I was just reading an article in Nature Magazine. It lays out an incredible new insulin that has the ability to sense glucose concentrations by locking up the insulin when concentrations are low and unlocking when high. It’s an amazing story.
Only animal studies have been done so far but the results look really promising.
I’ll attach the article, but know that it is very technical and detailed for the average reader.
Still it explains the mechanism is great detail.
It’s backed by Novo Nordisk. So there seems to be money behind it.
I’m very excited, after seeing several attempts of a glucose reactive insulin have failed over the years
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I second everything you say. It certainly deserves to be in Nature.
They modified Tresiba; apparently their motivation was the ongoing problem caused by nighttime lows for people using the long acting analogs. However the idea seems to have the potential to completely remove the need for long acting and short acting insulins as well as MDI and insulin pumps.
There were some details I couldn’t deduce from the paper. It’s not clear how long the inactive insulin sticks around in the blood stream. Normally insulin (of any sort) gets used in a few minutes; blood levels of insulin halve every three to four minutes. That’s what causes a low. The modification in question stops that by making the insulin inactive when there are low levels of glucose and/or fructose in the blood. The insulin, if I understood it correctly, regains the activity when the BG rises.
But what happens to the inactive insulin? How long before other clean-up processes eliminate the insulin. Insulin isn’t that stable at body temperature but it will last a few days without decomposing, so that isn’t a problem.
There is the potential here for a superhuman solution. Human insulin responses depend on the pancreas dumping enormous amounts of insulin into the blood stream on the whiff of sugar. Apparently this approach could be more subtle; placing inactive insulin in the blood (if it sticks around) doesn’t require the complex and error prone first-stage, second-stage responses of the pancreas. Better by design!
Maybe one day we will all, T1, T2, pre-diabetic, everyone, just go to the insulin clinic once a week for our weekly shot of insulin?
That’s just amazing - hope it works out for the best!
You make a good point about how long the insulin is active. If they use a long acting time release insulin not sure if it would be able to handle fast hikes in glucose. Unless a mixture of some sort was used.
We wouldn’t have to worry about different sugars though because only glucose will bind to insulin and only glucose makes it to the blood stream.
I used to mix insulin back when I was using ultra lente and regular. Only one injection. I guess anything is possible
Thank you ! I remember this Nature article. It’s hopeful. It’s also free to download. NNC2215. It would be great if it can get to market and not be prohibitively expensive. The sources are also good as are the details in the article.
I have been reading about this. It sounds amazing.
I’ll bet it will not be called insulin or they will find a way to sell it for more than $35 a month, providing that kind of pricing sticks around. I’ve been watching ads on TV about the various newer drugs being promoted, it appears that the retail price for almost all of them are around $1000 a month or so.
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That water has passed under the bridge with a Trump signed Executive Order.
I don’t know what that means. Do you mean it will be called insulin or it will no longer be 35 dollars and remember that was only for Medicare anyway. I pay more.
Call it the fog of war - I don’t know what drugs are affected by the reversal of Biden’s EO on some Medicare/Medicade drug priccing.
Drug companies own government. It’s a sad truth.
When I used to buy humalog without insurance in the early 90s it was 17 dollars a bottle. Up from the 11 for animal insulin I was taking that was novolog back then. Analog pig insulin, I think.
Anyway that exact same insulin retails for 200 now.
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Paying $200 is silly as that is an artificial price. A vial of Humalog is just under $50 bought at places like Canadian Insulin. If on medicare, however, $35/month make it even less.
Can we get back to the joy expressed earlier? I hadn’t seen the paper on this compound, thanks for posting the link to the article, but I didn’t see a reason to be excited but y’all were and I enjoyed being wrong.
Couple of things:
- Around 90% of all compounds that start in the clinic never make it out. This one isn’t even that far but it’s starting with known good drug so maybe it has a 89% chance.
- Wikipedia says Tresiba initially gets bound in the subcutaneous tissue and is released as active insulin
- “Smart Insulin” is the current buzzword for this type of drug since ~2010 if you are interested in the many other attempts at creating a glucose sensitive insulin
- $35 is not what drug companies sell insulin for. They sell it for full price and for some people $35 is their copay. Its not a solution as either the insurance plan costs go up to pay for it or benefits go down.
- The $35 insulin copay for medicare was written as federal regulation by congress. An EO can’t change this.
- The rescinded drug pricing EO instructed CMS to create 3 experiments testing ways to lower drug pricing and report back.
- The $200 price is capitalism in the absence of price regulation. The $50 price is (still really high!) a government regulated price. There are other impacts from those regulations that have to be balanced.