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April 1, 2002

Blood Tests and Insulin Injections, Research: Other Research

Question from Cantonment, Florida, USA:

I think it would be easier to cope with diabetes if needles weren't a part of it.Can you tell me what the near future holds to get rid of needles? Are there studies being done to test other ways to give insulin? My main question is: Why cant they put insulin in a patch? You may have to use several patches a day, but we use several needles a day too.

Answer:

The search for ways around subcutaneous injection for giving insulin has been going on for a long time:

It was shown long ago that swallowing insulin in capsules didn’t work because it was erratic and most of the insulin was broken down in the stomach or small intestine. More recently, there have been attempts to conjugate the insulin with another molecule to make it more permeable through the bowel wall.
Pressure injectors had a vogue some twenty years ago, but they were expensive, difficult to clean and a nuisance when you wanted to use two kinds of insulin. Besides which they seemed to sting just as much as needles.
Inhaled insulin seems to work, but some of the equipment was cumbersome, and there is some very recent evidence for long term damage to the lungs.
A patch might work, but the molecule of insulin is rather large to move through the skin without a low voltage current’ and making the dose precise might be difficult.
Probably your best hope at the moment is for insulin that is conjugated to make it permeable through the buccal mucosal membrane. The apparatus looks like a small asthma inhaler and it does work. There is some restriction on the variation of dosage, and for the moment you can’t give long acting insulin. It’s also not yet approved by the FDA and its only about 25% as efficient as injection so that it may be expensive when it is available. See Oralin.

I have a sense that transplantation of surrogate islet-like cells together with brief but sustained immunomodulation may get there first.

DOB