nr. 477 - 2011 - Institut for Natur, Systemer og Modeller (NSM)

1 Introduction
Insulin dependent diabetes mellitus (IDDM) or Type 1 Diabetes (T1D) is an autoimmune
disease that, in brief, is characterized by an unnatural depletion of the pancreatic
β-cells, which implies a drop in the production of insulin. Insulin is needed to regulate
the blood sugar level upon ingestion of nutrients 1 , or else hyperglycemia, i.e. elevated
blood sugar, occurs.
It is known that patients with T1D are genetically predisposed for the disease, but environmental
factors are needed to facilitate the events leading to overt diabetes (Pociot
(2009)) – often the symptoms become apparent only in late adolescence or adulthood
(Wang et al., 2006, p.80). It affects about 0.5% of the population in the developed
countries, and 5-15% of those diagnosed with Type 2 Diabetes (T2D) are believed to
have T1D – not T2D (Mathis et al. (2001)). Without daily subcutaneous injections of
insulin the disease is fatal (Lo and Clare-Salzler, 2006, p.17).
Despite intensive research, the exact etiology (the cause of the disease) remains illusive,
though progress has been made.
In 2004 Wild et al. (2004) made an assessment of how the prevalence of diabetes (T1D
and T2D) will evolve between the year 2000 and 2030, and their projections are dim!
Diabetes is mostly a problem in the western world today, but as more and more developing
countries switch from manual to knowledge-based sedentary labor as their primary
source of income, the number of people with diabetes in these countries is expected to
soar, and the total number of people in the world with diabetes will increase from 171
million in 2000 to 366 million by the year 2030 (Wild et al., 2004, p.1047).
Dire forecasts such as these together with the fact that the life expectancy of diabetics
is reduced 2 (Manuel and Schultz (2004)) emphasizes the need for an actual cure of diabetes
– the best case scenario would be the possibility of pre-natal screening for genes
known to induce diabetes, so precautionary measures could be taken. But this is still a
utopian scenario, so until the advent of such times, the best cause of action is research
in post-natal treatments; see chapter 3.
Since the first bolus of insulin was administered to a human, on January 11. 1922
(Rosenfeld, 2002, p.2277) 3 , it has been the foremost applied treatment for diabetes.
At the infancy of insulin-treatment the insulin was often bovine, porcine or canine in
origin, furthermore it was impure, which meant that albeit it was better than no treatment,
allergic reactions could ensue upon injection (Rosenfeld (2002)). This prompted
the need for better purification methods as well as research aimed at making analogs
to human insulin.
1 For a more thorough description of the mechanisms behind T1D see chapter 2
2 Insulin can be administered to cure the symptoms of diabetes throughout the entire life of a patient,
but diabetes is associated with sequela, see e.g. Franco et al. (2007).
3 The first successful administration was, however, not until January 23 (Rosenfeld, 2002, p.2278).
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