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Why is 100 important especially this November? We'll answer that question with another question. What do the Canadian $100 bill, 100 cents, and 100 years ago have in common?


This month we celebrate World Diabetes Day on November 14,1 which is the birthday of Dr Frederick G. Banting, one of four key collaborators in the discovery of insulin. He pursued the idea that an important element in the pancreas could help save the lives of persons with type 1 diabetes: insulin. It took the other members his team-collaborators at of the University of Toronto- to isolate insulin from the pancreas and formulate it into a lifesaving clinical reality. All of this happened 100 years ago this November, when the researchers demonstrated that insulin extract reduced blood sugar in laboratory animals.1 Because they felt so strongly that this medical breakthrough had to be available to all, they sold the patent for 100 cents ($1) so insulin could be affordable for everyone who needed it. To commemorate this, the Canadian $100 bill has an image of an insulin vial on the reverse side.


How ironic it is that a century later in the US, the price of insulin is so high. Persons may have to pay $100 for a vial of generic insulin or even hundreds of dollars for newer types of insulin. This is in stark contrast to other developed nations; insulin is sold for approximately $6.94 in Australia, $12.00 in Canada, and $7.52 in the UK.2,3 In fact, the US is more akin to Africa, where there is no generic insulin, and the cost of a single vial is often equal to 2 weeks' pay. Individuals with type 1 diabetes the world over often cannot obtain the insulin they need because of high cost or lack of supplies. Various organizations such as T1 International ( are working hard to bring awareness to this disparity.


To celebrate World Diabetes Day, this issue contains several important articles about diabetes. In the continuing education article, our Canadian colleagues have provided an excellent review of some of the diagnostic and treatment challenges for persons with diabetic foot infections, including the 20% who will develop osteomyelitis. They remind us that skin and soft tissue infection diagnosis in persons with diabetes is based on clinical criteria, although accessory investigations such as bone biopsy, X-ray, and advanced imaging modalities can improve osteomyelitis management.


Because the 5-year mortality following lower extremity amputation is higher than that of breast or prostate cancer, prevention and early detection are critical.4 This month's Practice Points summarizes the important role of patient self-monitoring with an infrared thermometer. An increased temperature of 4[degrees] F in at least one point on the foot indicates an increased likelihood of ulceration, which precedes lower limb amputations in 85% of cases.


This month, we also celebrate Dr Michael Kosiak and his classic pressure injury (PI) research from the 1950s. For example, this issue's Practice Reflections from nurse Mary Brennan and her colleagues explores hospital-acquired PIs in their facility. Further, as in past years, the European Pressure Ulcer Advisory Panel will celebrate "Stop Pressure Ulcer Day,"5 and the National Pressure Injury Advisory Panel will celebrate "World Wide Pressure Injury Prevention Day,"6 both on the third Thursday of the month. We hope you will visit each of these important associations' websites and obtain information about the prevention and treatment of PIs to educate the public, professionals, and politicians. Be sure to get the word out on social media and share your efforts! And as always, we welcome Letters to the Editor in response to any of our content; we are eager to hear your solutions for these current healthcare challenges.


Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN


R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM




1. International Diabetes Foundation. Insulin at 100. 2021. Last accessed September 8, 2021. [Context Link]


2. Belluz J. The absurdly high cost of insulin, explained. Vox November 2019. Last accessed September 8, 2021. [Context Link]


3. McGrail S. Insulin Prices 8x Higher in the US Compared to Similar Nations. PharmaNews Intelligence. October 2020. Last accessed September 8, 2021. [Context Link]


4. Armstrong DG, Wrobel J, Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 2007;4:286-7. [Context Link]


5. European Pressure Ulcer Advisory Panel. Stop pressure ulcers. Last accessed September 8, 2021. [Context Link]


6. National Pressure Injury Advisory Panel. 2021 World Wide Pressure Injury Prevention Day. Last accessed September 8, 2021. [Context Link]