[HN Gopher] Injection of "smart insulin" regulates blood glucose...
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Injection of "smart insulin" regulates blood glucose levels for one
week
Author : ksec
Score : 40 points
Date : 2023-12-27 16:05 UTC (6 hours ago)
(HTM) web link (arstechnica.com)
(TXT) w3m dump (arstechnica.com)
| ch4s3 wrote:
| This is really compelling, and the principle seem like it should
| work in humans. Can anyone with more knowledge of biochemistry
| think of any reasons why this gluconic acid polymer approach
| might not work in humans?
| ray__ wrote:
| Like most cool biotechnology tools like this, the hangups will
| probably come from ironing out safety, dosing, and delivery
| issues in the clinic, rather than some mismatch in the
| biochemistry. They mention one of them in the paper:
| In the long term, a balance is assumed to be established
| between the amount of injected PLL-FPBA and cleared PLL-FPBA.
| Thus, the long-term toxicity of the complex formulation needs
| to be thoroughly evaluated for clinical translation.
|
| Proving that PLL-FPBA only responds to glucose fluctuation (and
| no other physiological changes, with a large enough sample size
| to cover the range of possible physiological changes that could
| be experienced by patients), proving that it is biocompatible
| with all patients, proving that the dose-response is uniform
| and can be correctly tailored in all patients, and then proving
| that all of these results hold over very long periods of time
| with material that can be cost-effectively manufactured at
| scale will probably be the tricky part. There probably aren't
| any fundamental reasons that the chemistry of the gluconic acid
| polymer wouldn't work in humans.
|
| Citations 13-40 provide a pretty good overview of the history
| of glucose-responsive insulins. These ideas are awesome and I
| hope they can be successful some day, but I also get the
| impression that engineering improvements (and cost reductions)
| in insulin pump technology will provide more immediate quality-
| of-life improvements for the broader Type-1 Diabetic
| population.
| ch4s3 wrote:
| Incredibly interesting. This is exactly the sort of comment I
| was hoping to find on this post!
| 29athrowaway wrote:
| So if regular insulin is already overpriced, how overpriced will
| this medication be?
| medstrom wrote:
| May have a reasonable price in countries where insulin also
| does.
| EA-3167 wrote:
| From the article, this is a small animal study involving less
| than 10 animals, no one knows if this even works in humans or
| if the benefits seen here will translate into a larger study.
|
| This is so far from being a commercial product that asking
| about costs means nothing.
| nothercastle wrote:
| Guess people can visit Canada or Mexico weekly
| RecycledEle wrote:
| It is against US law to bring insulin back from Mexico.
|
| People still smuggle in a little, but there are penalties if
| they get caught with a lot of insulin.
|
| I live in Texas, about 12 hours from the Mexican border, so
| it's not worth the trip.
| copperx wrote:
| That's misleading. It might be a technical violation, but
| it is decriminalized. Bringing back a 90-day supply of
| personal-use non-controlled medications is completely fine.
| To be safe, carry a prescription and declare the
| medications at the border.
| nothercastle wrote:
| Probably does not count for weekly shots administered on
| the other side of the border
| cccybernetic wrote:
| Insulin is available at Walmart for about $25. The newer analog
| versions cost around $80. It's just private label Novo Nordisk,
| so all high quality.
| ChadNauseam wrote:
| if this is true, do you know the source of the meme that
| insulin is extremely expensive for uninsured people in the
| US?
| annthurium wrote:
| There are different types of insulin (short acting, long
| acting) and the cheapest version isn't always best for a
| specific person depending on their individual situation. If
| you want more information on the structural factors of the
| unaffordability of insulin this article could help:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597930/
| cma wrote:
| They lowered the price at some point in the few years, at
| least on some versions.
| RecycledEle wrote:
| A box of Fiasp or Levemir insulin costs $477-$560.
|
| The better insulins cost more.
|
| If I give myself the $24.88 WalMart insulin, I can not eat
| lunch at my regular time and then have to eat in the middle
| if class. (Assuming I had a high blood sugar reading going
| into lunch and gave myself R an hour before lunch.)
|
| If I can afford the Fiasp, I can go ahead and eat at my
| regular time. It's just expensive.
| pliny wrote:
| This is a weird objection because if the expensive
| insulin did not exist (effective price = $inf) it would
| not apply.
| steveklabnik wrote:
| The reality is that before we had these medications, more
| people just died. Yeah sure in some sense it does not
| apply, but that's missing the point.
| anonuser123456 wrote:
| The issue is largely the byzantine structure of the market,
| making it challenging for less sophisticated consumers to
| buy cheap insulin.
| steveklabnik wrote:
| > if this is true
|
| To be clear, your parent is telling the truth in a very
| literal sense. However, as always, the devil is in the
| details.
|
| First of all, this is a pretty recent development. The
| insulins available for cheap at WalMart used to be
| significantly worse.
|
| The second bit is that wait, how can it be worse? Well,
| "insulin" isn't always one thing: there are a variety of
| brands and ways of synthesizing it. They also have
| different properties. So there are certain things about
| this specific insulin that may not be great for a variety
| of reasons. Type 1 folks (I have less experience with type
| 2, so I just don't speak on it) that have more money or
| better insurance tend to use two insulins: a long term one,
| and a short term one. You take the longer term once per
| day, and then the shorter acting one on a more "as needed"
| basis. Of course, everyone's health works differently, and
| so the exact specifics here are between you and your
| doctor. Anyway, the point is, that this insulin is short-
| acting, and so to use it correctly, you have less leeway
| with time and dosage, and that can be rough. And mistakes
| can be deadly. Josh Wilkerson is a famous example of this
| in 2019: the insulin his doctor desired for him was gonna
| be $1200. He opted for taking this WalMart insulin instead,
| and made a mistake while taking it, due to the differences
| between it and his previous insulin. For that, he paid for
| his life.
|
| The third is, this is _still_ inacessible for various
| reasons, including money. WalMart is not located
| everywhere. It still costs money to get to WalMart and
| back. Also, it 's $25 per vial, but that says nothing about
| other costs too. How many vials do you need for a time
| period? Depends on the person. And a lot of factors. But
| let's just spitball one: this bottle has 100 units in it. A
| starting daily dosage, in my understanding, is like, 0.4-1
| units per kilogram of body weight. I weigh about 200 lbs.
| If we take the low end of that range, that would mean I
| would need roughly 32 units per day. This means I'm using
| two and a half vials of this per week, at $80/vial that's
| $200/week or $10,400/year. It really adds up.
|
| This also doesn't take into account other costs: you're
| gonna be needing to buy test strips as well, so that you
| can have some idea of how much you need to take. You're
| also gonna need to buy needles. These are single use. Oh
| and don't forget that, while you can buy these needles over
| the counter with no prescription, pharmacists are able to
| refuse to sell it to you for any reason, say maybe if they
| think you're going to be using those needles for other
| kinds of drugs, so you'd better not be in a bad way when
| you go into the pharmacy, or risk literally having the
| medicine that allows you to live with no way to put it into
| your body.
|
| So yeah, like, don't get me wrong, it's a good thing that
| they sell it. But people like to act all "mission
| accomplished" about it, when it's just not that simple.
| willio58 wrote:
| Just adding to what people are saying below, cheaper
| insulin is really new in the U.S.
|
| It's one of the only price-limited medications, and a major
| win for the Biden presidency (while it would be nice for
| this to happen for all drugs)
| Jolliness7501 wrote:
| I have "type 1" diabetes for 27 years. I hear similar stories
| like this (revolutionary cure working on animal models) every
| year or two. Until now non of them worked. I hope this one will
| be beeter but my expectations are quite low.
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