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People with diabetes can not produce enough insulin, a hormone that controls blood sugar. In type 1 diabetes, the body can no longer produce insulin, but the hormone has to be injected through the skin in varying amounts, depending on the meals and what someone eats. US scientists have developed a sugar-sensitive molecule that works like a "sponge" of insulin: it automatically delivers insulin into the blood when blood sugar levels rise. Mark Evans, Diabetes Specialist at Addenbrooke Hospital in Cambridge, but did not participate in the research, spoke to Chris Smith …
Mark – This is an approach from a group of approaches that people call smart insulins. They took the standard insulin that we already use to treat diabetes and combined it with a polymer, a big molecule much like a wool ball that absorbs insulin and can then release it .
The polymer they chose is boronic acid, which binds and responds to changes in glucose and sugar levels. Thus, by tinkering with this, they could quite easily find a formulation that means that the polymer is sensitive to glucose. In other words, this ball of wool is able to react to sugar, change the load and release more insulin at the appropriate time. In other words, when local glucose levels are higher. And most importantly, it is able to release less insulin than when the blood glucose is low.
Chris – At the moment, a diabetic person should adjust the amount of insulin that she injects into her body that she injects, in order to match what she expects that his meal will give him or his activity. So, that would free them from part of that, that would not mean that the molecule will calculate the amount of insulin to release, rather than them.
Mark – Absolutely, that will certainly help. The life of a person with diabetes, especially type 1 diabetes, is difficult and they spend all their time looking for their tails to do a lot of blood sugar testing and catch up on their ups and downs. And the hope is that something like this will at least help reduce the highs and fill in the lows of daily blood sugar.
Chris – What is the proof that this technique actually works?
Mark – So they tested their system in mice and pigs with type 1 diabetes under artificial glucose loading conditions. So, basically, give a drop of glucose and deliver either that insulin or an ordinary insulin. They also performed in mice a longer-or-shorter-term study on about two weeks of twice-daily injections and seem to work at least better than the insulin control that they gave in the particular experimental conditions for which they have tested that substance.
Chris – How is this new smart insulin really delivered? Is it injected in the same way as the traditional insulin with which the diabetic is familiar?
Mark – Yes. So, they delivered this by injection into these studies. At the present time, insulin must be administered on the skin of the body, whether by injection or more and more often, with insulin pumps, devices that pump insulin into permanently under the skin.
This new approach would probably replace existing insulins, but would be administered in the same way, by injection or infusion under the skin.
Chris – You mentioned that it's the glucose contained in this polymer that releases it or makes it spring from insulin. So you can match the amount of insulin you produce to the amount of glucose available. But could any other molecules do this accidentally? So you could unfortunately trigger a strong surge of insulin when you do not need it because something has pushed the molecule to release it inappropriately?
Mark – Absolutely, it's an excellent question and one of the questions that arises is: what is the specificity of this polymer for glucose compared to other sugars other than glucose? , such as fructose and natural products, for example in fruits. All this is part of the work that they will have to do to really try to understand well before they can go to studies on the man.
Chris – And say that they can do it, what are the implications for a person with diabetes? Because we can manage diabetes well nowadays, is not it? You can use pumps, you can use injections to keep people healthy.
Mark – So, as a clinician, I would see this used as an alternative to the insulin currently used by people, but used in the same way. And I think this will hopefully help alleviate some of the highs and lows of daily blood sugar.
Chris – And that will translate into a health benefit?
Chris – Absolutely. If people have less variable and more predictable glucose levels, we believe that glucose variability per se may be important in terms of the risk of complications, but secondly, if people have less variability, they may be more confident about lowering their blood glucose levels which reduces the risk of long-term complications.
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