
New pill can deliver insulin - theBashShell
http://news.mit.edu/2019/pill-deliver-insulin-orally-0207
======
samcday
> Once ingested, water dissolves a disk of sugar, using a spring to release a
> tiny needle made up almost entirely of freeze-dried insulin. The needle is
> injected into the stomach — which the patient can’t feel, owing to a lack of
> pain receptors in the stomach. Once the injection has occurred, the needle
> can break down in the digestive tract.

That's some pretty impressive ingenuity. Also sounds kinda terrifying if the
1.0 has any kind of edge case that involves tearing holes in your stomach
lining.

I'm not diabetic, but I still have vivid memories of sitting with my
grandmother while she constantly pricked her finger to test blood sugar and
jabbing insulin pens into her abdomen. It's always stuck with me as a
particularly unpleasant lifestyle to have to endure. Even still, if I were a
diabetic I think I'd still be waiting a year or two after the release of
something like this to make sure all the kinks have been ironed out ;)

~~~
RPLong
What doctors and researchers get wrong about diabetes is that pin-pricks and
injections are not even remotely bad. I don't know a single diabetic who cares
about injections and blood sugar tests. You get used to that within the first
week of diagnosis.

No, the unpleasant part of being diabetic is having to live every second of
your life as an act of weighing how what you're currently doing is going to
affect your blood sugar levels an hour for now:

\- Have I been sitting in this chair too long? \- Have I not been sitting down
enough this morning? \- Have I been drinking enough water? \- Did I just drink
too much water? \- I haven't been to the bathroom in two hours; does this mean
I'm screwed? \- If I eat a piece of toast after dinner, will I be able to have
sex with my wife without going hypoglycemic? \- I'd like to go hiking, but
it's hot outside and my insulin might spoil, so maybe I'll walk around the
block instead. \- I just plan on going to the grocery store for 20 minutes; do
I need to bring insulin in case there's a traffic jam on the way home?

Etc., etc. Pharmaceutical companies can't solve the real lifestyle problems
associated with diabetes short of inventing an actual cure.

~~~
daeken
> I don't know a single diabetic who cares about injections and blood sugar
> tests.

I'm diabetic and the sole reason I don't check my blood sugar (unless I think
something is drastically out of whack) is that it takes me upwards of 30
minutes to do a finger prick for testing. My anxiety skyrockets and nothing I
do can tell me that it's not going to be excruciating. Most of the time I end
up having my wife do it, which isn't a fun process for either of us.

It's not the worst thing, but it's deeply, deeply unpleasant for me. Come at
me with a 10ga needle, I won't flinch; come at me with a 30ga lancet and I'll
be a mess. I'm going to be switching to a CGM purely for this reason.

~~~
dotuser
I was on a CGM (Dexcom) for about 3 months until my new insurance would not
cover it. Even though it's convenient, it comes with its own set of problems -
having to restock every month (with copays) got tiring and somewhat expensive
compared to strips. I also had false low reads a number of times. And the
amount of wasted plastic (the applicator gun) is concerning if you are
environmentally conscious.

As for lancets, you might want to try the AccuCheck fastclix. It's a pen shape
device with a cartridge that holds 6 lancets. One cartridge can last me a
couple months as I tend to use the same lancet 10 or more times (I know,
probably not recommended). It's also the most painless lancet I've ever used
and it's easy to carry around.

~~~
GordonS
I had one of those for a while, and it does say you should only use each
lancet once. Realistically, I don't know if there are any real risks to
reusing them though?

~~~
dotuser
I reuse them until it becomes mildly discomforting at which time I know the
lancet has dulled. Of course AccuChek prefers that you use it once;)

------
jeffdavis
Type I diabetic here.

The injections are really not a significant problem for me. A lot of people
may recoil at the thought of injecting themselves often, as though it's
painful. It's either not painful or maybe a little, but I just don't care
much.

Much worse things about being diabetic are:

* Danger of low blood sugar

* Trying to get the right dose

* Timing the dose so it is effective at the right time

* Carrying around a bunch of stuff that I need or may need, like insulin and glucose tablets

* Trying to keep the insulin cold enough or fresh enough that it retains its potency

* Keeping my phone on and charged all the time, which has my blood sugar readings, and checking it at times where it might seem like I'm rude. I'd rather use a watch or special device, but the special devices are strangely bulky and don't hold a charge, and watches apparently can't receive blood sugar readings yet (without a phone also present).

None of those things are very terrible. Treatment is much better now. But they
are all way worse than the tiny insulin needle injections.

~~~
midnightcaller
Hey - I assume you're using a CGM - Dexcom?

Check out XDrip. Its an opensource community built collector for CGM data.
They have a version that runs on Google Wear so your android watch can act as
a collector. You can also still use your phone to collect and just have the
data appear on your watch.

Nightscout is another good related resource

[https://github.com/jamorham/xDrip-
plus/blob/master/Documenta...](https://github.com/jamorham/xDrip-
plus/blob/master/Documentation/WatchGuide.md)

~~~
georgebarnett
xDrip is such a great piece of software that few people know about.

If you’re want to see the future of medical care using smart devices, start
there.

~~~
shaklee3
Can you give a bit more detail on how you use it? Is extra hardware required?

~~~
georgebarnett
No extra hardware needed. Only your phone and a CGM if you wish to use one.

xDrip allows you to configure various care settings and then will provide real
time blood sugar feedback and dosing suggestions.

There’s (almost) nothing else like it in this space.

~~~
shaklee3
I'm confused as to what parakeet does. I have a Medtronic 670g with CGM, and
xdrip supports it. Apparently Medtronic already has an app, but xdrip uses
data from it. Also not really clear where nighscout fits in. Is that just the
service in the cloud to store it, and xdrip is the display?

~~~
midnightcaller
We have a Dexcom G5 and use Xdrip to read the data directly from the CGM. It
has a number of benefits over the OEM provided readers: -no forced replacement
times for sensors. -No forced delayed starts on new sensor insertions
-predictive algorithms and treatment recommendations. -more integrations into
third party systems (like IFTTT) -Opensource community project that keeps
evolving much faster than the OEMs

Nightscout is a cloud service to store data reading and treatments. Again its
community developed opensource solution which gives you complete ownership
over your data. Some of its earlier game changing features are now common in
the OEM solutions, but I still like the idea of owning this and it being
opensource. Nightscout is a really big help for us managing our son (whos 6)
since it makes it really easy to give real time access to his CGM and
treatments to anyone anywhere.

Nightscout is also the unofficial hub for the Opensource development in
diabetes. They've contributed so much that is now being used by OEMs. Im a big
supporter.

------
dpatru
I just watched a lecture on diabetes by Dr John McDougall last night. He
described type 2 diabetes as the body's natural way to limit weight gain. He
points out that morbidly obese people are often not diabetic: lack of insulin
resistance is what enabled them to keep growing. Viewed this way, diabetes is
a sign that a person has reached maximum weight. Giving a person additional
insulin at this point is like trying to override the body's defense mechanism
and forcing it to gain even more weight.

McDougall has lots of other interesting insights in the lecture and discusses
how he treats diabetics. He goes into some detail about how he decides how to
adjust medications and why he recommends his diet.

I'm posting this here because it may be of use to people who may not have
heard this information from their own doctors.

The lecture is found here:
[https://youtu.be/UgE2IdL6tMw?t=1103](https://youtu.be/UgE2IdL6tMw?t=1103)

The link starts the video at the point where McDougall starts discussing type
2 diabetes specifically. Before this he talks about insulin and type 1
diabetes.

~~~
SomeCollegeBro
I know several Type 2 diabetics who are not (and have never been) obese. While
obesity is definitely a cause for the disease, it is not the only cause there
is.

~~~
dpatru
I googled "diabetes in thin people" and found the term "skinny fat", slim but
with a high percentage of body fat. These are people who may appear to their
body to have enough fat stored to survive a tough winter. (This was how
McDougall describes the onset of diabetes.) Can people with low body fat get
diabetes?

~~~
dotuser
Did you mean, can a person with low body fat get Type 2 diabetes?

~~~
dpatru
yes

~~~
dotuser
Dominique Wilkins has type 2 diabetes. I would imagine his body fat is pretty
low.

------
sithlord
Study by Novo Nordisk. one of the fine companies responsible for raising
insulin prices by thousands of percent.

~~~
throwitaway6512
Read up on the matter. The culprits are pharmacy benefits managers who push
producers to increase list prices while demanding obscene rebates that are
never passed on to the consumers. Most producers don’t disclaim the rebates,
but Lars Fruegaard (Novos CEO) is on record saying that it increased from 64%
to 67% last year. So pharmacy benefits managers are pushing up the list price
but less and less is getting through to the producers. The American system is
rigged by the middlemen who approach consumers with ownership of “cheap drugs”
because of the rebates, while they approach the producers with ownership of
the consumers. As an alternative to that system Novo Nordisk is releasing
cheaper insulin through a partnership with Walmart where it goes directly to
the consumers.

Openness around rebates will be a great first step to help lower prices, but
the PBMs have gotten the industry into a reverse price war where everyone is
overbidding each other on price in order to provide the larges rebate to PBMs.
Something big has to change to revert that cause.

Disclaimer: I work for Novo Nordisk.

~~~
sdfj3423
>Read up on the matter.

Slightly off-topic, but could you talk about what pharmacy benefits managers
are supposed to do and actually do, for insulin especially, and their effect
on the market?

I Googled this term but can't make of sense of your comment based on what I've
read. (The definitions of pharmacy benefits managers that I found have nothing
to do with what you wrote.)

~~~
tokai
There is a paragraph in the wikipedia article on PBM[0] full of sources on
this.

[0]
[https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Co...](https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Controversies_and_Litigation)

------
arkades
If this is at all attractive to people, it's going to make insulin so damned
expensive.

The price of insulin is already rising: there aren't all that many generic
manufacturers of it, leaving them in a competition-free market. If this takes
off it's going to suck up a good chunk of the marketplace, and probably leave
us with maybe one or two generic manufacturers - enough to have an effective
monopoly. Insulin prices will spike the same way epi pens did.

Good tech. But sad re. what it's going to do to patients for a while.

~~~
coltonv
Manufacturing insulin isn't under patent or a trade secret is it? If the price
of insulin rises, then manufacturing insulin becomes more economically viable,
so new players will enter the arena, thus driving the price down.

Is there any reason this wouldn't be subject to the normal laws of supply and
demand?

~~~
Qwertystop
[https://www.cbsnews.com/news/how-drug-companies-keep-
insulin...](https://www.cbsnews.com/news/how-drug-companies-keep-insulin-
prices-high/)

Looks like a patent issue (every new improvement in production methods has its
own patent, so the insulins for which patents have expired are lower-quality
in one way or another) plus shipping costs (refrigerated bottled liquids with
a shelf life <6 months).

------
AngeloAnolin
Breakthrough like this needs to be designed so that people can afford it. It
just becomes burdensome (and depressing) for people who may need it and find
the cost out of reach.

On the other hand, given that treating diabetes is more costly to the society
in general (although more profitable for the pharma companies), shouldn't
there be more research to ensure people don't get into the trap of becoming
diabetic? One reason people become Type 2 diabetic is that they are completely
unaware that their lifestyle and food they are eating are slowly creeping in
to make them suffer with this disease. Healthy people only know about them
becoming diabetic because the cycle to get your blood sugar measured (A1C
Hemoglobin) is too far in between (annual checkups). If a person is more aware
of his/her blood sugar levels at shorter intervals, then a proactive approach
can be made so that the person can do changes that will help prevent diabetes.

~~~
onemoresoop
BigPharma is a business and has no incentive to prevent or cure disease but to
make sure the patient remains a customer

------
shawnz
What's the point of having this be an internal device? Why not use the same
technology to make external injection devices easier to use? It seems to me
like having the device be internal just increases the number of possible
failure modes and makes failures harder to spot/recover from.

------
bem94
Depending on what I eat, I need different ammounts of insulin, and adjust the
dose acordingly using my insulin pen and needle.

How does one adjust the dose in a pill? Do I take more or fewer pills?

They mention the insulin is "freeze dried". What does this mean in practice?
Do I need to carry around a climate controlled box with my insulin in?

~~~
jayalpha
"freeze dried"

"Freeze drying is a water removal process typically used to preserve
perishable materials, to extend shelf life or make the material more
convenient for transport. Freeze drying works by freezing the material, then
reducing the pressure and adding heat to allow the frozen water in the
material to sublimate."

You freeze it or shock freeze it and then "distill" the water of in vacuum.
The ice goes into the vapor phase, skipping the liquid phase. This process is
called sublimation and part of each first year high school chemistry
curriculum.

The substance, insulin or other peptides, will be stable after this at room
temperature for some time.

------
ironrabbit
I know we're a little ways off, but this seems like a great platform to
combine with automatic blood sugar measurement. Imagine taking one pill in the
morning that measures your blood sugar and internally administers insulin as
necessary. There are already externally attached pumps that do both (my
father, a type 1 diabetic, uses one) but having an electronic device
permanently attached to your stomach is a bit of a hassle.

------
friedegg
I can see why they're targeting type 2's, as they may need more of a fixed
insulin boost than full insulin replacement that I and other type 1's need.
Part of the fun being type 1 is figuring out proper adjustments to your
insulin dosages based on food, activity level, stress and other factors. It's
a clever design, though, and may help some people stay more compliant with
their treatment.

------
bleair
I view this is interesting research about medicine that has nearly zero
usefulness for actually treating diabetes in humans. Since this is a technical
audience, if you're diabetic I can't speak highly enough of the opensource
efforts combining a cgms (like a dexcom) with a pump and then software running
on android or iphon or raspberry pi to create a "feedback loop" to slowly but
usefully bring blood sugar back to desired range. For more see: For an
overview [https://diyps.org/2017/08/09/what-you-should-know-about-
clos...](https://diyps.org/2017/08/09/what-you-should-know-about-closed-
looping-diy-like-openaps-or-otherwise/) iPhone version call Loop
[https://loopkit.github.io/loopdocs/](https://loopkit.github.io/loopdocs/)
raspberry pi [https://openaps.org/](https://openaps.org/)

------
RPLong
Inhalable insulin was a total failure, even though it worked. I don't expect
this to succeed where inhalable insulin failed.

~~~
ricardobeat
Mannkind is still around, though not growing much. Why do you think it was a
total failure?

~~~
RPLong
Oh, really? I thought I read an article about how the product had been
discontinued. I stand corrected.

------
ajuc
I would be scared the needle hits hard food or something else and doesn't
inject the insulin with me not knowing it.

------
fredthomsen
Hope the price per pill is more reasonable that current prices on insulin
which are skyrocketed over 20 years.

------
m3kw9
I’m hoping Apple will pull out a miracle and able to measure blood sugar with
the Apple Watch. With that data, people can make apps to do really cool things
to help that person out.

~~~
amelius
Apple's focus is on "average" people, not people with diabetes.

Also it saddens me to hear "I hope that company X will solve Y" instead of "I
hope some university develops a method to solve Y".

~~~
ymolodtsov
Diabetes is becoming more and more common, especially in the US. It also could
be used for monitoring healthy people so they don’t fall into T2 diabetes. The
problem is, at the current technology level it might not be possible.
Johnson&Johnson tried to do that for decades and failed.

------
syntaxing
Is diabetes curable with gene therapy? I'm surprised we can cure hemophilia
with gene therapy but not diabetes. Is it impossible to get your pancreas to
create insulin naturally because it's missing something vital?

[1] [https://www.nih.gov/news-events/nih-research-matters/gene-
th...](https://www.nih.gov/news-events/nih-research-matters/gene-therapy-used-
treat-hemophilia)

~~~
sithlord
type 1 diabetes is an autoimmune disease where your immune system kills the
beta cells that live on the pancreas. you can get donar beta cells that will
work but your immune system will just kill them off again. This only works
with immunosuppresents which will cause 10x more issues than just taking
insulin.

~~~
syntaxing
Interesting, I never knew type 1 diabetes is an autoimmune disease. I just
thought the body just stopped creating insulin because the pancreas is messed
up.

------
maxander
A potential huge impact of this advance is inspiring further research into
peptide-based drugs; this is a whole new paradigm with the potential to be
comparable or better than the small-molecule drugs we currently focus on, but
the poor marketability of injections has kept most pharmaceutical companies
from being very interested in them.

------
waynecochran
Doesn't this have to work 100% of the time if you rely on it? I mean if it
works 99% of the time your odds are low you'll make it thru a year. It seems
like a cool idea, but the mechanism does seem like it would work not _every_
time.

------
osrec
Can anyone shed some light on why this can only help type 2 and not type 1
diabetics?

------
JohnJamesRambo
Is it not bad to have tiny needles traveling through your intestines?

~~~
donarb
There is no metal needle anywhere in the product. The needles are made of
freeze-dried insulin. It is injected into the stomach wall where it dissolves
into the bloodstream.

~~~
JohnJamesRambo
Oh I didn’t get that on the first read through.

------
auiya
This still seems dangerous to the stomach lining over time. Why not
suppositories?

------
adamc
What's it going to cost, though? A big problem with insulin now is the cost...

------
phyzome
And what happens if it gets stuck in your esophagus?

------
bitwize
So it's a roughly gömböc-shaped capsule, then?

------
th3o6a1d
This seems like a solution looking for a problem.

------
adventist
As a TYPE 1 Diabetic. All I can say is AMEN!

------
detaro
URL should probably be the source press release:
[http://news.mit.edu/2019/pill-deliver-insulin-
orally-0207](http://news.mit.edu/2019/pill-deliver-insulin-orally-0207), since
techcrunch is just a less detailed summary of that

~~~
sctb
Thanks! We've updated it from [https://techcrunch.com/2019/02/07/mits-insulin-
pill-could-re...](https://techcrunch.com/2019/02/07/mits-insulin-pill-could-
replace-injections-for-people-with-type-2-diabetes/).

------
visava
Plant based diet can reverse diabetes ( I and II ). For type I milk products
need to be stopped. Take 1% of your bodyweight as fruits. Take 1 % of your
body weight as Raw ( uncooked ) vegetables. Take 10% of that vegetable quota
as green leafy vegetables. Based on China Study by Colin Campbell.

e.g. weight 150 pounds 1.5 pounds fruits before 1 pm 1.5 pounds raw vegetables
for the day If you are still hungry you can eat cooked food after completing
daily raw fruits vegetable quota. Avoid all animal,milk,processed packaged
products and heated oils. Will reverse diabetes in 3 days for newly detected
patients. Add 1 day for each year you have diabetes

[https://biswaroop.com/](https://biswaroop.com/)
[https://www.youtube.com/watch?v=KgxvGu4fuGo&t=561s](https://www.youtube.com/watch?v=KgxvGu4fuGo&t=561s)
lookup his youtube videos

~~~
danhon
T1 can’t be reversed.

~~~
visava
This diet with stopping milk products can. Milk protein with 17 rings similar
to beta cells. Body in an attempt to kill milk protein which escapes into
blood without breaking down the ring structure also kills beta cells
[https://www.youtube.com/watch?v=4edofibXOiM](https://www.youtube.com/watch?v=4edofibXOiM)
watch at 48 mins

~~~
gus_massa
This part of the video makes no sense. (I didn't watch the rest.)

From the video:

> _If you observe milk protein (casein) under a microscope it will appears as
> this - there are 17 links in it._

The video says "links", you say "rings". It's a small but important
distinction. Proteins are made by linked aminoacids, so sing "link" is a good
approximation, but most of them don't look like "rings".

I can't find where the "17" comes from. After a few google searches I found
that casein has approximately 210 aminoacids, the number can vary, but it is
not 17.

(Also, you can't see a single casein protein under a normal microscope, nor
the parts of it. I guess it's only a metaphor, but it makes me suspicious.)

I don't find the part in the video that says that casein escapes to blood. (I
didn't try too hard.)

Casein is split in the stomach by the enzymes IIRC they are the regular
enzymes that also split the proteins in meat, and other food, not specialized
enzymes.

(There is an specialized enzyme for lactose that is an special sugar in milk,
but this is not what the video or you say. But if this were dangerous, we'd
have a lot of babies with diabetes. Moreover, only some adults produce the
enzyme to digest lactose, so it would be easy to test.)

I didn't find a source that says that beta cells have some proteins that are
similar to casein. It is posible, but I doubt.

And IIRC most autoinmune diseases, where the body get confused and start to
attack some part of it don't go away after you remove the initial agent that
causes the reaction. So stopping drinking milk won't stop the reaction.

------
phkahler
To all the type II diabetics here, I'd suggest looking in to iodine. I'm not
diabetic, but I started taking it for other reasons and as a side effect I
seemed to have better blood sugar regulation. There are also doctors out there
that claim it reduces insulin dependence.

I'm not claiming a cure, or even an actual treatment. Just want to point some
people to something that most people have never heard of.

------
m3nu
For the case of T2D, eating fewer carbs may be more effective than later
reducing it with expensive insulin and fancy MIT pills.

I often hear good stuff about these guys:
[https://www.virtahealth.com/](https://www.virtahealth.com/) (no affiliation)

edit: clarify that Virta is treating T2D primarily.

~~~
vonmoltke
Eating fewer carbs is completely ineffective when your pancreas is not
producing insulin in the first place.

~~~
m3nu
I was talking about type 2 diabetes, not type 1. You're of course correct
regarding type 1.

~~~
coldpie
Speaking as a T1D, please always specify. It's a shame these two totally
unrelated diseases have the same name.

~~~
thomasfedb
They're not "completely unrelated" — they are an absolute and a relative
deficiency of insulin production respectively. They do have significantly
different aetiologies though, and the conflation is very unhelpful.

