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This clip shows 12-year-old James Jarvis, who suffers from type 1 diabetes, at a pharmaceutical trade fair where he interviews Dr Richard Di Marchi, asking him why an alternative to injecting insulin is not available to diabetics. Dr Di Marchi explains that insulin cannot be administered orally because it is a peptide hormone, a type of protein, and would be degraded in the stomach. The clip includes footage of a trade display featuring the Eli Lilly Pharmaceutical Company, a leading manufacturer of insulin.

Educational value points

• No More Needles Please follows 12-year-old James Jarvis, who suffers from type 1 diabetes, as he tries to find out why a cure has not been found for diabetes. Since the age of 2, James has required two daily injections of insulin to keep him alive. The clip tracks aspects of James’s daily struggle with diabetes and the effects it has on those around him, and makes clear that insulin, while life saving, is not a cure. The documentary, co-directed by James’s mother Catherine Jarvis, makes use of a hand-held camera to follow James and includes his voice-over, which gives the sense that the story is being told from his perspective.

• The clip raises the issue of the need for people with type 1 diabetes to inject themselves daily with insulin, and the physical and emotional effects of this regime on both the patient and those around them. Type 1, or insulin-dependent, diabetes is an autoimmune condition in which the immune system destroys the cells in the pancreas that produce insulin. Ten per cent of people with diabetes have type 1 diabetes, and they are usually children and young adults. The cause of type 1 diabetes is not known but it is believed that sufferers have a genetic predisposition to the condition, which may be set off by a viral infection or a reaction to a toxin.

• In 2006 the World Health Organization estimated that 180 million people worldwide had diabetes, and predicted that this figure would double by 2030, mainly as a result of lifestyle factors that put people at risk of type 2 diabetes. Diabetes is the seventh-highest cause of death in Australia and is associated with an increased risk of cardiovascular disease including heart attack and stroke, as well as high blood pressure, visual impairment, nerve damage and kidney disease or failure.

• While there is no cure for diabetes, the disease in all its forms can be effectively controlled and managed with a combination of diet, regular exercise and medication. Daily injections of insulin are used to treat type 1 diabetes and some cases of type 2. However, before the development of insulin medication in the 1920s, the disease was managed by diet alone, which meant that many people with diabetes had a shortened life expectancy, and mortality rates from the disease were high. Insulin medication must be injected because it is a peptide hormone, a protein, and therefore if taken in oral form would be destroyed by the digestive juices in the stomach before it could enter the bloodstream.

• Researchers are attempting to develop alternative ways of moving insulin into the bloodstream, including an intranasal spray, a powder form of insulin that could be inhaled through the mouth into the lungs, an insulin patch that would provide a continuous low dose of insulin, and insulin tablets that would enable the insulin to enter the bloodstream before it was degraded by the digestive process. An insulin pump, which is connected by tube to a needle inserted under the skin of the abdomen and programmed to deliver insulin, is already available.

• In 1921, Canadian scientists Frederick Banting, Charles Best and John MacLeod made a landmark discovery when they isolated insulin from animal sources and injected the insulin into a 14-year-old with diabetes, reversing the effects of the disease. The researchers worked in partnership with the pharmaceutical company Eli Lilly and Company to purify and produce animal-based insulin medication on a large scale, and by 1924 the company was marketing insulin worldwide.

• Insulin medication was initially made from the insulin of cows, pigs and salmon, but in 1978 scientists at Genentech, a biotechnology research company, devised a method of genetically engineering a synthetic form of human insulin. They used DNA techniques that involved placing the human insulin gene in simple cells, such as those of bacteria or baker’s yeast, which then reproduced human insulin. Eli Lilly and Company obtained the licence for this method from Genentech and in 1982 became the first company to market a synthetic form of human insulin, called Humulin.

This clip starts approximately 14 minutes into the documentary.

Filming is being done at a trade show. Eli Lilly Pharmaceutical Company supplies 6 million people with daily insulin.
Subtitle Eli Lilly Pharmaceutical Company supplies 6 million people with daily insulin.*

Camerawoman We’ve got water and a lady behind a desk. Hello!

James Jarvis, a 12-year-old diabetic I’ve had to take injections for um, all my life. I sort of wonder why can’t…why isn’t there any other form of insulin, givage – say, like a pill.

Dr Richard Di Marchi Well insulin is a miraculous substance – it clearly sustains life – but, unfortunately, it is not a perfect drug. It happens to be a peptide hormone and peptide hormones are degraded in the stomach such that one cannot give this particular drug by the oral route. We would love to be able to provide that to you. Through the power of biotechnology, we have tried to screen for oral substances that could substitute for the natural peptide hormone itself. Unfortunately, we’ve been unsuccessful in finding such a substance. I personally want to see that happen. Even more so, I want to find a cure for the disease so that you would not have to take an oral pill, uh, every day.