Scientists aim to make a once-a-day type of insulin that would become active only in the presence of high glucose concentrations. ‘Glucose responsive’ or ‘smart insulins’ would mimic the action of the insulin-producing beta cells in the pancreas of a healthy individual, giving patients with type 1 diabetes the exciting possibility of freedom from counting carbohydrates and injecting insulin several times a day .
Amid the chatter of customers and tinkling of cutlery in a restaurant in London’s West End, head chef Alex Farrey watches over his kitchen staff as they plate up dishes. His job is one of precise measures and narrow time windows, made harder by the fact he has type 1 diabetes, and must control his glucose levels as precisely as he controls his kitchen.
The disorder means that his body does not produce insulin — the hormone that helps to control blood glucose levels. High levels of blood glucose can cause problems in the vascular system, eyes, kidneys, feet and nerves. If blood glucose is too low, it can make people feel weak; they may begin to tremble; and if left unchecked, it can lead to loss of consciousness, organ failure and death.
"It’s a pain having to take [glucose] readings and inject myself with insulin, and having to measure and record everything that I eat," Farrey says. Like the roughly 400,000 other people in the UK with type 1 diabetes, Farrey has to frequently measure the level of glucose in his blood and inject himself with insulin every time it gets too high – he has to do this as many as six times a day. "I’m used to it now but when I was a kid it was tough, especially missing out on things my friends were doing because their parents didn’t feel comfortable helping me with my blood readings or injections."
"What we call ‘diabetes burnout’ is a big problem in type 1 diabetes," says Kotryna Temcinaite, a research communications officer at charity Diabetes UK. "People have to manage their condition every day and can never take a holiday from measuring their blood glucose."
While insulin has helped people like Farrey to manage their disease, researchers are working on ways they can make it better. "Insulin is not a very good drug — it’s actually very bad," says Danny Chou, a diabetes researcher at The University of Utah in Salt Lake City, Utah, USA. "With other drugs, if a doctor gives you one pill, that’s good; two pills, that’s good; three pills it’s OK, not worse. With insulin, if you don’t have enough it’s bad and if you have too much it’s worse. It can push you into hypoglycaemia and kill you."
Scientists like Chou want to make an insulin that would need to be injected only, say, once a day and would become active only in the presence of high glucose concentrations. In this way, so-called glucose-responsive or smart insulins would mimic the action of the insulin-producing beta cells in the pancreas of a healthy individual.
"For most people with type 1 diabetes, a glucose-responsive insulin really approaches what they consider would be a miracle treatment for the disease," says Julia Greenstein, vice president of research at JDRF, a US-based international public charity that funds research and advocacy efforts including Chou’s, into type 1 diabetes. "The idea of not having to constantly count carbs and figure out the dose of insulin to give yourself would make a huge difference."
The prospects of a smart insulin making a difference to patients’ lives is one firmly for the future — most research projects are at the basic chemistry level, with researchers trying to show a proof of principle that such a treatment is possible. Thereafter, they will have to prove that their treatment is safe and that the large loads of injected insulin will be active only when needed and not cause hypoglycaemia. Justifying the potentially high prices to payers might also be a sticking point given other technologies that might soon be available to people with type 1 diabetes.
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