Why Insulin discovered 100 years ago and patent sold at $1 - costly !!

There are Doctors, Health specialists, Dieticians and more – who would guide the way you eat .. eat healthily, happily and be happy in life .. .. mostly they would recommend green vegetables and fresh fruits.   Fresh and seasonal fruits are an intrinsic part of a healthy diet. They are rich in a variety of antioxidants, vitamins and nutrients that are essential to carry out various body functions. Health experts often emphasise on the need of including fruits of all types and colours in one's diet. But if you happen to be a diabetic, you need to be a little cautious of what you have on your plate, even when it comes to fruits. Fruits that have high sugar content or glycaemic index like chikoo and melons are not very advisable for diabetics.  Whereas, consuming fruits like guavas and tomatoes have been linked to lowered blood sugar levels. Oranges too, are said to be beneficial for diabetics.. .. …

~   the life of a Diabetic is often mundane and uninteresting, wanting to eat, not allowed to eat, ending up eating clandestinely or keep professing that one has good control, but goes loose at every possible opportunity, ending up eating more than what one normally would! ~ a life of ‘having things but unable to enjoy’ worser than those who suffer from ‘have-nots’

Insulin (from Latin insula, island) is a peptide hormone produced by beta cells of the pancreatic islets; it is considered to be the main anabolic hormone of the body. It regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of carbohydrates, especially glucose from the blood into liver, fat and skeletal muscle cells. Beta cells are sensitive to glucose concentrations, also known as blood sugar levels. When the glucose level is high, the beta cells secrete insulin into the blood; when glucose levels are low, secretion of insulin is inhibited.

If beta cells are destroyed by an autoimmune reaction, insulin can no longer be synthesized or be secreted into the blood. This results in type 1 diabetes mellitus, which is characterized by abnormally high blood glucose concentrations, and generalized body wasting. In type 2 diabetes mellitus the destruction of beta cells is less pronounced than in type 1 diabetes, and is not due to an autoimmune process. Instead there is an accumulation of amyloid in the pancreatic islets, which likely disrupts their anatomy and physiology. Typically it is given by injection under the skin - three main types of insulin are :  short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).  Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.

The significance is because of growing number of Diabetics - Diabetes mellitus (DM), commonly referred to as diabetes, is a metabolic disorder in which there are high blood sugar levels over a prolonged period.  Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.  There are three main types of diabetes mellitus:  Type 1 DM resulting from the pancreas' failure to produce enough insulin due to loss of beta cells. Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly ~ the third form is Gestational diabetes.  It has been called the scourge of urban life. Poor lifestyle and obesity have led to a surge in type 2 diabetes, a condition that occurs when the body cannot produce enough insulin to regulate blood sugar levels.

Now scientists say that millions of people around the world with diabetes may not be able to access insulin over the next decade and more.  BBC reports that some 400 million people - more than half of them in China, India and the US - aged 20 to 79, are living with type 2 diabetes, which is the most common form of the disease. Their numbers are expected to climb to more than 500 million by 2030.  A new study in the Lancet Diabetes and Endocrinology journal says nearly 80 million people with the disease will require insulin by 2030 as the demand for the drug is projected to rise by 20% by then. But around half of those who need it - possibly the majority in Asia and Africa - will not be able to get it.  "Access is defined as the combination of availability and affordability " In addition to prices, it also means that a supply chain must be in place that can handle and safely distribute a refrigerated drug and the various supplies like sterile needles and syringes that must go along with it."

Why has insulin, a 97-year-old drug, which was hailed as one of the first "wonder drugs" of the 20th Century, remained consistently expensive over the years?  One reason, say scientists, is that three multinational companies - Novo Nordisk, Eli Lilly and Company, and Sanofi - control 99% of the $21bn (£16bn) global insulin market in terms of value and 96% in terms of volume. (The same companies control the entire US market.)  And although more than 90 of 132 countries have no tariffs for insulin, the drug still remains expensive for many - taxes, steep mark-ups, and other supply chain costs have pushed up the drug price and hurt affordability. The global control of the insulin market, according to David Henri Beran of Geneva University Hospitals and University of Geneva, means that countries have a small number of suppliers to choose from, "and this factor has resulted in people having to change the type of insulin they take as companies have withdrawn (some) formulations from the market".

There are different types of insulin and doctors prescribe the type that is the most beneficial to patients depending on how they respond to the drug, lifestyle choices, the patient's age, blood sugar goals and the number of injections to be taken every day. Several low and middle income countries are especially vulnerable to disruptions in supply. A study of insulin availability found supplies were low in six countries - Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka.

So why is a drug that was discovered nearly 100 years ago by two scientists at the University of Toronto still not available as a low-priced generic? (The scientists sold the patent to the university for $1.) Drugs which are in high demand usually become more accessible after their patents expire, thanks to cheap generic competitors. But that did not happen in this case. One reason, say scientists Jeremy A Greene and Kevin Riggs, is that insulin, which is a hormone produced by living cells, is more complex and harder to copy. And generic drug companies, they add, have not considered it "worthwhile" to do so.

Clearly, weak health systems, poor access to health facilities, health care delivery of diabetes care and pricing are all impeding access to insulin. That certainly is no sugar for Diabetics.

With regards – S. Sampathkumar

1^st Dec 2018.