Future of Diabetes?

Since the beginning of time, Humans– Similar to many organisms– are constantly subjected to the stress of evolution. Similar to how a bacteria ensures its survival by becoming resistant to the antibiotics exposed to it; we Humans are constantly developing newer, safer and more efficient inventions and ideas in order to create a sustainable future for us.

This may be in the form of technology, policies or treatment for diseases such as diabetes itself.

If you are loyal follower of this blog, you would know that treatment of diabetes has always been steadily advancing over the years (as covered in post 2, History of Diabetes <– Click to read if you haven’t!).

From extremely strict diets consisting of unbelievably low intake of carbohydrates which only, at best, helped delay the inevitable passing of an individual to the discovery of insulin which allowed individuals to almost lead their lives as normally. It goes without saying that treatment for Diabetes has definitely came a long way since its Inception.

However, even so, the underlying question still exists: How can we better improve the situation?

New methods for a brighter future

Until the very day when the problem of Diabetes is eradicated from the face of the earth, there will always been unceasing efforts from mankind to find new treatments for the disease. Scientists are always in research of better ways to achieve that.

1) Artificial Pancreas

One such treatment that is currently under research would be a  method that directly targets the source of the problem; by substituting the lost/damaged insulin-producing beta cells of the islets of Langerhan in the pancreas with the introduction of Artificial Pancreas (better known as bionic pancreas) for Diabetic patients.

And no, this treatment has nothing to do with grafting bionic pancreas into the patient’s body. (Sorry to disappoint)

An example of an artificial pancreas

In order to lead lives normally, Type I diabetes individual are subjected to injecting insulin 4 times a day and 365 days a year. On top of that, they have to constantly be aware of what they eat, the physical activities they do, measuring blood glucose level and many more. All these tasks are essential in order to calculate appropriate doses of Insulin to be injected in them.

However, even the most conscientious individual cannot perfectly match the insulin doses to their body’s requirement. As such, this results in periodic changes of blood sugar level resulting in Hyperglycemia (High blood glucose level) and Hypoglycemia (Low blood glucose level) which brings about many undesirable side effects and complications in life.

Hence, the hopes of creating the first approved Artificial pancreas is to permanently ease the burden of patients having to live with diabetes.

How does it work?

“The cool thing is it’s not brand-new technology.” stated by a Type I diabetic individual during a study of Artificial Pancreas.

The artificial pancreas combines the function two conventional pieces of diabetes technology that already exist in the market and is currently being used for treatment: (1) an insulin pump and (2) a continuous glucose monitor (CGM)

With the built-in utility of the CGM, the artificial pancreas would have the function of being able to calculate how much insulin should the Insulin pump deliver based on its reading by having a blood glucose level threshold. This systems eradicates the need of input and calculation of Insulin doses by the diabetic individual himself/herself. However, the user does have the option of manually adjusting the dosage based on his preference and situation.

Rough beginnings…

In the beginning, due to the fact that the idea was new, the invention was potentially seen as something dangerous. As such, artificial-pancreas studies were conducted in the confines of hospitals. In the first few studies, multiple wires were snaked inbetween the participants’ Insulin pump and CGMs as the programs that ran the devices were housed on laptops.

Furthermore, the artificial pancreas was also not enabled to dose insulin directly. For safety purposes, nurses and doctors would check the laptop on regular intervals to see what was the calculated dose by the artificial pancreas and then manually key in the appropriate dose in the pump for the patient.

Thomas Brobson at the hospital, testing an experimental version of the artificial pancreas.

Improvement from the past

Since then, through multiple studies, the artificial pancreas prototypes have built its trust in the medical community when it demonstrated that it could be run safely. This drove the researchers to upped the ante in order to further improve the product, and this is done through various ways.

1) Going wireless

The most crucial step into creating an artificial pancreas that seemingly allows an individual to lead his life normally is to replace all the laptops and wires. Some new prototypes of the pancreas has achieved this through substitution with wireless Bluetooth connections, whilst others have used a tablet computer.

An illustration of a smartphone app

One such example is the “Diabetes Assistant” of the Kovatchev’s artificial pancreas. This is a smartphone application that is programmed to control blood glucose level. The device wirelessly receives data from the CGM in the Pancreas and gives instruction via bluetooth to an insulin pump.

This brought about a high level of convenience where users can check their blood glucose level anytime and anywhere; and is aware when an insulin pump is being injected into their body.

2) The introduction of a 2nd pump

Through a recent study conducted by Daimiano of Boston’s university that involved 20 adults with type 1 diabetes, it was believed that a successful artificial pancreas may require the necessary addition of a 2nd pump consisting of glucagon in order to compensate with an individual’s active lifestyle, cravings and also natural impulses. This is because once insulin is introduced into the bloodstream, it cannot be taken back. And as a result, fluctuating blood glucose level may occur which may result in hypoglycemia.

This problem with this idea, however, is that form of glucagon that is currently available in the market. Powdered glucagon must be dissolved in water before being injecting into the bloodstream. Furthermore, Once dissolved in water, powdered glucagon also has a short life-span.

As such, what is needed in order to actualize this idea is to develop more stable forms of glucagon that is able to have a life-span of several days.

2) Inhalation Insulin

Another new treatment method that has recently been launched in the market is Inhalation Insulin; a revolutionized, painless method of taking in insulin without needles.

A strict and intensive treatment for type 1 diabetes requires at least four insulin injections daily. This is in contrary to painless oral diabetes pills in the market that helps your liver makes less glucose. It is no wonder why some patients opt for the painless method of pills over Insulin injections even though its highly discouraged by doctors.

(https://i0.wp.com/www.funnypicss.com/wp-content/uploads/2011/12/afraid-of-Injection.jpg)
Lets face it, not all of us can be like him

The concept of Inhalation Insulin has always been around since 1925. However, it wasn’t until 1990 when researchers from different companies (Namely — Pfizer, Novo, Nordisk, Mannkind and Lilly) whom made it possible.

Aside from Inhalation of Insulin into the pulmonary tract, there are many alternative routes to introduce Insulin into the human body without injection such as through the Nasal (nose) tract, Conjunctival (eyes) and even the Rectal tract.

As such, why specifically Inhalation Insulin (Through the pulmonary track)?

Well, this is simply because the pulmonary route is the only route that can absorb sufficient insulin with the best bioavailability (the absorption ability of a particular drug into the bloodstream) without the use of injection (promoter) as shown in the table below:

UntitledChallenges

However, this is where the real challenge with Inhalation Insulin comes in. The insulin particles has to travel down deep into our lungs in order to reach to the alveoli, also known as tiny sacs in our lungs.

The problem with this is that most insulin particles stops travelling either in the mouth or the bronchial in our lungs with inhaler devices. To get down to the alveoli of our lungs, it is crucial to have an arithmetical and specific diameter of each insulin particle.

This is the reason why it was so tough to create a good device for an insulin inhaler.

Past Inventions

The first ever Inhalation device created was by the company, Pfizer, with its product named: Exubera

A picture of Exubera

It is a product that works based on the “Dry powder” system where insulin is supposed to be delivered after inhalation when the inhaled insulin powder gets broken down and dispersed as it absorbs moisture in the lungs. It is because of this mechanism that the machine itself needs a lot of energy and space; which is why the product is very large.

An illustration of how the Insulin Powder gets broken down and dispersed

Here’s a video in order to illustrate better of what I’ve just said!

The design, however, did not catch on to the general diabetic population as it was big and chunky. And due to sales declination, Exubera was then discontinued. At the time of the discontuation of Exubera, there were also several companies pursuing the production Inhalation Insulin, e.g. Eli Lily and Company, MannKind Coporation and Novo Nordisk. By March 2008, all the Inhalation Insulin products produced by these company has been discontinued with only 1 exception: Mannkind Cooperation.

Mannkind Cooperation, Afreeza

Initially rejected by the US Food and Drug Administration (FDA) in 2011, after a re-submission of proposal on June 2014, the FDA has approved Mannkind Cooperation’s product, Afreeza, an inhaler with pre-measured, rapid-acting insulin in which you use before meals.

A picture of Afreeza

Unlike its previous counterpart, Exubera; Afreeza is small, compact and portable which promises to not only bring convenience of the user but also huge medical benefits with respect to diabetic patients.

Afreeza’s Insulin Powder also has been proven to get into and out of the human system faster than any rapid-acting insulin.

This equates to better post-meal blood sugar levels and also less delayed hypoglycemia.

Conclusion

Could there possibly be a near future with no diabetes? Or will we be in the constant loop of finding more and more treatment options? We certainly don’t know. But based on the current researches that is ongoing on, the future of diabetes treatment certainly seems bright.

Reference (Weblinks and articles)

Diabetes forecast. 2014. The artificial pancreas. [ONLINE] Available at:http://www.diabetesforecast.org/2014/mar/the-artificial-pancreas-aces.html?referrer=https://www.google.com.sg. [Accessed 17 November 15].

Healthline. 2015. Afreeza – Inhaled insulin gets real!. [ONLINE] Available at:http://www.healthline.com/diabetesmine/welcome-afrezza-inhaled-insulin-gets-real#3. [Accessed 17 November 15].

Sélam, Jean-Louis , 2008. Inhaled Insulin: Promises and Concerns. Journal of Diabetes Science and Technology, 2, 5. Avaliable at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771493/pdf/dst-02-0311.pdf  (<– Online article)

 

References (Images)

Diabetes net, (2014), Exubera [ONLINE]. Available at:http://www.diabetesnet.com/images/photo_exubera_inhaler.jpg [Accessed 17 November 15].
Funny pics, (2011), Afraid of Injection [ONLINE]. Available at: http://www.funnypicss.com/wp-content/uploads/2011/12/afraid-of-Injection.jpg [Accessed 17 November 15].

Hielscher, (2013), Ultrasonic Dispersion [ONLINE]. Available at: http://www.hielscher.com/wp-content/uploads/ultrasonic-dispersing-opt.png [Accessed 17 November 15].

Mannkind Coperation, (2014), Afreeza [ONLINE]. Available at: http://www.in-pharmatechnologist.com/var/plain_site/storage/images/publications/pharmaceutical-science/in-pharmatechnologist.com/drug-delivery/mannkind-small-step-for-delivery-tech-r-d-after-afrezza-s-giant-leap/9605781-1-eng-GB/MannKind-Small-step-for-delivery-tech-R-D-after-Afrezza-s-giant-leap.jpg[Accessed 17 November 15]

Diabetes Forecast, (2014), Artificial Pancreas [ONLINE]. Available at:http://www.diabetesforecast.org/files-legacy/images/v63n09_p38c_0.jpg [Accessed 17 November 15].

Unknown, (2013), Stressed man [ONLINE]. Available at: http://www.bloglet.com/gallery/molecular-medicine-the-future-of-the-medical-world/molecular-medicine-the-future-of-the-medical-world.jpg[Accessed 18 November 15]

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3 thoughts on “Future of Diabetes?

  1. Hello! All these methods do sound promising, especially the last one, Afreeza. May I know why it was initially rejected by the FDA, and whether it will be on the market anytime soon?

    Like

    1. 1. The FDA initially rejected Afrezza for a reasons such as insufficient evidence from clinical trials to prove its efficacy compared to other treatments (MedTone inhaler) and how it works in both type 1 and type 2 diabetics. Well, that’s the gist of it, but you can find out more about the FDA’s rejection here: http://www.pharmatimes.com/article/11-01-20/FDA_rejects_MannKind_s_inhaled_insulin_again.aspx#ixzz3s8ry7k6q.

      2. It already is available at pharmacies across the U.S.! It’s still not available in Singapore, if that’s what you’re asking.

      Liked by 1 person

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