Is Every Child Your Child? A Tale of Courage and Determination

Is every child my child? Does ideology end at the bedside of a sick child? I ponder those questions every day when I watch the bravest person I know – my granddaughter. Consider this:

A healthy, happy little boy was suddenly insatiably thirsty. He began urinating a lot and often and feeling increasingly tired. His skin became thin and dry. No matter how much he ate, he continued to lose weight. A few months later he was weak, gray, and skeletal. His eyesight weakened and then his retinas detached rendering him blind. Within nine months, the now bedridden child gasped for air. Less than a year after falling sick, he slipped into a coma and, mercifully, died.

The sad part to this tragic tale is that it was not rare. Ancient Egyptians, Greeks, Chinese, and Indians saw children and adults die in this horrible, mysterious fashion. A first-century Greek researcher, Arataeus of Cappadocia, described the disease as “the melting down of flesh and limbs into urine.” He used the Greek word for “passing through” or “siphon” to name it: diabetes.

For hundreds of years, researchers were stymied. It was suggested that diabetics eat things that the body would have to fight to turn to urine such as almonds and broken bits of coral. It didn’t work. Seventeenth-century Scottish researchers developed a diet treatment in which patients ate nothing but blood puddings, fat, and rancid meat. It didn’t work. In the 1800s, doctors bled diabetics; every day for a week or so, a vein would be opened and pints of supposedly bad blood was drained. It didn’t work. In the early 1900s, diabetic children were hospitalized and fed only 450 calories a day. They were starved to death. German scientists found that eating carbohydrates was linked to symptoms and so they locked up diabetic children and force fed them oatmeal. Nothing worked.

An import step came when German researchers used autopsy studies to link diabetes to the pancreas. The pancreas is a small seahorse-shaped gland that lies between the stomach and spine. You can locate it by pressing your right thumb and little finger together, keeping your other fingers straight and together, and then placing your thumb at the centre of your stomach, even with your lowest rib. Your three extended fingers now approximate the location and size of your pancreas.

German researcher Paul Langerhans advanced learning by postulating that the pancreas produces two types of cells. One is secreted into the small intestine and aids with digestion. He called them external cells. The other is secreted into the bloodstream to regulate glucose levels. He dubbed them internal (later the islets of Langerhans).  It was postulated that without the internal clusters of cells, sugars could not be metabolized from food and so suger entered the blood stream and gathered in increasingly high levels as the body could no longer clean and flush it out. Then the awful symptoms began.

It was a breakthrough but for decades afterward, researchers tried but failed to find a way to utilize the new understanding by artificially doing what a dead pancreas could not – extracting cells from a healthy a pancreas and injecting them into a diabetic patient. People continued to die.

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Photo: Queen’s University

Frederick Banting grew up on a small Ontario farm. He undertook medical training at the University of Toronto. After service as part of Canada’s First World War Army Medical Corps, and becoming both wounded and decorated, he became a surgeon in Toronto. He later opened a small practice in London, Ontario. The 29-year-old was barely eking out a living.

In the middle of a sleepless night, he was reading a medical journal about diabetes research when he experienced a eureka moment. It appeared clear to him that when extracting secretions from the pancreas, researchers were missing the possibility that external secretions were damaging the internal secretions. The two had to be separated, he thought, and then a serum could be developed using only the internal secretions.

The next weekend, he arrived without an appointment at the office of the University of Toronto’s professor of physiology, J. J. R. Macleod, who was famous for his work on the metabolism of carbohydrates. McLeod listened patiently but was unimpressed by the young man with little knowledge of current diabetes research, without a Ph.D., and with no clinical research experience. After several more visits, Banting was about to give up when he saw the professor lean back and close his eyes. But then, McLeod leaned forward, smiled, and said the idea just might work.

In April 1921, Banting arrived at McLeod’s small lab. He met fourth-year student Charles Best who would assist. They used dogs. Banting removed the pancreas of some to induce diabetes. He removed part of the panaceas from others and then, with blood vessels still in place, sewed the severed portion just below the skin of the abdomen. He then tied off, ligated, the grafted portion and waited for the external cells to die. Internal cell clusters were then extracted, purified and processed using water at first and, as they learned more, alcohol. They then injected the extraction into depancreatized dogs. Some showed slightly positive reactions but most didn’t. Many died. The determined Banting and Best slaved away in the smelly, sweltering lab, painstakingly honing the process of removing impurities from the extracts.

In July, after a number of revisions and failed experiments, they injected a depancreatized white terrier with duct-ligated extract. Blood sugar levels dropped from dangerous highs to near normal levels. With their extract in its body, the dog was metabolizing sugar as if its pancreas was still there. Unable to estimate the amount of extract necessary, the dog died. They learned. They injected another dog that had fallen into a diabetic coma with new extract and marveled as the dog awoke, wobbled to its feet, and then walked about the room. Banting and Best were ecstatic. They called their extract Isletin.

A month later, shortly after MacLeod’s return from an extended absence overseas, Banting stormed into the professor’s office with a list of demands including a salary, more assistance, and changes to the lab. A young man was hired to tend to the dogs, biochemistry professor James Bertram Collip joined the research team, a bigger lab was found, back pay for Banting and Best was paid, and a university lecturing job was found for Banting who at that point was just a few dollars from destitution.

Research moved more quickly when Banting began using the pancreas of unborn calves that he procured from local abattoirs. The diabetic dogs began responding better and living longer. Finally, it was time

His name was Leonard Thompson. He was 14 years old. He was from a poor family and so was a public ward patient at the Toronto General Hospital. His diabetes had been diagnosed nearly two years before. He was emaciated and near death. He weighed only 65 pounds. His skin was gray, he could no longer walk, and had trouble focussing and even staying conscious. Banting explained the extract trial to Thompson’s father who quickly consented.

On January 11, 1922, two doses of isletin extract were injected into young Thompson’s backside. Thompson was too ill to even flinch. The sugar in his blood and urine dropped by 25%. It was good but not great. The disappointing results were deemed the result of impurities in the extract and so they went back to work with Collip whipping up batches like a chef trying new recipes.

Two weeks later they walked back across the street to Toronto General Hospital’s H Ward. Leonard’s condition had worsened. He was now fading in and out of a coma. The boy was given two injections that afternoon and one the next morning. It worked. Miraculously, he sat up. He smiled. The fog that had haunted his eyes for so long suddenly cleared. He asked for food. Leonard was Lazareth.

Banting opposed patenting what they were now calling insulin. He insisted that medical advances belonged to all and were for the good of mankind. A patent was eventually applied for in the names of Best and Collip and with the direction that it would be assigned to the University of Toronto. It was written so anyone could use their process to manufacture insulin but that no one else could patent the process. It thereby deprived anyone from stopping anyone else from manufacturing insulin. American legalities later led to Banting’s name being added to the patent.

True to Banting’s principles, the Indiana-based Eli Lilly and Company was afforded an exclusive deal to manufacture insulin in the United States but for the first year it had to be distributed free of charge. Toronto’s Connaught Laboratories manufactured and distributed free insulin in Canada. It was also agreed that the university would happily send the formula to any researcher in the world for free, in return for a promise that insulin would not be produced for sale.

By the end of 1923, diabetes patients in Canada, the United States, and parts of Europe were receiving insulin injections. Each represented an inspiring and heartrending story of recovery as they stepped back from death’s door. The 1923 Nobel Prize for Physiology or Medicine was awarded to Banting and McLeod. McLeod shared his prize money with Collip and Banting shared his with Best.

Among the millions of lives that have been saved by the work of Banting and his Toronto colleagues, and those upon whose shoulders they stood, is my granddaughter. She’s eight years old. For three years now she has pricked her thumb to draw then test blood six to ten times a day. It hurts every time. Trust me, I’ve done it, and it hurts. She now injects herself with insulin six or more times a day. She watches what she eats and her Mom counts every carbohydrate consumed to adjust insulin dosages. It’s an awful disease but it doesn’t define her. Before the work of Banting, Best, and the others, though, it would have killed her.

We know now that type two diabetes is mostly contracted by adults and mostly due to lifestyle choices. But type one attacks children. No one knows why. For some reason, a virus that gives some kids a cold kills the pancreas of others. Today, over 420 million people around the world and about 10% of Canadians have diabetes. Most have type two. About 26,000 Canadian children have type one.

And so we are back to our initial question. God bless the determined researchers who are working in labs every day, uncelebrated, and often underfunded and underpaid. And God bless those who support the idea that our circle of community involves devoting charitable giving and a sliver of our tax money for research. We are helping people we’ll never meet. We are making all children ours. We are saying where ideological arguments should die so that fewer children will; at the bedside of a sick child.

Someday the cure for type one diabetes will be found. Banting and Best will be remembered. And on that day, I will stand with my granddaughter, and we will cheer.

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Lessons from the Snowman & 7-Year-Old

If warp speed is real, then we hit it. A thousand freezing needles stung our cheeks as tears swamped our eyes. The screams grew louder until we realized it was us. When finally crunching to a sudden stop on the sand-strewn rubber mat we sat frozen in place for a second or so until I groaned, rolled, and pulled myself to my knees. I wiped my face and stretched to realign tingling vertebrae. She, on the other hand, bounded up, leapt before me, and with wide-eyed, adrenaline fuelled, fist-clenched, unbridled joy squealed, “Let’s go again!”

“Sure,” I said. What else could I say? Quebec City’s toboggan slide, on the boardwalk – the Dufferin Terrace – adjacent to the majestic Château Frontenac, has been thrilling riders for over 100 years. Speeds have been reportedly clocked at over 70 miles an hour. I believe it.

She flopped atop the 10-foot solid-as-a-rock wooden toboggan with the thin red padding and we began the long haul back to the top. At the wooden ascending ramp, she moved in front and we trudged up and up and up. With the toboggan’s red rope around my waist, I measured each footfall on the cross pieces that resembled hockey sticks and presented no guarantee of a Wile E. Coyote slip and tumble back to the bottom, taking all those behind with me.

The summit offered a 10-by-10 wooden platform and spectacular view. The gigantic sky was cloudless and brilliantly blue and yet the St. Lawrence so far below morphed the sight to black and white. Only the Lévis ferry, gleaming white in the bright sun, broke the grey, pulsating river choked with chunks of gliding ice floes all disappearing at the horizon’s vanishing point.

The blissful moment ended with a French instruction grunted and tickets taken. We assembled ourselves on the long toboggan in the narrow centre lane. A thin metal bar blocked the bow while I adjusted my legs to flank hers, propped my boots upfront, and settled my arms over her shoulders to hold her in place. There would be no flopping about with possible injury on rough barriers that demarked the lanes, nearly touched us, and would soon be whirring by. A word in French, a dropped bar, and we were off. Warp speed.

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Canadian winters are not for the meek. Quebec City winters are especially harsh with mountains of snow and biting winds that whistle relentlessly up the river valley. Rather than deny winter, however, long ago the good folks of the fine city decided to welcome its challenge and revel in its glory. Observed every few years since 1894 but annually since 1955, the Quebec Winter Carnival is a three-week marvel.

A multi-room ice castle is built across the street from the magnificent, gothic National Assembly building. Nearby, the Plains of Abraham, where in 1759 the British defeated the French in a battle that still shapes Canada, hosts a festival of activities. What is best of all is that except for one crazy ride and a Ferris wheel, nothing is passive. There is no sitting down or strapping in and no watching others or screens. Instead, there is human foosball that had us playing, kicking, and cheering, dog sledding that had me leaning into turns behind the scurrying, yelping team, and hills where we dragged inner tubes and sleds back to the top to slide down again.

Forget other cities with subterranean sidewalks and malls and the hatless, silly-shod fashionable but freezing. Quebec City lives life outside with big boots, bigger coats, and even bigger toques. Forget delicate lunches in elegant settings. There are crepes, poutine, tourtiere, and stew, and then a line of maple syrup poured on a snow wall to be twirled around a tongue depressor for the sweetest and most Canadian of snacks. This is a place for practical people, enjoying unpretentious fare, and active, participatory fun. In Quebec City, low temperatures spark high spirits.

Our travelling companion was our energetic, witty, and always in the moment granddaughter who enabled us to see it all through the eyes and at the pace of a seven-year-old. Beyond the gift of her company and warm certainty of memories being forged and bonds being strengthened, she reminded us of the beauty of wonder. Her grade two French immersion allowed her to befriend a little girl in the hotel pool in a meeting of gentle sincerity. Absent were the false dichotomies of region, language, and religion, and in their place the essence of innocence.

The casual but intrepid way in which she tested her blood sugar level several times a day and accepted the insulin needle in restaurants, the hotel, and other places around town including a big police vehicle that an officer kindly offered, reminded us of her quiet courage. Type One diabetes is part of who she is. It does not and will never define her.

And then there is Bonhomme. The 7-foot tall snowman is not a mascot but an ambassador. He moves throughout the city in his traditional red hat and voyageur arrow sash welcoming guests and attracting crowds who swarm for pictures. Seldom is anyone alone with Bonhomme. Our granddaughter, however, watched, figured it out, devised a plan, and at just the right second, slid quickly from behind. His red-coated handler bellowed laughter at her cleverness and temerity. The snowman and 7-year-old exchanged a few thoughts in French and posed, just the two of them.

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And at that special moment, a second in time, there was the symbol of the Quebec Winter Carnival: traditional and corny, fun and funny, retro-cool and cold, and as Canadian as you can get. And smiling with him, the little girl who remains our most profound teacher, reminding us to be in the moment, accept difference without judgement, be courageous in adversity, remember what matters, to seek fun, love goofiness, eat when hungry, sleep when tired, and to unconditionally love and be loved.

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When Fight nor Flight are Options

It’s not fair. In fact, fair is the last thing it is. A happy, witty, intelligent, empathetic seven-year-old child bursts with life. She is fun and funny. She is gentle and caring. She loves the roughness of hockey and the sweetness of a frilly new dress. She loves catching bullfrogs and reeling in bass and yet trembles at the sight of a spider. She loves corny jokes and bouncing on her trampoline and quietly contemplating books beneath a blanket-fort. She is perfect. But then, she is not. Last year her pancreas died.

No one knows what causes type one diabetes. It is not like type two, which is caused by genetics or a bad diet or lifestyle. Doctors guess that a virus may be the culprit. The virus leads the body’s immune system to attack the pancreas, leaving it unable to produce insulin. Insulin is the hormone that regulates the sugars we eat and allows them to enter our cells and produce energy. But without the pancreas working as it should there is no insulin and so sugar levels in our cells go wild with the transformation not happening.

Until the 1920s, children around the world with type one diabetes were dying by the millions. A Canadian surgeon named Dr. Frederick Banting read German research and came to suspect what we now know. He convinced University of Toronto professor John Macleod, a leading diabetes researcher, to give him money and a laboratory. Working with a medical student named Charles Best, Banting began experiments first with dogs and then with cows. They found that extracting insulin from a healthy pancreas and injecting it into animals that had their pancreas removed controlled the animal’s sugar level. It was an astounding discovery.

Imagine the Pain Stopping

Banting (right) and Best. Photo: U. of T. Archives

Leonard Thompson was a 14-year-old old boy. He was skeletal thin and unable to stand or concentrate. He was near death. Leonard and his parents agreed that he would be Banting and Best’s first human test subject. He was injected with insulin. Within a few minutes he smiled for the first time in days, sat up, and wanted to eat. It was nothing short of a miracle. Other test subjects saw similar results. Child after child was invited back from heaven’s gate.

The 1923 Nobel Committee awarded Banting and Macleod the Nobel Prize in Physiology or Medicine. Banting shared his prize money with Best. Banting was told to patent his discovery. He said no. He did not want to profit from something that he wanted only to help children. Companies rushed in and soon insulin was being injected into young arms and saving lives.

It would be nice if the Banting and Best discovery was a Hollywood happy ending but it is still too early to cue the violins. Insulin injections manage the disease but still do not cure it. The management is tough. Picture yourself having to use a small instrument that jabs a sewing needle into your thumb, then squeezing to bring forth blood. I’ve done it. It hurts. Now picture doing that five to eight times a day. It hurts every time. Now picture your Mom or Dad waking you up in the middle of the night to do it again. Now picture yourself being injected with a needle, akin an epi pen, twice before breakfast, once at lunch, once at dinner, once before bed, and then more times depending upon what all the blood tests suggest. Imagine doing that every day for the rest of your life. How do you do that as a child at school, at summer camp, on camping trips, at sports tournaments, at restaurants, at birthday parties, at slumber parties, and at all the other times and places where you just want to be a regular kid eating kid stuff and doing kid things?

Being a parent is hard enough. Now picture a situation where you do everything perfectly. That is, through steely, relentless diligence your child eats perfectly, carbohydrates are counted, exercise is monitored, blood tests are taken and dutifully recorded, urination is tracked, headaches, dizziness, and fatigue are noted, the insulin levels in all the needles are carefully measured and administered, and yet, despite all that and more, in the middle of the night, your child’s sugar level crashes so low that she falls into diabetic seizure. It looks like epilepsy. If not discovered, discovered while you are asleep yourself remember, and then quickly addressed, it could lead to a coma and – it is too horrifying to contemplate – death.

There are diabetic associations in countries around the world. They help young parents to help their children. In cities and towns throughout Canada the Telus company generously supports the Junior Diabetes Research Foundation Walks for the Cure. Money and awareness is raised along with the hope that someday a cure may be found. Someday.

Meanwhile, my granddaughter carries on because that is her only option. She is fun, witty, clever, kind, creative, fearless, and quite simply the bravest person I know. I am in awe of her. Last Saturday I donned a purple tee shirt emblazoned “Team Kenzie Mac”. She and her family walked at our local Telus Walk for the Cure. We are her team. Everything else can wait. Everybody else can wait. Nothing else matters. We were there for her for the walk in the rain, we are here for her now, and we will be here for her always.

May I live to see that day that the work begun so long ago by Banting and Best is completed so that no child need suffer, that no parent need suffer, and that type one diabetes is cured, once and, I pray, for all.

To learn more about diabetes please check the Canadian Diabetes Association: https://www.diabetes.ca/ or the Junior Diabetes Research Foundation: http://www.jdrf.ca/

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