Insulin Injections

Easing The Burden For Diabetics With No More Insulin Shots

The concept of injected insulin therapy could someday become a thing of the past. Such advances would undoubtedly ease the treatment burden for diabetics around the world who take one to five insulin shots daily to control their disease. But do not discard the syringes and current regimens, as there is still a long way to go for this to happen. The new tools are likely to be years away from approval by the Food and Drug Administration, and some may never reach the market.

Those showcased at a recent American Diabetes Association meeting included two insulin pills that are in phase 1 and 2 trials. It is to be seen if they can overcome the obstacles that stymied earlier attempts, by preventing the degradation of the insulin molecule in the gut before it gets to the bloodstream and by shrinking the size of the molecule so it can get through cell membranes. Inhaled and oral spray insulin that may prove another route for administration. One system converts special liquid insulin into aerosol particles inhaled into the lungs where they enter the blood circulation as rapid-acting insulin.

Another is a skin patch, which administers insulin via a two-step process. First an electronic adhesive patch, powered by a small battery, painlessly vaporizes cells on the skin surface, creating microscopic openings, and then a small patch containing a reservoir of insulin is applied to the skin. The insulin applied is steadily absorbed into the body during 12 hours of wear. Both, the discovery of a new polymer that may allow for an effective insulin pill and positive clinical trial results for inhaled insulin, have increased the hope that the needle could once and for all be eliminated for people with diabetes.

No delivery system has quite worked out better than the trusty needle and syringe, which has been delivering insulin to people with diabetes since its discovery in the 1920s. Modern versions are much tinier, but they are basically the same. Still, experts have serious hesitations about the prospects for such a new delivery method, primarily because accuracy in dosing is so crucial in controlling blood sugar. Experts say that the most likely candidates for inhaled or oral insulin may be those who are poorly controlled through diet, exercise or insulin-sensitizing pills or who put off using insulin, a last resort, as long as possible because of the needle.

For many patients, though, the fear of the needle is more troubling than the needle itself. For a child facing diabetes for the first time, a needle is a very intimidating type of device, for an adult who has long-standing diabetes, the development of the need for insulin is often surprisingly to them less troublesome than they may have thought. For almost everyone, given a choice, nearly all patients would prefer not to have a needle, the pain is not so great, but people just hate the idea.