Before Insulin, Dehydration Was a Death Sentence
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The episode, word for word
Before 1921, type 1 diabetes was a death sentence.
There was no insulin. No CGMs. No pumps. No glucose tablets. Just a diagnosis and a timer.
Most people died within months. Some lasted a year or two if they followed brutal starvation diets, eating as little as 450 calories a day, just to buy a few more weeks. But eventually, their bodies would give out. They'd slip into diabetic ketoacidosis, become dehydrated, fall into a coma, and die.
The cause of death wasn't just high blood sugar. It was dehydration. Their bodies were flushing out so much glucose and water that they couldn't keep up. They'd drink and drink and drink, and it didn't matter. They were dying of thirst.
And then, in 1921, two Canadian researchers discovered insulin. And everything changed.
Today we're talking about the history of T1D, the discovery of insulin, and why hydration, something we take for granted, used to be the difference between life and death.
My name is Neil Greathouse, and this is Your Best T1D Year.
Alright, welcome to Week 7 of the Hydration Challenge: Refilling What T1D Drains. If you're just joining us, you're not behind. Jump in right now. Drink more water than you did last week.
So let's talk about history.
Because if you want to understand why hydration matters so much for T1D, you need to understand what happened before insulin existed.
In the early 1900s, if you were diagnosed with type 1 diabetes, doctors had one treatment option: starvation.
They called it the "Allen starvation diet," named after Dr. Frederick Allen, a physician who believed that if you stopped eating carbs, and stopped eating almost everything else, you could slow the progression of diabetes.
The diet was brutal. Some patients ate as little as 450 calories per day. That's less than two Chipotle burritos. For an entire day.
And it didn't work. It just prolonged death. Patients wasted away. They were weak, exhausted, and miserable. And eventually, they'd slip into DKA and die anyway.
Here's what was happening: without insulin, their bodies couldn't use glucose for energy. So their livers kept dumping more glucose into their blood. Their blood sugar would climb to 400, 500, 600 mg/dL or higher. And their kidneys would try to flush it out through osmotic diuresis.
They'd pee constantly. They'd drink water constantly. And they'd still be dehydrated. Because their bodies were losing water faster than they could replace it.
Thirst was the defining symptom of diabetes. The word "diabetes" literally comes from the Greek word for "siphon", because patients were like human water siphons. Water went in, and it immediately came out.
And when they couldn't keep up with the fluid loss, they'd develop DKA. Their blood would become acidic. They'd vomit, become confused, slip into a coma, and die.
Dehydration was the final blow.
On January 11, 1922, a 14-year-old boy named Leonard Thompson became the first human to receive an insulin injection.
Leonard weighed 65 pounds. He was dying. His doctors gave him one last shot, literally, with an experimental extract that two Canadian researchers, Frederick Banting and Charles Best, had isolated from dog pancreases.
The first injection didn't work well. It caused an allergic reaction. But 12 days later, on January 23, they tried again with a purified version.
And Leonard's blood sugar dropped. From over 500 mg/dL to 120 mg/dL.
He started eating again. He gained weight. He lived.
Before insulin, he had weeks to live. After insulin, he lived another 13 years, and he didn't die from diabetes. He died from pneumonia at age 27. But insulin gave him 13 years he wasn't supposed to have.
Here's the wild part: Frederick Banting and his team could have made millions from insulin. They could have patented it, licensed it, charged whatever they wanted. Insulin was the most groundbreaking medical discovery of the 20th century.
But Banting didn't want that.
He sold the patent to the University of Toronto for $1. One dollar. Because he believed insulin should be accessible to everyone. He didn't want people dying because they couldn't afford it.
In a 1923 speech, Banting said: "Insulin does not belong to me, it belongs to the world."
One hundred years later, insulin costs hundreds of dollars per vial in the United States. People are rationing it. People are dying because they can't afford it. Banting would be furious.
But here's what hasn't changed: hydration is still free. Water is still free. And it's still one of the simplest, most effective tools we have to manage T1D.
Before insulin, dehydration killed people with T1D. After insulin, dehydration is still one of the biggest complications, DKA, kidney disease, cognitive decline, slow insulin absorption. It's all tied to hydration.
You have access to insulin. Leonard Thompson didn't, until he did, and it saved his life.
You also have access to water. Clean, safe, drinkable water. For free. Or close to it.
Don't take either of them for granted.
Real quick, if you're sitting here thinking, "Neil, I have insulin, but I can't afford my CGM. I can't afford my test strips. I can't afford my endo visits," I need you to know about Blue Circle Health.
They offer free virtual care for adults with type 1 diabetes. Real endocrinologists. Real diabetes educators. They help with insulin access, prescription navigation, insurance appeals, and getting the supplies you need.
They've helped over 650 people. And it's all free. No insurance required.
Frederick Banting wanted insulin to be accessible. Blue Circle Health is trying to make care accessible too.
Go to bluecirclehealth.org and sign up.
Alright, here's your challenge: drink a glass of water and think about Leonard Thompson.
Seriously. Fill your bottle. Drink it. And remember that 100 years ago, people with T1D died of thirst. You don't have to.
Snap a photo of your water bottle. Post it to your Story and tag @thebetes. Write one thing you're grateful for. Use #RefillWhatT1DTakes.
Go to yourbestt1dyear.com if you haven't signed up yet. Over 1,100 people are in.
Look, T1D is hard. You didn't ask for this. You didn't deserve this. And some days, it feels like you're carrying a weight nobody else can see.
But here's the truth: you have tools Leonard Thompson didn't have. You have insulin. You have CGMs. You have clean water. You have access to information, to community, to care.
You can't control your pancreas. You can't reverse your autoimmune disease. But you can drink more water. You can honor the people who came before you by taking care of yourself with the tools they fought to give you.
Listen, I believe in you. I believe you're doing something Leonard Thompson would be proud of. You're not just surviving. You're living. And that matters.
You shouldn't have to wonder if hydration is "worth it." Banting gave us insulin for $1. You won't regret giving yourself water for free.
One glass. One day. One life.
I'll see you Wednesday.
Type 1 diabetes is relentless, but managing it doesn't have to be. New episodes drop every Monday, Wednesday, and Friday.
You're not doing a bad job, you're doing a difficult job. Nobody remembers easy.
Estimated Cold Open Hook: Bold: "Before 1921, type 1 diabetes was a death sentence." "Shouldn't/Won't" Placement: In encouragement closer (as per calendar) BCH Ad Length: 30 seconds Challenge Name Mentioned: "Hydration Challenge: Refilling What T1D Drains" "You're Not Behind" Language: At the top Jason Bateman Humor: Deadpan ("less than two Chipotle burritos") Tina Fey Humor: Observational ("human water siphons") Ted Lasso Encouragement: Warm closer ("You're not just surviving. You're living.")
Key History: Frederick Banting, Charles Best, Leonard Thompson, $1 patent, Allen starvation diet Key Science: DKA, osmotic diuresis, dehydration as cause of death
April 15 - 184
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.