The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Introduction: Enter Dr Lawrence
Balance: Signpost to Success
Juggling the Blue Carbohydrate and Red Insulin Balls
The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Conclusion: Commonsense Rules
The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Progress towards becoming a well-balanced diabetic is not helped by the wide range and increasing choice of insulins being put on the market. Is this complication really necessary? Over forty varieties of insulin (3) are advertised and none of them would be on the shelves unless manufacturers could make a profit by selling them. Commonsense tells me to complain loudly about having to find my way and make the right choices through the insulin maze. It does not matter if we select the wrong toothpaste or cat food, but insulin is different. The diabetic community cannot survive without this life-saving drug. We therefore form a captive market and, as any economist will tell you, this creates a perfect opportunity for experts to manipulate and exploit us. Have our gurus the time or inclination to guide us through this jungle of short, medium, long-term and mixed insulins? Do they explain the scientific jargon and help us make a free and informed choice?
In this search for the right insulin, newly-diagnosed diabetics, handcuffed by ignorance and fear, are particularly vulnerable. No way can they decide for themselves which insulin to use. They have to be guided by the care team who, in these circumstances, have no option but to take control. Let us hope that sooner rather than later, these fledgling diabetics will be able to fly from the nest and act on their own initiative to make an informed choice of which insulin suits them best.
Three clues will help us make up our mind. The first is not to abdicate in favour of the care team or encourage them to steal our melody. The second clue is not to make a decision until you have in front of you a complete list of all insulins on the market, both animal and ‘human’. Thus fortified, you and your helpers can work out what is possible for you. An informed, rather than an imposed, choice will result. The third clue is not to believe what the printed instructions tell you about the strength and duration of action of each kind of insulin. In my body, short-acting, neutral insulin reaches its peak after six hours and remains active for at least twelve hours. Two injections daily are enough. The label, however, informs us that it lasts only six hours and peaks after three hours. If my doctor or I had believed what the manufacturers told us, we would have been up the creek in a big way!
The debate about whether to choose animal or ‘human’ insulin has raged ever since the latter was invented in 1982. Two red herrings, now rotten and stinking, must be cleared away before rational argument can proceed. Whenever the ‘human’/animal insulin issue raises its head, there are people around who talk rubbish and tell us we need synthetic ‘human’ insulin because the world is threatened with a shortage of animal insulin. This is nonsense because such a shortage is not real. IDDT has figures to show that there are plenty of animal pancreases. Enough cattle and beef pancreases from slaughtered animals are available worldwide to supply what might be needed for two hundred million people. In the United Kingdom about three hundred and fifty thousand people are dependent on insulin. We are a long way from being short of animal pancreases to supply insulin for all who need it everywhere. Human insulin is not required now or in the foreseeable future to make up for a non-existent shortage of animal insulin. Let this red herring be buried once and for all. Those who persist in keeping this rumour alive are foolish; their behaviour in the face of the known evidence is unworthy of their training as doctors and scientists.
The other red herring, that there is no difference between natural animal and synthetic ‘human’ insulin, is equally far-fetched. Animal insulin is extracted from the pancreas of dead cows and pigs. Human insulin is produced in a completely different way, in a laboratory. “A great deal of research went into producing human insulin by means of genetic engineering. The genetic material of a bacterium of a yeast is reprogrammed to make insulin instead of the proteins it would normally produce. This insulin is purified so that it contains no trace of the original bacterium.” (4)
Synthetic human and natural animal insulins are produced from different raw materials in different ways. It follows that they are as unlike as chalk and cheese. I find it hard to believe that any reasonably intelligent doctor or scientist could be so misguided as to expect them to be the same and have the same effects. Complicated and costly research with double-blind samples and vast arrays of figures are not necessary to prove what any normal person can work out on the back of an envelope. Yet, in spite of this, when I started to use ‘human’ insulin in 1985, and found it played havoc with my life and my diabetic control, two eminent diabetic consultants told me that there was no difference between animal and ‘human’ insulin. My troubles, they insisted, were entirely imaginary, although my local doctor, my carers and friends all supported me. In my distress, I phoned the British Diabetic Association and found they had received three thousand unsolicited letters, all complaining about the difficulties experienced with ‘human’ insulin. This information made me realise I was not going mad and my self- confidence began to return. Is it too much to ask the medical profession to recognise that some people are not suited to synthetic ‘human’ insulin?
“The dismissal of patients’ reports of problems with ‘human’ insulin, because this is only anecdotal evidence, is quite wrong. All reported side effects for any drugs are always anecdotal. The demand for scientific evidence to prove that these side effects exist, is unrealistic because it is impossible to prove a negative.” (5)
It is hard to understand why this delusion of sameness persists. Even today, some experts are unwilling to believe that this difference between ‘human’ and animal insulin is real and that the ‘human’ variety can disagree with some diabetics. Let us hope that this red herring can be cast out and forgotten with its twin, the mythical shortage of animal pancreases.
When we have cleared away this confusion, the next task is to expose the censorship surrounding animal insulin. Many doctors leave us ignorant about animal insulin. The depth of this ignorance was exposed to me recently. It has shattered any fragile remnants I retained of good-will towards the medical and pharmaceutical establishments. I was being driven home one evening by a diabetic friend on ‘human’ insulin. I asked her how she was coping with it and told her it had not suited me. “Oh, I find it’s fine. It suits me perfectly. The only trouble is that I get hypos in the middle of the night. My husband has to feed me and rescue me. It worries him a lot. I don’t know what to do. I am going away to an international meeting for four nights and I won’t have him to sleep beside me.” I replied, “But if you change to animal insulin you will be all right. I live alone and don’t have to bother about sudden hypos by day or night.” She replied, “I couldn’t do that! My doctor wouldn’t hear of it. He would not approve. He says human insulin is the best!” Professor Teuscher pointed out at the 1999 AGM. of IDDT: “The problems are always blamed on the patient and never on the product. Where ‘human’ insulin and hypoglycaemia are concerned, it is a product problem and not a patient problem!”
I did not want to believe my ears. My friend is a highly intelligent professional woman working in a hospital. What had gone wrong? Surely, at least anybody who experiences sudden hypos by day or night should be encouraged to overcome this difficulty by changing to animal insulin. But apparently she is condemned to suffer needlessly. “There is a need to convince healthcare professionals and doctors that if a person is experiencing frequent and/or severe hypos or any other unexplained symptoms, then they should try natural animal insulin.”(6) It is amazing that, in this information age, thousands of diabetics are kept in ignorance of the availability and advantages of animal insulin and are allowed to suffer the fear and indignity of avoidable sudden hypos.
Whenever anybody tries to lift the veil of secrecy surrounding animal insulin, or mentions the limitations and difficulties of ‘human’ insulin, an angry chorus tries to shut them up, saying it is unfair to frighten and upset diabetics and their carers who are happy and settled on ‘human’ insulin. If this is so, and they are really happy, then why should they be upset? “And what does happy on ‘human’ insulin mean anyway? If you have never tried any other insulin you actually do not know how happy you are on human! I always remember a doctor saying to me about being unwell – the trouble is when you are unwell you don’t realise how unwell you are until you are well again. This also applies to happiness – how do we know if the people who are said to be happy on human insulin are as happy as they could be? We don’t know, nor do they and nor do their doctors.” (7) How do they know they have to put up with the problem, if they have never been told that there is an alternative treatment? Could you honestly say you preferred tinned salmon if you had never been lucky enough to taste fresh salmon?
Those who are satisfied with the status quo will not be involved, but a sizeable minority, including myself, cannot function on ‘human’ insulin. Currently about fifty thousand diabetics in the United Kingdom are on animal insulin and their number does not seem to be decreasing as the elderly die off. Their welfare should not be swept under the carpet to simplify life for doctors, reduce distribution costs for manufacturers, allow them to benefit from economies of scale and increase profits. We are informed that synthetic ‘human’ insulin will probably become standard. Those of us who need animal insulin will be victims of considerable commercial pressure. “Drug companies function on an international level and so do the medical profession, added to which they also have partnerships with each other. These partnerships exclude patients but include an agenda that may well be different from ours. We have only one agenda: to have the treatment that we need with the species of insulin that suits those needs.”(8)
To make matters worse, ignorance about the availability of animal insulin is widespread amongst professionals – doctors, diabetes specialist nurses and pharmacists. This can embarrass patients and they often have to become assertive to obtain the prescription they need. Already, to my dismay, animal insulin has been systematically withdrawn from the USA, Canada, Australia, France and the Irish Republic. For those who are lucky enough to live in the United Kingdom, it can still be found in Wrexham, Wales, where it is manufactured by C.P. Pharmaceuticals [now Wockhardt UK] in many varieties in both bottles and cartridges, and if you order cartridges, a well-designed insulin pen will be supplied free of charge.
What differences do those of us who have tried both kinds of insulin notice? The fundamental difference seems to be that animal insulin, as any of the thousands of diabetics using it can tell you, works more slowly and gently in your body and gives longer warnings of an approaching hypo. It helps your hormones play in tune without the discordant notes that seem to sound with ‘human’ insulins. This may have something to do with the antibodies still present in animal insulin which have been taken out of the ‘human’ variety. These antibodies may also explain why warnings of impending hypos come sooner and last longer. Perhaps it is the extreme purity of human insulin that makes it difficult for some of us to use, and causes us to question its value. It provides the extra insulin that diabetics need but, in doing so, does nothing to restore the system that regulates the blood sugar. The insulin supply is OK but the balancing mechanism is as cranky as ever. Could it be that those antibodies in the old-fashioned animal insulin made it work more gently and slowly within our body and helped our hormone system warn us earlier when the blood sugar was falling dangerously low? Did those clever genetic engineers concentrate so hard on making insulin that they forgot that we ordinary diabetics urgently needed help to know when blood sugar is falling abnormally low? Please could they remove their one-eyed goggles, swallow a mug of commonsense and look at the whole picture of being diabetic which is not simply the need for insulin. Please, if we have to be programmed for synthetic ‘human’ insulin, could we have our antibodies back? After this is done, we shall all feel a lot safer.
More than fifteen years have passed since synthetic ‘human’ insulin was launched on the market. Its advent was heralded as the start of a new era. Absorbing the propaganda, I could not wait to get my needle into this scientific miracle. I was disappointed and frustrated. Diabetics are still waiting to enjoy the benefits, scientific or anecdotal, that this discovery was supposed to have brought them. The promised progress, widely advertised at the time, has never materialised beyond an illusion invented by clever spin-doctors. It is time scientists stopped wooing and confusing us with all these wonderful new ‘designer’ insulins. They are only tinkering with our real problems and leading us up blind alleys. They need to roll up their sleeves and have the courage to tackle a more difficult project. The urgent need is to try to discover how to replace the reliable blood sugar control system we lost when we became diabetic. I believe that until success is achieved in doing this, we will need animal insulin, with its helpful antibodies, to lessen the unacceptable threat of sudden hypos that seems to be inherent in the use of ‘human’ insulins. I hope I am wrong and that some time in the future the promised wonders of this artificial insulin will appear. Until then, I cannot help feeling cheated. I have done nothing to deserve being caught up in this conspiracy of silence about alternative treatments. Which God was it that empowered the medical fraternity to feed me with misinformation and deny me the right to choose between using natural animal or genetically engineered ‘human’ insulin?