From cumbersome injections to precise formulations: how diabetes treatment has evolved over the decades

A personal recount of Robert Gawley’s experiences highlights the dramatic advances in diabetes management from manual injections and basic tools to sophisticated, tailored therapies, reflecting a century of medical innovation.

Robert Gawley’s memory of his diagnosis still begins with a date: June 30, 1962. The timing mattered because it came just before doctors at his nearest hospital went on strike, yet his physician, Paul Schwan, managed to get him in after a glucose tolerance test confirmed type 1 diabetes. Gawley spent two weeks in hospital as staff focused on stabilising his blood sugar and teaching him how to manage the condition himself, a reminder of how hands-on diabetes education had to be in an era when treatment was far less refined than it is now.

He recalls being shown, step by step, how to inject insulin: first practising with water and an orange before moving on to self-injection. His treatment also reflected the technology of the time. Glass syringes were common, needles had to be sharpened by hand with emery paper, and he would sterilise equipment with alcohol before travelling with his insulin supplies. The process, he said, was cumbersome and often painful, with the alcohol stinging at each injection. Later, he switched to a spring-loaded injector and eventually to disposable needles, small changes that made daily management noticeably easier.

That personal history sits within a much longer medical story. According to historians of diabetes, the disease has been recognised since antiquity, but insulin only became available in the 20th century after its breakthrough discovery in 1921. Early insulin therapy relied on animal-derived preparations, and later decades brought major refinements, including purification, better understanding of the hormone’s structure and the eventual move to recombinant DNA technology, which allowed manufacturers to produce insulin using microbes rather than animal tissue.

The evolution did not stop there. Reviews published by the Endocrine Society and other medical journals show how insulin therapy has diversified into rapid-acting, short-acting, intermediate-acting and long-acting formulations, along with more precise delivery systems and newer analogues designed to better match the body’s needs. What once required improvised tools and painstaking routines has become a more adaptable, though still demanding, form of chronic care. Gawley’s experience captures that shift clearly: diabetes management has become safer, simpler and more flexible, even as the daily discipline it requires remains much the same.