Injection of "smart insulin" regulates blood glucose levels for one week | Hacker News Reader

Injection of "smart insulin" regulates blood glucose levels for one week

arstechnica.com

52 pointsksec33 comments

I have "type 1" diabetes for 27 years. I hear similar stories like this (revolutionary cure working on animal models) every year or two. Until now non of them worked. I hope this one will be beeter but my expectations are quite low.

"Just another 5 years for a cure"

Fusion within our reach.

This is really compelling, and the principle seem like it should work in humans. Can anyone with more knowledge of biochemistry think of any reasons why this gluconic acid polymer approach might not work in humans?

Like most cool biotechnology tools like this, the hangups will probably come from ironing out safety, dosing, and delivery issues in the clinic, rather than some mismatch in the biochemistry. They mention one of them in the paper:

  In the long term, a balance is assumed to be established between the amount of injected PLL-FPBA and cleared PLL-FPBA. Thus, the long-term toxicity of the complex formulation needs to be thoroughly evaluated for clinical translation.

Proving that PLL-FPBA only responds to glucose fluctuation (and no other physiological changes, with a large enough sample size to cover the range of possible physiological changes that could be experienced by patients), proving that it is biocompatible with all patients, proving that the dose-response is uniform and can be correctly tailored in all patients, and then proving that all of these results hold over very long periods of time with material that can be cost-effectively manufactured at scale will probably be the tricky part. There probably aren't any fundamental reasons that the chemistry of the gluconic acid polymer wouldn't work in humans.

Citations 13-40 provide a pretty good overview of the history of glucose-responsive insulins. These ideas are awesome and I hope they can be successful some day, but I also get the impression that engineering improvements (and cost reductions) in insulin pump technology will provide more immediate quality-of-life improvements for the broader Type-1 Diabetic population.

Incredibly interesting. This is exactly the sort of comment I was hoping to find on this post!

There is also what Sigilon (now Eli Lilly) is doing, which is to encapsulate living cells in a matrix they cannot escape. The cells sense glucose levels and secrete appropriate levels of insulin locally. In the current iteration I think the millimeter sized beads are injected in the peritoneum, and are removable.

So if regular insulin is already overpriced, how overpriced will this medication be?

Insulin is available at Walmart for about $25. The newer analog versions cost around $80. It's just private label Novo Nordisk, so all high quality.

if this is true, do you know the source of the meme that insulin is extremely expensive for uninsured people in the US?

There are different types of insulin (short acting, long acting) and the cheapest version isn't always best for a specific person depending on their individual situation. If you want more information on the structural factors of the unaffordability of insulin this article could help: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597930/

A box of Fiasp or Levemir insulin costs $477-$560.

The better insulins cost more.

If I give myself the $24.88 WalMart insulin, I can not eat lunch at my regular time and then have to eat in the middle if class. (Assuming I had a high blood sugar reading going into lunch and gave myself R an hour before lunch.)

If I can afford the Fiasp, I can go ahead and eat at my regular time. It's just expensive.

This is a weird objection because if the expensive insulin did not exist (effective price = $inf) it would not apply.

My concern is that I need to live a fairly normal life, and I need to work. If I can not eat lunch at a normal time at work, and if I have to get up every 2 or 3 hours all night long to deal with my diabetes, then I can not work a normal job.

This is not a weird objection. The companies distributing the "expensive insulin" also distribute the affordable insulin, and created the cost disparity. Something strikingly apparent to anyone interacting with insurance companies for any chronic condition.

The reality is that before we had these medications, more people just died. Yeah sure in some sense it does not apply, but that's missing the point.

The issue is largely the byzantine structure of the market, making it challenging for less sophisticated consumers to buy cheap insulin.

They lowered the price at some point in the few years, at least on some versions.

> if this is true

To be clear, your parent is telling the truth in a very literal sense. However, as always, the devil is in the details.

First of all, this is a pretty recent development. The insulins available for cheap at WalMart used to be significantly worse.

The second bit is that wait, how can it be worse? Well, "insulin" isn't always one thing: there are a variety of brands and ways of synthesizing it. They also have different properties. So there are certain things about this specific insulin that may not be great for a variety of reasons. Type 1 folks (I have less experience with type 2, so I just don't speak on it) that have more money or better insurance tend to use two insulins: a long term one, and a short term one. You take the longer term once per day, and then the shorter acting one on a more "as needed" basis. Of course, everyone's health works differently, and so the exact specifics here are between you and your doctor. Anyway, the point is, that this insulin is short-acting, and so to use it correctly, you have less leeway with time and dosage, and that can be rough. And mistakes can be deadly. Josh Wilkerson is a famous example of this in 2019: the insulin his doctor desired for him was gonna be $1200. He opted for taking this WalMart insulin instead, and made a mistake while taking it, due to the differences between it and his previous insulin. For that, he paid for his life.

The third is, this is still inacessible for various reasons, including money. WalMart is not located everywhere. It still costs money to get to WalMart and back. Also, it's $25 per vial, but that says nothing about other costs too. How many vials do you need for a time period? Depends on the person. And a lot of factors. But let's just spitball one: this bottle has 100 units in it. A starting daily dosage, in my understanding, is like, 0.4-1 units per kilogram of body weight. I weigh about 200 lbs. If we take the low end of that range, that would mean I would need roughly 32 units per day. This means I'm using two and a half vials of this per week, at $80/vial that's $200/week or $10,400/year. It really adds up.

This also doesn't take into account other costs: you're gonna be needing to buy test strips as well, so that you can have some idea of how much you need to take. You're also gonna need to buy needles. These are single use. Oh and don't forget that, while you can buy these needles over the counter with no prescription, pharmacists are able to refuse to sell it to you for any reason, say maybe if they think you're going to be using those needles for other kinds of drugs, so you'd better not be in a bad way when you go into the pharmacy, or risk literally having the medicine that allows you to live with no way to put it into your body.

So yeah, like, don't get me wrong, it's a good thing that they sell it. But people like to act all "mission accomplished" about it, when it's just not that simple.

Just adding to what people are saying below, cheaper insulin is really new in the U.S.

It’s one of the only price-limited medications, and a major win for the Biden presidency (while it would be nice for this to happen for all drugs)

From the article, this is a small animal study involving less than 10 animals, no one knows if this even works in humans or if the benefits seen here will translate into a larger study.

This is so far from being a commercial product that asking about costs means nothing.

May have a reasonable price in countries where insulin also does.

Guess people can visit Canada or Mexico weekly

It is against US law to bring insulin back from Mexico.

People still smuggle in a little, but there are penalties if they get caught with a lot of insulin.

I live in Texas, about 12 hours from the Mexican border, so it's not worth the trip.

That's misleading. It might be a technical violation, but it is decriminalized. Bringing back a 90-day supply of personal-use non-controlled medications is completely fine. To be safe, carry a prescription and declare the medications at the border.

Probably does not count for weekly shots administered on the other side of the border

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