Novel insulins

What are novel insulins?

The term ‘novel’ insulins, means ‘new’ and covers any new form of insulin being developed. This includes fast-acting insulins, glucose-responsive ‘smart’ insulins and different delivery methods, such as weekly insulins and insulin pills. These new insulins are all synthetic, which means that they are chemically engineered in a lab.

Fast-acting insulins

As the name suggests, faster-acting insulins work faster to bring down blood glucose levels. The fastest insulins are called ultra-rapid insulins.

What are fast-acting insulins?

Ultra-rapid insulins have been edited to be absorbed slightly faster by the body than regular synthetic insulin. This means they reach the glucose in the blood in less time to start reducing blood glucose levels.

Why do we need faster insulins?

One of the challenges of closely managing glucose levels is that injected insulin takes longer to get to work than insulin produced naturally in the pancreas. That means that people with type 1 need to inject or infuse their insulin before eating, so it has more time to get working.

Speed is preventing fully closed loop systems

This slowness is also a barrier to fully automated closed loop (artificial pancreas) systems. As things stand, by the time these systems detect a rapidly rising blood glucose level caused by food or exercise, the insulin they deliver is too slow to compensate. That is why current hybrid closed loop systems still need the user to input food and exercise in advance.

Benefits for people with type 1 diabetes

Ultra-rapid insulins would give people with type 1 diabetes a lot more flexibility in their diabetes management. Eliminating the lag between injecting insulin and reducing blood glucose would allow people with type 1 to be more spontaneous.

Faster insulins could also enable us to create fully automated artificial pancreas systems that could take over the management of type 1 diabetes 24/7. A fully closed loop system would involve little to no input from the wearer, so they can spend less time managing their diabetes and more time living their life.

Creating faster-acting insulins is a key part of our work to improve the lives of people with type 1, until we find a cure.

Glucose-responsive smart insulins

Novel insulins also include ‘smart’ insulins, also known as glucose-responsive insulins, which are designed to turn on when they’re needed and off when they’re not.

What is smart insulin?

A person living with type 1 would take smart insulin just once a day as a pill or injection. This insulin would then lie dormant in the body until it detected rising blood glucose levels. It would then work to stabilise the amount of glucose in the blood, before becoming dormant again.

How does smart insulin work?

Researchers are exploring different ways to create an effective smart insulin. One idea is to trap the insulin in a cage-like structure. The cage detects changing glucose levels and releases varying amounts of insulin in response.

Another option is to chemically edit insulin to make it sense glucose itself. Some researchers are trying to edit insulin even further to make it change shape in response to glucose. When glucose levels are low, the insulin molecule would be physically closed, like a clam. As glucose levels rise, the insulin would change shape to open up, allowing it to react to glucose.

How would smart insulin help people with type 1?

In responding automatically to glucose levels in the blood, a smart insulin would essentially act the way insulin-producing beta cells do in a person without type 1 diabetes, freeing people with the condition from the relentless burden of glucose monitoring.

Smart insulins are promising but early in development

Although this research is at an early stage, at Breakthrough T1D UK we believe this idea could be utterly transformative for people with type 1. An effective smart insulin could offer tight glucose management, eliminate hypos, reduce the risk of complications and free people from glucose monitoring. All of this would greatly reduce the burden of type 1.

Other forms of novel insulins

Insulin injections can present challenges for people with type 1, with some people experiencing needlephobia and others developing skin problems due to multiple daily injections of insulin. To combat this, researchers are investigating alternatives to insulin injections and ways to reduce the number of injections people with type 1 need each day.

The pharmaceutical company Novo Nordisk are developing a basal insulin that only needs to be injected once a week rather than every day. The insulin, named insulin icodec, is proving safe and effective in the ONWARDS 6 clinical trial involving 582 people with type 1 diabetes.

Forms of insulin that can be taken via mouth rather than injection are also being developed. An international research team from Norway and Australia has created an insulin pill that can pass through the body in an inactive state to the liver. The insulin inside the pills is only released when they detect rising blood glucose levels, making this new form of insulin a smart insulin too. The researchers need to run more tests on their insulin pills before they could become available for people with type 1.

What role is Breakthrough T1D UK playing in the development of novel insulins?

Breakthrough T1D UK is actively supporting novel insulin research. We’re currently funding projects across the world to explore different possible designs for faster and smarter insulins. One way we are doing this is through the Novel Insulins strand of the Type 1 Diabetes Grand Challenge, in partnership with the Steve Morgan Foundation and Diabetes UK.