Super Long Acting Insulin Developed in India

January 25th, 2011

man with syringe
Scientists from India's National Immunology Institute (NII) have developed a new long-acting insulin that can control blood sugar in animals for up to 120 days with a single insulin injection. In contrast, the most effective long-acting insulin on the market today is only effective for a maximum of 18 hours.

The new diabetes medication, dubbed supramolecular insulin assembly-II, or SIA-II, is a "prodrug - a drug administered in an inactive form that becomes active after being administered. Prodrugs are generally better absorbed, distributed, and metabolized than active drugs.

Both bovine and human insulin versions of SIA-II are faring well in animal testing, and the researchers have every expectation that they will perform equally well in clinical trials in humans. "Personally speaking, SIA-II can straight away go to human trials," says NII Director Professor Avadhesha Surolia, "It is pretty safe, as we have not modified the insulin, nor is any addictive used."

The insulin's long lasting effects are due to a unique process called protein folding, in which bovine or human insulin is altered or "misfolded" to form a supramolecule which is protected from the body's enzymatic action. This protection allows the molecules to be stored in the body and be slowly released over long periods of time.

The NII team has been working on the patented SIA-II technology for two years, and recently entered into what Surolia calls "one of the biggest licensing deals from any academic institution in India", licensing the technology to Life Science Pharmaceuticals from Connecticut. A subsidiary of Life Science, Extended Delivery Pharmaceuticals, will be continuing trials of the new diabetic medication.

Experts speculate that the superlative long-term blood glucose control achieved with the use of the novel diabetes medication may indicate some level of recovery of the insulin producing cells in the pancreas that normally stop functioning in insulin dependent or type 1 diabetes.

There is some debate as to whether the super long-acting insulin will be of more benefit to type 1 or type 2 diabetics. India, dubbed "the diabetes capital of the world", has over 50 million diabetics, most of them type 2. Some Indians are paying an average one-quarter of their family income for their current diabetic medication. "Our motivation was to reduce the burden of diabetes," says Surolia, "It doesn't matter whether it's type 1 or 2."

Six Warning Signs of Diabetic Ketoacidosis

February 22nd, 2011

Ketoacidosis is a diabetic emergency which occurs as a result of a lack of insulin. Without insulin, the body is unable to use sugar for energy. Unable to use sugar, the body burns its fat stores for energy.

As the fat is broken down, byproducts called ketones are released, building up in the blood and urine. Ketones are acid waste products, and are dangerous at high levels. Blood sugar rises as the liver produces more glucose in an attempt to fuel the body, causing further acidity.

A diabetic who experiences two or more of the following warning signs, and has high glucose readings (over 300mg/dl) should contact their doctor or go to the hospital immediately:

  1. Breath that smells like fruit or nail polish remover
  2. Labored breathing (gasping)
  3. Pronounced thirst
  4. Stomach or abdominal pain
  5. Nausea and vomiting
  6. Flushed complexion

Diabetic ketoacidosis (DKA) usually develops slowly over 24 hours, starting with symptoms such as fatigue, mental stupor, decreased appetite, loss of appetite, headache, and fading consciousness. Often the symptoms of ketoacidosis lead to an initial diagnosis of type 1 diabetes.

Once the patient starts vomiting, their condition can deteriorate very quickly. If treatment is delayed, the diabetic can fall into a life threatening coma. Ketoacidosis is especially dangerous in the elderly.

Immediate treatment involves an insulin injection to reduce blood glucose levels, and the administration of fluids and electrolytes to combat the dehydration that accompanies DKA. The average adult DKA sufferer loses about one and a half gallons of fluid.

Ketoacidosis is a concern for insulin dependent type 1 diabetics, but occurs much less frequently in type 2 diabetics. Diabetics who are Hispanic or African American are more at risk of DKA. DKA is more common in children and adolescents, and, for unknown reasons, slightly more common in women.

DKA is often the result of an illness. Diabetic ketoacidosis can also result from:

  • A missed insulin dose
  • Incorrect insulin dosing
  • A malfunctioning insulin pump
  • An increased need for insulin (sometimes as a result of a growth spurt in children)
  • Infection
  • Surgery
  • Trauma
  • Heart attack
  • Use of cocaine

Diabetics can easily test their urine for ketones are using a test strip similar to a glucose test strip. Ketone testing should be done whenever the blood sugar is higher than 240 mg/dl, during an illness or health crisis such as a stroke, during pregnancy, and whenever a diabetic is experiencing nausea and/or vomiting. Diabetics who are ill should check their ketones every 4 to 6 hours to ensure adequate diabetes control.

DKA can largely be avoided with proper diet and self care when diabetics are ill or otherwise at risk, including adjusting insulin levels when needed. Before the introduction of insulin injections in the 1920's, DKA was almost always fatal. Since the 1950s, the mortality rate has, thankfully, been reduced to between one and ten percent.

Giving Your Cat Insulin Injections

March 14th, 2011

cat in gardenIf you have experience with feline diabetes you know how hard it can be to watch your furry family member suffer through weakness, vet appointments, diet changes and, possibly the most challenging of all, insulin injections. Knowledge of proper cat insulin injection techniques can make your life and your cat's life easier. If you have any questions or concerns talk to your vet.

Prepare the Insulin

  • Start by filling the insulin syringe slightly more than your cat's dose
  • Tap the insulin syringe to remove air bubbles
  • Slowly push the plunger until you have the correct dosage of insulin in the syringe

Prepare Your Cat

Create a routine to make your cat comfortable. At first he will likely try to get away, but eventually he should become familiar with the process, and you may even be able to train him to come when it is time for his insulin injection. Start by giving him lots of attention and affection, and maybe even a small treat. It is probably best to keep the insulin syringe out of your hands at first, so that he does not get scared. When you are ready to give your cat insulin, get on his level - don't come at him from above or he will feel threatened. Now it is time to find the injection site.

Injection sites

The scruff (top of the neck) is the most commonly used injection site for insulin for cats, however it may not be the best. The amount of skin and muscle in this area can slow absorption of the insulin, and can be more painful for the cat.

Other options for injection are the flank (between the ribs and the legs), the side or underside of the belly, and the side of the chest. Absorption tends to be quickest when given in the side or underside of the belly.

Insulin Injection

Each cat is different, and the proper type, dose and frequency of insulin for cats need to be determined by a veterinarian. Once you know the proper insulin dosing and have determined the best place for injection, place your thumb and index finger approximately an inch apart and pinch the skin to create a "tent". Make sure you are not grabbing any muscle.

The insulin injection should go into the hollow space under the "tent" of skin. It should not go into the skin itself, or into the muscle. If your cat is long-haired make sure that you can see the skin and that you are not giving him a "fur shot".

When you are giving the insulin injection be confident, smooth and fast. It is the puncture part that hurts, so go quickly through that part; you can slow down a bit while you inject the fluid.

Above all, be gentle and kind when giving your cat insulin, especially at first, and praise him when it is all done.

Insulin Jet Injectors Evolving

September 12th, 2011

Despite lackluster success to date, the market research firm Kalorama is predicting that the worldwide market for jet injectors will double over the next five years. Jet injectors are a needleless drug delivery system that distribute a fine jet of medication under such high pressure that it is able to penetrate the skin.

"Needle-free devices have come a long way to the present state and are playing an increasingly important role in the novel drug delivery technology markets," Kalorama drug delivery analyst Mary Anne Crandall wrote in a report titled Needle-Free Drug Delivery Markets. She predicts that their ease of use, safety and cost effectiveness, combined with evolving technology, will result in a future boom in jet injector sales.

"Needle free has been a part of insulin marketing for some time," says Crandall, "And now we are also seeing it with vaccines and [other] treatments." There are now over a dozen FDA approved needle-free jet injectors on the market, most designed for specific purposes such as administering vaccines, delivering hormone treatments, and administering growth hormone to children.

Bioject's VitaJet has traditionally been marketed as an insulin jet injector, although it is now being promoted for other home injection applications. There are insulin jet injectors specially designed for children, and even one for dogs and cats, the Zoe Pet Jet.

There are still some limitations to widespread usage of jet injectors. For example, jet injectors can't efficiently administer drugs intramuscularly. They are well suited to delivering subcutaneous insulin doses, but existing jet injectors are cumbersome compared to an insulin syringe or insulin pen, and require maintenance.

Currently, cost is also an issue, although Crandall believes prices will erode in the near future, spurring further sales. While initially expensive, jet injectors are designed to last for years. The pressurized gas cartridges needed to power many jet injectors (others use a spring loaded device) are an ongoing expense.

The number one issue may be discomfort. Although some diabetics find a needleless insulin injection quite tolerable, many find the pressure required to force the insulin through the skin painful. Some report bruising, swelling and even bleeding at the injection site, although that may be the result of an incorrect injector setting.

There are some obvious benefits to a needle free jet injection system, the most apparent being the option for the needle phobic to avoid needles. Other advantages are the speed and ease of use, safety (no bent or broken needles, or "sharps" to dispose of ), less risk of contamination, a better spread of insulin into the subcutaneous tissue, no scar tissue build up at the injection site, and no need to keep buying syringes.

"Needle-free jet injection devices can and should play a major role in solving the problems of needle stick injuries and needle phobia in the United States," according to Crandall. With the industry aware of and working on the drawbacks of the promising drug delivery devices, Crandall is probably right.

Diabetic Emergency: Treating Hypoglycemia with Glucagon

September 19th, 2011

glucagon kit

Like insulin, glucagon is a hormone made in the pancreas. But the two hormones have opposite effects - insulin lowers blood sugar, while glucagon raises it. This means glucagon can be used to treat an episode of severe hypoglycemia (low blood sugar) in diabetics.

Severe hypoglycemia is rare in most insulin dependent diabetics, but can cause a loss of consciousness and should be considered a medical emergency. Type 1 diabetics are advised to have a glucagon kit on or near them at all times, as are the parents and caregivers of children with diabetes.

About.com diabetes coach Gary Gilles has written a valuable guide to treating severe low blood sugar with glucagon, describing when and how glucagon should be used. Glucagon is administered as an injection, but unlike an insulin injection, it should be injected deep into the muscle.

To read Gilles' article on About.com, >Click Here.<

Overcoming Injection Anxiety

September 20th, 2011

Have you or someone close to you been newly diagnosed as an insulin dependent diabetic? Are you anxious about giving yourself or your dependent insulin injections? Many diabetics say that giving themselves an insulin injection is the hardest part of the condition.

Or perhaps you're an experienced diabetic who hasn't kept up to date on the latest insulin delivery methods like spring loaded syringes, insulin pens and insulin jet injectors. Skipping doses of diabetes medication can lead to poor blood sugar control and diabetes complications. WebMD feature writer Stephanie Watson offers some practical advice in an article titled Overcoming Objections to Injections.

Woman Murders Husband with Massive Insulin Injection

September 29th, 2011

The prosecutor in Alicante, Spain has requested a prison term of 29 years for a woman accused of murdering her husband with a lethal insulin dose.

Fifty-one-year-old Gregoria CS, a Spanish woman on diabetes medication since 1998, was responsible for administering medication to her husband, Juan Antonio GC, diagnosed with HIV.

Gregoria allegedly first dosed her husband with insulin on March 30th, 2007 after a family row, resulting in his admission to hospital in a hypoglycemic crisis. He remained in hospital for a month.

On a second occasion on June 28th, 2010, she injected her sleeping husband in the neck with a massive dose using three insulin pens, and when he woke up smothered his cries for help with a pillow.

The next morning the couple's children raised the alarm when their father would not wake up.He was transferred to hospital in Elche with severe hypoglycemia and was stabilized, but remained in a vegetative state until his death on February 4th, 2011.

The woman had accused her husband of psychological abuse. The prosecutor's requested term of imprisonment comprises 11 years for the first murder attempt and 18 years for the second.

From the online newspaper, RoundTownNews.

Is It Safe To Reuse An Insulin Syringe?

September 30th, 2011

Is it safe to reuse an insulin syringe? Bethany from California asked this question of Conditions Expert Dr. Otis Brawley on the health website CNN Health. Dr. Otis' answer reads in part:

"Insulin syringes are expensive, and many patients want to reuse needles to save money. Many also reuse the lancets used to prick the skin and draw blood to measure blood sugar.

You are right that the reuse of insulin syringes and lancets is dangerous. A used needle can have bacteria from the skin in and on it. Bacteria can contaminate the bottle of insulin when reinserted into the bottle. The bottled insulin is a growth medium that can allow the bacteria to reproduce. Insulin is stored in a refrigerator to prevent bacterial growth.

Certain types of bacteria when injected can be especially devastating and can even cause death. In the U.S., several thousand diabetic patients die each year due to bad sterile technique causing abscesses, skin infection and sepsis, which is generalized infection involving the blood.

There are some insulin injection devices that are designed to be reused. Insulin for these devices comes in cartridges with a needle. A new cartridge and needle is used with each dose. The cartridge system is not very useful for the patients who have to mix immediate and long acting insulin at a dose.

All of these risks [of diabetes complications] can be reduced through good blood sugar control, good diet, exercise, and taking diabetes medications properly. Mild diabetes can be controlled through diet and exercise. Moderate disease often requires oral diabetes medications, and more severe Type 2 disease requires oral diabetes medicines and insulin injections."

To read Dr. Otis' answer in its entirety, including sound advice on avoiding diabetes complications, >Click Here.<