Insulin
The Original Peptide Drug (1922)
Evidence grade 5 of 5, Settled. Read how the Atlas grades evidence.
Insulin holds the highest evidence grade with no reservation: a century of clinical use beginning with Leonard Thompson in January 1922, a Nobel Prize in 1923 (Banting and Macleod), Sanger's 1955 sequencing (the first protein ever sequenced, itself Nobel-recognized in 1958), and FDA approval of recombinant human insulin (Humulin) in 1982. It is life-saving and non-optional in type 1 diabetes and central to type 2 management, backed by an overwhelming and uncontested body of evidence.
- FDA
- FDA approved. Recombinant human insulin (Eli Lilly Humulin) approved 30 October 1982; many analog and formulation approvals since.
- WADA
- Prohibited at all times under S4.4 (Insulins and Insulin-Mimetics) of the WADA Prohibited List, for athletes without a documented medical need and Therapeutic Use Exemption.
Reference only. Not medical advice.
What can go wrong
Life-threatening hypoglycemia; complex individualized dosing. Non-medical use in bodybuilding is extremely dangerous: non-diabetic users retain normal insulin output, so injected insulin can drive blood glucose into coma and death within minutes, and such deaths are documented in the medical literature.
Talk to a clinician before taking this. The Atlas can tell you what has been studied about Insulin. It cannot tell you how it would interact with your body, your history, or anything else you are taking, and nothing on this page is a reason to start.
The first peptide drug ever used clinically (1922, Banting and Best in Toronto) and the first peptide structurally characterized and synthesized, the foundational proof that small amino-acid chains could be therapeutic drugs.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
- Type 1 diabetes
- A survival treatment: in type 1 the body makes no insulin, so injected or pumped insulin is required to live, replacing the missing hormone.
- Type 2 diabetes
- Used when other treatments are not enough, supplementing the body’s own insulin to control blood sugar, often later in the disease.
- Other diabetes
- Used in gestational and other forms of diabetes and to manage dangerously high blood sugar in hospital settings.
How it works
Insulin is the body’s master glucose-lowering hormone, released by the pancreas to let cells take up sugar from the blood and to drive the storage of energy as glycogen and fat. As a medicine it replaces or supplements that signal, and it is the foundational example of peptide medicine: a peptide hormone whose discovery turned a fatal disease into a manageable one.
Insulin is a 51-amino-acid peptide hormone built from two chains linked by disulfide bonds. It was originally extracted from animal pancreas, then made as recombinant human insulin, and is now most often produced as engineered analogs tuned to act faster, for meals, or more steadily across a day, for background control. It is delivered by syringe, pen, pump or even inhalation.
- Type
- Blood-sugar peptide hormone
- Role
- Replaces or supplements insulin
- Forms
- Rapid and long-acting analogs
- Delivery
- Injection, pump, inhaled
- Discovered
- 1921
- Issue
- Pricing and access
Sold For A Dollar, Then Priced Beyond Reach
Insulin is the original wonder drug, the molecule that turned type 1 diabetes from a death sentence into a manageable condition almost overnight after its discovery in 1921, work recognized with a Nobel Prize just two years later. Its discoverers, believing it belonged to humanity, sold the patent to the University of Toronto for essentially one dollar. The honest and uncomfortable part is what happened next. A century later, insulin remains out of reach for many: in the US its price climbed steeply for two decades, driven by a near-monopoly of three manufacturers, by patents extended through incremental improvements so a 1921 drug stayed proprietary, and by weak competition from biosimilars. Recent relief has come, a thirty-five-dollar monthly cap in Medicare and then, under public pressure, from the major makers, alongside emerging biosimilars, but globally a life-saving, century-old medicine is still unaffordable for millions. Few drugs illustrate the gap between a medicine’s value and its price more sharply.
Safety in detail
The single most important safety message for this entry is that off-label insulin use to build muscle is a documented cause of severe and sometimes fatal hypoglycemia. A published case series of 41 non-diabetic insulin users (Journal of Emergency Medicine and related literature) describes young men, almost all also using anabolic steroids and practicing heavy polypharmacy, presenting with coma from cryptic insulin injection. Because a non-diabetic body already produces normal insulin, adding exogenous insulin offers no legitimate anabolic benefit and carries a mortal risk. This use is separately banned in sport under WADA S4.4.
- Hypoglycemia (low blood sugar) is the main and potentially life-threatening risk, requiring careful dosing and monitoring.
- Weight gain and injection-site reactions are common.
- It is life-sustaining and non-optional in type 1 diabetes and widely used in type 2; the issues are dosing and access, not whether it works.
- Affordability has been a major policy concern, with recent moves to cap out-of-pocket costs.
Children and teenagers
Insulin has a genuine, essential pediatric use: children with type 1 diabetes, which often appears in childhood, depend on it to survive, managed by pediatric diabetes teams. This is the opposite of the gray-market peptides, a vital, properly-supervised pediatric medicine, and the affordability problem is especially acute for families. It is unequivocally appropriate, and necessary, in children who need it.
What people get wrong
Nothing recorded here yet. There is almost certainly something people get wrong about this one, and the blank space means we have not written it down, not that the record is clean.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
Insulin’s economy is dominated by three manufacturers that control about ninety percent of a market worth roughly twenty-nine billion dollars, a concentration that has long limited competition. Biosimilar makers and private-label products are beginning to add pressure, and patent extensions on incremental improvements kept a century-old drug proprietary. It is the textbook case of commercial forces shaping access to an essential medicine, where the price bears little relation to the low cost of making it.
How we got here
Frederick Banting and Charles Best isolated insulin from pancreatic extract at the University of Toronto in 1921, and Leonard Thompson received the first therapeutic injection in 1922, launching decades of animal-sourced (bovine and porcine) treatment. In 1982 Humulin became the first commercially available recombinant human insulin, replacing animal extraction with genetic engineering. From 1996 onward, engineered analogs such as Humalog (lispro), NovoLog (aspart), and Lantus (glargine) reshaped the molecule for faster mealtime action or steady 24-hour basal coverage.
Insulin was isolated in Toronto in 1921 by Banting, Best, Macleod and Collip, saved its first patient in 1922, and earned a Nobel Prize in 1923. Its discoverers sold the patent for essentially a dollar, believing it belonged to the world. Animal-derived insulin gave way to recombinant human insulin in the 1980s, the first such drug, then to engineered analogs from 1996, alongside pens, pumps and continuous monitors. US prices then climbed for two decades on monopoly and patent extension, prompting thirty-five-dollar caps and biosimilars in the 2020s, even as global access remained in crisis.
- 1921-1922Insulin is isolated in Toronto and saves its first patient.
- 1923The discovery earns a Nobel Prize, and the patent is sold for about a dollar.
- 1980sRecombinant human insulin becomes the first such drug.
- 1996 onwardEngineered analogs become the most common forms.
- 2020sThirty-five-dollar caps and biosimilars arrive while global access gaps persist.
The numbers behind the grade
- Type
- Peptide hormone (51 aa)
- Discovered
- 1921
- Approved
- Yes, foundational
- Use
- Diabetes
- Main risk
- Hypoglycemia
- Issue
- Affordability
The people taking it
The original peptide drug and one of the most consequential medicines ever made, included here as the reference point that proves peptide therapy can be transformative and life-saving.
Insulin’s users are among the most universal in this library: roughly nine million people with type 1 diabetes who depend on it to survive, and a large share of the tens of millions with type 2 who need it, across all ages and regions, including many children with type 1. It is a global, all-ages, survival medicine rather than a niche compound.
Used worldwide to treat type 1 and type 2 diabetes, in many rapid- and long-acting forms, by injection or pump. It is the benchmark against which the promise of peptide medicine is measured.
Set against the alternatives
Against the newer GLP-1 drugs like semaglutide, which transformed type 2 diabetes and obesity care, insulin remains irreplaceable, especially for type 1, where GLP-1s do not substitute for it. Against oral diabetes drugs like metformin, it is the essential option for type 1 and advanced type 2. Against amylin-based pramlintide, a co-secreted hormone used as an insulin adjunct, it is the foundation the adjunct supports. And historically it is the first peptide-hormone medicine, the ancestor of much of this library. Its strength is being irreplaceable and proven; its defining problem is access, not efficacy.
What we do not know
- How to make insulin universally affordable.
- How far automated insulin-delivery and closed-loop systems can reduce the burden of dosing.
- Whether next-generation oral or once-weekly insulins broaden practical use.
What could change
Biosimilar competitionBiosimilars and pricing reform aim to lower cost.Delivery innovationClosed-loop pumps, smart pens and inhaled and oral insulin research advance.Global accessEfforts continue to make insulin reach everyone who needs it.Once-weekly insulinLonger-acting insulins are in development.
Legal status
Fully FDA-approved and among the most essential medicines in the world, available by prescription in many formulations. The central access issue has been cost rather than availability, prompting price caps and assistance programs in recent years.
Status current as of July 2026. Regulatory positions change, sometimes quickly.
The market for this
What follows describes how this is bought and sold. It is not a buying guide and it is not an endorsement of any seller.
Available by prescription through pharmacies in regulated, approved formulations. It is a standard medical therapy, not a gray-market peptide; the practical concern is cost and coverage, addressed through caps and assistance programs.
Cost is insulin’s defining controversy: US prices soared for two decades and are now capped at thirty-five dollars monthly for many, while biosimilars are cheaper, yet a drug whose patent was sold for a dollar remains unaffordable for many worldwide.
Manufactured by major pharmaceutical companies under strict regulation as biologic and biosimilar products; a fully traceable, controlled supply.
Three dominant makersA small number of manufacturers supply most of the world’s insulin.Biosimilars and private labelEmerging biosimilar and private-label products are adding competition.Global access gapSupply and affordability remain critical problems in many countries.
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Insulin.
Nothing outstanding on this one.
Sources
First successful human clinical use of insulin: Leonard Thompson, 14, treated at Toronto General Hospital in January 1922 (11 Jan first extract, 23 Jan purified Collip extract).
University of Toronto, Thomas Fisher Rare Book Library (Discovery of Insulin exhibition)
Banting and Best isolated insulin from canine pancreas in summer 1921; discovery announced November 1921.
The discovery of insulin reversed a diabetes death sentence and led to the 1923 Nobel Prize in Physiology or Medicine (Banting and Macleod).
Frederick Sanger determined the full amino acid sequence of insulin in 1955, the first complete sequence of any protein; recognized with the 1958 Nobel Prize in Chemistry.
The first sequence: Fred Sanger and insulin (peer-reviewed, PMC/NIH)
FDA approved Eli Lilly's Humulin, the first recombinant-DNA human insulin, on 30 October 1982; first rDNA therapeutic approved for human use.
The path to Humulin: cloning and bacterial expression of the human insulin gene (peer-reviewed history).
Making, Cloning, and the Expression of Human Insulin Genes in Bacteria (PMC/NIH)
Insulins are prohibited at all times under S4.4 (Insulins and Insulin-Mimetics) of the WADA Prohibited List.
WADA 2025 International Standard Prohibited List (official PDF)
S4 Hormone and Metabolic Modulators category listing including insulins.
Documented case of severe hypoglycemia and coma from cryptic (off-label) insulin use in a non-diabetic bodybuilder.
Case series of 41 non-diabetic insulin users; metabolic consequences of anabolic steroid, insulin, and growth hormone abuse in recreational bodybuilders.
The discovery of insulin revisited: historical and clinical review.
The discovery of insulin revisited: lessons for the modern era (PMC/NIH)
The studies that matter
Banting, Best, Macleod and Collip1921-1922
The isolation of insulin and its first life-saving use in a child with type 1 diabetes, one of the landmark achievements of modern medicine, recognized with a Nobel Prize.
DCCT and UKPDS1990s
Large trials established that tight glucose control with insulin and other therapies reduces long-term diabetes complications.
Analog development1990s-2020s
Engineered insulins (rapid-acting like lispro and aspart, long-acting like glargine and degludec) refined how closely therapy mimics natural insulin release.