We're a long way from it, but progress is constant, and in the right direction.
What is Insulin Nirvana? Simply, the day PWD have an insulin product that can be used in a manner that can mimic actual healthy BG metabolism. I.e., you administer, it takes effect and peaks almost immediately, then fades away within minutes as well, "consuming" the sugar.
Combined with a pump, this would be nearly artificial beta cells, without the sensor side of it. Imagine, though being able to continuously make adjustments on your pump over two hours after eating to keep yourself basically flat. Or, pre-programmed bolus profiles, similar to basal profiles, that can be invoked when you eat certain known meals. This sort of profile would be far more detailed.
The Afrezza inhaler is a huge step forward in terms of the drug. The delivery system is primitive and imprecise, though.
I look forward to the days when I don't have to account for all the additional complexity of delayed action, peak, duration of action, etc., but can just look at my CGM and administer treatment that takes effect almost immediately, finishes its effect within a short period of time, and then I can rinse/repeat as necessary.
It's not a crazy fantasy. The faster-acting analogs from the 90s are what really allowed pump therapy to be a significant improvement over shots.
I think even with ultra rapid-acting insulin you'd still have lots of fiddling and calculating to do. It's just that instead of pre-bolus timing and such you'd be dealing with using five little boluses to cover one meal ...
Now of course, if it was linked to a CGM and all automatic, that's a different story.
Personally, though, coming from the days of R and NPH when I was a kid and teenager, I think the current insulin regimens we have are pretty awesome and allow for pretty great control.
Actually, Jen, with an endogenous-like exogenous insulin, most of the calcs go away. Keep in mind that a lot of the hassle is book-keeping to track IOB and prevent stacking, leading to hypos.
Of course, carb counting and correction calcs still need to be done, but they can be a bit more "guesswork" because anything too much or too little will not persist in its effect. Treating a low is much easier, and more quickly successful -- you're not also fighting a long tail of left-over insulin action.
If we had an insulin that was near instantaneously "on" or "off" like the real stuff, IOB considerations could pretty much go out the door.
However, there are new "twists" that come in to play: With such short time to peak, and short action duration, single large boluses would not work anymore (as you observe above). Practically all pumping would change over to square-bolus-like profiles, and MDI with these types of future insulins probably isn't practical.
I'd think if the insulin were super fast-acting a low could be even more problematic than it is today because instead of going down relatively slowly you could crash in a matter of minutes. I don't know about others, but for me speed of drop definitely had a huge impact on my low symptoms. I even passed out once as a teenager from dropping from 19 to 3 in under an hour. (That's about a 5-6 mg/dl drop per minute.) I typically don't even notice low symptoms at 3. If you happened to screw up and bolus too much, you could be in trouble before you had time to correct the situation, especially if the insulin was faster than food (I've read your body can absorb about 1 g of CHO per minute, hence the 15/15 rule for lows).
The real stuff is instantaneously on/off, but the real body also has a nearly zero rate of making mistakes ... I'd be much more nervous in the case of diabetes. Although it would be nice to have more rapid-acting insulin (maybe peaks and is gone in an hour?) for things like corrections.
Amen. That would be awesome. Imagine taking one injection at the start of the day and it automatically keeps you flat in the 80's irrespective of what you do or eat.
Faster acting insulin will just increase hypos without some way to curb it's affect with something like a two component pump. Our gut is unpredictable and the mixture going into it is constantly changing. Most PWD's also have some nerve damage causing their digestive system to slow down causing a delay, unpredictability, and at some point or on some days the need for a slower insulin reaction time.
We just need a smart insulin that only reacts to BG above a specific concentration and when BG drops below this level it
I think this is where treatments are heading. Just like with Dr. Faustman's research ( Massachusetts General in Boston), the cure only requires VERY infrequent injections . The differences are that Her" cure" actually makes your beta cells that produce insulin grow back, and you need a maintenance dosage to maintain the cells from being destroyed by the faulty auto-immune response that is the nature of type one diabetes. In the "nano"-treatment that is described in this link, It is not just that the high blood glucoses go away. The treatment that prevents themfrom occurring in the first place is far more precise than exogenous insulin dosing, and FAR less frequent. I could go for a shot once every 10 days; and then not think about blood glucose levels at all.
At any rate, this is fascinating.I still believe that I will experience a "cure" or a very less invasive and less-time consuming way to treat diabetes in my lifetime. God Bless,
Thanks for the link,ShawnMarie : The words announcement read Under the terms of the agreement, Merck will acquire all outstanding stock of SmartCells, Inc. In return SmartCells shareholders will receive an upfront cash payment and be eligible to receive clinical development and regulatory milestones for products resulting from the transaction for potential aggregate payments in excess of $500 million. Sales-based payments for products resulting from the transaction will also be payable. SmartCells' board of directors has unanimously approved the transaction.
"At SmartCells, we have made important progress in rapidly advancing from early concept towards clinical development," said Todd C. Zion, Ph.D., president, co-founder and chief executive officer. "This acquisition positions our novel technology for success in the hands of a leading pharmaceutical company with proven expertise and exceptional resources to deliver breakthrough diabetes products to patients."<
This was posted in 2010, and Is it that there has been no published reports about the research from from either Smartcells nor Merck what has been going on for 4 years? In the time since this original press release,has Dr. Zion just been mute and sat on his butt to get the money, or has he been researching and advancing the cause he used to sound so committed to advance? HMMMMM.. sorry for the sarcasm Maybe there is something more? BIG PHARMA AT IT'S "best".
God Bless,
Brunetta
thanks for posting the link ShawnMarie: THESE are the words posted in the 2010 press release: Under the terms of the agreement, Merck will acquire all outstanding stock of SmartCells, Inc. In return SmartCells shareholders will receive an upfront cash payment and be eligible to receive clinical development and regulatory milestones for products resulting from the transaction for potential aggregate payments in excess of $500 million. Sales-based payments for products resulting from the transaction will also be payable. SmartCells' board of directors has unanimously approved the transaction.
"At SmartCells, we have made important progress in rapidly advancing from early concept towards clinical development," said Todd C. Zion, Ph.D., president, co-founder and chief executive officer. "This acquisition positions our novel technology for success in the hands of a leading pharmaceutical company with proven expertise and exceptional resources to deliver breakthrough diabetes products to patients."<
Is it that Dr Zion of Smartcells has been mute and kept the money without any further comment about further research, since 2014? I have seen video interviews in which he sounded passionately committed to the cause. I can't believe that he has been sitting on his butt and not doing a thing towards active research. Maybe has been paid to keep silent... HMM
