Why are insulin technology improvements so slow

I was diagnosed in 1999. The speed of change in devices has been incredible, with Dexcom a total game-changer in 2005 and the G6 now so far ahead of the original Dexcom. Tandem is also adding a lot with their algorithms.

But it’s kind of amazing to me that I still use the Humalog, exact same insulin that I used 21 years ago. Has there been any improvement in insulin that I’m missing? I feel like for Diabetes to take a big step forward we need faster-acting insulin that stays in the system for shorter time.

Any thoughts? I’ve used Apidra and Fiasp - and I can’t tell if they’re all that different from Humalog. I’ve had struggles with them in the pump.

Afrezza is the fastest acting insulin. It enters bloodstream in 1 minute and starts working in 12 minutes (and it’s out of your system in 1.5-3 hrs) but the hang up for most people is that it is inhaled and most Dr.s don’t bother mentioning it to their patients. It can take some wrangling to get insurance to pay for it as well. I’ve been on it for 3 years and it is as fast as advertised.

Eli lily just announced a new insulin called Lyumjev and it has a slightly faster profile than Humalog.

It’s not perfect, but I do find Fiasp to be significantly faster than NovoRapid/Novolog. I can eat things I would avoid before without spiking most of the time. It works especially well for carby breakfasts, beer and fruit. I agree, it does not work well in a pump and I prefer injecting it.

Income flow is higher and faster with changes in gadgets than with insulin. After all, we can use only so much insulin. And the goal is to use less. So research and changes in pumps, CGMS, etc., are far more lucrative to the corporations. And that is why their money and efforts are behind the gadgetry.

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I think generally the pharma companies want to milk their insulin patents for as long as they possibly can. Now that there is push to allow generic insulin, or make it easier to get approved, they are looking for ways to make something more desirable than a cheap version of their previous insulin.

Also, I think that there are only so many ways you can make insulin really. Basically at this point what they are doing is patenting the mixture they make of insulin and the additives that they are using to make it work faster. I’m not sure how much better they can really make the current types of insulin. There isn’t much advancement that will be had unless someone finds a way to make a closed loop specific insulin that is super fast (unlikely at this point I believe), or some sort of encapsulated insulin that is blood sugar reactive. That last one is probably a long way away.

True, subcutaneously injected insulin will never work as fast as intravenous insulin and I guess that can’t make it work much faster than current types of insulin.

Very true. It’s a tough egg to crack. I’m certain if it was easy it would have happened by now. Most of the breakthroughs have been on insulin formulations that actually slow down adsorption for basal use.

True! Afezza cracks the egg by completely going around subcutaneous injection! It’s very innovative!

I’m really anxious to try Lilly’s Lyumjev

I tried inhaled insulin in a trial 15 years ago. It might be good for type 2 but for me it was impossible to properly dose. You never knew how much you were getting and if you coughed, you were blind and just had no idea.
Doses were Huge the smallest dose was equivalent to 3 units. So I generally had to use 2 puffs per meal but sometimes that was too much. And small corrections were not possible. If I had a cold I couldn’t use it at all. My a1c was at 6.9 when I started and a year later it was 8.1. So I got my first pump after the study ended.

I generally use it for major corrections and high carb meals - not for routine use. Perfect for that purpose for me. The fast action helps me avoid “chasing a stubborn high” and paying the price with a major crash hours later.

There are others here that swear by it for routine use, but the doses are too large for me to use it for that purpose. It’s still a remarkable product and can do things injectable insulin can’t.

Here is some recent work from Stanford about a new way of “stabilizing” monomer insulin that should be super-fast compared to what we now use.

While university research is a long ways from a commercial product, it underscores some of the challenges involved in “improving insulin”.

Stay safe out there …