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Halozyme for Turbo-Fast Insulin Delivery?
What is the biggest problem with treating Type 1 diabetes? The experts all say it’s that the insulins we have to inject simply aren’t fast enough; they don’t really mimic the effect of natural pancreas delivery because they take too long to kick in.
Several companies are rushing to solve this problem with the obvious: super-fast-acting insulin analogs, such as the relatively new Glulisine (aka Apidra), and BioDel’s ViaJect, currently being submitted for FDA review.
But achieving perfect timing, so that your insulin levels are high enough during meals, and not too high several hours later, remains elusive (lyrically stated).
A company called Halozyme Therapuetics based in San Diego, CA, may have a better answer: they’re developing an enzyme that can be injected along with your insulin that aids and speeds insulin absorption. The stuff is called Insulin PH20, and it’s being tested with Type 1 diabetics in Phase 2 studies right now.
On a recent investors’ earnings call, a company executive explained:
“We designed this Phase 2 study to compare glycemic control of a standardized liquid meal challenge and insulin pharmacokinetics or PK after administration of each of four dosage regimens. Humulin R with and without PH20 and Humalog with and without PH20. The combination doses of insulin plus enzyme are co-mixed and administered to the patients as a single injection. This crossover design single blind, open label, liquid meal steady collects data on at least 20 patients who will complete the trial.”
To me, this sounds exciting and scary at the same time; is there not enormous potential for mistakes, causing severe hypoglycemia?
According to the company, they’re looking at measure called “AUC,” or area under the curve — the goal being to keep patients at steady BG levels for the first 60 minutes after the injection of the drug (and during meal consumption).
They argue that the faster absorption and onset will not only “more closely resemble mealtime insulin release in a healthy person” but will also be followed by a “faster offset” so that patients won’t go low. The tangible benefits for us, they say, would be “less hypoglycemia, better glycemic control, and possibly less weight gain.”
Hmmm… again, a very provocative innovation that may or may not go mainstream and actually change our lives any time soon.
The good news for me is that Halozyme will be presenting more data in early June at the American Diabetes Association annual meeting in New Orleans — and I will be there to blog it live! I’ll let you know what I hear.
Meanwhile, I’d love to hear from you: in case anyone knows anything else juicy and newsworthy about Insulin PH20 right now?
Explore posts in the same categories: Diabetes Product Parade, Products
This is not a new development; the drug industry have been looking at using various additives to expedite the absorption of different insulin formulations for some time; most recently, Eli Lilly & Co. announced plans to do the same thing with Humalog plus hyaluronidase (rHuPH20) at last year’s ADA Scientific Sessions to make a faster version of Humalog. Its all about extending patents on products, not addressing a real patient need … do we really need a product that is minutes faster? I’m not convinced. I’d prefer if they focused on making a version of insulin that could not cause hypos, but they keep working on more of the same, rather than addressing the key flaws in all of these products.
Posted by: Scott | March 31st, 2009 at 6:40 amApidra actually works really well for me–Much better than Humalog did. My sugar really doesn’t go up at all after meals.
But I’d love to have something that works to bring down really high sugars faster. If my sugar’s up over 250, it can take a couple hours to bring it down. If an additive could do that, I’d be all for it.
Posted by: Elizabeth Joy | March 31st, 2009 at 9:35 amEven ‘R’ will work fast if you inject it IM
Posted by: nonegiven | March 31st, 2009 at 12:22 pmI am confused because my problem is the opposite. My 2 hour post prandial will be 80 or even 70 (necessitating a few swigs of juice), but my 4 to 6 hour post prandial will be 230. I have a problem with my insulin coverage wearing off way too quickly.
I am not sure if it’s because I eat whole grains that digest very slowly; I haven’t been able to figure it out. But if I eat dinner at 7 PM and go to bed at 10 PM with a sugar of 109, I will wake up at 6 AM with a sugar above 180. ??? And it’s not the dawn effect, as best I can tell.
Here’s something I’m curious about — apparently there is a type 1 diabetes vaccine being developed: Diamyd. I read a bit about it today, and the idea of a vaccine is quite exciting. As a future medical provider I hope to God it works, but as a type 1 diabetic I will be kicking myself for being too late to get it.
Posted by: Lauren | March 31st, 2009 at 5:52 pmThis sounds excellent. I’ve been fighting to get insulin to react quickly enough. Humalog, Apidra, Novolog – none of them work quickly enough. Yesterday I took a 14 unit shot of Novolog, waited a FULL HOUR before eating breakfast, and still managed to hit 300. I’d give anything to get an insulin that actually starts working in 15 minutes…
Using the Navigator, my A1cs have gone from 8.3+ to about 6.7. If I could get a fast acting insulin, I think with no other changes it would be almost 1 point lower.
Here’s hoping!
Posted by: Scott | March 31st, 2009 at 8:08 pmScott
Lauren, I have the similar problem (and also eat whole foods; am vegetarian) — 1-2 hrs. post-prandial looks good (or even low’ish) and several hours later I’m high. My endo thinks it’s bc of the length of time I’ve had DB (28 years) — food is now taking longer to “hit” (absorb?) than when I was younger. Are you a new’ish T1? or an old hat, like me? If you’re a pumper, I suppose you could create a basal profile that increases your rate a few hours after meals…. (but I haven’t tried that – I just test and test and correct and correct….)
Posted by: pamela | March 31st, 2009 at 10:50 pmHi Pamela, I’m a super-new type 1 (fewer than 2 years) and I am also a vegetarian, mostly vegan in fact. I’ve struggled with the delayed post-prandial spike since my dx so I doubt it’s a delayed gastric emptying issue. I eat tons of whole grains and fruit with moderate amounts of plant-based protein (still working on adding more veggies to my diet, ironically enough).
Basically I’m eating lots of carbs but they are fiber-rich “slow” carbs. My endocrinologist (who has yet to tell me a single thing I don’t already know) suggested I “eat dinner earlier.” Not very useful advice, and doesn’t really explain the late spike. I don’t pump, I inject, so it means lots and lots of post-prandial checking and corrections — you know the drill … *sigh*
Posted by: Lauren | April 1st, 2009 at 3:52 pmWell, sorry to welcome you to the club, Lauren
.
Despite your whole grains (I’m assuming this includes whole grain breads and not just oats, right? like bulghar wheat, bran, chick peas, etc.), I still think that whole grain carbs shouldn’t cause a delayed spike (not to mention your fruits).
So now I’m wondering if you have enough background insulin. In other words, if your post-prandial spikes are not being caused by a delayed food spike, but rather that you don’t have a good sustained background insulin (like Lantus) to manage your non-eating times. Have you tried a fast through a mealtime as a way to check your background insulin? And another thought – are you eating a lot of peanut butter, avocados, olive oil, or other slow fats that might be slowing down your carb absorption?
Lastly: fire your endo. Really. I once got my health plan to refer me off the plan when I wasn’t getting what I needed. You deserve to be working with someone you can learn from, who can be your partner in managing your health. Put the word out on the db blogs saying what town/city you’re in and ask for recommendations. There’s no reason you should put up with a r-ship with an endo who is not helping, esp. in your first years of learning to manage diabetes. (don’t get me started!
Posted by: pamela | April 1st, 2009 at 9:56 pmHi Pamela, I really appreciate your advice but I’m in a different boat when it comes to endocrinologists. What I look for in a doctor is DEFINITELY not what most patients want. The last thing I want is a relationship with my physician. I want the visits to be short, cut-and-dried, strictly business. The doctor is only someone I am consulting. I am the one making the decisions.
I believe this is a disease of self-management. I know way more about it, living with it every day, that my endocrinologist does — another reason that seeing him, or any endo, is useless for me. I will be a doctor in 2 years myself so I’m more current on the latest published articles and research than most docs with busy practices. I also value my privacy. I would never, ever allow my meter to leave my hands to be downloaded and “analyzed,” for example. But again I have a different perspective because I have been in the medical field for so long.
As for my background insulin, I am pretty insulin-sensitive so I don’t do much Lantus — and that could definitely be contributing to the post-prandial highs. I am going to try to sync my exercise with mealtime so I can burn off some of the sugar after dinner — but again, I’m always in class or at clinic so I tend to exercise whenever it’s most convenient for me on that particular day.
Posted by: Lauren | April 2nd, 2009 at 2:08 pmI think that might help, Lauren – upping your longer-acting insulin (whatever you use). Med school is pretty stressful on the schedule, and sometimes you can spike just from stress (including the stress of not enough background insulin).
What I love abt my endo is that she works with whatever is real for me. She’ll say, “OK, I see that you were up till 3am several days last week; do you think we should try a different basal on those days?” She’ll notice things I may not. Definitely a partner. Our first 10 mins. are always spent talking about my life (work, marriage, vacation, family, etc.) THEN we talk blood sugar. She treats the whole patient.
Posted by: pamela | April 2nd, 2009 at 10:35 pm