Our resident PhD candidate and dietician CHARLOTTE ROWLEY on what’s new in diabetes research.
In exciting news for people living with diabetes, a team of researchers, led by Professor Christoph Hagemeyer of Monash University, is developing a glucose responsive or “smart” insulin. Once in the body, the insulin will only be released when glucose levels rise above a certain point. And when glucose levels drop, insulin will stop being released, keeping blood glucose levels within a safe, stable range.
In people who don’t have diabetes, the pancreas is the organ that produces insulin depending on what’s going on in the body at any time. The pancreas usually delivers a small trickle of background insulin, but insulin production shoots up when we eat to help the body use the energy we have just consumed.
This is why you might take both a long-acting insulin, such as Solostar, Toujeo or Levemir, along with a short-acting insulin, such as Actrapid or Novorapid, with meals.
Estimating the correct levels of insulin to give yourself with a meal can be one of the most difficult aspects of daily diabetes management. Getting it wrong might mean feeling awful from your blood glucose levels sitting too high or experiencing a hypoglycaemic (hypo) episode.
Making insulin smarter
When you inject insulin, it will stay in your body for anywhere between four and 48 hours, depending on the type of insulin. There is no way to “turn it off” or remove it from the body once it has been delivered. If you have taken too much insulin you will need to eat more to keep your blood glucose levels stable and monitor your glucose levels.
While newer pumps on the market can adjust insulin delivery based on CGM data, thereby reducing the time spent outside of target range, not everyone is keen to wear a pump and a lot of people can’t afford one. The good news is that smart insulins, with novel delivery methods, have the potential to revolutionise diabetes care. By responding more precisely to the body’s changing glucose levels, they will make life easier for people living with diabetes.
Not only will smart insulin respond to the changing blood glucose levels, but it will also last for up to three days in the body – significantly cutting down on insulin injections. And, because it is glucose-responsive, there is no need to count carbohydrates. This has the potential to put a big dent in the mental burden of diabetes by reducing the number of decisions people need to make around their diet.
No more injections?
Along with smart insulin, scientists are currently investigating new methods of delivery, with oral pills and skin patch options being researched.
These innovations have the potential to resolve one of the key challenges people have with insulin – injections. A 2016 study incorporated live beta cells (the cells that produce insulin) within a skin patch. Because the patch is external, there is no risk of the immune system rejecting it, as can occur with organ transplantation. Insulin capsules, which melt away to release insulin into the system when blood glucose levels are high, are also on the table.
When will smart insulin be available?
Before you rush out and ask your GP to set you up with a glucose responsive insulin, bear in mind that it is still in the early stages of development and the first opportunity to try it will be as part of a clinical trial. Additionally, as with any new scientific development, the first round of new medication will not be the answer to all your diabetes prayers. It is likely that the first release of new medications will assist only with mealtime insulin requirements, with a standard basal (long acting) insulin injection still required.
Over time, the aim is to develop a medication that only needs to be taken once a day at most, but it is thought that people will need to inject or consume the glucose responsive insulin multiple times to begin with. Lastly, while the goal is for no hypoglycaemic events at all, current studies suggest that fewer than five mild hypo events per week is a more reasonable expectation.
All that being said – this is exciting! When we think about how far diabetes management has come since the first person was treated with insulin just 102 years ago, this is set to be another amazing leap forward.
References and further information
Small Nano Sugar: a new glucose-responsive insulin delivery system – Type 1 Diabetes Grand Challenge
West Australians can call our Diabetes WA Helpline for free. If you’re living in regional WA, you also have free access to our Diabetes WA Telehealth Service.
