked a pivotal day in Banting’s life. He was preparing a lecture on the pancreas to be delivered in the coming days. As part of his preparation, he studied various books covering surgery, gynecology, and obstetrics. During this research, he came across an article by Moses Baron that opened up new avenues of thought and investigation.

Baron noted that according to post-mortem reports, individuals who had died due to gallstones had their pancreatic ducts blocked by these stones. As a result, the cells responsible for producing digestive enzymes had either shrunk or died. However, the Islets of Langerhans remained remarkably healthy. Baron also pointed out that in such individuals, blood sugar levels consistently remained normal.

After much contemplation, Banting concluded that a certain deficiency in the pancreas must be linked to diabetes. As he pondered this thought, he fell asleep. Suddenly, at two in the morning, he woke up, switched on the light, and began writing. His notes read: “Ligate the pancreatic duct of dogs. Wait for six weeks. Then remove and extract.” After jotting this down, he turned off the light and went back to sleep.

“Ligate” is a medical term that means to tie tightly. It is commonly used in reference to arteries, veins, and ducts.

Banting believed that the pancreas secreted some substance that controlled sugar levels. If he could isolate this secretion, he could potentially cure diabetes. The next morning, he presented his idea to his supervisor. After hearing him out, the professor sensed there was some truth in Banting’s hypothesis. However, the necessary equipment Banting needed was not available to them. The professor advised Banting to meet Professor J.J.R. Macleod, the head of Physiology at the University of Toronto. Banting approached Macleod with a request for ten dogs and a laboratory assistant for an eight-week research period. Although Macleod was initially skeptical due to many unproven theories, Banting’s conviction impressed him, and he agreed to support the research.

Experiments on Dogs

In May 1921, Banting travelled to Toronto to begin working with Macleod. Macleod assigned him two assistants, each helping for four weeks. By drawing lots, Charles Herbert Best, a physiology graduate student, was chosen to assist Banting during the first four weeks. After those weeks, Nobel was supposed to join, but he never arrived, missing an opportunity for recognition.The experiment was conducted on ten dogs. The ducts of their pancreases were ligated and then removed. As a result, all the dogs’ pancreases shrank in size. The acinus cells, responsible for producing digestive juices, also ceased functioning.

Banting and Best carefully cut the pancreas into tiny pieces and ground them with sand. They then mixed this with seawater, which has a salinity and chemical strength similar to that of blood and bodily tissues. Interestingly, very few people know that the chemical composition of seawater closely resembles that of human blood. After filtering this mixture, they were able to inject the solution into animals, marking a crucial step in their research.

All the dogs from which the pancreas had been removed developed diabetes. When they were given injections of this solution, their blood sugar levels—which had soared to dangerously high levels—dropped rapidly. The sugar stopped appearing in their urine, and their wounds began to heal. The dogs regained their lost strength and lived for a considerable time. However, Macleod was not completely satisfied with these results. He instructed Banting to repeat the experiment to ensure consistent and reliable outcomes.

Victory Over Diabetes Was Not Yet Achieved

Banting’s experiments did not signify the final success; rather, they marked the beginning of a long journey ahead. Numerous obstacles awaited to be overcome along the way. To speed up the extraction process, Banting administered secretin injections to his animals for several hours until the acinar cells died. Afterwards, he ground and filtered the pancreases. This method produced much better results, but Banting noticed that the acinar cells were not completely eliminated, which caused toxins to spread among the dogs.

During his experiments, Banting had a breakthrough idea: the pancreas of a newborn calf might contain insulin, but possibly not trypsin — an enzyme found in pancreatic juice that breaks down insulin. This made sense because digestive enzymes are not needed before birth. Before birth, the fetus receives nourishment directly from the mother and therefore does not require digestive juices.

Best and Banting extracted insulin from the pancreases of newborn calves using alcohol. This insulin was then administered to diabetic dogs. Those treated with the insulin remained healthy for nearly ten weeks, while the dogs that did not receive the injections died within a few days.

Banting and Best injected each other to prove that insulin was safe and would not harm humans.

However, current research shows that taking insulin unnecessarily can be extremely dangerous and may even lead to death. Afterward, Banting and Best requested volunteers for their trials. Three patients were given insulin injections, resulting in a rapid drop in their blood sugar levels and a significant improvement in their health. Unfortunately, each patient developed an abscess at the injection site, which was a serious complication.

MacLeod soon realized the significance of Banting’s work. In 1922, he assigned his entire staff to focus on the properties of insulin and making it suitable for human use. Dr. J.B. Collip was appointed to oversee this crucial task. Collaborating with Best and Scott, they succeeded in producing insulin in large quantities. Since then, insulin production has continued to evolve and improve. Best developed “Zinc Protamine Insulin,” which could control blood sugar levels for twice as long compared to insulin extracted directly from the pancreas. This innovation meant that instead of multiple daily injections, only a single injection was needed. While Dr. Pegandorn initially created protamine insulin, it was Best’s insight to combine it with zinc that marked a major breakthrough.

Banting and Best were rightfully awarded the Nobel Prize for their groundbreaking work. Banting received numerous degrees and honors from various universities and scientific institutions in recognition of his contributions. Best also earned significant acclaim and respect for his invaluable role in this medical breakthrough.