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)