Is real-time blood sugar control becoming a reality with smart insulin?

People with type 1 diabetes must monitor their blood glucose levels and inject precise doses of insulin several times a day to avoid health complications. Now, diabetes researchers are developing smart insulins that could be administered only once a week and manage blood sugar in real time. Medical News Today investigated whether smart insulins really could be life-changing for people with type 1 diabetes.
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Type 1 diabetes occurs when the body does not produce enough insulin, the hormone that controls blood glucose (sugar). The condition is less common than type 2 diabetes, which affects around 462 million people worldwide. Nevertheless, more than 8 million people around the world live with type 1 diabetes.
Type 1 diabetes
insulin
type 2 diabetes
462 million people
8 million people
Although the exact cause of this condition is unknown, having a parent or sibling with the type 1 diabetes may increase a person’s risk of developing it. Environmental factors, including some viral infections, can also cause type 1 diabetes by triggering an autoimmune response which destroys the insulin-producing beta cells in the pancreas.
viral infections
autoimmune response
beta cells
A diagnosis of type 1 diabetes, which most commonly happens in childhood or early adulthood, but can occur at any age, means a lifetime of monitoring your blood glucose levels and injecting insulin several times a day to control them.
diagnosis of type 1 diabetes
New technologies, such as continuous blood glucose monitors, insulin pumps, and smart insulin pens can make the management of blood glucose easier, but still cannot entirely eliminate the dangers of blood glucose going too high (hyperglycemia) or too low (hypoglycemia).
continuous blood glucose monitors
insulin pumps
smart insulin pens
hyperglycemia
hypoglycemia
Why is controlling blood sugar a challenge?
The constant challenge for people with type 1 diabetes is keeping their blood glucose in the healthy range. Hypoglycemia can lead to unconsciousness and even death.
Hyperglycemia increases the risk of many health complications, including:
health complications
diabetic retinopathy, which can lead to vision loss
diabetic retinopathy
vision loss
diabetic neuropathy, which affects nerve function
diabetic neuropathy,
problems with wound healing
wound healing
kidney disease, or diabetic nephropathy, which can lead to kidney failure
diabetic nephropathy
cardiovascular disease, heart attack, stroke, and peripheral vascular disease
cardiovascular disease
heart attack
stroke
peripheral vascular disease
dental problems, including tooth loss and gum disease
gum disease
mental health problems, such as depression.
depression
If a person keeps their blood glucose under control, the likelihood of health complications is greatly decreased, and new technologies make it easier for people to monitor and regulate their blood glucose levels.
Continuous blood glucose monitors, which are inserted just under the skin, or implanted in the body, can connect to smartphones, or to insulin pumps, avoiding the need for people to do regular finger-prick tests to check their blood glucose levels.
finger-prick tests
Insulin pumps, which are attached to the skin, or clothing, and deliver fast-acting insulin through a very fine tube, are an alternative to frequent injections.
Insulin pumps
They can help people who have problems giving themselves injections or who struggle to avoid high or low blood glucose, as they deliver tiny amounts of insulin frequently. However, they can be expensive and are not suitable for everyone with type 1 diabetes.
An alternative to an insulin pump is a smart insulin pen. These reusable injector pens are linked to a smartphone app that calculates and tracks doses. They can deliver variable doses as needed and send real time data to a person’s healthcare provider.
smart insulin pen
Rachel Connor, Director of Research Partnerships at JDRF UK, explained to Medical News Today:
JDRF UK
“It is relentless to live with type 1 diabetes because you have to try to do the job of a biological organ with imperfect tools. So-called smart insulins have the potential to respond to changing blood glucose levels in real time without adjusting insulin pump settings, taking extra insulin injections or continuously monitoring blood glucose levels.”
What are smart insulins?
Smart insulins, or “glucose-responsive” insulins, are the latest in a range of novel insulins being developed in the search for better treatments for type 1 diabetes.
The Type 1 Diabetes Grand Challenge, which is supported by Diabetes UK, JDRF and the Steve Morgan Foundation, has allocated £2.7 million to fund six research projects into new diabetes treatments.
Type 1 Diabetes Grand Challenge
Diabetes UK
JDRF
the Steve Morgan Foundation
Novel insulins under development include:
Novel insulins
Fast-acting insulins — these are insulins that have been chemically edited so they are absorbed faster by the body and can reduce blood glucose levels rapidly. Some ultra rapid insulins can reach the blood in 4-7 minutes, around half the time taken by currently available insulins.
4-7 minutes
Weekly injections — to try and help remove the chore of daily injections, the drug company Novo Nordisk is developing a form of insulin, called insulin icodec, that is injected only once a week. Although a long way from being a marketable treatment, this has shown promise in the ONWARDS 6 trial of 582 people with type 1 diabetes.
Novo Nordisk
the ONWARDS 6 trial
Oral insulin — researchers from Australia and Norway have developed a capsule that is taken by mouth and travels through the digestive system to the liver. The covering of the capsule prevents the insulin being broken down by stomach acid or digestive enzymes on its journey. Once in the liver, tiny particles called nanocarriers that are attached to the insulin molecules detect increased glucose levels and release their insulin as needed. Clinical trials are due to start in 2025.
Oral in
s
ulin
Smart capsules — scientists at the University of Birmingham in the United Kingdom are developing a capsule that could be injected once a week. The theory is that the capsule would slowly degrade, releasing insulin whenever blood glucose gets too high. However, this treatment is in the early stages of development, so it could be many years before trails in people can begin.
Smart capsules
Smart, or “glucose-responsive” insulins — these are administered once a day, and remain inactive in the body until blood glucose levels rise. When this happens, they respond rapidly to bring the level down before returning to the inactive state.
Smart, or “glucose-responsive” insulins
According to the JDRF, smart insulins could greatly reduce the burden of type 1 diabetes by offering tight glucose management, eliminating hypos [hypoglycemia], reducing the risk of complications and freeing people from glucose monitoring.
the JDRF
Mimicking the body’s natural responses
But how can a synthetic insulin respond to blood glucose levels in the same way as a healthy person’s pancreas?
One development is a cage-like structure surrounding the insulin that can detect varying glucose levels. When high levels are detected, the ‘cage’ releases the appropriate amount of insulin in response.
Researchers are also exploring ways to chemically edit insulin so it can sense glucose, or change shape in response to glucose. In a low-glucose environment, the molecule would be tightly closed, but rising glucose levels would make it open up so it could react to bring the levels back down.
change shape
“We hope new forms of insulins will do more of the work of managing type 1 diabetes to alleviate some of this burden and make it much easier to live life with type 1 diabetes with less worry about managing the condition,” Connor commented.
A crucial step forward in diabetes treatment
Elizabeth Robertson, MD, Director of Research at Diabetes UK, noted in a press release:
Elizabeth Robertson, MD
press release
“By supporting these groundbreaking research projects, we are aiming to develop new insulins that more closely mimic the body’s natural responses to changing blood sugar levels. This could significantly reduce the daily challenges of managing type 1 diabetes, and improve both the physical and mental health of those living with the condition. We are hopeful that this research will lead to life-changing advancements in type 1 diabetes care.”
However, Connor cautioned that it may be some years before smart insulins are available for people with type 1 diabetes.
“No glucose responsive insulins are yet available in the clinic. The scientists we’re funding are at a relatively early stage of their research, and the products they are trying to develop aren’t yet ready for clinical testing,” she told us.
“It’s really hard to give timescales in drug development – things can sometimes go very rapidly and get accelerated, like we saw happen with covid vaccines. Or, as often happens, we could hit hurdles along the way that make the process take longer. This funding will push us closer to first in man clinical trials, where small numbers of people with type 1 diabetes would try the products to assess their safety,” she added.