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In Sickness and in Health: Diabetic treatments need an injection of common sense
Sunday Telegraph, 31.10.04
By James Le Fanu
Animal insulins can suit diabetic patients far better than human insulin, says Dr James Le Fanu
Medicine is, for the most part, a sane and scientific enterprise but it can be surprisingly intolerant of even the most well-intentioned criticism.
Thus, some of those with diabetes find that modern regimes of treatment can cause, perhaps paradoxically, severe problems – but their difficulties have fallen on deaf ears, with serious implications.
Since the discovery of the life-saving potential of insulin in 1921, diabetics have successfully controlled the level of sugar in their blood by regularly injecting themselves with the hormone, derived from pigs and cows. This is cheap, plentiful and highly effective.
Then, in the early 1980s, scientists managed to produce human insulin by the revolutionary process of genetic engineering. They inserted the relevant gene into a bacterium that reproduced billions of times, producing the hormone in prodigious quantities.
In practical terms, the chemistry of human insulin is virtually identical to the animal varieties, but it seemed obvious that the human form must be “better” and doctors accordingly advised their patients that they should switch.
Some found, quite unexpectedly, that their previously well-controlled diabetes suddenly went haywire, as the levels of sugar in the blood oscillated wildly. Matthew Kiln, a family doctor, found that he could no longer anticipate the potentially serious state when his blood sugar fell too low – known as a “hypo” – which must be promptly corrected before coma supervenes. His personality changed, too, and he became uncharacteristically more irritable and argumentative, with unfortunate consequences for his personal and professional life.
Surveys revealed that about one in four diabetics were experiencing similar difficulties. No one could come up with a satisfactory explanation but most were able, albeit with some difficulty, to persuade their doctors to do the sensible thing and switch them back to the animal-based insulins.
Dr Kiln and his contemporaries had realised that there was something wrong because they knew, from personal experience, how the control of their diabetes had deteriorated. This opportunity is, however, denied to those who have come after them, and who are routinely started on the genetically engineered human form.
No doubt, this works for many but certainly not for all, as revealed by the experience of another doctor-cum-diabetic, Ann Robinson, a 46-year-old psychiatrist.
Dr Robinson discovered that she had diabetes a couple of years ago, but expected to be back at work in no time. Her human insulin injections, as intended, kept the levels of sugar in her blood within the normal range, but she felt terrible. “I did not feel like me with an illness. I felt like someone else,” she says. “I became a zombie. I could not concentrate for more than a few minutes and, whenever I took the least exercise such as going for a walk, my blood sugar went right through the floor.”
The months went by and her perplexed consultant changed Dr Robinson’s regime of injections no less than five times, but to no avail. She realised eventually that there was no alternative but to take early retirement on medical grounds.
Then, one evening in July, while idly flipping through a medical journal, she chanced upon an article by Dr Kiln that rang a peal of bells with her. She rushed round to her family doctor, brandishing Dr Kiln’s article, and persuaded him to switch her from human to pig insulin. Within a couple of days, her life changed.
“I woke feeling hungry for the first time in two years,” she says, as if, once again, her body’s metabolism was working as it should. Her intellect emerged from the twilight as she found she could concentrate once more, her joints loosened up and her personality returned. “I was me again,” she says.
Dr Robinson wonders how many others there are like her: children, for example, whose behavioural and learning problems are blamed on their reaction to being diagnosed as having diabetes, but who will become their sunny selves again simply by switching to pig insulin. But how are they (or their parents) to know?
And there’s the rub. Ten years ago, Dr Kiln helped set up the Insulin Dependent Diabetes Trust to promote research and publicise this important issue – but, astonishingly, no one really seems to want to know. It is scarcely revolutionary to propose that some of those with diabetes might do better with animal-based insulins – but, for many and complex reasons, neither the diabetes specialists nor the drug companies are prepared to give them a sympathetic hearing.
Indeed, it remains an uphill struggle to ensure that the animal insulins are even available. This is perhaps not unrelated to the fact that they are far less profitable to the drug companies than the much more expensive human forms. Enough said.
The IDDT can be contacted at:
Insulin Dependent Diabetes Trust [IDDT]
PO Box 294