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There are approximately 9 million people with type 1 diabetes. Their typical routine might look like this: Wake up at 7 am and check your blood sugar. Have breakfast at 9 am, count carbs, and check your blood sugar. Have lunch at 11:30 am and take insulin. Have a snack at 1 pm, count carbs, and take insulin. Repeat every 1-2 hours depending on your blood sugar.
“With type 1 diabetes, you have to think carefully about every decision you make from the moment you wake up,” says Grace Bennett, who works for type 1 diabetes charity Breakthrough T1D, and was diagnosed with type 1 diabetes aged 12.
“When you feel like snacking, you have to ask yourself if you really want to snack,” she explains. “Is my blood sugar at a level where I should be snacking, or am I eating because I'm hungry?”
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People with type 1 diabetes (T1D) have bodies that can't produce insulin, so they need regular injections of the synthetic hormone. Daily life with type 1 diabetes involves closely monitoring blood sugar levels and carefully adjusting insulin intake.
But what if a once-weekly dose of insulin was enough? Or what if the insulin itself could “sense” blood glucose levels, making hourly checks a thing of the past? Six new research projects at universities in the US, China and Australia aim to do just that, as researchers continue to explore newer, “smarter” insulin composite materials.
Blood sugar, also known as blood glucose, is the body's main source of energy. When you eat food, your body breaks down most of it into glucose and releases it into your bloodstream. When glucose levels rise, your pancreas releases a hormone called insulin, which allows your cells to use glucose for energy.
In people with T1D, the pancreas either cannot produce insulin or produces very little. No or low insulin production blocks glucose from getting into the body's cells, causing glucose to build up in the bloodstream. High glucose levels are dangerous. If left untreated, it can lead to heart disease, kidney damage, extreme fatigue, and other serious conditions. In 2019, diabetes was the direct cause of 1.5 million deaths worldwide.
“It's a disease that's basically lifelong, but at the same time it's a disease that's largely invisible unless you're looking at an insulin pump or a continuous glucose monitor,” Grace says.
Your blood sugar level is constantly changing. It can go up or down depending on your stress levels, whether you exercise, the foods you eat, and the levels of other hormones in your body. Weather can also affect your blood sugar levels.
“You may be doing the exact same thing as the day before in terms of insulin, diet and exercise, but hormones and exercise can dramatically change your blood sugar levels – something you never stop thinking about,” explains Grace. This makes it very difficult for people with type 1 diabetes to maintain stable blood sugar levels, even with the latest technology to monitor glucose and administer insulin when needed.
“There were times when I literally had to convince myself that I had no other choice. I couldn't say, 'I'm not going to take my medicine because it makes me feel bad' or 'I'm going to take a day off.' That would land me in the emergency room and potentially the worst case scenario,” she added.
Glucose-responsive insulin (or “smart” insulin) promises an end to continuous glucose monitoring, which can be a burden for many T1D patients. Instead, patients can take a pill or inject insulin once each morning. Smart insulin remains inactive in the body until blood glucose levels rise. When smart insulin detects a change in glucose levels, it “wakes up” and allows glucose levels to stabilize before returning to its inactive state.
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The effect is similar to that produced by a functioning pancreas, which releases insulin only when the body needs it. For Grace, using glucose-responsive insulin will not only impact the physical aspects of T1D, but it will also ease the mental strain that comes with maintaining a strict daily routine.
“Knowing you're using insulin to sense and respond to your blood sugar levels means you spend less time thinking about what you're doing. For example, you can take a walk around the block without having to carry a bag of honey in case your blood sugar gets low,” adds Grace.
Research into smart insulin is still in its early stages, but it's hoped that it could one day ease the burden on people who currently have to monitor their blood sugar levels multiple times a day.
The Type 1 Diabetes Grand Challenge is funding more than €3m (£2.7m) to six projects involving universities in the US, China and Australia to develop smart insulin. One project at Stanford University in the US aims to develop an ultrafast insulin that mimics a type of insulin used by cone snails to immobilise their prey and is released quickly into the bloodstream. Another project at China's Zhejiang University aims to reduce insulin injections to once a week by tweaking the way the hormone is released from the body's stores.
“If you would have told me at 12 years old that one day we would be researching insulin that works this way in the human body, I would have said, 'No way, that's crazy,'” Grace says. “The progress that has been made in researching these new insulins and management tools is truly amazing.”