Very Rapid-Acting Insulin on the Fast Track

Thank you to Kelly Close, for the tip-off on the potential answer to many of our prayers.  I wrote recently about the compulsion to pre-inject for meals (20-30 min ahead of time at least) if you want to have a prayer of bringing down your post-meal blood sugars (without adding an additional injection of Symlin — which can cause lows and make insulin dosing especially tricky).  Pre-injecting works well indeed, but I need not elaborate on its boundless inconvenience.  (Sh&$t! Time for lunch already? But I’ve got to wait half-an-hour before I jump in!)

Biodel A company called Biodel, Inc. may be beating the path to our rescue.  It’s new Viaject product is a “very rapid acting novel formulation of recombinant human insulin.”  Essentially it’s Humulin Regular insulin with “unique additives” that make it absorb extremely rapidly, i.e. much faster than today’s rapid acting insulin analogs.  The company claims that studies show Viaject absorbs in about half the time of Humalog!  Also, they say Viaject shows “lower variability in action than both Humulin Regular and Humalog,” which I assume means a smoother absorption curve — potentially improving BG control. 

The Big Idea here is creating an ultra-fast injectable that resembles the body’s normal release of insulin into the bloodstream.  Judging from investors’ reaction, Biodel seems to be on the fast-track to success.

Kelly assumes that some of my readers here at DiabetesMine.com are taking part in the current Phase 3 clinical trials of Viaject (which called for patients on Regular insulin only; no pumpers in the control group). If that’s true, I’d love to hear from you.  Is it fast and furious?  Is it a major improvement, or what?

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12 Responses

  1. Scott K. Johnson
    Scott K. Johnson December 12, 2006 at 8:21 am | | Reply

    This would really be a helpful tool for many of us.

    In addition to the timing of meals, I assume that this could help lower high blood sugars faster too.

  2. Scott
    Scott December 12, 2006 at 9:09 am | | Reply

    I also read recently about Biodel, which is indeed promising. John Walsh, the author of the book “Pumping Insulin” wrote:

    “Although called ‘rapid insulin’, Novolog and Humalog are not that fast, having little effect on the glucose for the first 15 to 20 minutes, reaching a halfway point in activity at just over two hours, and then trailing off in activity over about 6 hours.”

    As you note, the inconvenience factor is one issue, added to the challenge of trying to prejudge the carb content of a meal before its served at a restaurant, or worse, anticipating how much a child with type 1 diabetes will actually eat.

    I am hopeful that this development might enable the dosage of insulin AFTER eating. At present, only one insulin analog (Apidra/insulin glulisine) has been tested for that, but the relatively slow speed still makes it a lousy match for addressing postprandial spikes. Now, if they could eliminate all possibility of hypoglycemia (SmartInsulin, Inc. is working on that), life might improve significantly!

  3. Laura
    Laura December 12, 2006 at 10:00 am | | Reply

    That would be awesome as I also have the bad habit of after meal dosing.

  4. Scratch
    Scratch December 12, 2006 at 10:16 am | | Reply

    I can see one fly in the ointment here. While an insulin which would act even faster has desirable effects for improving postmeal blood sugar levels, there is also increased risk of inadvertent hypoglycemias. It’s bad enough when a diabetic does the accidental Novo/Humalog instead of Lantus/Levemir shot, it could be even worse with a super fast acting insulin.

    Probably the best way to prevent those would be the requirement of a delivery device totally unlike a syringe or pen for Lantus or Levemir.

  5. kelly
    kelly December 12, 2006 at 11:03 am | | Reply

    I wanted to note this is still in trials and the trials are versus regular and so with most of the data, you can’t yet compare to Humalog. But the company’s hope is that it will be faster than Humalog, Novolog, and Apidra, and it would be great to have this alternative. In the meantime, I’m trying to do as Amy does and take insulin earlier! By the way I definitely agree Symlin can be really complex in terms of insulin dosing – I don’t think it actually causes the lows, but the insulin causes it, when you aren’t sure how much less to take and you take too much. It took me about two months to come up with a good regimen, but that has really fixed my post-prandials, which usually aren’t more than 40 points above the pre-meal level – that was hard for me to get with insulin. Still lucky that I had the time and a great doctor to help me figure it out and that the nausea was temporary – I definitely would’ve had to quit if that were ongoing.

  6. Michael Park
    Michael Park December 12, 2006 at 2:02 pm | | Reply

    I don’t understand the concept of the speed of insulin causing lows… that’s just silly… it would just be the change to a new regime which would do that. I think the most important thing with timing of insulin/food is Glycemic Index values… In theory we would all know the carb count of our meals and take the fast acting insulin so that it would be acting at the precise moment that our metabolism is converting the food into energy so that our blood sugar doesn’t rise at all…..
    How fast do you consume a 65 Carb meal? Are people so crazy to think that you can time everything perfectly… the non-diabetic body doesn’t even do that… While I fully support the aim for tightening up control, I personally welcome a degree of imprecision.
    I think that Novorapid’s 15 minutes is about perfect. It encourages us to think in advance aobut what we are going to eat. In restaurants, sure it can be a little tricker, but that’s why we eat salads, they get us eating and fill up the time before the main course, all without raising our sugars as much as the impending main course.
    For now, I’m just greatful that I’m not still using the insuling timing that I started with, 17 years ago….. -Timing the peaks of NPH such that it would roughly line up with lunch time, as I was too young to do my own injections at school, and it wasn’t reasonable to expect a teacher to do that- Now, I’m happy to eat a lunch where I don’t feel low before and high for the next hour after.

  7. Felix Kasza
    Felix Kasza December 12, 2006 at 4:43 pm | | Reply

    Hi Michael,

    > I don’t understand the concept of the speed of insulin causing lows… that’s just silly

    Assume you find some food whose digestion perfectly matches your insulin action curve. If you bolus the correct amount, then matching amounts of insulin and carbs would be absorbed into the bloodstream at every moment in time, right?

    Now pick a faster insulin — say one with half the length of the action curve (but the same shape). Obviously, you will get all the insulin absorbed into the bloodstream while only half the food has been digested — and if you correct the resulting low, you’ll go high later when the second half of the food is absorbed.

    Not silly. Very real. If you want to try this right now, I recommend calculating a bolus for a few nice, greasy, slices of deep-pan pizza. Inject with your first bite — all of the bolus. See what happens.

    Cheers,
    Felix.

  8. Michael Park
    Michael Park December 12, 2006 at 9:47 pm | | Reply

    Thanks Felix,
    but I still don’t understand the complication… Normally I dose the amount for the entire meal and take it so that it will act at a time that will be appropriate. I don’t see how this would be different with a faster acting insulin.
    Taking insulin in a timely manner has been a constant concern, and keeping that 15 minutes in mind is a constant. Is there a reason why I can’t just replace the 15 with a 7 when this magical insulin appears on the market?! (keeping in mind I’m always making decisions with GI values in mind)
    Is there some fundamental difference between how bolusing works as compared to regular insulin dosing?

  9. Felix Kasza
    Felix Kasza December 13, 2006 at 7:46 pm | | Reply

    Hi again, Michael,

    and thanks for explaining what I was missing.

    A very rapid-acting insulin would better match a spike from eating, say, a pound of grapes. (I am ready, willing, and able to kill for a pound of muscat grapes — but only if I can avoid The Mega Spike!)

    For smaller amounts of high-glucose, rapid-absorption foods, bolusing early may work; I have let myself drop down to 40 mg/dL before eating to indulge in a guilty pleasure. But a very fast insulin would be better, and never mind the easier corrections for highs.

    Oh well. Maybe someday, someone will recall my useless pancreas to a sense of its duty — without immunosuppressants, of course; they are not worth the benefit for me. Until then, the faster the insulin, the happier I’ll be!

    Cheers,
    Felix.

  10. Florian
    Florian December 17, 2006 at 6:18 am | | Reply

    Instead of concentrating so much on the type of insulin, how fast it works, time of bolus (before or after eating) etc, how about adjusting and modifying the food that is eaten. The bs spike after eating is caused by the type and kind of food, amount of food (carbs), the glycemic index, etc.

  11. Charles
    Charles January 4, 2007 at 12:14 am | | Reply

    Love Your Blog! -

    42 years with this malady. Been through it all. One can make it! Hope to check in soon with details. . .

  12. Scott
    Scott June 25, 2007 at 5:45 am | | Reply

    Hey Folks, I think the point here is being missed. First, we’re talking about an insulin that is only a few minutes faster than Humalog/Novolog-Novorapid/Apidra, not dramatically so. The difference here is that it is structurally the same as regular human insulin, plus some additives that assist in insulin absorption into the bloodstream. But anyone concerned about hypos because its too fast is likely to be disappointed!

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