Type 1 Diabetes: from Cubism to a cure | Robin Goland | TEDxMet

Translator: Jim Taylor
Reviewer: Denise RQ Amelia was diagnosed
with type 1 diabetes at the age of ten. She looked pretty good despite a difficult
– some may say devastating – diagnosis. Her parents, who were with her,
looked a lot worse. Type 1 diabetes occurs
because the immune system attacks the insulin producing cells
of the pancreas. People with diabetes struggle
each day to take care of it. It's really hard,
especially for the children. High blood sugars can lead
to devastating complications, like blindness and amputation.

I make it a point to meet all the newly diagnosed patients
and their families when they come to
the Naomi Berrie Diabetes Center that I co-direct. When I met Amelia and her family,
her mother told me an astonishing thing. She said that her grandfather,
Amelia's great-grandfather, was the first person
to receive insulin at my hospital. I was stunned. I have in my office the multi-volume chart of the first person
to get insulin for diabetes at New York Presbyterian Hospital. I use his pictures to teach
the Columbian medical students about diabetes. "Are you related to Edwin Manheimer?" "My name is Karen Manheimer", she said. Edwin Manheimer
was admitted to the hospital for a recent diagnosis
of type 1 diabetes in 1922.

Back then, type 1 diabetes
was a fatal disease. He was 11 years old.
He weighed 30 pounds. He couldn't lift his head up
from the pillow. It became too sad for his family
to take care of him at home. They brought him to the hospital. It's really sad for me
to show these pictures, because we take care of a lot of patients,
a lot of children, with type 1 diabetes and before 1922 they all would have died. The situation for type 1 diabetes
was unchanged before 1922 for thousands of years. The first description of diabetes
is shown on the Ebers Papyrus from thousands of years ago.

Diabetes has been described in antiquity as the melting of the flesh
on the limbs into urine. Life was said to be short and unpleasant.
It could have been a description of Edwin. All of that changed in 1922, when an orthopedic surgeon
and a medical student made a revolutionary discovery. They extracted the hormone insulin
from beagle dogs and found that it lowered sugar
in the blood and apparently cured diabetes. Edwin's doctors in New York City
wrote to the scientists in Toronto after hearing of this startling research and asked if they would consider
sending this newly discovered hormone to try in their dying little patient
at the New York Presbyterian Hospital. The insulin came in the mail, as it was described,
covered in roots and twigs. The chart goes on to say the doctors
injected it into the little boy and he walked. Edwin, weighing 30 pounds at admission,
weighed 60 pounds at discharge. The nurses notes
are the most extraordinary part of this amazing chart.

The nurses, a few weeks after
the treatment with insulin was started, began describing Edwin as poorly behaved. He ran in the halls.
He stole food from the nurses station He was generally annoying! In short, he was a normal 11 year old boy. He was discharged from the hospital
taking insulin among the first people in the world. He grew up. He started a family. He worked in a family chemical company
that his family still runs today. By all accounts he was a lovely man,
a volunteer for the boy scouts.

He developed devastating complications
of diabetes. His two sons do not remember him
when he wasn't blind. He died of these complications
at the age of 50. Insulin treatment back then was barbaric. The outlook for people diagnosed today
is much brighter for a healthy, normal life expectancy
free of terrible complications. Thanks to scientists
collaborating together on a study called the NIH Trial Net Study
we have found ways to identify type 1 diabetes
in relatives of our patients even before it occurs. We're working for the future
to prevent diabetes so that no additional family members
will develop it. Amelia, five years after her diagnosis
of diabetes, is doing great. Even her parents are doing great! Jay Kee developed type 1 diabetes
at 11 months old.

Among his first words
were momma, dadda and pump. That's his insulin pump.
Really shouldn't happen. He takes his blood sugar by finger stick
8-15 times a day. He inserts his pump. Patients use a glucose censor that they have to insert
every week or so under their skin. It's hard. The strides in the clinical care
have been spectacular. It is not enough. Jay Kee and his family,
and all of my patients, worry a little bit about their diabetes
every day, sometimes more. Too low a blood sugar can cause coma. Too high blood sugars,
over a long period of time, can lead to complications. We need more. The advances have been great,
but they're arguably incremental steps over the discovery of insulin
made in 1922. We perhaps need a revolution, a new way of looking
at a world without diabetes. I recently went to see
the cubist exhibit at the MET. I discovered it was about science. A patient observed to me that Picasso and Braque
are the scientists of the art world. They worked together
to discover new ways to look at the world.

The results were unimaginable
before they came along. You can't see it until you see it. Their work led to a revolution
that changed the world forever much the ways the discoveries
of Banting and Best changed the world forever for my patients. I believe we are poised on the brink
of a revolution in the science of diabetes and it was with this thought in mind that we started
the Naomi Berrie Diabetes Center. We want to be ready. We put the research labs
right next to the doctors offices where the patients are cared for.

It seemed to us the
fasted way to the cure is to have everybody
talking to each other the doctors taking care of the patients,
the scientists trying to cure it, and to allow the patients
access to the scientists as the best way to provide
hope and optimism for the future. What I didn't imagine,
and what turned out to be more powerful, were the insights
the patients would provide to the scientists. We give lab tours
to our patients and families, including this one,
our diabetes camp for children. Our little campers go on outings
to New York City landmarks and museums, like the MET. These under-served kids, often it's the only time
they leave their neighbourhood, except to go to the doctor.

This year, 29 of 30 kids said the lab tour was the best part
of diabetes camp. One kid said bowling was better! Doctor Rudy Leibel,
my co-director and basic scientist, showed the children
laboratory mice with diabetes. The child in the red hat was concerned
that their blood sugar was very high. He said, "If you let the blood sugar
stay high for a long time, then what you'll have there
are three blind mice!" Doctor Leibel asked the kids, would they consider participating
in experimental treatment trials.

One little girl said, "Not me. I'm perfectly healthy. I'm fine with my insulin. I think those trials
could be pretty risky," important information
for the scientists to hear, but one little boy said, quietly,
"I'll do it. Diabetes hurts." That was it for me. It took all my self-control
not to say, "OK, tour over. We have children worried
about going blind.

We have children who are suffering.
Go back to work." We also give tours to grown-ups,
including recently the artist John Currin and Rachel Feinstein,
whose child was diagnosed recently with type 1 diabetes. They were shocked to find
the labs were a mess and reminded them of their studios. Artists come to basic science
laboratories and see art. This observation is extremely comforting to many of my patients who come on the lab tour
and wonder out loud, can't I make the scientists
stop goofing around? Can't I force them
to be more narrowly focused? Pointing out that science is often messy, that the results come
from unexpected directions, go in unexpected places, you can't see it until you see it. That's where the discoveries are made.

I have already seen examples
of this in my career. When preliminary experiments
were proposed to me in a new field, stem cell research, a few years ago, my response was, "That's insane.
That's never going to work." I was wrong. We can now take skin biopsies
in my patients, turn the cells into stem cells,
and turn them into any cell in the body. When the scientists make heart cells,
they beat in the dish. It's unbelievable. When we make pancreatic cells,
the cells secrete insulin.

In the future, we'll be able, I think, to have the time when trials are done of transplantation of pancreatic cells that were generated
from my patients skin cells. Another advance
that I would have said was impossible comes from the laboratory
of Doctor Domenico Accili at Columbia. I've taught the Columbian
medical students for decades, that only the pancreas can make insulin. Also, incorrect. Doctor Accili has shown
that the intestine can be induced to make insulin. in the future, instead of insulin shots,
my patients might take a pill that causes their gut to make insulin. A cure for diabetes might arise from this very basic research. I tell my patients diagnosed today that I take care of people
who were perfectly healthy; they've had diabetes 40, 50 years
and not only that, there is no way that my patients today
will have it this long because the science is moving fast. Meryl was diagnosed
before her second birthday and she's now 12.

She's had diabetes a decade. Enough. My patients and I are ready for Cubism to emerge
in the science of diabetes. Meryl drew this picture
when she was really little, and when a cure is discovered
for my patients with diabetes it will be a really great day, and we will turn our diabetes center
into a bowling alley. Thank you. (Applause).

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