[gorb314]

I think this is an interesting research direction.

From my perspective though, being a T1, what I want is an even faster acting insulin than we already have, with a shorter "on" time.

To explain: the shortest acting insulins we have right now take effect about 30 minutes after injection. Then the dose stays active for about 4 hours. So for me to react to a high blood sugar, and until I can be certain that I did not inject too much (nor too little), can take up to 4 hours.

That is almost unbearably long, especially when my blood sugar climbs through the roof, and I am not sure whether it is because my pump line was blocked. Overloading on insulin (called "stacking") to compensate for a crazy high blood sugar can be very dangerous - plus I can't think straight when my sugar is that high. Nothing sucks more than having to sit and wait for a high blood sugar to come down...

Contrast that lagged response time to eating food, especially high GI sugars such as a soft drink, orange juice, or even bread. This can spike my insulin in a matter of minutes.

All this makes matching sugar spikes with insulin response curves very hard; it is a one-side-overdamped-and-other-side-underdamped dynamic system. Any diabetic will tell you how crazy a "roller coaster ride" can be, which is what happens when you overcompensate on either end.

To get back to the topic of the 'smart' insulin: if this research can lead to an insulin that can always be in my bloodstream, ready to act when my blood sugar rises, and stop when my blood sugar falls, and if it can do this quick enough, then that would be a game changer.

[zippergz]

Have you tried the inhaled insulin? It takes effect MUCH faster than any injected insulin, does it’s job, and is out of your body quickly so also reduces the risk of stacking. In some ways it is not as convenient as a pump, but it works much better in terms of timing.

[zby]

How do you take it? I imagine it would be ideal to quickly beat hyperglycemia when you underestimate a meal bolus. But I don't see it replacing a pump (or pens), because it would be difficult to: measure it exactly and keep supplying it continuously.

[zippergz]

I know people who quite successfully use it in place of a pump, along with a single basal shot from a pen each day. It’s just a small inhaler with disposable plastic dose dispensers in various numbers of units. It because it works so quickly it is not a problem to measure accurately. If you use too little, you’ll quickly know and can take another. But you are correct that it could not replace basal insulin. I suppose you also could use it as a supplement to a pump and there are probably people who do it, but not in my circle.

[danudey]

The only inhaled insulin I can find is Afrezza, and WebMD says:

> It's not for diabetes emergencies such as diabetic ketoacidosis (DKA).

So probably not great for this. Seems more like something you take during a meal to keep from going hyperglycemic and not something you take when you're having problems.

https://www.webmd.com/diabetes/inhaled-insulin

[oaktrout]

This in itself isn't really a mark against Afrezza. DKA is traditionally managed in a hospital setting. I believe WebMD is directed at the consumer and they won't be recommending any insulin for the management of DKA.

[sithlord]

You don't treat DKA with insulin, at home at least. DKA usually means you have become super dehydrated, and likely all your blood work will be way out of whack.

To be fair, I have only gone into DKA once, when I was diagnosed, so it was certainly an extreme - but, I would guess most people who end up in DKA also have some kind of extreme.

[1123581321]

Fellow T1 here--when you're in that situation you shouldn't sit while your bolus barely keeps up with fast carbs, you should do something physically active to help get your numbers down more quickly.

I share your wish in your last paragraph very much!

[pixl97]

If only physical activity paid as much as holding a chair down.

[1123581321]

Yes, it's tough (for the first world.) I've done walking meetings and during COVID some conference calls on the go, but if I ate a bunch of pasta for lunch and didn't take my insulin first, and have typing to do...

[FigurativeVoid]

That's a really great point. I am T1 as well. The improvements I would love is an insulin that is denser and more stable.

If we had insulin that was say.. 1000 units/mL (10x stronger) and didn't degrade as fast, then we could have some really cool and slim devices. You could also have a longer lasting pump site.

[ninjin]

Not so sure about the pump sites. My experience is that the reason for changing pump sites is not just about your insulin cartridge running low, but also about tissue damage at the pump site. Based my own two years of pump usage, changing every three days (as recommended) rarely leads to visible damage, but pushing it to say four days frequently does. Sample size of one though.

[FigurativeVoid]

Yeah. I'm not sure. Sensors can stay in for 1-2 weeks, but it's not delivery device.

[zby]

What the article speculates is a way to load up insuline in the blood that would not act if the blood glucose is below let's say 120 - but when it is above - then the insuline opens and acts. This is the fastest possible way of it to act. Even if it degrades and you could not keep much of it constantly in the blood stream - then you could inject it much before the meal and it would just start acting when the blood sugar increases and also you could inject more than enough and not worry about injecting too much of it - because it would never lead to hypo.

This would be the ideal - in a way it would be better than functioning pancreas - because pancreas needs a few minutes before releasing insuline and this would act instantly.

[RHSeeger]

It would be nice to have something like this with a several hour window. I currently suffer from the dawn phenomenon, and my blood sugar spikes by 100+ most mornings (starting anywhere between 5am and 7am). It's super frustrating to have to get up every day at 630-7am to check my blood sugar and, if necessary (most days), take some insulin.

[UnpossibleJim]

Waking up to the GCM an hour before the alarm every morning is horrible. While maybe not the worst thing about being a T1, I'm still loathe to do it =P

I will say this, though. The CGM (continuous glucose monitor) was one of the best things to help me regulate my blood sugars - even though insurance hates to cover it from time to time (not always - it's weird). As a person who has a tendency to suffer from extreme lows, I'm excited for this new "hinged" insulin, should it make it to market.

[RHSeeger]

> The CGM (continuous glucose monitor) was one of the best things to help me regulate my blood sugars

I couldn't agree more. I rave about my CGM, even with it's flaws.

- A little bit more confidence that I'll know when my blood is low, especially when sleeping

- Being able to check my blood sugar with 0 effort. I don't even mind poking holes in my fingers that much, but the difference between "get up, go downstairs, test blood, come back, get back into what I was doing" and "look at my phone" is HUGE. I "check my blood" dozens of times a day now, because it takes no effort.

- The chart, being able to see where my blood has been every 5 minutes over the past timeframe, is fantastic. I can see not only where it is but how it got there.

- Because I check my blood so often, I've gotten a better "feel" for how my blood is impacted by different things.

- Being able to go online and see the graphs of my blood sugar over timesframes over months... Once again, it just adds more information to understanding of my body and blood sugars.

The CGM "transforms", in every sense of the word, my ability to regulate my blood sugars.

[gukov]

Have you looked into Fiasp? I found it to be faster than Apidra.