Diabetics may soon be able to ditch the needle and swallow a pill instead

Diabetes is a terrible disease - not least because many patients have to inject themselves with insulin twice daily.

The pain of daily injections — even the slim insulin pen needles — is real enough to discomfit even the most stoic among us.

Now, scientists at the Massachusetts Institute of Technology and Novo Nordisk (the first company to bring the insulin pen to market in 1985) have developed an insulin pill that can reportedly deliver the same dosage as an injection.

Representational image. Image by Martin Büdenbender from Pixabay

The innovation could be life-changing for the millions of people living with diabetes - more than 72 million people in India have diabetes.

About insulin

Our pancreas produces insulin, a hormone that takes up glucose from the blood and transports it inside each cell - where it is further broken down for energy.

There are two main types of diabetes: type 1 in which the body doesn’t make insulin, and type 2 in which the body produces inadequate amounts of insulin or builds a resistance to insulin.

Type 1 diabetes, also known as insulin-dependent diabetes, is usually congenital - so even young babies with this condition have to be poked with needles several times a week to deliver much-needed insulin to their bodies.

Human insulin is produced in labs by Escherichia coli (a bacteria) through recombinant DNA technology (transfer of genes from one species to another). Until recently, the only way we could take insulin was by injecting it just below the skin. This led to many innovations, notably the insulin pen which became commercially available in 1985.

Why the injection?

The challenge with taking insulin orally so far was that insulin, a protein, could be digested in the stomach before it had a chance to reach the bloodstream - until insulin reaches the blood, it can’t do its job.

This is why for the last 97 years (according to one account, the first insulin injection was given on 11 January 1922), insulin has been administered via injections. With every injection, though, there is a small amount of pain. Even when the needle is extremely fine.

For people who have a fear of needles, it is obviously awful to take daily insulin injections.

Seeing this, scientists across the world had been trying to make an insulin pill that could stay intact in the stomach but still manage to deliver the required dose of insulin to the small intestine.

The innovation

In February 2019, scientists from Novo Nordisk and MIT engineers developed a blueberry-sized capsule with a “small needle made of compressed insulin”. The idea was that when someone took the capsule, the outer cover would dissolve in their stomach and the needle would inject insulin into the stomach lining from where it would enter the bloodstream.

The same team announced in October 2019 that they had found another way to deliver insulin to the small intestine - which has fewer pain receptors, so even the microneedles shouldn’t cause pain.

This new capsule breaks open inside the small intestine into a micro-parachute with three folded arms, each with a 1 mm microneedle comprising insulin.

The scientists explained that the opening force is enough to insert the microneedles into the topmost intestinal lining. Once inserted, the needles dissolve to deliver the drug. The scientists claim that what’s left of the capsule gets excreted with stool and poses no risk of blockage in the gastrointestinal tract or gut.

“We performed numerous safety tests on animal and human tissue to ensure that the penetration event allowed for drug delivery without causing a full-thickness perforation or any other serious adverse events,” said Alex Abramson, one of two lead authors of the research. The other lead author was Ester Caffarel-Salvador.

Funding for the research came from Novo Nordisk and the National Institutes of Health, US. The findings were published in Nature Medicine, a peer-reviewed journal, on 7 October 2019.

Though still in the clinical trial phase, the new insulin pill has brought hope to many diabetics around the world.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please watch our video on the Insulin Pen.