Before 1921 the diagnosis of diabetes was a death sentence, with an average life expectancy of less than 2 years in young people, who were only kept alive by a starvation regimen that reduced them to walking skeletons. 1 Tattersall RB The pissing evil: a comprehensive history of diabetes mellitus. Swan and Horn, Fife2017 The discovery of insulin in 1921 was transformative and many patients with diabetes went on to live full and productive lives. This article is available free of charge.