A Normal Life

Elizabeth Hughes was one of the first people to receive insulin, which saved her life and turned her into a reluctant poster child in the fight against diabetes.

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Published in Diabetes Dialogue in January 2012

In 1922, Elizabeth Hughes, the daughter of a prominent American family, was the most famous diabetes patient in the world. A girl of 14, weighing just 45 pounds, she was wasting away and near death after three years of living on a starvation diet that was as low as a paltry 500 calories a day.

At the time, before the discovery of insulin, people with type 1 diabetes faced a certain death, usually within a year. If they were fortunate, they could prolong their lives by a few months or years by sticking to a rigid diet that radically restricted carbohydrates and only allowed patients to consume as much food as their bodies could efficiently metabolize.

Every morsel was carefully measured out, every gram of food was weighed and every bite slowly savoured. Many desperate children couldn't endure the relentless hunger - some resorted to sneaking food, even birdseed and toothpaste, to quell their gnawing stomach pangs.

They became like living skeletons, barely able to move, and lived with the sickening certainty that their death was imminent. Elizabeth was one of those children - always hungry and sometimes so frail she couldn't walk. But she knew that in order to survive she could barely eat. It was a cruel treatment, but it was the only treatment there was.

Elizabeth survived. She survived because she had the internal fortitude to be extremely self-disciplined about her diet, but also because her family was rich and powerful and could afford to pay for the very best diabetes care of the era.

Her doctor was Frederick Allen, the leading diabetologist of the time, who developed the "starvation therapy" diet and ran a clinic in New York for children with diabetes. She also had a private nurse caring for her around the clock, constantly monitoring her food intake.

She survived because she had a hopeful spirit that allowed her to rise above her physical suffering and still take pleasure in the world around her; she nourished herself with books, music, nature, friends and dreams of travelling the world one day. But, most important, she survived because she was born at the right time - by a hair.

While Elizabeth was in catastrophic decline and likely just weeks from death, a team of doctors in Toronto was working desperately to increase the meagre quantity of a pancreatic extract that had shown promising results in a handful of diabetes patients.

Thousands of people were clamouring for this seemingly magical substance, but it was in short supply and still experimental - there simply wasn't enough to go around. In August 1922, Elizabeth became one of a handful of lucky patients to be selected by Dr. Frederick Banting in the first clinical trial for insulin. It saved her life.

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