KERSTEN Hall has the most profoundly personal reason for wanting to tell the story of insulin, which he injects four times a day. Without it, he’d be dead.
His diagnosis with type one diabetes 10 years ago came as a shock. Kersten was in his 40s, feeling grumpy and tired as he worked on a book, and put it down to middle age. Then he went to his doctor, who carried out tests.
Kersten says: “This look of horror came over his face and he said, ‘Did you drive to the surgery today?’ and you could see him thinking, ‘This guy cannot be behind a wheel’. There was that much sugar in my blood that it had basically turned to treacle. That turns your world on its head. Type one usually presents in childhood or teens. It’s unusual to get it in middle age.”
Kersten, 52, from Leeds, was sent to the city’s St James’s Hospital the same day and went home with an insulin pen to begin his lifelong regime of injections. That day was also the beginning of eight years of research, which has resulted in a book, Insulin – The Crooked Timber, which unearths the story of how a substance initially described as “thick brown muck” by one of its pioneers became a lifesaver that was first successfully used to treat a patient in 1922.
“Life deals you the hand, and you have to play it as best you can,” says Kersten. “I thought if I’m going to be injecting myself with this stuff, let’s find out more about its story and that’s what got me digging into it.”
The saga he has revealed exposes bitter rivalries amongst doctors in Canada over who did what and when to create the first effective treatment, as well as the vast fortunes made from it on Wall Street and the scientists choking on chemical fumes in a converted stable in 1940s Leeds, where a key breakthrough was made. “It’s like Game of Thrones, except with lab coats and pipettes instead of chain mail and poisoned daggers,” says Kersten.
“What struck me when I started getting into this is that it’s a story of monstrous egos, toxic career rivalries, and people stabbing each other in the back and taking credit for something they didn’t do.”
Kersten’s background as a biochemist gives him an acute insight into the condition he lives with as one of the 400,000 people in Britain who have type one diabetes. They cannot metabolise sugar from carbohydrates in food, and their bodies produce toxic compounds that can cause coma. Insulin returns the elevated sugar in their systems to healthy levels.
Before every meal, Kersten has to work out how much carbohydrate it contains and then the amount of sugar it will release. He then knows how much insulin to inject. If his blood sugar is too low, it can make him pass out. Too high, and there are long-term risks of serious problems including blindness and cardiovascular disease.
He says: “You’re constantly walking a tightrope, and that is what got me writing this book. I’d always hoped a degree in biochemistry would come in handy, but I never anticipated it would be like this. Before the discovery of insulin, type one diabetes was a death sentence. Nothing could be done for you.
"The best thing they could do is put you on a starvation diet to delay the inevitable. You’re going to waste away, your body is going to start producing these poisonous compounds and you’re going to slide into a coma. So when insulin is first discovered, the clinicians are turning cartwheels.”
The breakthrough in Toronto in the early 1920s saw a 14-year-old boy become the first patient successfully treated with insulin derived from animals. But it was almost 20 years later, in Leeds, that the story took a great leap forward and the foundations were laid for today’s insulin treatment – in the unlikely surroundings of a former stable in Headingley where research was being carried out not on diabetes, but on wool.
In 1941, scientists Archer Martin and Richard Synge were working on the chemical structure of wool – and their method turned out to be the key to cracking the structure of insulin.
Kersten says: “They are working away in this converted stable that’s billowing with chloroform fumes. By the time one of them finished their four-hour shift, when the other came to relieve him, he would find himself on the end of a string of expletives because they were suffering from chloroform intoxication. Two guys working in a fume-filled former stable on the analysis of wool doesn’t sound terribly exciting and yet from that you unravel the chemical secrets of insulin.”
That in its turn paved the way for the development of genetically-engineered human insulin used today by diabetics like Kersten. A fledgling American biotechnology company, Genentech, made the breakthrough, and when it was floated on the New York Stock Exchange in 1980, its founders became multimillionaires in the frenzy to buy shares. Almost 60 years after the development of insulin as a treatment for a fatal condition made headlines around the world, it was leading news bulletins all over again.
Tracing the story – and making its science understandable for a general readership – has been a challenge, but one that fascinated Kersten as he moved into writing after working as a research fellow in molecular biology in the University of Leeds school of medicine.
“I’d always been interested in the history of scientists and the stories of their discoveries. It’s a really tough balancing act to write a popular science book. It’s got to be about the people.”
As the world was hit by Covid when he was researching and writing, Kersten was struck by how much the story of insulin has to teach about dealing with future challenges – whether new pandemics or climate change – by emphasising that people cannot rely on technology alone, but have to behave differently.
“When I started writing this, Covid hadn’t happened and then as the pandemic hit I began to reflect that the story of insulin has wider lessons for us all. The press hailed insulin as a miracle cure. But the doctors of the time knew that it was nothing of the sort.
“What it does is transform an otherwise fatal condition into a long-term chronic one that can be managed. Everyone knows that you need insulin to live with diabetes, but to live well with it requires brains. I inject myself with this stuff four times a day to keep me alive, but to live well I have to do more than that. It has to go hand in hand with appropriate behaviour on my part in regard to diet and exercise, and therein is the message.
“Very often we think technology will do all the heavy lifting when it comes to solving a problem, but the truth is a little more subtle. For technologies to be their most effective, they’ve got to walk hand-in hand with us behaving sensibly. It’s a partnership between us and the technologies.
“Whether we’re facing up to the challenges of global pandemics, climate change or artificial intelligence, we mustn’t get too complacent or too passive and think the men in white coats will always find a pill for it.”
Insulin – The Crooked Timber: A History from Thick Brown Muck to Wall Street Gold is published by Oxford University Press.