In 1921, insulin was discovered and since then diabetes has been transformed from a fatal condition to one that can be managed. Nonetheless, there are still significant challenges that remain, even with centuries of medical advance in insulin therapy. The inconvenience for those with diabetes to constantly monitor blood glucose levels, calculate insulin doses and balance exercise and diet is still an issue even with all of our modern technology.
This is where smart insulin comes in, sometimes referred to as glucose-responsive insulin. It is designed to automatically adjust its activity in response to changes in blood glucose levels which could reduce the need for constant monitoring and the risks of complications could be lowered. This could transform diabetes management.
In the pancreas there are specialised cells which continuously monitor blood glucose levels and release insulin when needed. These are called the pancreatic beta cells and they allow for the concentration of glucose in the bloodstream to remain relatively stable. Someone who has type 1 diabetes has an immune system which destroys these insulin-producing cells which means insulin must be externally supplied. Those with advanced type 2 diabetes also require insulin treatment when their bodies can no longer produce enough insulin or respond to it.
Naturally, injected insulin can not replicate the actions of a healthy pancreas. Too much insulin can cause hypoglycaemia which is where blood glucose falls too low. This causes dizziness, confusion and sometimes death. Hyperglycaemia can occur if there is too little insulin and blood glucose levels are dangerously high and over time this can damage blood vessels, nerves and eyesight. All of these risks mean that those using insulin must make constant decisions about their dosage several times a day.
So you may be wondering, how does smart insulin actually work? Smart insulin would only become triggered when blood sugar rises above a certain threshold as it responds directly to glucose levels rather than remaining continuously active after injection. One of the most promising approaches involves attaching insulin molecules to glucose-sensitive compounds that act as biological sensors. These molecules are called glucosides which have a similar shape to glucose. The glucoside binds to the ring when blood sugar levels are low, keeping the insulin in an inactive state. When the blood glucose rises the glucoside is replaced by glucose which triggers the insulin to shift its shape and become active. This helps bring blood sugar level down. It is said that smart insulins such as this one “have the potential to be truly transformative in the management of type 1 diabetes”.
One of the main benefits of smart insulin is that it could reduce the risk of hypoglycaemia. Insulin activity would decrease as blood glucose levels fall and patients would be much less likely to experience threatening drops in blood sugar.
Secondly, those with diabetes wouldn’t have to suffer the burden of constantly monitoring and injecting insulin. Patients would only need occasional injections that automatically adapt to their body’s needs. There are also long term health benefits as the complications and chances of cardiovascular disease are reduced as blood glucose levels stay within a healthy range. Smart insulin improves glucose control and therefore may help prevent these conditions from developing.
Overall, not only does smart insulin have the ability to dramatically improve quality of life for a range of people, but it can also reduce the stress associated with living with diabetes.
Unfortunately, smart insulin is not yet available for clinical use despite its enormous potential. There are many steps that must be taken before technology can become a reality. In the case of smart insulin, it must be manufactured so that it responds rapidly enough to rising glucose levels while remaining inactive and stable when glucose concentrations are normal. Scientists must also make sure treatment is safe and effective over long periods of time. The aim is to have smart insulin available as an orally administered product by 2030.
Nevertheless, advances in biotechnology and drug delivery systems have accelerated research in recent years, and scientists believe ‘smart insulin’ could become one of the most important developments in diabetes treatment since insulin itself was first discovered.
In conclusion, smart insulin represents an exciting example of how biochemistry can be used to solve real-world medical problems. By combining our understanding of chemical pathways, proteins and molecular interactions, researchers are able to develop treatments that could mimic the body’s natural processes more closely than ever before. Even though there are significant challenges left to overcome, smart insulin has the ability to make diabetes safer and less stressful for the millions of people living with the condition worldwide.
Chloe Tohme
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