Indian Scientists developed Insulin Pill for diabetics | Hacker News Reader

Indian Scientists developed Insulin Pill for diabetics

jagranjosh.com

109 pointsconductor25 comments

> the effects of the pill lasted longer than injected insulin

A non-diabetic might think this was a good thing, but it's more likely to be a serious problem. The actual research article (http://pubs.acs.org/doi/abs/10.1021/bm401580k) is paywalled, so I can't see what its pharmacokinetics are, but I'm not inclined to give the benefit of the doubt; unlike most drugs, insulin needs rapid uptake, precise timing and precise dosing. Even if it did survive the digestive tract, interactions with foods that altered the effective dose, or sped up or slowed absorption, would be likely to sink it in actual use.

Estrogen and progestin are given in slow-release IUDs or subdermal methods. Is science not able to apply the same?

Insulin is reactive. It regulates the glycemia (amount of sugar in the blood), which would vary highly in its absense depending on the time elapsed since the last meal.

Estrogen and progestin need to be at a certain, constant level. Insulin needs to be at varying levels based on blood sugar. To much insulin and you go into hypoglycemic shock.

I'm a type 1 diabetic. If this wouldn't work with rapid-acting insulin, might it not be a good thing for long-acting insulin, e.g. Detemir/Levemir (which I currently take)?

I'm type 1 too, there's potential, but the same problem with degradation exist. If you eat something that slows down or speeds up digestion or alters it in any way, it could give you a lot of highs and lows. It's like how certain foods take longer for the carbs to be absorbed and cause lows first then highs later. Alcohol could be effected even more too.

The precision of the timing and dosing depends a lot on what kind of diabetic you are. A type 1 with no endogenous production is going to need precision, and I can't imagine somebody wanting tight control giving up their pump and going with a pill!

type-2's on the other hand, have insulin resistance often accompanied by astonishingly high endogenous production. They can sometimes achieve nice control by just having a base of exogenous insulin that's just high enough for their pancreas to supply the rest of what they need -- the precision is supplied by the still largely functioning pancreas. I know at least one type-2 that has been put on insulin with instructions to inject X units with dinner, with no consideration of the actual content of the meal! Presumably a pill would work fine for that group.

Doesn't Type 2 already have pill-based treatments?

Yes, there are pills that will both increase insulin sensitivity (metformin), and to stimulate insulin secretion (the sulfonylureas). These are basically the first line of treatment. But the disease tends to progress to the point where they are no longer enough. The insulin resistance keeps increasing, and at some point insulin secretion also starts to fall off -- though it's usually still very high compared to a non-diabetic. At that point, exogenous insulin is all that's left. Unfortunately, it also seems to be used as a bit of a threat by MDs ("you'd better loose weight and start exercising, or you're going to need injections!")

BTW, I'm not an MD, just a somewhat informed layman. I just happen to be married to a type-1, and have type-2 running through my family, so I've been motivated to learn a bit about it all (mainly in an attempt at self-preservation!)

We put people on insulin glargine all the time (lasts 24h, peakless). This medication sounds potentially very useful. It wouldn't mean that all insulin could be oral, but if it works then perhaps we could save people from having to do their glargine injections.

For basal-bolus therapy, you do want to have a long-acting, "peakless" dose which is then augmented by "spikes" of insulin when needed. So this pill is more likely to replace the long-acting insulins like Lantus/Levemir.

I think any forward progress in oral insulin is worth a close look.

One thing I've learned from my Type 1 wife is to never get excited about this sort of stuff. Her father was a Lilly executive and they tried to get her to use the insulin nose spray back in the 80s. She passed, and a few years later it was pulled from the market as it was destroying the user's nasal passages.

She was also a beta tester for a blood meter that didn't need disposable test strips. It got pulled by the FDA.

I always root for advances in diabetes management, or dream of dreams, a cure. But I'm not expecting it.

Living with a type 1 for a number of years has given me a similar view. On the other hand, very real (and often hyped) advances really do happen. When pumps first came out, they were almost magic, ditto with continuous glucose monitoring.

My dad died in the mid-1980s from type 1 diabetes, when I was a child.

Literally, because it was hard to take blood samples to monitor glucose and inject the right amount of insulin.

I'm told that with modern equipment (am guessing the continuous glucose monitoring you mention) he would almost certainly have survived.

So yes, not all advances like this end up working. But overall, within our short lifetimes, the best ones are creating substantial improvements.

one thing to worry about - insulin cross-reacts with the IGF receptor and insulin is a mild carcinogen; but insulin variants and insulin reformulations can be extremely potent carcinogens. Presumably they did IGF cross-reaction studies, but the post-digestive tract form might have different properties even, and before getting too excited, I'd want to wait for results from a longitudinal study in the clinic.

Here's the link to paper, if someone wants to take a gander: http://pubs.acs.org/doi/abs/10.1021/bm401580k?journalCode=bo...

The Indian media is a bit breathless in declaring that this is the first time an insulin pill has been developed, but that doesn't seem to be the case [1]. Not to take anything away from new research, but I wish these discoveries were reported with some moderation because there's a long way between a discovery and a pill that can actually be sold.

1. http://www.reuters.com/article/2013/10/09/us-novonordisk-ora...

Now all that they need is to get it FDA approved to market in the US market. We need a sure shot remedy for diabetes which is alternatively known as "The Plague of Our Time" Read this article: http://blog.seattlepi.com/timigustafsonrd/2012/02/28/obesity...

They tested this only in rats. First they need to test this in humans. Perhaps it has nasty side effect. Perhaps the side effects appear after a few months. Perhaps human food has more variation than rat food (one day salad and the following day ice cream vs everyday apple and sunflower seeds).

We already have one for type-2. Don't eat carbs.

Really, if you have an intolerance to something... why are you still eating it?

This isn't entirely snarky. The ACCORD trial was a spectacular failure (http://www.nejm.org/doi/full/10.1056/NEJMoa0802743). Nobody really knows why (as far as I know), but since high blood glucose is known to cause problems, and lowering it by giving extra insulin does not seem to help (remember that type-2's usually have high spectacularly insulin levels to begin with), we've got to consider other approaches.

Avoiding carbs seems to both normalize glucose and lower insulin in type-2s, so it's not a dumb approach. On the other hand, a low carb diet tends to increase insulin resistance, so if it turns out that both the glycemia and insulin levels are not the cause of the adverse symptoms, but rather symptoms in themselves, going low carb may make everything much worse. (e.g. it might make the numbers we can measure look better, while worsening whatever metabolic abnormality is causing the diabetes in the first place)

Not sure why you're being downvoted. This is a perfectly valid approach to managing type 2 diabetes.

My mother is a type 2 diabetic and has been on a diet in which she consumes less than 30 grams of carbohydrates every day. To put that in perspective, the recommended daily consumption of carbohydrates is about 300 grams. The vast majority of American adults consume more (sometimes much more).

She cannot eat bread, pasta, fruit, potatoes, or even carrots, among other things. Surprisingly, some forms of sugar substitutes can also raise blood glucose levels. But she can eat many kinds of vegetables, meat, eggs, and dairy products. Just no sugar, and no carbs.

The diet has been very successful. She barely needs insulin anymore, and she's at the lowest A1C level she's ever had -- even lower than when she was taking lots of insulin. As a bonus, she's returned to a healthy weight.

That's outstanding. I wonder if her doctor recommended that or she found out herself? A lot more doctors need to get educated ... or at least less indoctrinated by the drug companies.

I've lost 30lbs myself in the last year being on a low carb high fat diet [with no exercise whatever]. It's miraculous. Diabetes and alzheimers run in my family, so I'm fairly certain I'll never eat bread/pasta/chips again.

It's just something she decided to do. Her doctor was more than happy to just keep pumping her full of insulin. But as it turns out, diabetics can be successful avoiding carbohydrates the same way lactose intolerants are successful avoiding dairy and people with peanut allergies are successful avoiding peanuts. It just makes sense, really.

> Now all that they need is to get it FDA approved to market in the US market.

Yah, lets not rush the FDA. There is a very good reason they take a long long time to approve these kinds of things. You sometimes need massive studies and a long time to detect problems.

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