The LRB Podcast Insulin Wars
Apr 1, 2026
Liam Shaw, an evolutionary biologist and author, discusses the century-long saga of diabetes treatments and the people and companies behind them. He traces early pancreatic experiments, the Toronto breakthrough that birthed insulin, the rise of engineered insulins and soaring prices, and the advent of GLP-1 drugs like semaglutide and their social and supply-chain consequences.
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Modified Insulins Created Patents And Higher Prices
- Companies created modified insulins like Humalog to change action profiles (e.g., faster acting), enabling patents and new delivery systems.
- These tweaks improved therapy but also reinstated proprietary pricing despite earlier expectations of cheaper biotech insulin.
A Young Man Died After Rationing Insulin He Couldn't Afford
- High US list prices led to tragic outcomes like Alex Smith, who died after rationing insulin when he lost parental insurance and faced a $1,300 monthly bill.
- Campaigners used such cases to spotlight opaque pricing and lobbying over insulin affordability.
GLP‑1 Links Blood Sugar Control To Appetite
- GLP‑1 is a gut peptide released after eating that stimulates insulin and suppresses glucagon while slowing gastric emptying, linking diabetes treatment to appetite control.
- This physiological role explains why GLP‑1 drugs affect weight and hunger as well as blood sugar.
