Symposium on optimal insulin delivery. Introduction: History and goals of insulin treatment.

Sixty years have now passed since that brief 18-month span of time that brought insulin from the realm of hypothesis to the reality of treatment for human diabetes. There were rumblings around the turn of the century that the "discovery" of insulin was inevitable, although there is no doubt that the tenacity, energy, and observations of Drs. Banting and Best and their colleagues in Toronto ushered in the "insulin era." The euphoria that followed has been well-described by a number of observers. Lives could be saved. In the ensuing 60 years, however, an increasing prevalence of morbidity concomitant with an increasing prevalence of morbidity been observed, as well as increasing insight into the contribution of hyperglycemia to diabetic "sequelae." C. H. Best himself did not let the miracle and wonder of insulin treatment obscure the necessity of viewing the hormone as a drug, and wrote in 1974: "We hope for and expect more physiological methods of giving insulin." The symposium on the following pages was designed to explore the optimal use of insulin as a pharmacologic agent. To place the present and future in perspective and also celebrate 60 years of insulin use, a retrospective look is included (Table 1). The 19th century generated the intellectual ferment that culminated in the insulin era. Claude Bernard isolated glycogen and contributed greatly to our knowledge of carbohydrate metabolism. Both he and Schiff explored the potential role of the pancreas by ligating and sclerosing the pancreatic ducts with oil or paraffin.(ABSTRACT TRUNCATED AT 250 WORDS)