Canadian News: Possible Developments in insulin Delivery
I have heard that it is possible to get away from insulin injections either by using nasal insulin sprays or some form of insulin that can be taken by mouth. Are these claims true and are we going to be able to get away from insulin injections in the future? 
There is no doubt that insulin delivered via the nose is absorbed through the mucous membranes and can lower the blood glucose. Unfortunately, only a small percentage of insulin taken in this manner is absorbed into the bloodstream and it is therefore an inefficient, unpredictable and expensive way of administering insulin.
If insulin is taken orally it is digested in the stomach and becomes inactive. It is possible to prevent this by incorporating insulin into a fat droplet (liposome), which enables it to be absorbed from the gut without being broken down by the digestive juices. However, the absorption is very erratic and there is no way of knowing when the insulin will be released from the droplet and become active.
Inhaled insulin (Exubera made by Pfizer) became available in the UK in 2006. Unfortunately Exubera was withdrawn in 2008 because of lack of uptake and doubts about its safety. It seems unlikely that any other form of inhaled insulin will become available.
All these developments are exciting but there are various issues to be aware of when considering the effectiveness of inhaled and oral insulin.
- People must be confident of receiving an accurate dose of the insulin.
- Inhalers often use very large doses of insulin.
- We do not yet know the potential side effects of such large doses.
- The inhalers being developed so far do not totally eliminate the need for insulin injections.
- The devices need to be portable, compact and competitively priced.
INSULIN PUMPS AND ARTIFICIAL PANCREAS
I recently read about a device called a ‘glucose sensor’, which can control the insulin administered to animals with diabetes. Will this ever be used on humans and if so what can we expect from it?
Research has been going on for many years into the development of a small electronic device that could be implanted under the skin and continuously monitor the level of glucose in the blood. The technical problems of such a device are considerable and it seems unlikely to be used routinely in people with diabetes for several years. Not only are there technical problems in achieving an accurate reflection of blood glucose level by an implanted glucose sensor, but there is also the major problem of‘hooking it up’ to a supply of insulin to be released according to the blood glucose level. Clinical trials are being carried out in the USA and France using an intravenous glucose sensor in conjunction with an implantable pump. The early results are encouraging, but it will be several years before it is widely available.
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