1. Douglas H. McConnell, M.D., FACS 2017
A Tale of Two
Pioneers
Douglas H. McConnell, M.D., FACS
2017

2. Introduction I am not Dr. Khan Scientific Discovery
The ART and Science of Diabetes
Knowledge Development Journey
Stanford Journey - Chemistry

3. Periodic Table

4. Steinhart Periodic Table

5. Diabetes Mellitus “Diabetes” is Greek for syphon or “to flow”
Mellitus only added much later - Latin for “sweet”
1600 BC Hesy-Ra Egyptian Physician and Official noted frequent urination and wasting
2600 BC to 1922 is 3522 years of human history!
100 years ago - Diabetic coma wards!

6. Breakthroughs
1870’s Langerhans defined the beta cells - Islands or “Insula”
1889 Minkowski and von Mering at Strasberg created Diabetes by canine pancreatectomy
For 30 years attempts were made to isolate and extract the Pancreatic factor - worldwide search
1910 Sir Edward Albert Sharpey-Schafer defined the endocrine function of the pancreas “Insulin”
How to extract Insulin?

7. Banting Contribution Fredrick Grant Banting 1891-1941
Failed his first year at the university!
Rebooted into medical program
Graduated as M.D. and into Army age 25
Seriously wounded in stayed with his men
Awarded the Military Cross in 1919

8. Banting Post War Began training as a surgeon - orthopaedics
Returned to home London Ontario
Physician/Surgeon needed part time work
Part time teacher in physiology
Preparing a talk about diabetes for students

9. Journal Entry October 1920 Diabetus (sp)
Ligate pancreatic ducts of dog
Keep dogs alive till acini degenerate leaving Islets
Try to isolate the internal secretion of these to relieve glycosurea.

10. Summer Research Project May 1921
University of Toronto laboratory of John MacLeod (skeptic)
Medical Student Charles Best
July and August “isletin” extractions effective
November 16, 1921 Insulin extracted from porcine and bovine CHILLED pancreas

11. Human Use December 1921 James Collip - biochemist
Enhanced the extraction and stability of the “isletin” substance
January 11, 1922 used on Leonard Thompson
May 3, 1922 “The Effects Produced on Diabetes by Extracts of Pancreas”

12. Canadian Team Fredrick Banting - Physician, Surgeon, Educator
Charles Best - Medical Student, later physician
John Macleod - Physiology Lab Director
James Collip - Biochemist
Acrimony and controversy

13. Announced
1923 Nobel Prize for Medicine and Physiology awarded to Banting and McLeod
Prize money split 4 ways
No license fees - given to the world!
University of Toronto supervised the early production of Insulin beginning in 1923
Bovine and Porcine extraction utilized until recombinant DNA technology years

14. Frederick Banting Charles Best 1923

15. Nexus

16. Rheumatic Mitral Stenosis
Sister-in Law
Rheumatic Mitral Stenosis
Severe Symptoms

17. Cardio Pulmonary Bypass Progress
1937
1967

18. Who is this famous American?

19. Charles Lindbergh

21. Combat Training South Pacific

22. Operative CABG
Preferred treatment when multi vessel revascularization required
Early intervention to preserve LV function
Requires close diabetic management during procedure
Challenging

23. Cardiac Surgery Diabetic patients - both type 1 and 2 have:
Elevated risk of death and stroke
Increased peri-operative complication rate due to peripheral vascular and aortic disease
Will require insulin drip for intra and post operative management
Elevated risk of wound complications

24. Prevention Management
Delay the onset or stop CAD progress
Careful medical management
Patient education
Preventing CAD is far better than revascularizing the heart with surgery or stents

25. Thank You