When I had the good fortune about ten years ago to visit this country and to work for a few months in the Laboratory of Professor Tiselius at Uppsala, I did not succeed in learning much of your language, but I did manage to learn one word which is very much used, and that is the word 'tack'. This word expresses what I want to say tonight. I wish to thank the Academy for the honour that has been done me in recognising my work with the award of a Nobel Prize, an honour which makes me doubt if I am worthy of it when I think of the great chemists who have held this prize before me and when I think of the pleasure I had from doing much of this work, for in spite of the many difficulties and set-backs that one encounters I'm sure that scientific research must be one of the most fascinating and exciting occupations.
We protein chemists are I think particularly enthusiastic about our subject for we believe that we are studying a subject that is just in its infancy, a subject with great possibilities for the future that will develop rapidly and that we hope will be of great benefit to medicine and to humanity.
It is particularly encouraging to me and I hope to other protein chemists that the Academy has honoured my work on proteins in this way, for indeed this work like most other scientific work is not the result of the efforts of one man but is extremely dependent on the work of many others. It is dependent on the many protein chemists of the past who have by much painstaking work laid the foundation of our science and several of whom have also been honoured here. I would also mention the debt my work owes to my teachers, Albert Neuberger who first taught me how to do research and A.C. Chibnall who first aroused my interests in proteins. My work is also greatly dependent on the protein chemists of the present and owes much to the free exchange of ideas and techniques which I have had with my colleagues all over the world and especially am I grateful to my colleagues Hans Tuppy, and E.O.P. Thompson and others who have collaborated with me in this work on insulin. And particularly I hope that this prize will be an encouragement to other protein chemists as it is to me. For to the scientific worker encouragement is very much appreciated. So often if one takes stock at the end of a day or a week or a month and asks oneself what have I actually accomplished during this period, the answer is often 'nothing' or very little and one is apt to be discouraged and wonder if it is really worth all the effort that one devotes to some small detail of science that may in fact never materialize. It is at times like the present that one knows that it is always worth-while and I am extremely grateful to the Academy and the Nobel Foundation for giving me this great encouragement.
With increasing frequency, individuals with Type 1 diabetes are being placed on insulin pump therapy (also called Continuous Subcutaneous Insulin Infusion or CSII for short). Unlike the usual form of intensified management which generally requires injections of insulin between 4 to 6 times per day and uses a combination of rapid or short-acting insulin as well as intermediate-acting insulin or long acting insulin, pump therapy uses only rapid-acting insulin and gives the insulin in tiny doses (called "basal insulin") around the clock. An insulin pump also allows you to give "boluses" (a few extra units of insulin) when you are about to eat.
There are hardly any scientific studies comparing intensified therapy (i.e.; multiple injections of insulin given with a needle) with pump therapy despite the fact that there are hundreds of thousands of pump users in the world. The few studies that are available have shown, at best, only modest improvement in blood sugar control with pump therapy. Maybe this is a fault of the way the studies were done or maybe pump therapy does not necessarily produce better control as reflected by A1C levels and frequency of hypoglycemia. Regardless, the great majority of people with diabetes who go on pump therapy LOVE it and would NEVER go back to conventional injections. The most common comment I hear is: "It's so much more convenient." Note that I do not hear that it is less work (cuz it ain't less work; if anything it's more work).
One potential turn off about being on a pump is that you have to wear it, basically, around the clock (it is disconnected when showering, swimming and so forth but otherwise it is "always attached"). Sure, that sounds pretty unpleasant, BUT I must say that these words are seldom spoken by actual pump users; it's pretty well only people that haven't tried a pump yet who voice this concern.
So, if you are considering pump therapy I'd suggest you mull over the following (I'll mention only major points):
The Bad: Pumps have to be worn around the clock (with brief exceptions). Pumps are very expensive (count on at about $6,500.00 CDN) and about $300.00 per month for supplies - and that does not include the cost of insulin or blood glucose test strips). Pumps are not less work than conventional intensified therapy; they are more work.
And The Good: Despite the extra work involved, people almost always find pump therapy makes managing diabetes more convenient (easier to bolus for meals and - especially - snacks; much greater flexibility regarding meal timing & exercise, etc) Pumps help avoid inconsistencies in glucose control caused by erratic absorption of typical insulin injections (especially with NPH insulin). Some people experience less hypoglycemia; especially overnight hypoglycemia I find that many people who advise me they would like to switch to pump therapy are checking their blood sugars two or three times per day and are not on an optimized, intensive insulin schedule and believe that changing to a pump will, in and of itself improve and stabilize their blood sugar readings. This is FALSE. Switching to a pump does NOT, just by virtue of being on a pump, make things better any more than driving a Porsche rather than a Hyundai makes you a better driver. Indeed, many (but most definitely not all) people with poor control can achieve excellent control WITHOUT a pump if they monitor their blood sugars four or more times per day and are given expert and ongoing instruction about intensified insulin management. Pumps are highly sophisticated computers. Pumps are also STUPID! They only do what they are programmed to do. They do not monitor your blood sugar levels and they do not figure out on their own how much insulin to give you. You have to tell them how much to give you. The bottom line: If you are on intensified therapy (and if you are not, ask yourself; why not?) and doing well with it and are happy (so to speak) with it, then there's no compelling reason to make a change. If, however, you are not doing well with intensified therapy or if the lifestyle of pump therapy appeals to you, then insulin pump therapy may well be a better option so long as you:
Can obtain the funding to pay for the pump and supplies.
Are highly motivated and up to the challenge of very frequent glucose monitoring, carbohydrate counting, and, crucially, frequent contact with the health care team.
At the risk of sounding corny, I must say that with every smiling face I see on a new pump user; with every "Oh doctor, I should have done this sooner" I hear, I become more and more convinced that pump therapy is the way of the future.
A very informative article is available at the CDA web site. And a site with lots of links to pump-related sites (including various pump manufacturers) is here.
If you are a pump wearer and are looking for accessories (like pants with a hidden pocket to hold your pump), these can be very hard to find. Pump Wear Inc. appears to have some interesting items. (I have no financial - or other - relationship with this company and mention this only as a 'for your information;' not as an endorsement).
Frederick Sanger was born on August 13, 1918, at Rendcombe in Gloucestershire, the second son of Frederick Sanger, M.D., a medical practitioner and his wife Cicely. He was educated at Bryanston School and at St. John's College, Cambridge, where he took his B.A. degree in natural sciences in 1939. Since 1940 he has carried out research in the Department of Biochemistry at Cambridge. From 1940 to 1943 he worked with Dr. A. Neuberger on the metabolism of the amino acid lysine and obtained a Ph.D. degree in 1943. From 1944 to 1951 he held a Beit Memorial Fellowship for Medical Research and since 1951 he has been a member of the External Staff of the Medical Research Council. His present position is Head of the Division of Protein Chemistry in the M.R.C. Laboratory for Molecular Biology at Cambridge. Since 1943 his work has been concerned largely with problems related to the determination of the structure of proteins. These studies resulted in the determination of the structure of insulin. Sanger was awarded the Corday-Morgan Medal and Prize of the Chemical Society in 1951. In 1954 he became a Fellow of the Royal Society and a Fellow of King's College, Cambridge. He is an Honorary Foreign Member of the American Academy of Arts and Sciences; Honorary Member of the American Society of Biological Chemists, Member of the Academies of Science of Argentina and Brazil, Honorary Member of the Japanese Biochemical Society, and Corresponding Member of the Association Qulmica Argentina
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