Interesting - Insulin in Pill form?

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Thanks for positng @ClaudnDaye

“Injections are invasive, painful, and because of that there is a significant non-compliance among the [type 1] patients that are using insulin,” said Prof Samir Mitragotri, a co-author of the study from Harvard University,

[RANT MODE ON] - I question if the Professor actually takes insulin. These kind of comments drive me nuts. My 2 year old son has no problem getting stuck with a pen. He will even point where he wants the shot. I have no problem jamming a syringe into my calf for an IM shot. After the first 100 needles you just get used to it and they don’t [usually] hurt. Yes I do hit a nerve from time to time.

Giving insulin is not like getting blood drawn or getting some vaccines that are done IM where it kind of hurts. Heck, IMS needles (the ones the physioperson shoves into the muscles hurt - but insulin needs… never (ok rarely).

Yes there are people with needle phobia but come on. I think most PWD would rather have the research dollars spent on something else than an insulin pill.

AND - why is Afrezza not mentioned? That is already a needle free solution. [/RANT MODE]

This part is more interesting…

Simon Heller, professor of clinical diabetes at the University of Sheffield welcomed the research. “This is exciting and of considerable potential particularly in type 1 diabetes as delivering food and insulin makes a lot of sense as both need to be delivered to the liver at the same time when eating,” he said. “It is this rather than not injecting which is the potential [benefit].”

I wonder how quickly protein would be absorbed by the digestive system compared to carbohydrate uptake. The timing would be tricky…

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My 4 year old son has been getting shots for 2.5 years and he still screams bloody murder for every single shot. lol. This part, I think, is subjective to the patient.

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Have you considered using I-port ?

https://www.medtronicdiabetes.com/products/i-port-advance

Does that fix psychological trauma associated with just thinking about getting the shot?

XD

The I-port is inserted, and left there, I think up to 3 days. Then injections are done through the I-port, without making a new puncture in the skin.

Then a new I-port is placed in a new location.

So still may be trauma, just less often.

Do you think trauma is due to physical pain, or the anticipation?

Been awhile, but when I was 5-6 years old, getting one injection per day (with larger needles), I still recall how unpleasant it was. I also felt it was not fair that siblings did not have to do the same. That feeling of unfair made the injection time more stressful.

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He uses pod so only one shot every three days. Still doesn’t like it though.

I stand corrected. One of those YDMV things.

I often wonder if because my kid watched me take shots and then did not see shots as being abnormal or scary.

Tonight he was trying to delay bedtime. He was making noise in his room so I went up to see waht the demand was. Image a sweet 2 year old voice saying… “Daddy, we need to test my blood glucose.” I figured it was a delay tactic but had to test to teach him that when he asks we test. BG was fine. :smile:

Now what kid would want a BG test to delay bedtime. Could have just asked for a glass of water to avoid the finger poke.

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Liam doesn’t mind finger sticks at all. Just the pod shot and the cgm (sometimes)… But the pod is the rough one every time.

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I think the point is that insulin that could be delivered in pill form would be better than needles because it’s more physiological. I saw an interesting talk by Robert Geho, who is developing a type of insulin that reaches the liver.
Most of the body’s insulin is delivered there before going out into circulation in the bloodstream. So most T1Ds have an underinsulinized liver relative to the insulin levels in their blood. I think we don’ thave any idea how much better control would be (or what follow-on benefits might accrue) from delivering insulin in this manner.

Also, while removing shots alone isn’t a huge thing, our 4-year-old HATES needles and getting teachers to dose him with a pen or a syringe is … not trivial. i mean, we do what we gotta do but I guarantee that if we could give Samson pills rather than syringes he (and his teachers) would feel 1000 percent more comfortable.

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I watched that. Be careful with that guy’s video’s. He’s the CEO of a company, and has an MBA. He does not have a medical background, other than the company he works for is Diasome Pharmaceuticals.

He has led financing for several biotech companies, and he’s been involved in forming several science focused companies. So his videos are geared at trying to elicit interest in what his company is doing.

He comes across as a medical expert, but he says a lot of things that are not exactly correct.

Sure the mechanism of our delivery is different than non-D’s, but without the alpha cells, having insulin going to the liver is still missing some important stuff.

His video was missing some stuff when he talked about delivering insulin to the liver for diabetics. We really don’t need insulin to get glucose and carbs in. GLUT2 (Glucose transporter 2) is the primary transporter of glucose and fructose for the liver. It does not need insulin for facilitated diffusion like GLUT4 does for our muscle tissues and fat cells.

Anyway, Robert Geho is the CEO of a company trying to generate interest in his company and his company’s research. I appreciate the effort they are making - just, you know, grain of salt with what he says…

I didn’t realize that Geho wasn’t the one in the company with the medical background – Obviously he has a vested interest in hawking Diasome, but somehow I thought he was his brother, who has the Md and PhD (W. Blair Geho) and a pharma background. Good catch.

Still, the idea that delivering insulin more physiologically may improve biomarkers is not just coming from him. another hint in that direction comes from implantable pumps, which direct insulin through the portal vein as it normally would go.And from other experiments where, for instance, some one has a pancreas transplant but either does or doesn’t have the insulin routed through the portal vein.

Also, many Type 1s DO have functional alpha cells, so I’m not sure what you mean by that? While there’s some dysfunction in how they operate, it’s not clear that if you direct insulin first to the liver and the portal vein, you would still see that dysfunction, is it?

Well, I don’t know. The liver still responds to glucagon, so I know the liver works fine. But my alpha cells don’t do anything! I know there is some variability among diabetics as far as alpha cell functionality. In general though, I think the longer you have it, the less functional they become.

That is a whole new ballgame! I would love that.

Injecting it directly into the portal vein is much different than Geho’s angle of an additive to the insulin and still injecting it subcutaneously.

I do a lot of IV shots, which is as close as I can get to a normal pancreas. Not going directly to the liver, but still going directly into the blood. It is completely different than a subcu shot.

so any pump that does that would absolutely be wonderful. I have been hoping for something like that.

That would be a game changer! Not only does the insulin start to work almost instantly, it is completely gone in under an hour. No IOB !

The pill thing, the BCG tuberculosis vaccine, Fiasp and insulin additives that make it faster, CGM controlled pumps - all those things are child’s play compared to a pump that could deliver to the portal vein.

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but the insulin if delivered via a pill would wind up in the portal vein, right? I mean if it makes it through digestion intact, it’s going to go through the portal vein right?

But how fast would that be?

Insulin you inject gets into your blood, so some of it also gets to the portal vein. But the timing of it is the issue. Not only the time it takes to get started, but the time it takes to deplete.

I just think the pill thing is not really much of a benefit because of the speed. And also the dosing limitations.

Think about how closely you adjust doses for Samson. Very small adjustments like figuring out if you want to do 0.75 units versus 0.80 units. Would pills give you the same granularity?

I don’t know, I am just skeptical of the pill thing because I heard about the research being done on insulin pills when I was 5 years old, and my parents told me about it. And as a 5 year old it was very exciting news, because I wouldn’t have to take shots anymore!

But that was a few years ago (give or take several decades :wink: ).

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I don’t think, though, that insulin dosing is going to work exactly the same way with a pill.It’s possible that it could be like Affrezza, which has just “small, medium, and large” sizes. I think the point is that we don’t KNOW for sure that it wouldn’t deliver big benefits, and it would *certainly deliver the small one of not having to jab your child a gazillion times a day. It might also deliver things like more physiological responses to hypos and better BG control as well. A lot of it has to do with how it’s going to unspool once it hits the spot where it’s needed. What are the dynamics? We just don’t know.

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I hate to say it - but this is the kind of thing I want.

When I was ranting earlier about shots, my point of my rant was - how does the new technology improve insulin delivery compared to what I currently have (pump for me, MDI shots for my son).

So if the pill’s only benefit over shots is the reduction in pain, I just do not want it. I still think that you will need a shot for a basal insulin anyways so it would just be a reduction in shots. And if you have a pump for basal - it would be a combination of pump/pills.

To me the benefit of shots (or subcutaneous delivery of insulin with a pump) are I can be accurate in my dosing, I can give insulin when I have a stomach problem/illness, we can give my kid a shot when he is sleeping with high BG without waking up, etc.

The only downfall is the absorption time and for some people the pain/inconvenience.

What excites me about the implantable pumps, is that they deliver insulin very close to how the pancreas does it. People on the implantable pumps sound like they love them.

Now the pain of the implantable pump is you have to get cut open and it is awkward to get insulin in to the pump, but that is a pain I think I would be ok with.

So - as you can imagine I am disappointed that development of implantable pumps has been suspended. But someone is siphoning off research dollars to develop a pill which I can’t see a massive benefit to me over what I am used to doing.

I hope to be proven wrong and the pill is a giant success.

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To save my children being in pain, I would climb mountains. If this was the ONLY benefit…I would swoop it up because I don’t want my son to experience more pain than he needs too in his life…

Just this morning, just removing his POD he was crying and saying “it hurts papa”.

Give me the pill any day.

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the problem is that implantable pump research is dead :frowning: There’s like one research group, out in the scientific wilderness at this point, working on the problem. The risk of infection, the risk of catastrophic malfunction that you can’t just fix immediately, the fact that you need a much more concentrated insulin – these are all such huge hurdles that I guess no one is willing to invest the $$$ in future development.

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I hear you, but in a few years, the pain probably won’t bother him so much. I say this, not as a way to minimize his and others pain, but in the grand scheme of things, he will most likely accept these things without issue pretty soon. If there was a way to get rid of the pain, that would be best of course.

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